Detailed information is available at www.healthcare.gov. For additional information on immunizations, visit the immunization schedule section of www.cdc.gov. • charges for surgical and non-surgical treatment of Temporomandibular Joint Dysfunction (TMJ). • charges for hearing aids and associated exam for device testing and fitting, including but not limited to semi- implantable hearing devices, audiant bone conductors and Bone Anchored Hearing Aids (BAHAs). A hearing aid is any device that amplifies sound. • Medically Necessary orthognathic surgery to repair or correct a severe facial deformity or disfigurement. • charges for services related to gender affirmation, including behavioral counseling, hormone therapy, genital reconstructive surgical procedures, and chest reconstructive surgical procedures. Virtual Care Dedicated Virtual Providers Includes charges for the delivery of real-time medical and health-related services, consultations and remote monitoring by dedicated virtual providers as medically appropriate through audio, video and secure internet-based technologies. Includes charges for the delivery of mental health and substance use disorder-related services, consultations, and remote monitoring by dedicated virtual providers as appropriate through audio, video and secure internet-based technologies. Virtual Physician Services Includes charges for the delivery of real-time medical and health-related services, consultations and remote monitoring as medically appropriate through audio, video and secure internet-based technologies that are similar to office visit services provided in a face-to-face setting. Includes charges for the delivery of real-time mental health and substance use disorder consultations and services, via secure telecommunications technologies that shall include video capability, telephone and internet, when such consultations and services are delivered by a behavioral provider and are similar to office visit services provided in a face-to-face setting. Convenience Care Clinic Convenience Care Clinics provide for common ailments and routine services, including but not limited to, strep throat, ear infections or pink eye, immunizations and flu shots. Genetic Counseling Charges for genetic counseling for an individual who is undergoing genetic testing or is a potential candidate for
genetic testing. May be performed prior to and/or following the genetic test. Nutritional Counseling Charges for nutritional counseling when diet is a part of the medical management of a medical or behavioral condition. Enteral Nutrition Enteral Nutrition means medical foods that are specially formulated for enteral feedings or oral consumption. Coverage includes medically approved formulas prescribed by a Physician for treatment of inborn errors of metabolism (e.g., disorders of amino acid or organic acid metabolism). Internal Prosthetic/Medical Appliances Charges for internal prosthetic/medical appliances that provide permanent or temporary internal functional supports for non- functional body parts are covered. Medically Necessary repair, maintenance or replacement of a covered appliance is also covered.
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Obesity Treatment • charges made for medical and surgical services only at approved centers for the treatment or control of clinically severe (morbid) obesity as defined below and if the services are demonstrated, through existing peer reviewed, evidence based, scientific literature and scientifically based guidelines, to be safe and effective for the treatment or control of the condition. Clinically severe (morbid) obesity is defined by the National Heart, Lung and Blood Institute (NHLBI) as a Body Mass Index (BMI) of 40 or greater without comorbidities, or a BMI of 35-39 with comorbidities. The following items are specifically excluded: • medical and surgical services to alter appearances or physical changes that are the result of any medical or surgical services performed for the treatment or control of obesity or clinically severe (morbid) obesity; and • weight loss programs or treatments, whether or not they are prescribed or recommended by a Physician or under medical supervision.
HC-COV2
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