Outpatient Therapeutic Treatment Services. Benefits are available for outpatient services rendered in a health care provider’s office, in the outpatient department of a hospital, in an ambulatory surgical facility, or other facility in connection with a medical or surgical procedure covered under Section 1, Outpatient Facility, Office and Professional Services. Benefits include:
A. Hemodialysis and peritoneal dialysis;
B. Radiation therapy, including radiation administration;
C. Cardiac Rehabilitation benefits for Members who have been diagnosed with significant cardiac disease, or who have suffered a myocardial infarction, or have undergone invasive cardiac treatment immediately preceding referral for Cardiac Rehabilitation. Cardiac Rehabilitation is a comprehensive program involving medical evaluation, prescribed exercise, cardiac risk factor modification, education and counseling. Benefits include:
1. Continuous EKG telemetric monitoring during exercise, EKG rhythm strip with interpretation, physician’s revision of exercise prescription, and follow up examination for physician to adjust medication or change regimen; and
2. Increased outpatient rehabilitation services (physical therapy, speech therapy and occupational therapy) for Cardiac Rehabilitation of ninety (90) visits per therapy per Benefit Period.
3. Services must be provided at a place of service equipped and approved to provide Cardiac Rehabilitation.
D. Pulmonary rehabilitation benefits for Members who have been diagnosed with significant pulmonary disease.
1. Limited to one (1) program per lifetime.
2. Services must be provided at a place of service equipped and approved to provide pulmonary rehabilitation services.
E. Transfusion services and Infusion Services, including home infusions, infusion of therapeutic agents, medication and nutrients, enteral nutrition into the gastrointestinal tract, chemotherapy, and prescription medications;
F. Radioisotope treatment.
Outpatient Therapeutic Treatment Services. Benefits are available for outpatient services rendered in a health care provider's office, in the outpatient department of a hospital, in an ambulatory surgical facility, or other facility in connection with a medical or surgical procedure covered under Section 1, Outpatient Facility, Office and Professional Services. Benefits include:
A. Hemodialysis and peritoneal dialysis; B. Oral chemotherapy; and radiation therapy, including radiation administration;
Outpatient Therapeutic Treatment Services. Benefits are available for outpatient services rendered in a Contracting Provider’s office, in the outpatient department of a hospital, in an ambulatory surgical facility, or other Contracting Provider outpatient facility in connection with a medical or surgical procedure covered under Section 1, Outpatient Facility, Office, and Professional Services. Benefits include services and treatments such as:
A. Hemodialysis and peritoneal dialysis;
B. Chemotherapy;
C. Radiation therapy, including oncology dialysis;
D. Cardiac Rehabilitation benefits are provided to Members who have been diagnosed with significant cardiac disease, as defined by CareFirst BlueChoice, or, who have suffered a myocardial infarction or have undergone invasive cardiac treatment immediately preceding recommendation for Cardiac Rehabilitation, as defined by CareFirst BlueChoice. Coverage is provided for all Medically Necessary services, as determined by CareFirst BlueChoice. Services must be provided at a CareFirst BlueChoice approved place of service equipped and approved to provide Cardiac Rehabilitation. Prior authorization is not required for Cardiac Rehabilitation.
E. Pulmonary Rehabilitation benefits are provided to Members who have been diagnosed with significant pulmonary disease, as defined by CareFirst BlueChoice, or, who have undergone certain surgical procedures of the lung, as defined by CareFirst BlueChoice. Coverage is provided for all Medically Necessary services, as determined by CareFirst BlueChoice. Services must be provided at a CareFirst BlueChoice approved place of service equipped and approved to provide pulmonary rehabilitation. Prior authorization is not required for pulmonary rehabilitation.
F. Infusion and transfusion services;
G. Electroshock therapy; and
H. Radioisotope treatment.
Outpatient Therapeutic Treatment Services. Benefits are available for outpatient services rendered in a health care provider’s office, in the outpatient department of a hospital, in an ambulatory surgical facility, or other outpatient facility in connection with a medical or surgical procedure covered under Section 1, Outpatient Facility, Office, and Professional Services. Benefits include services and treatments such as:
A. Hemodialysis and peritoneal dialysis;
B. Chemotherapy;
C. Radiation therapy, including oncology dialysis;
D. Cardiac Rehabilitation benefits are provided to Members who have been diagnosed with significant cardiac disease, as defined by CareFirst, or, who have suffered a myocardial infarction or have undergone invasive cardiac treatment immediately preceding recommendation for Cardiac Rehabilitation, as defined by CareFirst. Coverage is provided for all Medically Necessary services, as determined by CareFirst. Services must be provided at a CareFirst approved place of service equipped and approved to provide Cardiac Rehabilitation.
X. Xxxxxxxxx Rehabilitation benefits are provided to Members who have been diagnosed with significant pulmonary disease, as defined by CareFirst, or, who have undergone certain surgical procedures of the lung, as defined by CareFirst. Coverage is provided for all Medically Necessary services, as determined by CareFirst. Services must be provided at a CareFirst approved place of service equipped and approved to provide pulmonary rehabilitation.
F. Infusion and transfusion services;
G. Electroshock therapy; and
H. Radioisotope treatment.
