{"component": "clause", "props": {"groups": [{"snippet_links": [{"key": "determine-the", "type": "clause", "offset": [83, 96]}, {"key": "illness-or-injury", "type": "definition", "offset": [114, 131]}], "size": 33, "samples": [{"hash": "1gXDiqFsHWQ", "uri": "/contracts/1gXDiqFsHWQ#diagnostic-services", "label": "Health Care Benefits Agreement", "score": 36.1349133425, "published": true}, {"hash": "8QfjJUYo6s0", "uri": "/contracts/8QfjJUYo6s0#diagnostic-services", "label": "Health Care Benefits Agreement", "score": 35.985294342, "published": true}, {"hash": "jVkqvuYuEyE", "uri": "/contracts/jVkqvuYuEyE#diagnostic-services", "label": "Health Care Benefit Program", "score": 35.371181488, "published": true}], "snippet": "that is, tests performed to diagnose your condition because of your symptoms or to determine the progress of your illness or injury.", "hash": "7da18dea568222e4bf0c52c6e15ff6e2", "id": 5}, {"snippet_links": [{"key": "ordered-by", "type": "definition", "offset": [11, 21]}, {"key": "recognized-provider", "type": "definition", "offset": [24, 43]}, {"key": "specific-condition", "type": "clause", "offset": [87, 105]}, {"key": "examples-include", "type": "clause", "offset": [123, 139]}, {"key": "not-limited", "type": "clause", "offset": [149, 160]}], "size": 76, "samples": [{"hash": "aAxblCQlMDn", "uri": "/contracts/aAxblCQlMDn#diagnostic-services", "label": "Hmo Plan Contract", "score": 36.2775535583, "published": true}, {"hash": "6fxILvya06K", "uri": "/contracts/6fxILvya06K#diagnostic-services", "label": "Hmo Plan Contract", "score": 35.6349258423, "published": true}, {"hash": "dfyEiQ4uYoM", "uri": "/contracts/dfyEiQ4uYoM#diagnostic-services", "label": "Hmo Plan Contract", "score": 34.9852104187, "published": true}], "snippet": "Procedures ordered by a recognized Provider because of specific symptoms to diagnose a specific condition or disease. Some examples include, but are not limited to:", "hash": "401dbbf7ff18004137d85c744d59b4bc", "id": 1}, {"snippet_links": [{"key": "necessary-procedures", "type": "clause", "offset": [4, 24]}, {"key": "assist-the", "type": "clause", "offset": [28, 38]}, {"key": "determine-the", "type": "clause", "offset": [88, 101]}, {"key": "dental-treatment", "type": "clause", "offset": [111, 127]}, {"key": "oral-examinations", "type": "clause", "offset": [140, 157]}], "size": 70, "samples": [{"hash": "guXIM8LgN65", "uri": "/contracts/guXIM8LgN65#diagnostic-services", "label": "Labour Agreement", "score": 29.9456825256, "published": true}, {"hash": "gnh12V65duh", "uri": "/contracts/gnh12V65duh#diagnostic-services", "label": "Labour Agreement", "score": 26.7085819244, "published": true}, {"hash": "Rzo9SxmfUy", "uri": "/contracts/Rzo9SxmfUy#diagnostic-services", "label": "Collective Agreement", "score": 26.6464824677, "published": true}], "snippet": "All necessary procedures to assist the dentist in evaluating the existing conditions to determine the required dental treatment, including: Oral examinations Consultations", "hash": "0e23bb4317e24f12d30be41a39d6c056", "id": 2}, {"snippet_links": [{"key": "diagnostic-imaging", "type": "definition", "offset": [15, 33]}, {"key": "laboratory-tests", "type": "clause", "offset": [35, 51]}, {"key": "medically-necessary", "type": "definition", "offset": [82, 101]}, {"key": "ordered-by", "type": "definition", "offset": [106, 116]}, {"key": "treatment-of", "type": "clause", "offset": [157, 169]}, {"key": "illness-or-injury", "type": "definition", "offset": [180, 197]}, {"key": "health-care-service", "type": "definition", "offset": [218, 237]}, {"key": "specialized-tests", "type": "clause", "offset": [239, 256]}, {"key": "blood-tests", "type": "clause", "offset": [334, 345]}, {"key": "subject-to", "type": "clause", "offset": [413, 423]}, {"key": "pocket-expenses", "type": "definition", "offset": [445, 460]}], "size": 55, "samples": [{"hash": "bz8sHQ3jFQt", "uri": "/contracts/bz8sHQ3jFQt#diagnostic-services", "label": "Medical and Hospital Service Contract With Point of Service Rider", "score": 26.697467804, "published": true}, {"hash": "2b27iuervqT", "uri": "/contracts/2b27iuervqT#diagnostic-services", "label": "Medical and Hospital Service Contract", "score": 26.697467804, "published": true}, {"hash": "lTLiknnAlVg", "uri": "/contracts/lTLiknnAlVg#diagnostic-services", "label": "Medical and Hospital Service Contract", "score": 26.4702262878, "published": true}], "snippet": "All prescribed diagnostic imaging, laboratory tests and services are covered when Medically Necessary and ordered by a Physician as part of the diagnosis or treatment of a covered illness or injury, or as a preventive Health Care Service. 