Common use of Office Visits Clause in Contracts

Office Visits. a. See all exclusions.* b. Health education, except when: 1) Provided during an office visit for non-preventive health care services; or 2) It is counseling that is treated as a preventive health care service. c. Any weight loss programs and related health care services, except as otherwise covered as preventive health care services. d. Nutritional counseling, except when provided: 1) During a confinement as covered under the “Hospital Services” section of this contract; or 2) As outpatient self-management training and education for the diagnosis and treatment of diabetes by a certified, registered, or licensed health care professional working in a program consistent with the national standards of diabetes self-management education as established by the American Diabetes Association; or 3) Through a provider’s office, clinic system or hospital setting to a member who has been diagnosed by a 4) As counseling that is treated as a preventive health care service. e. Marital counseling, relationship counseling, family counseling except as covered under this contract, or other similar counseling or training services. f. Professional sign language and foreign language interpreter services in a provider’s office. g. Exams, other evaluations and/or services for employment, insurance, licensure, judicial or administrative proceedings or research, except as otherwise covered under this section or treated as a preventive health care service. h. Charges for duplicating and obtaining medical records from non-participating providers unless requested by PIC. i. Genetic testing and associated health care services, except as covered under this contract. j. Hypnosis and chelation therapy, except chelation therapy will be covered when medically necessary for the treatment of heavy metal poisoning. k. Routine foot care, unless required due to blindness, diabetes or peripheral vascular disease. l. Treatment of cleft lip and cleft palate, except for such treatment of a covered dependent child if treatment is scheduled or started prior to the covered dependent child reaching age 19. m. Vision therapy/Orthoptics. n. Health care services provided by an audiologist that are not provided in an office setting. o. Counseling, studies, or services ordered by a court or law enforcement officer that are not determined to be medically necessary, except as covered under #11 and #12 of the “Office Visits” section of this contract. p. Nutritional and food supplements, except for folic acid as covered under the Preventive Health Care Services Schedule and amino-acid based elemental formulas and enteral feedings as covered under the “Durable Medical Equipment (“DME”) Services, Prosthetics, and Orthotics” section of this contract. q. Conversion therapy.

Office Visits. a. See all exclusions.* b. Health education, except when: 1) Provided during an office visit for non-preventive health care services; or 2) It is counseling that is treated as a preventive health care service. c. Any weight loss programs and related health care services, except as otherwise covered as preventive health care services. d. Nutritional counseling, except when provided: 1) During a confinement as covered under the “Hospital Services” section of this contractconfinement; or 2) As outpatient self-management training and education for the diagnosis and treatment of diabetes by a certified, registered, or licensed health care professional working in a program consistent with the national standards of diabetes self-management education as established by the American Diabetes Association; or 3) Through In a providerphysician’s office, clinic system or hospital setting to a member who has been diagnosed by aa physician with a chronic medical condition; or 4) As counseling that is treated as a preventive health care service. e. Marital counseling, relationship counseling, family counseling except as covered under this contract, or other similar counseling or training services. f. Professional sign language and foreign language interpreter services in a provider’s office. g. Exams, other evaluations and/or services for employment, insurance, licensure, judicial or administrative proceedings or research, except as otherwise covered under this section or treated as a preventive health care service. h. Charges for duplicating and obtaining medical records from non-participating providers unless requested by PIC. i. Genetic testing and associated health care services, except as covered under this contract. j. Hypnosis and chelation therapy, except chelation therapy will be covered when medically necessary for the treatment of heavy metal poisoning. k. Routine foot care, unless required due to blindness, diabetes or peripheral vascular disease. l. Treatment of cleft lip and cleft palate, except for such treatment of a covered dependent child if treatment is scheduled or started prior to the covered dependent child reaching age 19. m. Vision therapy/Orthoptics. n. Health care services provided by an audiologist that are not provided in an office setting. o. Counseling, studies, or services ordered by a court or law enforcement officer that are not determined to be medically necessary, except as covered under #11 and #12 of the “Office Visits” section of this contract. p. Nutritional and food supplements, except for folic acid as covered under the Preventive Health Care Services Schedule and amino-acid based elemental formulas and enteral feedings as covered under the “Durable Medical Equipment (“DME”) Services, Prosthetics, and Orthotics” section of this contract. q. Conversion therapy.