|
This list does not include prescription drugs or brand name items; please use generic search terms.
Eligibility for various goods and services may change at any time. Please search to ensure eligibility prior to each purchase.
For more information on Dependent Care FSA, please click here for plan guidelines.
A "detailed receipt" includes ALL of the following: date of service, patient name, provider name, amount, and service or expense.
Expense | Eligible? | Documentation Needed |
---|---|---|
72-hour kits |
![]() |
|
ABA therapy |
![]() |
Detailed receipt |
ADD/ADHD Testing |
![]() |
Letter of Medical Necessity |
Abdominoplasty |
![]() |
Letter of Medical Necessity |
Acne treatments |
![]() |
Detailed receipt |
Acupressure |
![]() |
Detailed receipt |
Acupressure mat |
![]() |
Detailed receipt |
Acupuncture |
![]() |
Detailed receipt |
Adaptive seat |
![]() |
Letter of Medical Necessity |
Adoption fees |
![]() |
|
Adoption medical expenses |
![]() |
Detailed receipt |
Air filter for humidifier |
![]() |
Letter of Medical Necessity |
Air purification systems |
![]() |
|
Air respirator system |
![]() |
Letter of Medical Necessity |
Alarm systems |
![]() |
|
Alcoholism treatment |
![]() |
Detailed receipt |
Allergy medications |
![]() |
Detailed receipt |
Allergy testing |
![]() |
Detailed receipt |
Allergy treatments and products |
![]() |
Letter of Medical Necessity |
Alopecia treatments |
![]() |
|
Alternative healer |
![]() |
Letter of Medical Necessity |
Ambulance services |
![]() |
Detailed receipt |
Amputee rings (car modification) |
![]() |
Letter of Medical Necessity |
Anesthesia (medical/dental) |
![]() |
Detailed receipt |
Antacids |
![]() |
Detailed receipt |
Anti-Distraction monitors |
![]() |
Letter of Medical Necessity |
Antibiotic ointment |
![]() |
Detailed receipt |
Antifungal treatments |
![]() |
Detailed receipt |
Antiseptic skin cleansers |
![]() |
Detailed receipt |
Apnea monitors |
![]() |
Detailed receipt |
Aquatic therapy |
![]() |
Letter of Medical Necessity |
Arthritis gloves |
![]() |
Detailed receipt |
Artificial eyes |
![]() |
Detailed receipt |
Artificial limbs |
![]() |
Detailed receipt |
Artificial teeth |
![]() |
Detailed receipt |
Assisted living facility |
![]() |
|
Asthma medications or treatments |
![]() |
Prescription |
Athletic mouth guards |
![]() |
|
Athletic shoes |
![]() |
|
Automated external defibrillators (AED) |
![]() |
Detailed receipt |
Automatic locks (car modification) |
![]() |
Letter of Medical Necessity |
Automobile modifications |
![]() |
Letter of Medical Necessity |
Baby formula |
![]() |
|
Baby monitor |
![]() |
Letter of Medical Necessity |
Balance boards |
![]() |
Letter of Medical Necessity |
Bandages |
![]() |
Detailed receipt |
Bariatric surgery |
![]() |
Detailed receipt |
Bathtubs |
![]() |
|
Batteries (for medical equipment and devices) |
![]() |
Detailed receipt |
Bed-wetting alarms |
![]() |
Letter of Medical Necessity |
Belly bands |
![]() |
Detailed receipt |
BioScan |
![]() |
Letter of Medical Necessity |
Biofeedback therapy |
![]() |
Detailed receipt |
Bioidentical hormone replacement therapy (BHRT) |
![]() |
Letter of Medical Necessity |
Bioptic telescopes (car modification) |
![]() |
Letter of Medical Necessity |
Birth control pills |
![]() |
Prescription |
Birthing classes |
![]() |
Detailed receipt |
Bladder control device |
![]() |
Detailed receipt |
Blood donor fees |
![]() |
Letter of Medical Necessity |
Blood pressure monitoring devices |
![]() |
Detailed receipt |
Blood storage |
![]() |
Letter of Medical Necessity |
Blood sugar test kits and strips |
![]() |
Detailed receipt |
Body Restoration Technique (BRT) |
![]() |
Letter of Medical Necessity |
Botulinum toxin injections (BOTOX) |
![]() |
Letter of Medical Necessity |
Braces |
![]() |
Detailed receipt |
Braille books |
![]() |
Detailed receipt |
Braille magazines |
![]() |
Detailed receipt |
Breast feeding classes |
![]() |
Detailed receipt |
Breast implant removal |
![]() |
Letter of Medical Necessity |
Breast implants |
![]() |
Letter of Medical Necessity |
Breast pump bustier |
![]() |
Detailed receipt |
Breast pump supplies |
![]() |
Detailed receipt |
Breast pumps |
![]() |
Detailed receipt |
Breast reconstruction surgery |
![]() |
Letter of Medical Necessity |
Breast reduction surgery |
![]() |
Letter of Medical Necessity |
Breath testing |
![]() |
Letter of Medical Necessity |
Breathalyzer |
![]() |
Letter of Medical Necessity |
Bug repellant sprays |
![]() |
|
COBRA premiums |
![]() |
|
COVID 19 antibody IV therapy |
![]() |
|
COVID 19 testing |
![]() |
Detailed receipt |
CPAP cleaners |
![]() |
Detailed receipt |
CPAP cleaning machines |
![]() |
Detailed receipt |
CPAP converters |
![]() |
Detailed receipt |
CPAP supplies |
![]() |
Detailed receipt |
CPR classes |
![]() |
|
CT heart calcium scan |
![]() |
Letter of Medical Necessity |
Cabinet lowering |
![]() |
|
Calamine lotions |
![]() |
Detailed receipt |
Cancer insurance premiums |
![]() |
|
Cane |
![]() |
Detailed receipt |
Car Modifications |
![]() |
Letter of Medical Necessity |
