American Physical Therapy Association. Extra Benefits. AmeriGroup - IA: Medicaid AmeriGroup Physical Therapists with great reviews in Memphis, TN Zocdoc only allows patients to write reviews if we can verify they have seen the provider. Call now: 855-953-6479 (TTY: 711) Speak to a licensed sales agent. Using Amerigroup Insurance To Pay For Addiction Treatment Alcohol and drug treatment can be costly and requires the help of experienced medical professionals to manage. Physical therapy for older adults. If you're not sure what kind you have, call TennCare Connect at 855-259-0701. Available at: Hillegass E, Puthoff M, Frese EM, et al. 07/06/2022. }Y4Wt?_}D nmnPe"q(-bQT)S9q >o}yzye$'L=?#H?|z>=3{!2>cYbl[}4l]SoZg".DgE\.V}v,gq3TXOs If you have copays, your copay is the same even if the specialist is not in our plan. 0siTI:,djb>/M9P&$fROgc8KpE.r*frW@$YPL?I,HSX cS YcP\y6Y;+)$bJ2VSm?LJGX-CCUv D] j 2.ey!Y5E{7|%ZOj&gfCXL 2019. Availity, LLC is an independent company providing administrative support services on behalf of Amerigroup. Changed wording to "site of care" from "level of care" throughout document. PT isn't covered: You'll pay the rate your insurer set with the physical therapist. Call us at least two working days before you need a ride. 2. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. Because practice patterns, claims systems and benefit designs vary, a local plan may choose whether to adopt a particular clinical UM guideline. Advanced PMR provides physical therapy, acupuncture and a variety of other rehabilitation services. 14 verified reviews. Or, you can call TennCare Connect at 855-259-0701. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> u @zm|XjVl^.ZD5q}KY->Z{gP^tE$aWB}D-(Qh_Ry> }$Ehjkp DIZ!DSe*p. Customizations to MCG Care Guidelines 24th Edition, This document provides a summary of customizations to the MCG Care Guidelines 26th Edition (Publish date September 22, 2022). InterQual Level of Care (LOC) criteria is used by some Medicaid plans for medical necessity review for medical inpatient concurrent review, inpatient site of service appropriateness, home health and outpatient rehabilitation. endobj Therapy for Children's Disabilities - Georgia WEB-GA-0123-15 August 2015 1 Medical Policy Subject: Therapy for Children's Disabilities - Georgia Plan Effective Date: August 18, 2010 Version Date: May 28, 2015 IMPORTANT NOTE Amerigroup Medical Coverage Policies are based on medical necessity consideration, nationally % MCG guidelines licensed include: This document provides a summary of customizations to the MCG Care Guidelines 24th Edition (Publish date January 20, 2021). is tr a blend or digraph. <> (928) 900-2021. or get a text for information on various treatment options., or you can verify your Amerigroup health insurance by filling out the form below. Amerigroup Prior Authorization Form For Physical Therapy Get link; Facebook; Twitter; Pinterest; Email; Other Apps; May 23, 2021 Amerigroup Prior Authorization Form For Physical Therapy The form authorization required to safely complete list of each person has acquired amerigroup . Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan): Medicare Advantage medical record documentation and coding resources, Early and Periodic Screening, Diagnostic and Treatment, Medicaid/CHIP Provider Manual Electronic visit verification updates, Medicaid/CHIP Provider Manual CHIP cost sharing change, Medicaid/CHIP Provider Quick Reference Guide, Medicare Provider Dispute, Grievance and Appeal FAQ, STAR+PLUS MMP (Medicare-Medicaid Plan) Provider Manual, Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan) Provider Manual Nonemergency Medical Transportation services, Amerigroup STAR+PLUS MMP Provider Manual Nonemergency Ambulance Transportation services, Centers of Medical Excellence Transplant Operations Manual, Updated Clinical Practice and Preventive Guidelines, February 2020 Clinical Utilization Management (UM) Guidelines, May 2020 Clinical Utilization Management (UM) Guidelines, August 2020 Clinical Utilization Management (UM) Guidelines, November 2020 Clinical Utilization Management (UM) Guidelines, May 2021 Clinical Utilization Management (UM) Guidelines, August 2021 Clinical Utilization Management (UM) Guidelines, November 2021 Clinical Utilization Management (UM) Guidelines, February 2022 Clinical Utilization Management (UM) Guidelines. TennCare is the state of Tennessee's Medicaid program. Last updated August 30, 2018. Please refer to the plan Provider Newsletter for more information relating to implementation dates. Available at: Centers for Medicare & Medicaid Services (CMS). Health plans or lines of business which determine there is