All Policies and Precertification
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This policy is not intended for services or procedures that include the taking of photographs; rather, it is intended for services or procedures that are primarily photographic in nature.
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
Coverage is subject to the specific terms of the member's benefit plan.
The taking of photographs is not a distinct eligible service. Therefore, any photography services, e.g., photography of pigmented lesions, whole body integumentary photography, external eye, etc., are not covered.
Internal Medical Policy Committee 3-17-2021 Annual Review - No changes to criteria
Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically.
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