Other Diagnostic and Therapeutic Services. Diagnostic and Therapeutic Covered Services when authorized by a Member's PCP and HPN’s Managed Care Program include the following: anti-cancer drug therapy; complex allergy diagnostic services including RAST and allergoimmuno therapy; complex diagnostic imaging services including nuclear medicine, computerized axial tomography (CT scan), cardiac ultrasonography, magnetic resonance imaging (MRI), and arthrography; complex neurological diagnostic services including electroencephalograms (EEG), electromyogram (EMG) and evoked potential; complex vascular diagnostic and therapeutic services including Xxxxxx monitoring, treadmill or stress testing, and impedance venous plethysmography; complex psychological diagnostic testing; complex pulmonary diagnostic services including pulmonary function testing and apnea monitoring; hemodialysis and peritoneal renal dialysis; other Medically Necessary intravenous therapeutic services as approved by HPN, including but not limited to, non-cancer related intravenous injection therapy; otologic evaluations only for the purpose of obtaining information necessary for evaluation of the need for or appropriate type of medical or surgical treatment for a hearing deficit or a related medical problem; Positron Emission Tomography (PET) Scans; therapeutic radiology services; and treatment of temporomandibular joint disorder. Different Copayment and/or Coinsurance amounts may apply to these Covered Services. Please refer to your Attachment A Benefit Schedule.
Other Diagnostic and Therapeutic Services. Diagnostic and Therapeutic Covered Services when prescribed by an Insured's Physician and authorized by the Managed Care Program include the following: Anti-cancer drug therapy, non-cancer related intravenous injection therapy or other Medically Necessary intravenous therapeutic services as approved by SHL; Hemodialysis and peritoneal renal dialysis; Therapeutic radiology services; Complex allergy diagnostic services including RAST and allergoimmuno therapy; Otologic evaluations only for the purpose of obtaining information necessary for evaluation of the need for or appropriate type of medical or surgical treatment for a hearing deficit or a related medical problem; Complex diagnostic imaging services including nuclear medicine, computerized axial tomography (CT scan), cardiac ultrasonography, magnetic resonance imaging (MRI) and arthrography; Complex vascular diagnostic and therapeutic services including Xxxxxx monitoring, treadmill or stress testing and impedance venous plethysmography; Complex neurological diagnostic services including electroencephalograms (EEG), electromyogram (EMG) and evoked potential; Complex psychological diagnostic testing; Complex pulmonary diagnostic services including pulmonary function testing and apnea monitoring; Treatment of temporomandibular joint disorder; and Positron Emission Tomography (PET) Scans. Different Copayment and/or Coinsurance amounts may apply to these Covered Services. Please refer to your Attachment A Benefit Schedule.
Other Diagnostic and Therapeutic Services. Diagnostic and Therapeutic Covered Services when authorized by an Insured's Provider and SHL’s Managed Care Program include the following: • therapeutic radiology services; • complex diagnostic imaging services including nuclear medicine, computerized axial tomography (CT scan), cardiac ultrasonography, magnetic resonance imaging (MRI) and arthrography; • complex vascular diagnostic and therapeutic services including Xxxxxx monitoring, treadmill or stress testing and impedance venous plethysmography; • complex neurological diagnostic services including electroencephalograms (EEG), electromyogram (EMG) and evoked potential; • complex psychological diagnostic testing; • complex pulmonary diagnostic services including pulmonary function testing and apnea monitoring; • anti-cancer drug therapy; • hemodialysis and peritoneal renal dialysis; • complex allergy diagnostic services including RAST and allergoimmuno therapy; • otologic evaluations only for the purpose of obtaining information necessary for evaluation of the need for or appropriate type of medical or surgical treatment for a hearing deficit or a related medical problem; • treatment of temporomandibular joint disorder; • other Medically Necessary intravenous therapeutic services as approved by SHL, including but not limited to, non-cancer related intravenous injection therapy; and • Positron Emission Tomography (PET) Scans. Different Copayment and/or Coinsurance amounts may apply to these Covered Services. Please refer to your Attachment A Benefit Schedule. Physician Surgical Services – Inpatient and Outpatient Covered Services include surgical services that are generally recognized and accepted procedures for diagnosing or treating an Illness or Injury. Post-Cataract Surgical Services Covered Services include Medically Necessary services provided for the initial prescription for corrective lenses (eyeglasses or contact lenses) and frames or intra-ocular lens implants for Post-Cataract Surgical Services. Certificate of Coverage Contact lenses will be covered if an Insured’s visual acuity cannot be corrected to 20/70 in the better eye except for the use of contact lenses.