Carpet removal |
![]() |
|
Cervical pillows |
![]() |
Letter of Medical Necessity |
Chelation therapy |
![]() |
Letter of Medical Necessity |
Child diapers |
![]() |
|
Childcare instruction |
![]() |
|
Chinese herbal practitioner |
![]() |
Letter of Medical Necessity |
Chiropody |
![]() |
Detailed receipt |
Chiropractic care |
![]() |
Detailed receipt |
Cholesterol test kits and supplies |
![]() |
Detailed receipt |
Chondroitin supplements |
![]() |
Detailed receipt |
Christian Science practitioner |
![]() |
Detailed receipt |
Circulating cold water therapy device |
![]() |
|
Circumcision |
![]() |
Detailed receipt |
Clear aligners |
![]() |
Detailed receipt |
Cochlear implants |
![]() |
Detailed receipt |
Cognitive Behavioral Therapy (CBT) |
![]() |
Letter of Medical Necessity |
Coinsurance |
![]() |
Detailed receipt |
Cold laser therapy |
![]() |
Letter of Medical Necessity |
Cold medications |
![]() |
Detailed receipt |
Cold packs |
![]() |
Detailed receipt |
Cold sore medications |
![]() |
Detailed receipt |
Cold water therapy |
![]() |
Letter of Medical Necessity |
Collagen injections |
![]() |
Letter of Medical Necessity |
Colon cancer screening test |
![]() |
Detailed receipt |
Colonoscopy preparation kits |
![]() |
Detailed receipt |
Compound medication |
![]() |
Detailed receipt |
Compression therapy |
![]() |
Letter of Medical Necessity |
Computer glasses (non-prescription) |
![]() |
Detailed receipt |
Computer programs for visually impaired |
![]() |
Letter of Medical Necessity |
Condoms |
![]() |
Detailed receipt |
Conference for a medical condition |
![]() |
Letter of Medical Necessity |
Contact lens service agreements and warranties |
![]() |
|
Contact lenses and supplies |
![]() |
Detailed receipt |
Continuous glucose monitors |
![]() |
Detailed receipt |
Continuous positive airway pressure (CPAP) |
![]() |
Detailed receipt |
Contraceptives (over-the-counter) |
![]() |
Detailed receipt |
Contraceptives (prescription) |
![]() |
Prescription |
Contributions to state disability funds |
![]() |
|
Controlled substances (prescribed) |
![]() |
Prescription |
Convaid wheelchair |
![]() |
Letter of Medical Necessity |
Convalescent homes |
![]() |
Letter of Medical Necessity |
Copayments |
![]() |
Detailed receipt |
Cord blood storage |
![]() |
Letter of Medical Necessity |
Corn cushions |
![]() |
Detailed receipt |
Corn removal |
![]() |
Detailed receipt |
Corn trimmers |
![]() |
Detailed receipt |
Corneal keratotomy |
![]() |
Detailed receipt |
Corneal ring segments |
![]() |
Detailed receipt |
Cosmetic procedures or surgeries (in relation to birth defect, accident, or disease) |
![]() |
Letter of Medical Necessity |
Cosmetics |
![]() |
|
Cotton balls |
![]() |
|
Cotton swabs |
![]() |
|
Cough suppressants |
![]() |
Detailed receipt |
Counseling |
![]() |
Detailed receipt |
Cranial electrotherapy stimulation device |
![]() |
Detailed receipt |
Cranial-sacral therapy |
![]() |
Letter of Medical Necessity |
Credit card processing fees (related to FSA eligible expenses only) |
![]() |
Detailed receipt |
Crutch substitute |
![]() |
Detailed receipt |
Crutches |
![]() |
Detailed receipt |
Crystalens |
![]() |
Detailed receipt |
Custodial care |
![]() |
Letter of Medical Necessity |
Customized seats (car modification) |
![]() |
Letter of Medical Necessity |
Cutar Emulsion lotions |
![]() |
Detailed receipt |
Cyst removal |
![]() |
Detailed receipt |
DNA collection |
![]() |
Letter of Medical Necessity |
DNA storage |
![]() |
Letter of Medical Necessity |
Dance lessons |
![]() |
|
Decongestants |
![]() |
Detailed receipt |
Deductibles |
![]() |
Detailed receipt |
Dehumidifier |
![]() |
|
Dehydration treatments |
![]() |
Detailed receipt |
Dental bridges |
![]() |
Detailed receipt |
Dental crowns |
![]() |
Detailed receipt |
Dental emergency kits |
![]() |
Detailed receipt |
Dental fillings |
![]() |
Detailed receipt |
Dental floss |
![]() |
|
Dental implants |
![]() |
Detailed receipt |
Dental reconstructions |
![]() |
Detailed receipt |
Dental sealants |
![]() |
Detailed receipt |
Dental treatments |
![]() |
Detailed receipt |
Dental veneers |
![]() |
Letter of Medical Necessity |
Denture adhesives |
![]() |
Detailed receipt |
Denture cleansers |
![]() |
Detailed receipt |
Dentures |
![]() |
Detailed receipt |
Denturist |
![]() |
Detailed receipt |
Dermabrasion |
![]() |
Letter of Medical Necessity |
Diabetic bracelets |
![]() |
Detailed receipt |
Diabetic equipment |
![]() |
Detailed receipt |
Diabetic supplies |
![]() |
Detailed receipt |
Diagnostic services |
![]() |
Detailed receipt |
Diaper rash ointments |
![]() |
Detailed receipt |
Diaper services |
![]() |
|
Diarrhea medications |
![]() |
Detailed receipt |
Diathermy |
![]() |
Detailed receipt |
Dietary supplements |
![]() |
|
Dietician expenses |
![]() |
Letter of Medical Necessity |
Digestive aids |
![]() |
Detailed receipt |
Disodium phosphate |
![]() |
Detailed receipt |
Disposable medical masks |
![]() |
Detailed receipt |
Door hardware modifications |
![]() |
|
Doula services |
![]() |
Letter of Medical Necessity |