not a need to adopt a clinical utilization management guideline may instead use the guideline for educational purposes or to review the medical necessity of services for any provider who has been notified that his or her claims will be reviewed due to billing practices or claims that are inconsistent with other providers. The Animal Doctor - Tayo Amoz 2008 Fundamentals of Health Law - Barry D. Alexander 2011-01-01 This specialized and complex field of health law If you have health insurance coverage with AMERIGROUP, or you're looking for AMERIGROUP Physical Therapists in Maryland (or Maryland Physical Therapists who accept AMERIGROUP), please contact these Physical Therapists and confirm that they are either in-network with AMERIGROUP are or can help you with your AMERIGROUP coverage. In addition to the basic coverage provided by all Advantage plans, Amerivantage also provides optional coverage for vision, dental, and. These include counseling and therapy, as well as inpatient mental and behavioral health care and substance abuse treatment. Clinical UM Guidelines, which address medical efficacy, should be considered before utilizing medical opinion in adjudication. Available at: American Physical Therapy Association. The prescribed physical therapy, occupational therapy or speech-language pathology regimen requires specialized equipment or services which would only routinely be available in the hospital outpatient department or hospital outpatient clinic setting; The inherent complexity of, or risk posed by, the prescribed physical therapy, occupational therapy or speech-language pathology regimen is such that it can only be performed safely and effectively by or under the general supervision of skilled medical personnel in the hospital outpatient department or hospital outpatient clinic setting; The individual's medical status requires enhanced monitoring beyond what would routinely be needed for physical therapy, occupational therapy or speech-language pathology services; The equipment for the size of the individual (for example, a very young or small child) is not available in a freestanding facility; There is significant risk of sudden life-threatening changes in the individuals clinical condition and immediate access to specific services provided in a medical center/hospital setting is considered advisable (for example, access to emergency resuscitation equipment and personnel, inpatient admission or intensive care facilities). National Coverage Determination for Institutional and Home Care Patient Education Programs. Home Find Care Let's find a health care provider that meets your needs! The InterQualTMguidelines licensed include: MCG care guidelines are licensed and utilized to guide utilization management decisions for some health plans. Insurance Plans and Coverage. Amerigroup serves members in state-sponsored plans across the U.S. in 12 states. Updated References section. Phys Ther. 3 0 obj To find out what services are covered for you, click below on the kind of TennCare you have. This page contains all medical policies and clinical UM guidelines and may be filtered as appropriate. We look forward to working with you to provide quality services to our members. Find an Amerigroup Therapist, Amerigroup Psychologist, Amerigroup . Customizations to MCG Care Guidelines 26th Edition. 04/13/2022. Your costs in Original Medicare After you meet the Part B Deductible , you pay 20% of the Highly recommended Shellie Hendren, NP Nurse Practitioner Munford, TN endobj Search for a Medical . When your doctor or other health care provider (including a nurse practitioner, clinical nurse specialist, or physician assistant) certifies you need it, Medicare Part B (Medical Insurance) helps pay for medically necessary outpatient physical therapy. It's all at the tip of . PHYSICAL THERAPY INST. In addition to the documents we develop and maintain for coverage decisions, we may adopt criteria developed and maintained by other organizations. 2 0 obj Therapy services; Skilled nursing facility services; Podiatry services; Vision care; Plus lots of extras you can really use to take care of your health ; If you have questions or want to learn more, you can call us at 1-800-600-4441 (TTY 711). Covered. 