Noncovered
Services/Items
Treatment of Varicose Veins of Lower Extremity
Posterior Tibial Nerve Stimulation (PTNS)
Sacral Neuro-modulation
Frequency of Hemodialysis Services
Chiropractic Services
Osteopathic Manipulative Treatment
Strapping
Therapy & Rehabilitation Services
Therapy Services billed by Physicians/Nonphysician Practitioners
Biofeedback
Psychiatric Inpatient Hospitalization
Psychiatric Partial Hospitalization Program
Psychological & Neuropsychological Tests
Transcranial Magnetic Stimulation for Major Depressive Disorder
Respiratory Therapeutic Services
Radiation Therapy for T1 Basal Cell & Squamous Cell Carcinomas of the Skin
Allergen Immunotherapy
Laser Treatment Psoriasis
Routine
Foot Care
Wound
Care
Emergency &
Non-Emergency Ground Ambulance Services
Hyperbaric Oxygen Therapy
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