Dropped floors (car modification) |
![]() |
Letter of Medical Necessity |
Drug addiction treatments |
![]() |
Detailed receipt |
Drug overdose treatments |
![]() |
Detailed receipt |
Drug testing |
![]() |
Detailed receipt |
Durable medical equipment (DME) |
![]() |
Detailed receipt |
Dyslexia testing and treatment |
![]() |
Letter of Medical Necessity |
Ear molds |
![]() |
Detailed receipt |
Ear plugs |
![]() |
Letter of Medical Necessity |
Ear wax removal drops |
![]() |
Detailed receipt |
Educational classes for a medical condition or disease management |
![]() |
Letter of Medical Necessity |
Egg crate mattresses |
![]() |
Letter of Medical Necessity |
Egg storage fees |
![]() |
Detailed receipt |
Elbow switches (car modification) |
![]() |
Letter of Medical Necessity |
Electrical outlets |
![]() |
|
Electronic cigarettes |
![]() |
|
Elevator |
![]() |
|
Enemas |
![]() |
Detailed receipt |
Enteral formula |
![]() |
Detailed receipt |
Epsom salts |
![]() |
Detailed receipt |
Erectile dysfunction aids |
![]() |
Letter of Medical Necessity |
Erectile dysfunction medication |
![]() |
Detailed receipt |
Essential oils |
![]() |
|
Exercise equipment |
![]() |
Letter of Medical Necessity |
Expanded doorways |
![]() |
|
Expectorant |
![]() |
Detailed receipt |
Expenses not incurred during the FSA coverage period |
![]() |
|
Expenses that have already been reimbursed or that could be reimbursed by another medical plan |
![]() |
|
Experimental drugs |
![]() |
Prescription |
Experimental medical services |
![]() |
Letter of Medical Necessity |
Experimental surgery |
![]() |
Letter of Medical Necessity |
Exploratory surgery |
![]() |
Letter of Medical Necessity |
Eye drops |
![]() |
Detailed receipt |
Eye examinations |
![]() |
Detailed receipt |
Eye patches |
![]() |
Detailed receipt |
Eye surgery |
![]() |
Detailed receipt |
Eye wash and supplies |
![]() |
Detailed receipt |
Eyeglass cases |
![]() |
|
Eyeglass express fee (expedited shipping) |
![]() |
Detailed receipt |
Eyeglass lanyards |
![]() |
|
Eyeglass repair |
![]() |
Detailed receipt |
Eyeglasses |
![]() |
Detailed receipt |
FMLA records charges |
![]() |
|
Face masks |
![]() |
Detailed receipt |
Fertility enhancements |
![]() |
Detailed receipt |
Fertility treatments (for participant, spouse, or dependent) |
![]() |
Detailed receipt |
Fertility treatments (for surrogate) |
![]() |
|
Fetal monitors |
![]() |
Detailed receipt |
Fever reducing medications |
![]() |
Detailed receipt |
Finance charges |
![]() |
|
First aid creams |
![]() |
Detailed receipt |
First aid kits |
![]() |
Detailed receipt |
First aid liquids |
![]() |
Detailed receipt |
First aid tape |
![]() |
Detailed receipt |
Fitness trackers |
![]() |
|
Fixture relocation |
![]() |
|
Floor-mounted steering (car modification) |
![]() |
Letter of Medical Necessity |
Flooring replacement |
![]() |
|
Flu medications |
![]() |
Detailed receipt |
Flu shots |
![]() |
Detailed receipt |
Fluoridation devices |
![]() |
Letter of Medical Necessity |
Fluoride |
![]() |
Detailed receipt |
Fluoride pills |
![]() |
Detailed receipt |
Fluoride rinse |
![]() |
Detailed receipt |
Foam Wedge supply |
![]() |
Letter of Medical Necessity |
Foam roller therapy |
![]() |
Letter of Medical Necessity |
Food scales |
![]() |
Letter of Medical Necessity |
Foot Zoning |
![]() |
Letter of Medical Necessity |
Foot arch bandages |
![]() |
Detailed receipt |
Foot arch supports |
![]() |
Detailed receipt |
Foot care (general hygiene and cosmetic) |
![]() |
|
Foot care (medical nail clipping) |
![]() |
Letter of Medical Necessity |
Foot care medications |
![]() |
Detailed receipt |
Foot care supplies |
![]() |
Detailed receipt |
Foot creams |
![]() |
Detailed receipt |
Foot powders |
![]() |
Detailed receipt |
Foot sprays |
![]() |
Detailed receipt |
Form completion fees |
![]() |
|
Fracture fork (tuning fork to find fractures) |
![]() |
|
Full body scan |
![]() |
Letter of Medical Necessity |
Funeral expenses |
![]() |
|
Gambling addiction treatment |
![]() |
Letter of Medical Necessity |
Gas medication |
![]() |
Detailed receipt |
Gastric bypass |
![]() |
Detailed receipt |
Gastric bypass with excess skin removal |
![]() |
Letter of Medical Necessity |
Gastric sleeve |
![]() |
Detailed receipt |
Gauze pads |
![]() |
Detailed receipt |
Genetic testing |
![]() |
Letter of Medical Necessity |
Gestational carrier |
![]() |
|
Glucosamine supplements |
![]() |
Detailed receipt |
Glucose gels |
![]() |
Detailed receipt |
Glucose monitoring equipment |
![]() |
Detailed receipt |
Glucose tablets |
![]() |
Detailed receipt |
Gluten sensor |
![]() |
Letter of Medical Necessity |
Gluten-free products |
![]() |
|
Grading of property exterior |
![]() |
|
Gym memberships |
![]() |
|
Gynecologist |
![]() |
Detailed receipt |
HCG injections |
![]() |
Prescription |
Hair colorants |
![]() |
|
Hair regrowth products |
![]() |
|
Hair removal |
![]() |
|
Hair transplants |
![]() |
|
Hair treatments |
![]() |
|
Halfway houses (transition homes) |
![]() |
Letter of Medical Necessity |
Hand controls (car modification) |