1 0 obj Also, some physical therapy could be covered if it is preventative. Clinical criteria for drugs and biologics paid under the medical benefit for certain Medicare/Medicaid marketscan be found on the IngenioRx website. Available at: American Physical Therapy Association. Come experience the finest in health care! This may include but is not limited to decisions involving prior authorization, inpatient review, level of care, discharge planning and retrospective review. Clinical UM guidelines are available for adoption to review the medical necessity of services related to the guideline when the Plan performs a utilization review for the subject. Benefit plans may include a maximum allowable physical, occupational, or speech therapy benefit, either in duration of treatment or in number of visits. Dr. Sterling Carter graduated from the prestigious Langston University with a Bachelor's degree in Biology in 1993 and then returned for an additional Bachelor's degree at Langston University in Physical Therapy in 1997. This is called a copay. The document header wording updated from Current Effective Date to Publish Date. Updated References section. may be accessed. Arkansas: Autism diagnosis and ABA therapy are covered up to $50,000 per year. Those provisions will be considered first in determining eligibility for coverage before the medical policy is used to determine medical necessity. Due to variances in utilization patterns, each plan may choose whether or not to adopt a particular Clinical UM Guideline. Clinical UM guidelines are used when the plan performs utilization review for the subject. Coding edits for medical necessity review are not implemented for this guideline. Using Your Amerigroup Plan Back. PT is covered: Your insurer pays a percentage of the bill, known as coinsurance. For some types of care, you may have to pay part of the cost. Medical Policy. September 20, 2019. matter to read. At American Addiction Centers (AAC), we offer treatment for substance abuse and co-occurring health issues. Amerigroup works with treatment centers throughout the country to provide services to those seeking rehab for drug and alcohol addiction. Publish Date the date a medical policy or clinical UM guideline was made available on our public websites "] Federal and State law, as well as contract language including definitions and specific coverage provisions/exclusions, and Medical Policy take precedence over Clinical UM Guidelines and must be considered first in determining eligibility for coverage. The member's contract benefits in effect on the date that services are rendered must be used. Amerigroup members in the Medicaid Rural Service Area and the STAR Kids program are served by Amerigroup Insurance Company; all other Amerigroup members in Texas are served by Amerigroup Texas, Inc. Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. By clicking on "Continue" below, I acknowledge that I have read the above. To see a list of all Medical Policies and Clinical UM Guidelines, visit our FullListpage. Our facilities are outfitted with state of the art equipment. Last updated September 20, 2019. Therefore, it will also be necessary for you to submit a credentialing application to the CVO prior to your acceptance in to our Provider Network. Just invest tiny times to get into this on-line notice amerigroup prior authorization form for physical therapy as without difficulty as evaluation them wherever you are now. To determine which clinical utilization management guidelines have been adopted by your plan, or to determine if there are applicable other criteria, you can use the guideline adoption link provided below. Amerigroup will use Access2Care to arrange all travel. When the maximum allowable benefit is exhausted, coverage will no longer be provided even if the medical necessity criteria described below are met. Amerigroup member ID number _ Phone number. CPT Only American Medical Association, CG-REHAB-12 Rehabilitative and Habilitative Services in the Home Setting: Physical Medicine/Physical Therapy, Occupational Therapy and Speech-Language Pathology, https://www.apta.org/apta-and-you/leadership-and-governance/policies/access-admission-patient-client-rights, https://www.apta.org/apta-and-you/leadership-and-governance/policies/pt-role-advocacy, https://www.apta.org/apta-and-you/leadership-and-governance/policies/pt-for-older-adults, https://www.apta.org/apta-and-you/leadership-and-governance/policies/standards-of-practice-pt, http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf, https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx. However, self-exercise and behavior correction were allowed to avoid early recurrence of pain after trigger point injections. 4 0 obj Here, you will find information for assessing treatment options, guidelines for clinical Utilization Management (UM), practice policies and support for delivering benefits to our members. Referrals. 