Subsection 144-101-II-25.04 - NON-COVERED SERVICESA. The Department does not cover any service that is not described in Section 25.03 or that does not have an approved PA if required.B. The Department does not cover services that are delivered for cosmetic or aesthetic purposes.C. The Department does not reimburse for missed appointments but they may be reported using the appropriate CDT code for tracking purposes once per member per missed appointment. A member cannot be billed for a missed appointment even if the member was notified in advance there would be a charge.D. Dental-related services not covered in this Section of the MBM may be covered in other Sections. These include, but are not limited to, some oral and maxillofacial surgery and maxillofacial prosthetic services. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-25, subsec. 144-101-II-25.04