![]() |
Letter of Medical Necessity |
Hand sanitizers |
![]() |
Detailed receipt |
Hand sanitizing wipes |
![]() |
Detailed receipt |
Handicap placards and license plates |
![]() |
Detailed receipt |
Headache medications |
![]() |
Detailed receipt |
Headphones for hearing impaired |
![]() |
Letter of Medical Necessity |
Health club dues |
![]() |
|
Health reimbursement arrangements (HRA) |
![]() |
|
Health savings account (HSA) contributions |
![]() |
|
Health screenings |
![]() |
Detailed receipt |
Hearing aid accessories |
![]() |
Detailed receipt |
Hearing aids |
![]() |
Detailed receipt |
Heart rate monitors |
![]() |
Detailed receipt |
Heat therapy |
![]() |
Letter of Medical Necessity |
Heat wraps |
![]() |
Detailed receipt |
Heating pads |
![]() |
Detailed receipt |
Hemorrhoid treatments |
![]() |
Detailed receipt |
Herbal medications |
![]() |
|
High colonic irrigation |
![]() |
Letter of Medical Necessity |
Holistic healer |
![]() |
Letter of Medical Necessity |
Home birth (with a licensed midwife) |
![]() |
Detailed receipt |
Home health services |
![]() |
Letter of Medical Necessity |
Home modifications |
![]() |
|
Homeopathic care |
![]() |
Letter of Medical Necessity |
Homeopathic medications |
![]() |
|
Hormone replacement therapy (HRT) |
![]() |
Letter of Medical Necessity |
Hospice care |
![]() |
Detailed receipt |
Hospital services |
![]() |
Detailed receipt |
Hot packs |
![]() |
Detailed receipt |
Household help |
![]() |
|
Human guide |
![]() |
Letter of Medical Necessity |
Humidifiers |
![]() |
Letter of Medical Necessity |
Hydrogen peroxide |
![]() |
Detailed receipt |
Hydrotherapy |
![]() |
Letter of Medical Necessity |
Hyperbaric oxygen therapy |
![]() |
Letter of Medical Necessity |
Hypnosis therapy |
![]() |
Letter of Medical Necessity |
Hypnotherapy |
![]() |
Letter of Medical Necessity |
Hypoallergenic encasement products |
![]() |
Letter of Medical Necessity |
Illegal surgeries and treatments |
![]() |
|
Immunizations |
![]() |
Detailed receipt |
Implantable Collamer Lens surgery (ICL) |
![]() |
Detailed receipt |
Imported drugs |
![]() |
|
Inclinator |
![]() |
|
Incontinence supplies (adult diapers) |
![]() |
Detailed receipt |
Infant diapers |
![]() |
|
Infection control |
![]() |
Detailed receipt |
Infertility treatments |
![]() |
Detailed receipt |
Infrared Sauna |
![]() |
|
Infrared mammograms |
![]() |
Detailed receipt |
Injection snoreplasty |
![]() |
Letter of Medical Necessity |
Insect bite devices |
![]() |
Detailed receipt |
Insect bite treatment solutions |
![]() |
Detailed receipt |
Insect bite treatment wipes |
![]() |
Detailed receipt |
Insect sting treatment solutions |
![]() |
Detailed receipt |
Insect sting treatment wipes |
![]() |
Detailed receipt |
Insulin |
![]() |
Detailed receipt |
Insulin pouches |
![]() |
Detailed receipt |
Insulin pumps |
![]() |
Detailed receipt |
Insurance premiums |
![]() |
|
Intense pulsed light therapy |
![]() |
Letter of Medical Necessity |
Internal Family System therapy (IFS) |
![]() |
Letter of Medical Necessity |
Intrauterine devices (IUD) |
![]() |
Detailed receipt |
Inversion systems |
![]() |
Letter of Medical Necessity |
Irrigation syringes |
![]() |
Detailed receipt |
Joy-stick system (car modification) |
![]() |
Letter of Medical Necessity |
Kenesio tape |
![]() |
Detailed receipt |
Ketamine Therapy |
![]() |
Letter of Medical Necessity |
Kinesiology |
![]() |
Letter of Medical Necessity |
Knee scooters |
![]() |
Detailed receipt |
LAP-BAND surgery |
![]() |
Detailed receipt |
LASIK eye surgery |
![]() |
Detailed receipt |
Laboratory fees |
![]() |
Detailed receipt |
Lactation consultant |
![]() |
Detailed receipt |
Lactation supplies |
![]() |
Detailed receipt |
Lactose intolerance pills |
![]() |
Detailed receipt |
Language training for a medical condition |
![]() |
Letter of Medical Necessity |
Lap pools |
![]() |
|
Laser bacterial reduction |
![]() |
Detailed receipt |
Laser eye surgery |
![]() |
Detailed receipt |
Laser treatments |
![]() |
Letter of Medical Necessity |
Late fees |
![]() |
|
Latex gloves |
![]() |
Detailed receipt |
Laxatives |
![]() |
Detailed receipt |
Lead-based paint removal |
![]() |
|
Left-foot accelerators (car modification) |
![]() |
Letter of Medical Necessity |
Left-handed gear selections (car modification) |
![]() |
Letter of Medical Necessity |
Legal fees |
![]() |
|
Lice treatment |
![]() |
Detailed receipt |
Lice treatment medications |
![]() |
Detailed receipt |
Lice treatment supplies |
![]() |
Detailed receipt |
Licensed birthing centers |
![]() |
Detailed receipt |
Life Alert medical emergency alert system |
![]() |
Detailed receipt |
Life coach |
![]() |
|
Lifestyle screenings |
![]() |
Detailed receipt |
Light boxes |
![]() |
Letter of Medical Necessity |
Light therapy |
![]() |
Letter of Medical Necessity |
LipiFlow |
![]() |
Letter of Medical Necessity |
Listening systems for hearing impaired |
![]() |
Letter of Medical Necessity |
Lodging/hotel/motel (Limit of $50 per night for patient and $50 per night for one caregiver.) |
![]() |
