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218 2. Non-covered services include a service that is: a. Not reasonably necessary for the diagnosis and treatment of an illness or injury, or for the correction of an organic system, as determined upon review by the department, or that is not identified in a screening required under 7 AAC 110.205; b. Not properly prescribed or medically necessary in accordance with criteria established under 7 AAC 105 - 7 AAC 160 or by standards of practice applicable to the prescribing provider; c. Incurred for an evaluative or periodic checkup, examination, or immunization • that is in connection with the participation, enrollment, attendance, or accomplishment of a program or activity unrelated to the recipient's physical or mental health or rehabilitation; or • unless it is for a mammogram; part of an EPSDTscreening; or required by the department for the purpose of determining eligibility forMedicaid; d. For or in connection with cosmetic therapy or plastic or cosmetic surgery, including rhinoplasty, nasal reconstruction, excision of keloids, augmentation mammoplasty, silicone or silastic implants, facioplasty, osteoplasty (prognathism and micrognathism), dermabrasion, skin grafts, and lipectomy; however, coverage is available if required for the following corrective actions if performed within the normal course of treatment or otherwise beginning no later than one (1) year after birth or the event that caused the need for the corrective action: repair of an injury; improvement of the functioning ofa malformed body member; or correction of a visible disfigurement that would materially affect the recipient's acceptance in society; e. A nonmedical charge imposed by a recipient's friend or relative; f. For a person who is in the custody of federal, state, or local law enforcement, including a juvenile in a detention or correctional facility, except as an inpatient in a medical institution; g. For an experimental or investigational service, including one • that is in a phase I or II clinical trial as defined in the United States Department of Health and Human Services, National