Common use of Other Diagnostic and Therapeutic Services Clause in Contracts

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 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 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.and

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.