...your doctor at least once each year even if you feel healthy. Breast Cancer Screening: Women between the ages of 50 to 75 should get a mammogram, an x-ray of...

...months Comprehensive oral evaluations Limit: one every three calendar years Prophylaxis routine dental cleanings Routine Dental Cleanings Limit: one every six months Radiographs (x-rays) Routine periodic bitewing x-rays Limit: one...

...Transportation Yes $10 copay for ambulance transportation Dental Benefits Type of Service Package A Package C Prior Authorization Needed? Oral Exams and X-Rays Yes Yes Oral exams, x-rays and preventive...

...x-rays, deep cuts, etc. Used to treat a condition or injury that can’t wait for a PCP visit and is not life threatening. Hospital Emergency Room Open 24 Hours a...

...and X-Rays Yes No HIP Basic members age 19- 20 are eligible for (EPSDT) services and some limited enhanced preventive and diagnostic dental services. Yes Yes Yes Oral exams, x-rays...

These pharmacy policies apply to the TRICARE Prime® Demo by CareSource Military & Veterans™ plan. These pharmacy policies apply to our Georgia Medicaid plan(s). Pharmacy policies offer guidance on determination...

...health partners who offer these services. Services that Require a Referral Other services like lab tests, x-rays or physical therapy need a referral. That means you must get an OK...

CareSource PASSE™ may update this page with information about how to work with our plan. Have a question not addressed on this page? Contact Provider Services at 1-833-230-2100. You can...

...visits Home health care Preventive care and exams X-rays Asthma and diabetes programs Physical therapy Chiropractic services Lead screening tests for children Immunizations Family planning services Pregnancy and OB/GYN visits...

...you get. For example, most office visits have a copay, while an x-ray or other test might have a coinsurance. A copay is a flat dollar amount and is paid...