Other Diagnostic and Therapeutic Services. Diagnostic and Therapeutic Covered Services when authorized by a Member's PCP and HPN’s Managed Care Program include the following: • anti-cancer drug therapy; • complex allergy diagnostic services including RAST and allergoimmuno therapy; • complex diagnostic imaging services including nuclear medicine, computerized axial tomography (CT scan), cardiac ultrasonography, magnetic resonance imaging (MRI), and arthrography; • complex neurological diagnostic services including electroencephalograms (EEG), electromyogram (EMG) and evoked potential; • complex vascular diagnostic and therapeutic services including Xxxxxx monitoring, treadmill or stress testing, and impedance venous plethysmography; • complex psychological diagnostic testing; • complex pulmonary diagnostic services including pulmonary function testing and apnea monitoring; • hemodialysis and peritoneal renal dialysis; • other Medically Necessary intravenous therapeutic services as approved by HPN, including but not limited to, non-cancer related intravenous injection therapy; • otologic evaluations only for the purpose of obtaining information necessary for evaluation of the need for or appropriate type of medical or surgical treatment for a hearing deficit or a related medical problem; • Positron Emission Tomography (PET) Scans; • therapeutic radiology services; and • treatment of temporomandibular joint disorder. Different Copayments may apply to these Covered Services. Please refer to your Attachment A Benefit Schedule.
Other Diagnostic and Therapeutic Services. Diagnostic and Therapeutic Covered Services when prescribed by an Insured's Physician and authorized by the Managed Care Program include the following: • Anti-cancer drug therapy, non-cancer related intravenous injection therapy or other Medically Necessary intravenous therapeutic services as approved by SHL; • Hemodialysis and peritoneal renal dialysis; • Therapeutic radiology services; • Complex allergy diagnostic services including RAST and allergoimmuno therapy; • Otologic evaluations only for the purpose of obtaining information necessary for evaluation of the need for or appropriate type of medical or surgical treatment for a hearing deficit or a related medical problem; • Complex diagnostic imaging services including nuclear medicine, computerized axial tomography (CT scan), cardiac ultrasonography, magnetic resonance imaging (MRI) and arthrography;
Other Diagnostic and Therapeutic Services including all routine Medical Services required 24 during the Outpatient Visit including but not limited to all medical supplies, central service items, and 25 nursing support or care.
Other Diagnostic and Therapeutic Services. Terminal devices (example: hand or hook) and artificial eyes. Braces which include only rigid and semi-rigid devices used for supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. Adjustment of an initial Prosthetic or Orthotic Device required by wear or by change in the patient's condition when ordered by a Plan Provider.
Other Diagnostic and Therapeutic Services. 5.20 Durable Medical Equipment Diagnostic and Therapeutic Covered Services when authorized by a Member's PCP and HPN’s Managed Care Program include the following: • anti-cancer drug therapy; • complex allergy diagnostic services including RAST and allergoimmuno therapy; • complex diagnostic imaging services including nuclear medicine, computerized axial tomography (CT scan), cardiac ultrasonography, magnetic resonance imaging (MRI), and arthrography; • complex neurological diagnostic services including electroencephalograms (EEG), electromyogram (EMG) and evoked potential; • complex vascular diagnostic and therapeutic services including Xxxxxx monitoring, treadmill or stress testing, and impedance venous plethysmography; • complex psychological diagnostic testing; All benefits for Durable Medical Equipment (“DME”) includes administration, maintenance and operating costs of such equipment, if the equipment is Medically Necessary or Prior Authorized. DME includes, but is not limited to: • Braces; • Canes; • Crutches; • Intermittent positive pressure breathing machine; • Hospital beds; • Standard outpatient oxygen delivery systems; • Traction equipment; • Walkers; • Wheelchairs; or • Any other items that are determined to be Medically Necessary by HPN’s Managed Care Program. Form No. HPN-Ind_AOC(2015) Page 14 Replacements, repairs and adjustments to DME are limited to normal wear and tear or because of significant change in the Member’s physical condition. HPN will not be responsible for the following: • Non-Medically Necessary optional attachments and modifications to DME for the comfort or convenience of the Member; • Accessories for portability or travel; • A second piece of equipment with or without additional accessories that is for the same or similar medical purpose as existing equipment; • Home and car remodeling; and • Replacement of lost or stolen equipment. Medical Supplies are routine supplies that are customarily used during the course of treatment for an Illness or Injury. Medical Supplies include but are not limited to the following: • Catheter and catheter supplies – Xxxxx catheters, drainage bags, irrigation trays; • Colostomy bags (and other ostomy supplies); • Dressing/wound care-sterile dressings, ace bandages, sterile gauze and toppers, Xxxxx and Kerlix rolls, Telfa pads, eye pads, incontinent pads, lambs wool pads, sterile solutions, ointments, sterile applicators, sterile gloves; • Elastic stockings; • Enemas and douches; • IV supplies;...
Other Diagnostic and Therapeutic Services. 5.20 Self-Management and Treatment of Diabetes Diagnostic and Therapeutic Covered Services when prescribed by an Insured's Physician and authorized by the Managed Care Program include the following: • Anti-cancer drug therapy, non-cancer related intravenous injection therapy or other Medically Necessary intravenous therapeutic services as approved by SHL; • Hemodialysis and peritoneal renal dialysis; • Therapeutic radiology services; • Complex allergy diagnostic services including RAST and allergoimmuno therapy; Coverage includes medication, equipment, supplies and appliances that are for the treatment of diabetes. Diabetes includes Type I, II, and gestational diabetes. Covered Services include: • Supplies, training and education provided to an Insured for the care and management of diabetes, after he is initially diagnosed with diabetes, to include counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes; • Supplies, training and education which is necessary as a result of a subsequent diagnosis that indicates a Form No. SHL-Ind_AOC(2015) Page 13
