occupational therapy means treatment to develop a [Covered Person’s] ability to perform the ordinary tasks of daily living.. i. Physical Therapy - except as stated below, the treatment by physical means to relieve pain, restore maximum function, and prevent disability following disease, Injury or loss of limb. Exception: For a [Covered Person] who has been diagnosed with a biologically-based mental illness, physical therapy means treatment to develop a [Covered Person’s] physical function. Coverage for Occupational Therapy and Physical Therapy, combined, is limited to 30 visits per Calendar Year. Infusion Therapy - the administration of antibiotic, nutrients, or other therapeutic agents by direct infusion. Note: The limitations on Therapy Services contained in this Therapy Services provision do not apply to any Therapy Services that are received under the Home Health Care provision or to therapy services received under the Diagnosis and Treatment of Autism or Other Developmental Disabilities provision. . (g) DIAGNOSIS AND TREATMENT OF AUTISM AND OTHER DEVELOPMENTAL DISABILITIES We provide coverage for charges for the screening and diagnosis of autism and other developmental disabilities. If a primary diagnosis is autism or another developmental disability We Member’s provide coverage for the following medically necessary therapies as prescribed through a treatment plan. These are habilitative services in that they are provided to develop rather than restore a function. The therapy services are subject to the benefit limits set forth below: occupational therapy where occupational therapy refers to treatment to develop a ability to perform the ordinary tasks of daily living; Member’s physical therapy where physical therapy refers to treatment to develop a Member’s physical function; and speech therapy where speech therapy refers to treatment of a Member’s speech impairment. Coverage for occupational therapy and physical therapy combined is limited to 30 visits per Calendar Year. Coverage for speech therapy is limited to 30 visits per Calendar Year. These therapy services are covered whether or not the therapies are restorative. The therapy services covered under this provision do not reduce the available therapy visits available under the Therapy Services provision. . If a Member’s primary diagnosis is autism, and the Member is under 21 years of age, in addition to coverage for the therapy services as described above, We also cover medically necessary behavioral interventions based on the principles of applied behavior analysis and related structured behavioral programs as prescribed through a treatment plan.
occupational therapy means treatment to develop a [Covered Person’s] ability to perform the ordinary tasks of daily living.. i. Physical Therapy - except as stated below, the treatment by physical means to relieve pain, restore maximum function, and prevent disability following disease, Injury or loss of limb. Exception: For a [Covered Person] who has been diagnosed with a biologically-based mental illness, physical therapy means treatment to develop a [Covered Person’s] physical function. Coverage for Occupational Therapy and Physical Therapy, combined, is limited to 30 visits per Calendar Year. Infusion Therapy - the administration of antibiotic, nutrients, or other therapeutic agents by direct infusion. Note: The limitations on Therapy Services contained in this Therapy Services provision do not apply to any Therapy Services that are received under the Home Health Care provision or to therapy services received under the Diagnosis and Treatment of Autism or Other Developmental Disabilities provision. . (g) DIAGNOSIS AND TREATMENT OF AUTISM AND OTHER DEVELOPMENTAL DISABILITIES We provide coverage for charges for the screening and diagnosis of autism and other developmental disabilities. If a Member’s primary diagnosis is autism or another developmental disability We provide coverage for the following medically necessary therapies as prescribed through a treatment plan. These are habilitative services in that they are provided to develop rather than restore a function. The therapy services are subject to the benefit limits set forth below: occupational therapy where occupational therapy refers to treatment to develop a Member’s ability to perform the ordinary tasks of daily living; physical therapy where physical therapy refers to treatment to develop a Member’s physical function; and speech therapy where speech therapy refers to treatment of a Member’s speech impairment. Coverage for occupational therapy and physical therapy combined is limited to 30 visits per Calendar Year. Coverage for speech therapy is limited to 30 visits per Calendar Year. These therapy services are covered whether or not the therapies are restorative. The therapy services covered under this provision do not reduce the available therapy visits available under the Therapy Services provision. . If a Member’s primary diagnosis is autism, and the Member is under 21 years of age, in addition to coverage for the therapy services as described above, We also cover medically necessary behavioral interventions based on the principles of applied behavior analysis and related structured behavioral programs as prescribed through a treatment plan.