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"label": "Hmo Health Benefits Contract", "score": 32.9805984497, "published": true}, {"hash": "aeCIws6pZxo", "uri": "/contracts/aeCIws6pZxo#diagnostic-services", "label": "Individual Health Maintenance Organization (Hmo) Contract", "score": 31.6611862183, "published": true}], "snippet": "Indicated diagnostic services that can be considered every 3 months for individuals with special healthcare needs are denoted with an asterisk. Clinical oral evaluations once every 6 months * Comprehensive oral evaluation\u2013 complete evaluation which includes a comprehensive and thorough inspection of the oral cavity to include diagnosis, an oral cancer screening, charting of all abnormalities, and development of a complete treatment plan allowed once per year with subsequent service as periodic oral evaluation Periodic oral evaluation \u2013 subsequent thorough evaluation of an established patient* Oral evaluation for patient under the age of 3 and counseling with primary caregiver* Limited oral evaluations that are problem focused Detailed oral evaluations that are problem focused Diagnostic Imaging with interpretation A full mouth series can be provided every 3 years. The number of films/views expected is based on age with the maximum being 16 intraoral films/views. An extraoral panoramic film/view and bitewings may be substituted for the full mouth series with the same frequency limit. Additional films/views needed for diagnosing can be provided as needed. Bitewings, periapicals, panoramic and cephlometric radiographic images Intraoral and extraoral radiographic images Oral/facial photographic images Maxillofacial MRI, ultrasound Cone beam image capture Tests and Examinations Viral culture Collection and preparation of saliva sample for laboratory diagnostic testing Diagnostic casts \u2013 for diagnostic purposes only and not in conjunction with other services Oral pathology laboratory Accession/collection of tissue, examination \u2013 gross and microscopic, preparation and transmission of written report Accession/collection of exfoliative cytologic smears, microscopic examination, preparation and transmission of a written report Other oral pathology procedures, by report * Indicates preventive services that can be considered every 3 months for individuals with special healthcare needs are denoted with an asterisk. Dental prophylaxis once every 6 months* Topical fluoride treatment once every 6 months \u2013 in conjunction with prophylaxis as a separate service* Fluoride varnish once every 3 months for children under the age of 6 Sealants, limited to one time application to all occlusal surfaces that are unfilled and caries free, in premolars and permanent molars. Replacement of sealants can be considered with prior authorization. Space maintainers \u2013 to maintain space for eruption of permanent tooth/teeth, includes placement and removal fixed \u2013 unilateral and bilateral removable \u2013 bilateral only recementation of fixed space maintainer removal of fixed space maintainer \u2013 considered for provider that did not place appliance There are no frequency limits on replacing restorations (fillings) or crowns. Request for replacement due to failure soon after insertion, may require documentation to demonstrate material failure as the cause. Reimbursement will include the restorative material and all associated materials necessary to provide the standard of