Letter of Medical Necessity |
Long-term care premiums |
![]() |
|
Long-term care services |
![]() |
Letter of Medical Necessity |
Long-term disability insurance premiums |
![]() |
|
Magnetic therapy |
![]() |
Letter of Medical Necessity |
Makeup |
![]() |
|
Marriage counseling |
![]() |
|
Massage chairs |
![]() |
|
Massage therapy |
![]() |
Letter of Medical Necessity |
Massage wheel |
![]() |
Letter of Medical Necessity |
Mastectomy Camisole |
![]() |
Detailed receipt |
Mastectomy bras |
![]() |
Detailed receipt |
Maternity clothes |
![]() |
|
Maternity global fees |
![]() |
Detailed receipt |
Mattresses |
![]() |
Letter of Medical Necessity |
Meals |
![]() |
|
Medi-Scope |
![]() |
Detailed receipt |
Medical ID bracelets |
![]() |
Detailed receipt |
Medical ID necklaces |
![]() |
Detailed receipt |
Medical care outside U.S. |
![]() |
Detailed receipt |
Medical emergency alert systems |
![]() |
Detailed receipt |
Medical equipment maintenance |
![]() |
Detailed receipt |
Medical equipment repairs |
![]() |
Detailed receipt |
Medical information storage plans |
![]() |
Detailed receipt |
Medical literature, books, pamphlets, or audio |
![]() |
|
Medical newsletters |
![]() |
|
Medical records charges |
![]() |
Detailed receipt |
Medical savings account (MSA) contributions |
![]() |
|
Medical slings |
![]() |
Detailed receipt |
Medicare Part A Taxes |
![]() |
|
Medicare premiums |
![]() |
|
Medicare supplement premiums |
![]() |
|
Medicated cold creams |
![]() |
Detailed receipt |
Medicated conditioners |
![]() |
Detailed receipt |
Medicated lip products |
![]() |
Detailed receipt |
Medicated lotion |
![]() |
Detailed receipt |
Medicated mouth rinses |
![]() |
Detailed receipt |
Medicated ointments |
![]() |
Detailed receipt |
Medicated shampoos |
![]() |
Detailed receipt |
Medicated soaps |
![]() |
Detailed receipt |
Medicated toothpastes |
![]() |
Detailed receipt |
Medication flavorings |
![]() |
Detailed receipt |
Medications from other countries (consumed in the U.S.) |
![]() |
|
Medications from other countries (consumed in the other country) |
![]() |
Detailed receipt |
Medicine droppers |
![]() |
Detailed receipt |
Menstrual care products |
![]() |
Detailed receipt |
Menstrual cups |
![]() |
Detailed receipt |
Menstrual cycle medications |
![]() |
Detailed receipt |
Menstrual discs |
![]() |
Detailed receipt |
Menstrual liners |
![]() |
Detailed receipt |
Menstrual pads |
![]() |
Detailed receipt |
Menstrual sponges |
![]() |
Detailed receipt |
Metabolic Services |
![]() |
Letter of Medical Necessity |
Metabolic support programs |
![]() |
Letter of Medical Necessity |
Microdermabrasion/ Microneedling |
![]() |
Letter of Medical Necessity |
Midwife services |
![]() |
Detailed receipt |
Migraine medications |
![]() |
Detailed receipt |
Mileage reimbursement (travel related to healthcare services) |
![]() |
Detailed receipt |
Mira Dry |
![]() |
Letter of Medical Necessity |
Missed appointment fees |
![]() |
|
Modified-effort steering (car modification) |
![]() |
Letter of Medical Necessity |
Mole removal |
![]() |
Detailed receipt |
Moleskins |
![]() |
Detailed receipt |
Motion sickness medications |
![]() |
Detailed receipt |
Nasal Care |
![]() |
Detailed receipt |
Nasal sprays |
![]() |
Detailed receipt |
Nasal strips |
![]() |
Detailed receipt |
Natural lens replacement |
![]() |
Detailed receipt |
Naturopathic healer |
![]() |
Letter of Medical Necessity |
Nerve ablation |
![]() |
|
Neti pot supplies |
![]() |
Detailed receipt |
Neti pots |
![]() |
Detailed receipt |
Neurofeedback therapy |
![]() |
Detailed receipt |
Newborn-care instruction |
![]() |
|
Nicotine gums (over-the-counter) |
![]() |
Detailed receipt |
Nicotine patches (over-the-counter) |
![]() |
Detailed receipt |
Nipple shields |
![]() |
Detailed receipt |
Nitrile gloves |
![]() |
Detailed receipt |
Non-prescription ski goggles |
![]() |
|
Non-prescription sports goggles |
![]() |
|
Non-prescription swim goggles |
![]() |
|
Note-taker for a hearing impaired child in school |
![]() |
Letter of Medical Necessity |
Nursing bras |
![]() |
|
Nursing home expenses |
![]() |
Letter of Medical Necessity |
Nursing pads |
![]() |
Detailed receipt |
Nursing services |
![]() |
Detailed receipt |
Nursing supplies |
![]() |
Detailed receipt |
Nutritional supplements |
![]() |
|
Nutritionist |
![]() |
Letter of Medical Necessity |
Obstetrical care |
![]() |
Detailed receipt |
Occlusal mouth guards |
![]() |
Detailed receipt |
Occupational therapy |
![]() |
Detailed receipt |
Office visits |
![]() |
Detailed receipt |
Ointment rubs |
![]() |
Detailed receipt |
Operation (for non-cosmetic purposes) |
![]() |
Detailed receipt |
Oral appliances |
![]() |
Detailed receipt |
Oral pain relieving creams |
![]() |
Detailed receipt |
Organ donor's expenses |
![]() |
Detailed receipt |
Ortho-bionomy therapy |
![]() |
Letter of Medical Necessity |
Orthodontics |
![]() |
Detailed receipt |
Orthokeratology |
![]() |
Detailed receipt |
Orthokeratology (ortho-K) |
![]() |
Detailed receipt |
Orthopedic inserts |
![]() |
Detailed receipt |
