◦ Migraine or cluster headaches ◦ Multiple sclerosis ◦ Non-healing venous, arterial, and pressure ulcers ◦ Thermal burns 48. Imaging of the sinus for rhinosinusitis using x-ray or ultrasound 49. Immunizations, physical exams and associated services (laboratory or similar tests) for the purpose of travel or employment, even if recommended by the CDC 50. Implantable drug delivery systems (IDDS or infusion pumps) for chronic, non-cancer pain 51. Incarceration: Services and supplies provided while confined in a prison or jail 52. Infertility or fertility testing or treatment after initial diagnosis, including drugs, pharmaceuticals, artificial insemination, and any other type of testing, treatment, complications resulting from such treatment (e.g., selective fetal reduction), or visits for infertility 53. In Vitro Fertilization (IVF) and all related services and supplies, including all procedures involving selection of embryo for implantation 54. Knee arthroplasty: Multi-compartmental arthroplasty and partial knee arthroplasty (including bi- compartmental and bi-unicompartmental) 55. Knee arthroscopy for osteoarthritis of the knee 56. Late fees, finance charges, or collections charges 57. Learning disabilities treatment after diagnosis, except as covered under the following benefits: ◦ “Applied Behavior Analysis (ABA) Therapy” on page 38; ◦ “Therapy: Habilitative and Rehabilitative” on page 72; ◦ When part of treating a mental health disorder; or ◦ When part of treating a substance use disorder. 58. INTENTIONALLY LEFT BLANK. 59. Lumbar artificial disc replacement 60. Lumbar fusion for degenerative disc disease 61. Lumbar radiculopathy/sciatica surgery: Minimally invasive procedures that do not include laminectomy, laminotomy, or foraminotomy, including, but not limited to, energy ablation techniques, Automated Percutaneous Lumbar Discectomy (APLD), percutaneous laser, nucleoplasty, etc. 62. Magnetic resonance imaging, (upright) (uMRI), also known as “positional,” “weight-bearing” (partial or full), or “axial loading” 63. Maintenance care (see definition on page 182) 64. Manipulations of the spine or extremities, except as described under “Spinal and extremity manipulations” on page 68 65. Marriage, family, or other counseling or training services, except as provided to treat an individual member’s neuropsychiatric, mental health, or substance use disorder 66. Massage therapy services when the massage therapist is not a preferred provider 2024 UMP Select (PEBB) Certificate of Coverage 113