care, polishing of restoration, and local anesthesia. The reimbursement for any restoration on a tooth shall be for the total number of surfaces to be restored on that date of service. Only one procedure code is reimbursable per tooth except when amalgam and composite restorations are placed on the same tooth. Reimbursement for an occlusal restoration includes any extensions onto the occlusal one-third of the buccal, facial or lingual surface(s) of the tooth. Extension of interproximal restorations into self-cleansing areas will not be considered as additional surfaces. Extension of any restoration into less than 1/3 of an adjacent surface is not considered an additional surface and will not be reimbursable (or if paid will be recovered). Restorative service to include: Restorations (fillings) \u2013 amalgam or resin based composite for anterior and posterior teeth. Service includes local anesthesia, pulp cap (direct or indirect) polishing and adjusting occlusion. Gold foil - . Service includes local anesthesia, polishing and adjusting occlusion but only covered if the place of service is a teaching institution or residency program Inlay/onlay restorations \u2013 metallic, service includes local anesthesia, cementation, polishing and adjusting occlusion but only covered if the place of service is a teaching institution or residency program Porcelain fused to metal, cast and ceramic crowns (single restoration) \u2013 to restore form and function. Service requires prior authorization and will not be considered for cosmetic reasons, for teeth where other restorative materials will be adequate to restore form and function or for teeth that are not in occlusion or function and have a poor long term prognosis Service includes local anesthesia, temporary crown placement, insertion with cementation, polishing and adjusting occlusion. Provisional crowns are not covered. Recement of inlay, onlay, custom fabricated/cast or prefabricated post and core and crown, Prefabricated stainless steel, stainless steel crown with resin window and resin crowns. Service includes local anesthesia, insertion with cementation and adjusting occlusion. Core buildup including pins Pin retention Indirectly fabricated (custom fabricated/cast) and prefabricated post and core Additional fabricated ( custom fabricated/cast) and prefabricated post Post removal Temporary crown (fractured tooth) Additional procedures to construct new crown under existing partial denture Coping Crown repair Protective restoration/sedative filling Service includes all necessary radiographs or views needed for endodontic treatment. Teeth must be in occlusion, periodontally sound, needed for function and have good long term prognosis. Emergency services for pain do not require prior authorization. Service requires prior authorization and will not be considered for teeth that are not in occlusion or function and have poor long term prognosis. Endodontic service to include: Therapeutic pulpotomy for primary and permanent teeth Pulpal debridement for primary and permanent teeth Partial pulpotomy for apexogensis Pulpal therapy for anterior and posterior primary teeth Endodontic therapy and retreatment Treatment for root canal obstruction, incomplete therapy and internal root repair of perforation Apexification: initial, interim and final visits Pulpal regeneration Apicoectomy/Periradicular Surgery Retrograde filling Root amputation Surgical procedure for isolation of tooth with rubber dam Hemisection Canal preparation and fitting of preformed dowel or post Post removal Services require prior authorization with submission of diagnostic materials and documentation of need. Surgical services Gingivectomy and gingivoplasty Gingival flap including root planning Apically positioned flap Clinical crown lengthening Osseous surgery Bone replacement graft \u2013 first site and additional sites Biologic materials to aid soft and osseous tissue regeneration Guided tissue regeneration Surgical revision Pedicle and free soft tissue graft Subepithelial connective tissue graft