34. Spinal and Extremity Manipulation Therapy Services We cover outpatient visits for Spinal and Extremity Manipulation therapy Services when provided by a Participating Provider in the Participating Provider’s office. Covered Services include:  Evaluation and management.  Diagnostic radiology.  Musculoskeletal treatments.  Hot and cold packs,  Treatment for the onset of an illness or injury, aggravation of an illness or injury, and the exacerbation of an illness or injury. To locate a Participating Provider, visit www.chpgroup.com. The CHP Group is a Participating Provider we contract with to provide Spinal and Extremity Manipulation therapy Services. If you need assistance searching for a Participating Provider, or to verify the current participation status of a provider, or if you do not have access to the online directory, please contact Member Services. Self-referred Spinal and Extremity Manipulation Therapy Services We cover self-referred outpatient visits for Spinal and Extremity Manipulation therapy Services. The visit maximum shown in the “Benefit Summary” will be exhausted (used up) for a Year when the number of visits that we covered during the Year under this EOC, plus any visits we covered during the Year under any other evidence of coverage with the same group number printed on this EOC, add up to the visit maximum. You do not need a referral or prior authorization. Physician-referred Spinal and Extremity Manipulation Therapy Services We cover physician-referred outpatient visits for Spinal and Extremity Manipulation therapy Services when you receive a referral from a Participating Provider. These Services are subject to Utilization Review by Kaiser using criteria developed by Medical Group and approved by Kaiser. However, you do not need authorization for an initial evaluation and management visit and up to six treatment visits for a New Episode of Care. Spinal and Extremity Manipulation Therapy Services Exclusions  Dermal friction technique.  East Asian massage and tui na.  Nambudripad allergy elimination technique (NAET).  Qi gong.  Services designed to maintain optimal health in the absence of symptoms.  Sonopuncture. 35. Substance Use Disorder Services We cover Substance Use Disorder Services subject to Utilization Review by Kaiser using criteria developed by Medical Group and approved by Kaiser. You may request these criteria by calling Member Services. Coverage includes medical treatment for withdrawal symptoms (including methadone maintenance) and acupuncture treatment for Substance Use Disorder. Acupuncture visit limits do not apply to acupuncture treatment for Substance Use Disorder. The benefits described in this “Substance Use Disorder Services” section comply with the Mental Health Parity and Addiction Equity Act. EWCLGDED1983ACT0124 67 WAPEBB-CL-ACT