Outpatient diagnostic tests and therapeutic services and supplies A 20% of the cost for Medicare covered Covered services include, but are not limited to: services X-rays Radiation (radium and isotope) therapy including technician A separate facility materials and supplies charge could apply for Surgical supplies, such as dressings the facility in which Splints, casts and other devices used to reduce fractures and the services are dislocations received. Laboratory tests Blood - including storage and administration. Coverage of whole blood and packed red cells begins only with the fourth pint of In addition, DME, Part blood that you need - you must either pay the costs for the first 3 B drugs, physicians’ pints of blood you get in a calendar year or have the blood donated services and doctor’s by you or someone else. All other components of blood are office visit cost share covered beginning with the first pint used. may also apply Other outpatient diagnostic tests
Outpatient diagnostic tests and therapeutic services and supplies Covered services include, but are not limited to: X-rays Radiation (radium and isotope) therapy including technician materials and supplies Surgical supplies, such as dressings Splints, casts and other devices used to reduce fractures and dislocations Laboratory tests Blood - including storage and administration. Coverage of whole blood and packed red cells begins only with the fourth pint of blood that you need - you must either pay the costs for the first 3 pints of blood you get in a calendar year or have the blood donated by you or someone else. All other components of blood are covered beginning with the first pint used. Other outpatient diagnostic tests A 20% of the cost for Medicare covered services A separate facility charge could apply for the facility in which the services are received. In addition, DME, Part B drugs, physicians’ services and doctor’s office visit cost share may also apply
H8067_ISNP_HMO_NONPOS_Model_wRx_v2-MD_EOC.docx