Distal or proximal wedge Soft tissue allograft Combined connective tissue and double pedicle graft Non-Surgical Periodontal Service Provisional splinting \u2013 intracoronal and extracoronal \u2013 can be considered for treatment of dental trauma Periodontal root planing and scaling \u2013 with prior authorization, can be considered every 6 months for individuals with special healthcare needs Full mouth debridement to enable comprehensive evaluation Localized delivery of antimicrobial agents Periodontal maintenance", "hash": "45ace5549d7095252d55e169b132d732", "id": 6}, {"snippet_links": [{"key": "dental-examinations", "type": "clause", "offset": [3, 22]}, {"key": "plan-year", "type": "clause", "offset": [67, 76]}, {"key": "benefits-will", "type": "clause", "offset": [90, 103]}, {"key": "requested-by", "type": "clause", "offset": [263, 275]}], "size": 23, "samples": [{"hash": "jiqjbuh3s4P", "uri": "/contracts/jiqjbuh3s4P#diagnostic-services", "label": "Preferred Provider Organization Insurance Contract", "score": 26.6591377258, "published": true}, {"hash": "gIfRvnnn0gK", "uri": "/contracts/gIfRvnnn0gK#diagnostic-services", "label": "Preferred Provider Organization Insurance Contract", "score": 26.6591377258, "published": true}, {"hash": "cXXoJCm82W1", "uri": "/contracts/cXXoJCm82W1#diagnostic-services", "label": "Preferred Provider Organization Insurance Contract", "score": 26.6591377258, "published": true}], "snippet": "1. Dental examinations, visits and consultations two (2) times per Plan Year..\n2. X-rays. Benefits will be provided for the following radiographs: Intra oral complete (full) series or panoramic film will be provided once every three (3) years unless specifically requested by us. \u2022 Intra-oral periapicals. First film and additional films. \u2022 Intra-oral occlusals. Two films will be provided per plan year. \u2022 Bitewings. One set of two or four films will be provided once per plan year.", "hash": "ded332d1e142e7d84173280eedfcd48f", "id": 7}, {"snippet_links": [{"key": "oral-examinations", "type": "clause", "offset": [0, 17]}, {"key": "fiscal-year", "type": "definition", "offset": [47, 58]}], "size": 23, "samples": [{"hash": "67xWPXQ4TRc", "uri": "/contracts/67xWPXQ4TRc#diagnostic-services", "label": "Collective Bargaining Agreement", "score": 26.1704311371, "published": true}, {"hash": "aEOPMo90ZQD", "uri": "/contracts/aEOPMo90ZQD#diagnostic-services", "label": "Collective Bargaining Agreement", "score": 25.3134841919, "published": true}, {"hash": "6yDJ2WI2Rzz", "uri": "/contracts/6yDJ2WI2Rzz#diagnostic-services", "label": "Collective Bargaining Agreement", "score": 25.3093776703, "published": true}], "snippet": "Oral examinations and consultations twice in a fiscal year.", "hash": "d8c063e78846fab5d80dfc4f974bb45a", "id": 8}, {"snippet_links": [{"key": "professional-services", "type": "definition", "offset": [21, 42]}, {"key": "associated-with", "type": "definition", "offset": [43, 58]}, {"key": "other-testing", "type": "clause", "offset": [70, 83]}, {"key": "medical-laboratory", "type": "definition", "offset": [109, 127]}, {"key": "test-results", "type": "clause", "offset": [181, 193]}, {"key": "testing-equipment", "type": "clause", "offset": [235, 252]}], "size": 21, "samples": [{"hash": "7tAFT34J3Kt", "uri": "/contracts/7tAFT34J3Kt#diagnostic-services", "label": "Medical and Hospital Service Contract", "score": 25.421628952, "published": true}, {"hash": "k0FmRL3kgVv", "uri": "/contracts/k0FmRL3kgVv#diagnostic-services", "label": "Medical and Hospital Service Contract", "score": 25.4175224304, "published": true}, {"hash": "iupTiwAPQqs", "uri": "/contracts/iupTiwAPQqs#diagnostic-services", "label": "Medical and Hospital Service Contract", "score": 25.4175224304, "published": true}], "snippet": "Non-patient-specific professional services associated with machine or other testing including oversight of a medical laboratory to assure timeliness, reliability, and usefulness of test results and overseeing calibration of laboratory testing equipment.", "hash": "f53b55c56551dc4c71d4e4eafd77e675", "id": 