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108. Sleep apnea diagnosis and treatment as indicated in referenced Medicare national and local coverage determinations 109. Sleep therapy services performed at the following locations are not covered: ◦ Emergency room services ◦ Inpatient hospitalization ◦ Urgent-care facilities 110. Sound therapies for treatment of tinnitus, including, but not limited to: ◦ Masking devices (sound maskers) ◦ Altered auditory stimuli ◦ Auditory attention training 111. Spinal cord stimulation for chronic neuropathic pain 112. Spinal injections, therapeutic (except as described under “Spinal injections” on page 70) of the following types: ◦ Facet injections ◦ Intradiscal injections ◦ Medial branch nerve block injections 113. Spinal surgical procedures known as vertebroplasty, kyphoplasty, and sacroplasty 114. Stem cell therapies for musculoskeletal conditions 115. Stereotactic body radiation therapy for the treatment of primary tumor of the following cancer types: ◦ Bone ◦ Head and neck ◦ Adrenal ◦ Melanoma ◦ Merkel cell ◦ Breast ◦ Ovarian ◦ Cervical 116. Stereotactic radiation surgery for conditions other than central nervous system primary and metastatic tumors 117. Surrogacy 118. Telephone or virtual consultations or appointments, except as described under “Telemedicine services” on page 77 119. Tinnitus specific therapies including, but not limited to: ◦ Tinnitus retraining therapy (TRT) ◦ Neuromonics tinnitus treatment (NTT) ◦ Tinnitus activities treatment (TAT) 2024 UMP Classic (PEBB) Certificate of Coverage 119

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