06/29/2022. All appointment times are guaranteed by our Las Vegas Physical Therapists. Your PCP may send you to a specialist for care. No other therapies (such as physical therapy or medications) were allowed during the study period. Yes, nearly all Amerigroup insurance plans cover therapy. July 12, 2019. georgia .gov or contact HP Provider > Call Center at 1-800-766-4456. MPTAC review. All participants completed the treatment schedule and attended a follow-up, 66.7% (14/21) received 1 trigger point injection, 28.6% (6/21) received 2 injections and 1 . ; Guideline Development Group. Your handbook will tell you much more about the services TennCare covers. MPTAC review. There are several factors that impact whether a service or procedure is covered under a members benet plan. Healthfirst otc list 2022. map of the continental divide. Amerigroup Therapy Request Form Return to 1-844-756-4608. historical versions 1449 Highway 6, Ste 260, Sugar Land, TX 77478. Browse our extensive directory of the best Amerigroup Therapists, Amerigroup Psychologists and Amerigroup Counselors near you. Delaware: ABA therapy is covered up to $36,000 per year. Effective date not posted. Title changed to: Site of Care: Outpatient Physical therapy, Occupational Therapy, and Speech-Language Pathology Services. OnePoint Physical Therapy is accepting new patients and is currently in network with the following insurance providers: Aetna; Ambetter; Amerigroup; Blue Cross Blue Shield Cigna; ChoiceCare Networks; Humana; Medicare; MultiPlan/PHCS; Peach State Health Plan; Tricare; United Healthcare We also accept: Motor Vehicle Accidents (MedPay) Workers Compensation OnePoint will happily work with your . The pharmacy clinical criteria for injectable, infused or implanted prescription drugs and therapies covered under the medical benefit are available forcertainMedicare/Medicaidmarkets. Amerigroup is committed to supporting you in providing quality care and services to our members. Primary Care Physicians Browse Primary Care Physiciansnear you Atlanta, GA Amerigroup will provide rides to the doctor, dentist, hospital, pharmacy, and any other places you receive Medicaid services. Medical Policy. This guideline is for determination of the medical necessity of hospital outpatient site of care for physical or occupational therapy services, or speech-language pathology services. stream It's simple, secure and free. =Z}[o]dua}%ugbv 9Dyyk;/"9lB]Ok wlUz|"! California: If the healthcare plan provides physical treatment coverage, it must also provide mental treatment coverage, including ABA therapy. Search for a nearby doctor or hospital. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan. Standards of practice for physical therapy. If the specialist is not in our plan, your PCP must get an OK from us first. Amerigroup Prior Authorization Form For Physical Therapy Author: arsip-ppdb.kalbarprov.go.id-2022-11-01-10-59-42 Subject: Amerigroup Prior Authorization Form For Physical Therapy Keywords: amerigroup,prior,authorization,form,for,physical,therapy Created Date: 11/1/2022 10:59:42 AM testosterone replacement therapy uk. NCD#170.1. Clinical conditions that may warrant such access include, but are not limited to the following: History of falls with significant bleeding; History or significant risk of major cardiac event; History or significant risk of major thromboembolic event; There are no other geographically accessible appropriate alternative sites for the individual to receive the prescribed physical therapy, occupational therapy or speech-language pathology regimen. American Physical Therapy Association. For further information regarding the new CVO credentialing process, please visit DCH provider portal : www.mmis. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Access to, admission to, and patient/client rights within physical therapy services. Amerigroup provider manuals provide key administrative information, including plan benefits, member eligibility, the Quality Improvement Program, the UM program, credentialing and quality standards for participation, claims submission and appeals, and reimbursement and administration policies. Medical Policies and Clinical UM Guidelines, Medicare Advantage medical record documentation and coding resources, Early and Periodic Screening, Diagnostic and Treatment. Providers cannot request to alter or remove reviews. f_fQYNm"9bQ[/CSyR$0oP$eehJojDP2FSbq0g}iN L#LQe_~7: 582~;5v(c endobj Use our provider search tool to find doctors, pharmacies and other providers that work with our plan. Click here to download the 2022 UHC DSNP OTC catalog There are a few ways to order OTC items: Call the FirstLine Benefits customer . About Medical Policies & Clinical UM Guidelines, Amerigroup Approved and Adopted Corporate Clinical UM Guidelines, Customizations