49 Areas of Limited Coverage Note: These services and benefits are not included in the A+ coverage option. Acupuncture Charges for acupuncture treatments are covered medical charges, when performed by a physician, but only when performed for a pain diagnosis. The Plan does not cover acupuncture treatments performed for any other reason, including conditions like allergy and sinus problems, cold and flu symptoms, etc. Allergy Testing and Treatment Charges for allergy testing and treatment of allergies are covered medical charges but are limited to the charges of a physician for diagnostic allergy testing and allergy serums dispensed by the physician, including allergy injections administered in the provider’s office. Bariatric Surgery The Plan provides in-network coverage for Medically Necessary bariatric surgery that meets with CareFirst Administrator’s clinical criteria for Medical Necessity and the recommended procedural guidelines. There is no out-of-network coverage for bariatric surgery . Precertification is required. Guidelines for Coverage for Bariatric Surgery The guidelines set forth below provide an overview of the requirements for Medically Necessary bariatric surgery. These guidelines are subject to periodic change without notice and should be reviewed with CareFirst Administrators well in advance when bariatric surgery is being considered. We recommend that you and/or your physician contact CareFirst Administrators in advance of this procedure. • The individual should be at least 18 years of age or should have reached full expected skeletal growth; • Body Mass Index (BMI) of 40 or greater; or • BMI of at least 35 with at least one clinically significant comorbidity, including but not limited to, cardiovascular disease, Type 2 diabetes, hypertension, coronary artery disease, or pulmonary hypertension; • Failure of medical management, including evidence of active participation within the last two years in a weight-management program that is supervised either by a physician or a registered dietician for a minimum of six months without significant gaps. The program must include monthly documentation of ALL of the following components: − Weight; − Current dietary program; and − Physical activity (e.g., exercise program). Programs such as Virta’s weight management program are acceptable alternatives if done in conjunction with the supervision of a physician or a registered dietician, and detailed documentation of participation is available for review. For individuals with long-standing morbid obesity, participation in a program within the last five years is sufficient if reasonable attendance in the weight-management program over an extended period of time of at least six months can