General Medical Services Not Covered by BCBS

While coverage varies by plan, BCBS of South Carolina typically does not cover the following medical services:

• Acupuncture – Alternative treatment using needle insertion to relieve pain or promote healing.

• Bariatric Surgery – Weight-loss surgeries such as gastric bypass, unless meeting specific medical criteria.

• Cosmetic Surgery – Procedures performed for aesthetic reasons, unless considered reconstructive.

• Dental Care (Adult) – Routine exams, cleanings, fillings, and extractions for adults.

• Hearing Aids – Devices to assist with hearing loss, unless covered under a specialized plan.

• Long-Term Care – Extended care services, including nursing homes and in-home care.

• Private-Duty Nursing – One-on-one nursing care in the home or hospital setting.

• Routine Eye Care (Adult) – Regular vision exams, prescription glasses, and contact lenses.

• Routine Foot Care – Basic foot care, including nail trimming and callus removal, unless medically necessary.

• Weight Loss Programs – Diet, exercise, or counseling programs for weight management, unless part of an approved medical treatment plan.

Physical Therapy Services Not Covered by BCBS

BCBS considers physical therapy medically necessary when it addresses functional impairments due to disease, injury, congenital conditions, or prior interventions. However, some therapy services are excluded from coverage, including:

• Vocational Rehabilitation – Therapy focused on job-related skills and employment training.

• Pulmonary Rehabilitation – Respiratory therapy for lung conditions, unless associated with a lung transplant.

• Cognitive Retraining – Therapy to improve memory, attention, and problem-solving skills.

• Community Re-entry Programs – Support services for reintegrating into the community after injury or illness.

• Long-Term Rehabilitation – Extended physical therapy beyond short-term recovery needs, unless significant progress is documented.

• Massage Therapy – Hands-on techniques for muscle relaxation and circulation improvement, as they are considered non-medical.

• Work-Hardening Programs – Intensive rehabilitation to prepare individuals for returning to work, unless covered under a worker’s compensation plan.

Final Takeaways

• These exclusions are based on BCBS policies, not clinic decisions.

• Any of these services can be added as a self-pay option for $40 per service during a session.

• Some services, such as long-term rehabilitation, require documented progress to be considered medically necessary.

• If you are unsure about your coverage, we recommend reviewing your policy or contacting BCBS directly.

What Does "Medical Necessity" Mean?

Medical necessity refers to treatments that are deemed essential for your health based on clinical guidelines. A service is considered medically necessary if it:

✔ Treats a specific medical condition, injury, or functional limitation.
✔ Has been proven effective through research and medical standards.
✔ Requires the skill of a licensed physical therapist (not something you can do independently).
✔ Has measurable goals that show improvement over time.

If a service does not meet these standards, BCBS will not cover it, even if it may be beneficial.

For example, if physical therapy helps you regain mobility after surgery, it is considered medically necessary. However, if therapy is for general wellness, injury prevention, or relaxation (such as massage therapy or acupuncture), it may not be covered.

If you have any questions regarding your coverage, we encourage you to contact BCBS of South Carolina for more information about your specific plan.