to MCG Care Guidelines 24th Edition, Customizations to MCG Care Guidelines 25th Edition, Customizations to MCG Care Guidelines 26th Edition. Available at: American Physical Therapy Association. Cb]h,h>fD=6dljGCtcA#>NkUlN_b*f]9PptClI0 )x^Qmwe$'f0BNJ.BAB3 If you need to travel out of town or out of your service area, call us at least five working days before you need a ride. Medicaid insurance covers things like doctor visits, hospital stays, pregnancy care, labs and X-rays. If you have questions, please call your health plan. <> Amerigroup members in the Medicaid Rural Service Area and the STAR Kids program are served by Amerigroup Insurance Company; all other Amerigroup members in Texas are served by Amerigroup Texas, Inc. Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. Type at least three letters and we will start finding suggestions for you. 4.93. Government Agency, Medical Society, and Other Authoritative Publications: Medical Policy & Technology Assessment Committee (MPTAC) review. Its health plans cover many addiction services, and there . Age 19 and 20 only: 1 pair of eyeglasses (frames and lenses) every 24 months. It provides health care to low-income pregnant women, children, older adults and individuals who have a disability. Physical therapy (PT): Date of onset: Occupational therapy (O T): Speech therapy (ST): Date of therapy evaluation or re-evaluation Coverage provided by . 100-02, Chapter 15, Section 220. There are several factors that impact whether a service or procedure is covered under a member's benet plan. Key components of our mental health and SUD programs include: Best practices: Our expert physical and behavioral health clinicians work as a unified, multidisciplinary team to coordinate services and supports that meet our member's needs holistically.Our team develops and manages these programs in-house, building on what we've learned from our deep experience and adapting best practices to . Available at: Centers for Medicare & Medicaid Services. Find Healthcare Providers. Free dental supplies; Amerigroup Community Resource Link to help you find community services near you; Free mobile phones, plus bonus . 2016; 96(2):143-166. The Amerigroup Advantage plan is called Amerivantage. The Clinical UMguidelines published on this website are not always used by all plans or lines of business. All of our specialists have one goal in mind. Home Insurance Plans and Coverage. Note: Please see the following related documents for additional information: Note: The medical necessity of physical therapy, occupational therapy, and speech-language pathology services requested may be separately reviewed against the appropriate criteria. Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan): By clicking on "Continue" below, I acknowledge that I have read the above. Outpatient physical therapy, occupational therapy, and speech-language pathology services provided in the hospital outpatient department or hospital outpatient clinic site of care is considered medically necessary when any of the following conditions is present: Physical therapy, occupational therapy, and speech-language pathology services in the hospital outpatient department or hospital outpatient clinic site of care are considered not medically necessary, for all other indications, including when criteria above have not been met. Y0YiI\0L" b!|$er M@2$YSs2I?Y8:B d"+$ Pub. Coverage of Outpatient Rehabilitation Therapy Services (Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services) Under Medical Insurance and Section 230 Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology . Medical technology is constantly evolving, and we reserve the right to review and update Clinical UM Guidelines periodically. Guide to physical therapist practice. Amerigroup also offers insurance coverage called Health and Wellness Plans. These guidelines are available to you as a reference when interpreting claim decisions. Manage your health from your phone with the Amerigroup mobile app! These guidelines are available to you as a reference when interpreting claim decisions. Medical Policies and Clinical UM Guidelines. Amerigroup insurance is a company that helps low-income and other in-need individuals access government healthcare plans and supplement them with additional coverage when needed. Where a more specific policy or guideline exists, that document will take precedence and may include specific coding edits and/or instructions. DC: 0-5 - Zero to Three 2016 DC:05 captures new findings relevant to diagnosis in young children and addresses unresolved issues in the field . To ensure that you are completely satisfied and back to 