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) 3.25 Hospital Services (except as expressly limited or excluded by this Contract) means those services for registered bed patients that are: Generally and customarily provided by acute care general Hospitals in accordance with the standards of acceptable community practice; Performed, prescribed, or directed by Participating Providers; and Medically Necessary for conditions which carmot be adequately treated in Other Health Care Facilities or with Home Health Care Services or on an ambulatory basis. 3.26 HospitalistJAdmitting Panelist means a physician who specializes in treating inpatients and who rnay coordinate a Member's health care when the Member has been admitted for a Medically Necessary procedure or treatment at a Hospital. 3.25.01 3.25.02 3.25.03 ') 3.27 Injectable Medication means a medication that has been approved by the Food and Drug Administration (FDA) for administration by one or more of the following routes: intramuscular injection, intravenous injection, intravenous infusion, subcutaneous injection, intrathecal injection, intrarticular injection, intracavernous injection or intraocular injection. Pre-authorization is required for Injectable Medications. 3.28 Limitation rneans any provision (other than an Exclusion) which restricts coverage under this Contract. 3.29 Master Application means the Subscribing Group application form entitled 'Master Application' which becomes a part of the Contract when the Master Application has been completed and executed by the Suhscribing Group and AvMed. 3.30 Maximum Allowahle Payment means the maxirnum amount that AvMed will pay for any covered service rendered by a Non-participating Provider or supplier of services, medications, or supplies. The maximurn amount that AvMed will pay for each such covered service can be found on the Maximum Allowable Payment Schedule available at www.avrned.org. 3.31 Medically Necessary means the use of any appropriate medical treatment, service, equipment, and/or supply as provided by a Hospital, skilled nursing facility, physician, or other provider which is necessary for the diagnosis, care, and/or treatment of a Member's illness or injury, and which is: 3.31.0 I 3.31.02 3.31.03 3.31.04 3.31.05 3.31.06 j ) Consistent with the symptom, diagnosis, and treatment of the Member's condition; The most appropriate level of supply and/or service for the diagnosis and treatment of the Member's condition; In accordance with standards of acceptable community practice; Not primarily intended for the personal comfort or convenience of the Member, the Member's family, the physician, or other health care providers; Approved by the appropriate medical body or health care specialty involved as effective, appropriate, and essential for the care and treatment of the Member's condition; and Not experimental or investigational. 3.32 Medical Office means any outpatient facility or physician's office in the Service Area utilized by a Participating Provider. 3.33 Medical Services (except as limited or excluded by this Contract) rneans those professional services of physicians and other Health Professionals, including medical, surgical, diagnostic, therapeutic, and preventive services that are: 3.33.01 A V -G 100- 2009 MP-5319 (10/09) Generally and customarily provided in the Service Area; 5