Self-injectable and certain specialty drugs (not part of day surgery) excluded as a medical benefit
Service Benefit Category Id
10849
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Bariatric surgery
Service Benefit Category Id
10850
Diagnostic lab tests
Service Benefit Category Id
10851
Diagnostic x-rays
Service Benefit Category Id
10852
MRI, CT scan, positron emission tomography and nuclear cardiac imaging tests
Service Benefit Category Id
10853
6 visits first year of life, 3 visits second year, 1 visit per calendar year from age 2 through 18
Service Benefit Category Id
10854
Additional visits
Service Benefit Category Id
10855
One visit per member per calendar year
Service Benefit Category Id
10856
Additional visits
Service Benefit Category Id
10857
MRI, CT scan and nuclear cardiac imaging tests
Service Benefit Category Id
10858