Orthopedic shoes |
![]() |
Letter of Medical Necessity |
Orthopedic supports |
![]() |
Detailed receipt |
Osteopathic fees |
![]() |
Detailed receipt |
Ostomy supplies |
![]() |
Detailed receipt |
Otoscope |
![]() |
Detailed receipt |
Over allowable amounts |
![]() |
Detailed receipt |
Over maximum allowable charges |
![]() |
Detailed receipt |
Over-the-counter medications |
![]() |
Detailed receipt |
Ovulation kits |
![]() |
Detailed receipt |
Ovulation monitors |
![]() |
Detailed receipt |
Oxygen |
![]() |
Detailed receipt |
Ozone therapy |
![]() |
Letter of Medical Necessity |
PET scans |
![]() |
Detailed receipt |
PRK eye surgery |
![]() |
Detailed receipt |
Pain relievers |
![]() |
Detailed receipt |
Pain relieving creams |
![]() |
Detailed receipt |
Palm grips (car modification) |
![]() |
Letter of Medical Necessity |
Paramedic shears |
![]() |
|
Parking at medical facility |
![]() |
Detailed receipt |
Particulate respirator masks |
![]() |
Detailed receipt |
Pastoral counseling |
![]() |
|
Paternity testing |
![]() |
|
Patterning exercise therapy |
![]() |
Detailed receipt |
Pedal extender (car modification) |
![]() |
Letter of Medical Necessity |
Pedometer |
![]() |
|
Penile prostheses |
![]() |
Detailed receipt |
Perfume |
![]() |
|
Period-proof underwear |
![]() |
Detailed receipt |
Periodontal rinse |
![]() |
Detailed receipt |
Personal electronics |
![]() |
|
Personal hygiene items |
![]() |
|
Personal trainer fees |
![]() |
Letter of Medical Necessity |
Petroleum jelly |
![]() |
Detailed receipt |
Phone consultations with a licensed provider |
![]() |
Detailed receipt |
Physical exams |
![]() |
Detailed receipt |
Physical exams for caregiver |
![]() |
|
Physical fitness exercise classes |
![]() |
Letter of Medical Necessity |
Physical fitness exercise programs |
![]() |
Letter of Medical Necessity |
Physical therapy |
![]() |
Detailed receipt |
Physical treatment unrelated to specific health problems |
![]() |
|
Physio-Neuro Therapy (PNT) |
![]() |
Letter of Medical Necessity |
Piercings (including piercings for migraine relief) |
![]() |
|
Pill cutters |
![]() |
Detailed receipt |
Pill organizers |
![]() |
Detailed receipt |
Pillows |
![]() |
Letter of Medical Necessity |
Platelet rich plasma injection |
![]() |
Detailed receipt |
Polygraph testing |
![]() |
|
Porcelain margins |
![]() |
Detailed receipt |
Porch lifts |
![]() |
|
Portable power station |
![]() |
Letter of Medical Necessity |
Positional therapy devices |
![]() |
Letter of Medical Necessity |
Power seats (car modification) |
![]() |
Letter of Medical Necessity |
Pregnancy charges paid monthly per contract |
![]() |
Detailed receipt |
Pregnancy test kits |
![]() |
Detailed receipt |
Pregnancy tests |
![]() |
Detailed receipt |
Prenatal portrait services |
![]() |
|
Prenatal vitamins |
![]() |
Detailed receipt |
Prepayments |
![]() |
|
Prescription drug discount programs |
![]() |
|
Prescription drugs |
![]() |
Prescription |
Prescription drugs for cosmetic purposes |
![]() |
|
Prescription ski goggles |
![]() |
Detailed receipt |
Prescription sports goggles |
![]() |
Detailed receipt |
Prescription swim goggles |
![]() |
Detailed receipt |
Preventive care screenings |
![]() |
Detailed receipt |
Preventive care services |
![]() |
Detailed receipt |
Private hospital rooms |
![]() |
Detailed receipt |
Professional therapeutic pastes |
![]() |
Detailed receipt |
Progesterone hormones |
![]() |
Prescription |
Prolotherapy |
![]() |
Letter of Medical Necessity |
Prosthetics |
![]() |
Detailed receipt |
Protection plans |
![]() |
|
Prothrombin time (INR) home testing devices |
![]() |
Detailed receipt |
Provider discounts |
![]() |
|
Psychiatric care |
![]() |
Detailed receipt |
Psychoanalysis |
![]() |
Detailed receipt |
Psychotherapy |
![]() |
Detailed receipt |
Pulse oximeters |
![]() |
Detailed receipt |
Pulsed electromagnetic field wearable device |
![]() |
Detailed receipt |
Push/pull levers (car modification) |
![]() |
Letter of Medical Necessity |
Quad forks (car modification) |
![]() |
Letter of Medical Necessity |
Quad key holders (car modification) |
![]() |
Letter of Medical Necessity |
Quad key turners (car modification) |
![]() |
Letter of Medical Necessity |
Radial keratotomy (RK) |
![]() |
Detailed receipt |
Radon home system |
![]() |
Letter of Medical Necessity |
Radon test kits |
![]() |
Detailed receipt |
Railings or bars for support |
![]() |
|
Raised roofs (car modification) |
![]() |
Letter of Medical Necessity |
Ramps (car modification) |
![]() |
Letter of Medical Necessity |
Reacher grabber tools |
![]() |
|
Reading glasses |
![]() |
Detailed receipt |
Reasonable and customary (R&C) fees |
![]() |
Detailed receipt |
Recliner chairs |
![]() |
|
Reconstructive surgery (following accident, medical procedure, medical or condition) |
![]() |
Detailed receipt |
Record copy fees |
![]() |
Detailed receipt |
Records transfer fees |
![]() |
Detailed receipt |
Red light therapy |
![]() |
Letter of Medical Necessity |
Reflexology |
![]() |
Letter of Medical Necessity |
Rehabilitation centers |
![]() |