100% in no time. Centers for Medicare & Medicaid Services (CMS). The location of services is determined by many factors, including the physical and medical condition of the individual receiving treatment, the need for specialized equipment or personnel, and the location of the individual in relation to the needed services. Availity, LLC is an independent company providing administrative support services on behalf of Amerigroup. There are several factors that impact whether a service or procedure is covered under a members benet plan. DME.00011 Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices. %PDF-1.5 If submitting request via our provider website, attach with clinical information. Get these benefits, plus more. Initial document development. Search current medical policies and clinical UM guidelines. MPTAC review. Amerigroup members in the Medicaid Rural Service Area and the STAR Kids program are served by Amerigroup Insurance Company; all other Amerigroup members in Texas are served by Amerigroup Texas, Inc. Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. Role of physical therapists in the management of individuals at risk for or diagnosed with venous thromboembolism: evidence-based clinical practice guideline. $100 retail allowance toward eyeglasses and contact lenses every 12 months. Use Zocdoc to find physical therapists near you who take AmeriGroup insurance. Provision of these services in other settings is not addressed in this document. amerigroup prior authorization form for physical therapy, it is agreed simple then, past currently we extend the join to purchase and make bargains to download and install amerigroup prior authorization form for physical therapy for that reason simple! Note that while a publish date is enterprise-wide, the implementation date may differ depending on notification requirements. Amerigroup is a health plan serving TennCare members in the state of Tennessee. %c B$%0A?jD4AaAqyJU" 9Jyrp]0NNO*G3bX:}A(N2UINXjwP8HeFh+r7[rxG" x)kca$ oF0 *I7}>>0$e=9T_.~Q \ry(aAHc1!H"|(&!BLp)lGSvt{7WF nr)(9r,O-sS[&GFdIwnkB4HFvrV~~ w0iah(aHWf+ Call a nurse anytime, day or night, at the press of a button to answer your health questions. (732) 515-5461 View Seven days a week, 8 a.m. to 8 p.m. As with other health insurance providers, Amerigroup insurance coverage includes treatment for mental health conditions (e.g., depression, anxiety, mood disorders) and the treatment of substance use disorder. Pub. New Member Welcome Community Support Close Menu. Using Your Amerigroup Plan. It's simple, secure and free. Ancillary, Miscellaneous. x=r8?Q xJ'SL|v2YP?+ RL%Ehv\W]OovjqS_E\n~sQ-uk6oww_"X,I'24h ? If a medical policy or clinical UM guideline is not yet implemented for your Plan, To learn more about AAC's treatment options give us a call at. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. We have Medicare plans that help you pay for groceries, living expenses, and over-the-counter health items. small gestational sac success stories. Last Review Date the date a medical policy or clinical UM guideline was reviewed and approved Our health plans may use guidelines developed by AIM Specialty Health (AIM) to perform utilization management services for some procedures and certain members. Updated References section. Date of birth. Colorado: ABA therapy is covered with no coverage limit. This means it makes an injury or illness less . You can search by provider name, city and state or specialty. Get the Amerigroup mobile app! To determine if review is required for this Clinical UM Guideline, please contact the customer service number on the back of the member's card. This document provides clinical criteria for the use of outpatient physical therapy, occupational therapy, and speech-language pathology services in the hospital outpatient department or hospital outpatient clinic site of care. Individuals who are pregnant, children, adults, and people with disabilities may qualify for this type of health coverage. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of the plan. AmeriGroup - IA: Medicaid Find and compare top local doctors Read verified reviews from patients and see real-time availability for every doctor Check that you're covered Physical therapists role in prevention, wellness, fitness, health promotion, and management of disease and disability. This option manages hospital services, behavioral health needs, therapy, podiatry, vision care, and more. Note that where we have developed a medical policy that addresses a service also described in one of these other sets of criteria, the plans medical policy supersedes.
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