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11a - Durable Medical Equipment (DME) -Page 1

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11a - Durable Medical Equipment (DME) Non Medicare -Page 1

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11a1 - Durable Medical Equipment for use outside the home

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11b - Prosthetics /Medical Supplies-Page 1

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11b – Non-Medicare Prosthetics Medical Supplies -Page 1

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11c - Diabetic Supplies and Services -Page 1

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11c2 - Diabetic Therapeutic Shoes /Inserts – Page 1

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12 - Dialysis Services -Page 1

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12 - Dialysis Services - Page 2

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13a - Acupuncture -Page 1

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13b - Over-the-Counter (OTC) items - Page 1

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13c - Meal Benefits -Page 1

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13g - Dual Eligible SNPs with Highly Integrated Services -Page 1

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13h - Additional Services (MMP) -Page 1

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13h1 - Early and Peroidic Screening, Diagnostic, and Treatment (EPSDT) Services -Page 1

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13h2 - Tobacco Cessation Counseling for Pregnant Women - Page 1

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13h3 - Freestanding Birth Center Services – Page 1

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13h4 - Respiratory Care Services – Page 1

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13h5 - Family Planning Services – Page 1

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13h6 - Nursing Home Services – Page 1

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13h7 - Home and Community Based Services – Page 1

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13h8 – Personal Care Services – Page 1

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13h9 - Self-Directed Personal Assistance Services – Page 1

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13h10 - Private Duty Nursing Services – Page 1

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13h11 - Case Management (Long Term Care) – Page 1

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13h12 - Institution for Mental Disease Services for Individuals 65 or older – Page 1

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13h13 - Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities – Page 1

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14a – Medicare-covered Zero Dollar Preventive Services – Page 1

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14c – Other Defined Supplemental Benefits

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16c5 - Maxillofacial Prosthetics - Page 1

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16c6 - Implant Services - Page 1

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17b1 – Contact Lenses– Page 1

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