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Important Note:
Medical policy is not an authorization, certification, explanation of benefits or a contract. Benefits and eligibility are determined before medical guidelines and payment guidelines are applied. Benefits are determined by the subscriber certificate that is in effect at the time services are rendered. This document is provided for informational purposes only and is based on research of current medical literature and review of common medical practices in the treatment and diagnosis of disease. Medical practices and knowledge are constantly changing and BCBSVT reserves the right to review and revise its medical policies periodically and without notice.
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