9}, {"snippet_links": [{"key": "the-plan", "type": "clause", "offset": [0, 8]}, {"key": "benefits-for", "type": "clause", "offset": [18, 30]}, {"key": "laboratory-tests", "type": "clause", "offset": [73, 89]}, {"key": "ordered-by", "type": "definition", "offset": [116, 126]}, {"key": "illness-or-injury", "type": "definition", "offset": [183, 200]}, {"key": "not-defined", "type": "definition", "offset": [211, 222]}, {"key": "preventive-care", "type": "clause", "offset": [226, 241]}, {"key": "services-covered", "type": "clause", "offset": [303, 319]}, {"key": "the-services", "type": "definition", "offset": [347, 359]}], "size": 14, "samples": [{"hash": "6GskUpvamAo", "uri": "/contracts/6GskUpvamAo#diagnostic-services", "label": "Member Benefit Agreement", "score": 31.6744918823, "published": true}, {"hash": "cYM6z0D6qvI", "uri": "/contracts/cYM6z0D6qvI#diagnostic-services", "label": "Member Benefit Agreement", "score": 27.3696098328, "published": true}, {"hash": "llbulkwOXO4", "uri": "/contracts/llbulkwOXO4#diagnostic-services", "label": "Member Benefit Agreement", "score": 26.8590011597, "published": true}], "snippet": "The Plan provides Benefits for Diagnostic Services, including diagnostic laboratory tests and x-rays, when they are ordered by a Provider to diagnose specific signs or symptoms of an illness or injury. Services not defined as Preventive Care under section 4.B.55 will be considered Diagnostic Services. Services covered under this section include the services of a Physician with a specialty in radiology.", "hash": "2d7f8ef23f168e139c4a2c9aa722b16d", "id": 10}], "next_curs": "ClwSVmoVc35sYXdpbnNpZGVyY29udHJhY3RzcjgLEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2IhxkaWFnbm9zdGljLXNlcnZpY2VzIzAwMDAwMDBhDKIBAmVuGAAgAA==", "clause": {"title": "Diagnostic Services", "size": 532, "parents": [["covered-medical-services", "COVERED MEDICAL SERVICES"], ["benefits", "Benefits"], ["training", "Training"], ["termination", "Termination"], ["out-of-network-benefits", "Out-of-Network Benefits"]], "children": [["quality-systems", "Quality Systems"], ["technical-quality-agreement", "Technical Quality Agreement"], ["timeframes", "Timeframes"], ["facility", "Facility"], ["maintenance-of-records-audits", "Maintenance of Records; Audits"]], "id": "diagnostic-services", "related": [["chiropractic-services", "Chiropractic Services", "Chiropractic Services"], ["pharmacy-services", "Pharmacy Services", "Pharmacy Services"], ["diagnostic", "Diagnostic", "Diagnostic"], ["specific-services", "Specific Services", "Specific Services"], ["hospice-services", "Hospice Services", "Hospice Services"]], "related_snippets": [], "updated": "2025-07-24T04:27:57+00:00", "also_ask": ["What are the essential elements to include in a Diagnostic Services clause to protect both parties?", "How can the scope of diagnostic services be clearly defined to avoid disputes?", "What are the most common risks or liabilities associated with diagnostic services provisions?", "How do courts typically interpret ambiguous diagnostic service obligations?", "What negotiation levers exist for limiting or expanding the provider\u2019s responsibilities under this clause?"], "drafting_tip": "Specify the types of diagnostic services provided to prevent scope disputes; define performance standards to ensure service quality; clarify reporting obligations to facilitate timely communication.", "explanation": "The Diagnostic Services clause defines the scope and terms under which diagnostic evaluations or tests are provided within an agreement. It typically outlines the types of diagnostic services covered, the responsibilities of each party regarding scheduling, performance, and reporting of results, and may specify standards or qualifications required for those performing the diagnostics. This clause ensures that both parties have a clear understanding of what diagnostic services are included, how they will be delivered, and helps prevent disputes over service expectations or quality."}, "json": true, "cursor": ""}}