Letter of Medical Necessity |
Rehydration liquids |
![]() |
Detailed receipt |
Remote switches (car modification) |
![]() |
Letter of Medical Necessity |
Rescue suction device |
![]() |
|
Residential treatment programs |
![]() |
Detailed receipt |
Resorts |
![]() |
|
Respite care |
![]() |
Letter of Medical Necessity |
Retainer |
![]() |
Detailed receipt |
Retinal imaging services |
![]() |
Detailed receipt |
Retinol cream |
![]() |
Detailed receipt |
Retreats |
![]() |
|
Right-hand turn signal (car modification) |
![]() |
Letter of Medical Necessity |
Rubbing alcohol |
![]() |
Detailed receipt |
SAD lights |
![]() |
Letter of Medical Necessity |
Safety glasses (non-prescription) |
![]() |
|
Safety glasses (prescription) |
![]() |
Detailed receipt |
Safety rails |
![]() |
Detailed receipt |
Sales tax |
![]() |
Detailed receipt |
Sanitary napkins |
![]() |
Detailed receipt |
Scar medications |
![]() |
Detailed receipt |
Schools and education |
![]() |
Letter of Medical Necessity |
Scientology auditing |
![]() |
|
Sclerotherapy (varicose vein procedure) |
![]() |
Letter of Medical Necessity |
Scooter lifts (car modification) |
![]() |
Letter of Medical Necessity |
Seat cushion |
![]() |
Letter of Medical Necessity |
Seat lift mechanisms |
![]() |
Letter of Medical Necessity |
Self rising portable smart seat |
![]() |
Letter of Medical Necessity |
Semi auto-injector |
![]() |
Detailed receipt |
Service animals |
![]() |
Detailed receipt |
Sexual dysfunction |
![]() |
Letter of Medical Necessity |
Sharps containers |
![]() |
Detailed receipt |
Shipping and handling fees (for healthcare related expenses) |
![]() |
Detailed receipt |
Shoe cushions |
![]() |
Detailed receipt |
Shoe inserts |
![]() |
Detailed receipt |
Shoe insoles |
![]() |
Detailed receipt |
Shower |
![]() |
|
Shower chairs |
![]() |
Letter of Medical Necessity |
Sink fixtures |
![]() |
|
Sinks |
![]() |
|
Sinus medications |
![]() |
Detailed receipt |
Siren detector (car modification) |
![]() |
Letter of Medical Necessity |
Sitz baths |
![]() |
Detailed receipt |
Skin sanitizing wipes |
![]() |
Detailed receipt |
Skin tag removal |
![]() |
Letter of Medical Necessity |
Sleep aids |
![]() |
Detailed receipt |
Sleep apnea services |
![]() |
Detailed receipt |
Sleep deprivation treatments |
![]() |
Detailed receipt |
Sleep studies |
![]() |
Detailed receipt |
Sleep study |
![]() |
Detailed receipt |
Smart home upgrades |
![]() |
|
Smoke detector systems |
![]() |
|
Smoking cessation drugs (prescription) |
![]() |
Prescription |
Smoking cessation gum (over-the-counter) |
![]() |
Detailed receipt |
Smoking cessation patches (over-the-counter) |
![]() |
Detailed receipt |
Smoking cessation programs |
![]() |
Detailed receipt |
Snore guards |
![]() |
Letter of Medical Necessity |
Snow blowers |
![]() |
|
Somnoplasty |
![]() |
Detailed receipt |
Spas |
![]() |
|
Speaker phone |
![]() |
|
Special equipment (related to healthcare expenses) |
![]() |
Letter of Medical Necessity |
Special food diet |
![]() |
|
Special home for mental disabilities |
![]() |
Letter of Medical Necessity |
Speech therapy |
![]() |
Detailed receipt |
Spermicide |
![]() |
Detailed receipt |
Splint |
![]() |
Detailed receipt |
Stairway modifications |
![]() |
|
Steamer or inhaler - hand held |
![]() |
Letter of Medical Necessity |
Steering column extension (car modification) |
![]() |
Letter of Medical Necessity |
Steering cuff (car modification) |
![]() |
Letter of Medical Necessity |
Steering knobs (car modification) |
![]() |
Letter of Medical Necessity |
Sterilization procedures |
![]() |
Detailed receipt |
Stethoscope |
![]() |
Detailed receipt |
Stretch mat |
![]() |
Letter of Medical Necessity |
Structural integration |
![]() |
Letter of Medical Necessity |
Student health plan premiums |
![]() |
|
Sublingual allergy drops |
![]() |
Letter of Medical Necessity |
Sun protective clothing |
![]() |
|
Sunburn treatments |
![]() |
Detailed receipt |
Sunglass clips |
![]() |
|
Sunglasses (non-prescription) |
![]() |
|
Sunglasses (prescription) |
![]() |
Detailed receipt |
Sunscreens |
![]() |
Detailed receipt |
Supplements |
![]() |
|
Support hose |
![]() |
Detailed receipt |
Support stockings |
![]() |
Detailed receipt |
Suppositories |
![]() |
Detailed receipt |
Surcharges |
![]() |
Detailed receipt |
Surgery (for non-cosmetic purposes) |
![]() |
Detailed receipt |
Surgical procedures (for non-cosmetic purposes) |
![]() |
Detailed receipt |
Surrogate carrier |
![]() |
|
Surrogate expenses |
![]() |
|
Swimming lessons |
![]() |
|
Swimming pool maintenance |
![]() |
|
Swimming pools |
![]() |
|
Syntonic phototherapy |
![]() |
Letter of Medical Necessity |
TENS units and supplies |
![]() |
Detailed receipt |
Tampons |
![]() |
Detailed receipt |
Tanning salons and equipment |
![]() |
|
Tape recorders visually impaired |
![]() |
Letter of Medical Necessity |
Taxes on healthcare services and products |
![]() |
Detailed receipt |
Teeth bonding |
![]() |
Letter of Medical Necessity |
Teeth grinding prevention devices |
![]() |
Detailed receipt |
Teeth whitening |
![]() |
|
Teething gels |
![]() |
Detailed receipt |
Telephone |
![]() |
|
Telephone consultation fees with a licensed provider |
![]() |
Detailed receipt |
Telephones for hearing impaired |
![]() |
Detailed receipt |
Television |
![]() |
|
Temporary dental procedures |
![]() |
Detailed receipt |
Testosterone hormones |
![]() |
Prescription |
Therapeutic horseback riding (equine-assisted therapy) |
![]() |
Letter of Medical Necessity |
Therapeutic listening |
![]() |
Detailed receipt |
Thermography |
![]() |
Detailed receipt |
Thermometer |
![]() |
Detailed receipt |
Throat lozenges |
![]() |
Detailed receipt |
Tips/gratuities |
![]() |
|
Toe caps and finger caps |
![]() |
Detailed receipt |
Toilet accessories |
![]() |
Letter of Medical Necessity |
Toilet safety bars |
![]() |
Letter of Medical Necessity |
Toilet safety frames |
![]() |
Letter of Medical Necessity |
Toilet safety rails |
![]() |
Letter of Medical Necessity |
Toilet seat risers |
![]() |
Letter of Medical Necessity |
Toiletries |
![]() |
|
Toilets |
![]() |
|
Tonometer |
![]() |
Letter of Medical Necessity |
Toothache and teething pain relievers |
![]() |
Detailed receipt |
Toothbrush |
![]() |
|
Toothpaste |
![]() |
|
Topical analgesics |
![]() |
Detailed receipt |
Topical steroids |
![]() |
Detailed receipt |
Tracking device |
![]() |
Letter of Medical Necessity |
Transfer boards (car modification) |
![]() |
Letter of Medical Necessity |
Transplants |
![]() |
Detailed receipt |
Transportation and parking (for related eligible expenses) |
![]() |
Detailed receipt |
Transportation fares (taxi, rental car, bus, etc.) |
![]() |
Detailed receipt |
Travel expenses |
![]() |
Letter of Medical Necessity |
Tri-pins, three-pronged grip (car modification) |
![]() |
Letter of Medical Necessity |
Tubal ligation |
![]() |
Detailed receipt |
Tubal ligation reversal |
![]() |
Detailed receipt |
Tumor removal |
![]() |
Detailed receipt |
Typewriter for the visually impaired |
![]() |
Letter of Medical Necessity |
UV protection clothing |
![]() |
|
Ultra violet ray (UVR) treatments |
![]() |
Letter of Medical Necessity |
Ultrasound |
![]() |
Detailed receipt |
Umbilical cord freezing |
![]() |
Letter of Medical Necessity |
Umbilical cord storage |
![]() |
Letter of Medical Necessity |
Underwear |
![]() |
|
Underwear, disposable or non-disposable (menstrual care) |
![]() |
Detailed receipt |
Urinalysis |
![]() |
Detailed receipt |
Usual, customary, and reasonable (UCR) fees |
![]() |
Detailed receipt |
V-grips (car modification) |
![]() |
Letter of Medical Necessity |
Vaccinations |
![]() |
Detailed receipt |
Vacuum cleaners |
![]() |
|
Vaginal laser therapy |
![]() |
Letter of Medical Necessity |
Vaginal rejuvenation |
![]() |
|
Vaporizers |
![]() |
Detailed receipt |
Varicose vein surgery |
![]() |
Letter of Medical Necessity |
Vasectomy |
![]() |
Detailed receipt |
Vasectomy reversal |
![]() |
Detailed receipt |
Vibration therapy |
![]() |
Letter of Medical Necessity |
Violence prevention classes |
![]() |
Letter of Medical Necessity |
Virtual visits |
![]() |
Detailed receipt |
Vision care |
![]() |
Detailed receipt |
Vision correction procedures |
![]() |
Detailed receipt |
Vision discount programs |
![]() |
|
Vision masks (non-prescription) |
![]() |
|
Vision masks (prescription) |
![]() |
Detailed receipt |
Vision products (over-the-counter) |
![]() |
Detailed receipt |
Vision training |
![]() |
Letter of Medical Necessity |
Visual alert system for hearing impaired |
![]() |
Letter of Medical Necessity |
Vitamins |
![]() |
|
Walkers |
![]() |
Detailed receipt |
Warning system modifications |
![]() |
|
Warranties |
![]() |
|
Wart removal (freezing products) |
![]() |
Detailed receipt |
Wart removal (medicated bandages and gels) |
![]() |
Detailed receipt |
Water pick flossers |
![]() |
Letter of Medical Necessity |
Waterproofing of cast |
![]() |
Detailed receipt |
Weight loss counseling |
![]() |
Letter of Medical Necessity |
Weight loss foods |
![]() |
|
Weight loss medication |
![]() |
Detailed receipt |
Weight loss programs |
![]() |
Letter of Medical Necessity |
Weight scales |
![]() |
Letter of Medical Necessity |
Well-child visits |
![]() |
Detailed receipt |
Wheelchair carriers (car modification) |
![]() |
Letter of Medical Necessity |
Wheelchair lifts |
![]() |
|
Wheelchair ramps |
![]() |
Detailed receipt |
Wheelchair replacement parts |
![]() |
Detailed receipt |
Wheelchair tie downs (car modification) |
![]() |
Letter of Medical Necessity |
Wheelchairs |
![]() |
Detailed receipt |
Wheelchairs (car modification) |
![]() |
Letter of Medical Necessity |
Wigs |
![]() |
Letter of Medical Necessity |
Window air conditioners |
![]() |
|
Window controls (car modification) |
![]() |
Letter of Medical Necessity |
Wobble chairs |
![]() |
|
Work-related physical exams for employee |
![]() |
Detailed receipt |
Wrist supports |
![]() |
Detailed receipt |
X-rays |
![]() |
Detailed receipt |
YAG laser treatment |
![]() |
Letter of Medical Necessity |
Yeast infection medications |
![]() |
Detailed receipt |
Yoga |
![]() |