Commercial
  
  
  
  
  
  
  
  
  
  
  
MPattachmentdataPub
  
7999eac3-0fd4-46fd-a3da-5aa891460ecf.aspx
  
LipectomyandLiposuction11.08.03k11.08.03kSurgery (11)Lipectomy and Liposuction7999eac3-0fd4-46fd-a3da-5aa891460ecf3060Lipectomy and Liposuction11.08.033/30/2021 2:00 PM
6/28/2021
566a6aa9-700e-465f-9152-07c434e222dd.aspx
  
SpinalDiscectomy(IndependenceAdministrators)11.14.29h11.14.29hSurgery (11)Spinal Discectomy (Independence Administrators)566a6aa9-700e-465f-9152-07c434e222dd3061Spinal Discectomy (Independence Administrators)11.14.294/1/2021 7:00 AM
7/1/2021
e58b0eb9-4cd1-457f-b640-9b45679601a8.aspx
  
TelemedicineServices(Independence)00.10.41h00.10.41hAdministrative (00)Telemedicine Services (Independence)e58b0eb9-4cd1-457f-b640-9b45679601a83086Telemedicine Services (Independence)00.10.414/1/2021 5:00 PM
7/1/2021
937f3238-7708-4364-bb64-542f489718a0.aspx
  
eviCoreLabManagement(Independence)06.02.52u06.02.52uPathology and Laboratory (06)eviCore Lab Management (Independence)937f3238-7708-4364-bb64-542f489718a03241eviCore Lab Management (Independence)06.02.526/2/2021 3:00 PM
{"3242": {"Id":3242,"MPAttachmentLetter":"B","Title":"Procedure Codes Requiring Prepayment Reviews","MPPolicyAttachmentInternalSourceId":5494,"PolicyAttachmentPageName":"126867d9-b0d7-4167-8c03-262e9acaa81e"},"3243": {"Id":3243,"MPAttachmentLetter":"A","Title":"Procedure Codes Requiring Pre-service and Prepayment Reviews","MPPolicyAttachmentInternalSourceId":5495,"PolicyAttachmentPageName":"2cbd1c99-a6f3-47b0-bd9b-f6163f59f69a"},}
7/1/2021
64a87ebe-6da1-41d2-8cb7-94a7b69a5631.aspx
  
RoutineCostsAssociatedwithQualifyingClinicalTrials07.00.20g07.00.20gMedicine (07)Routine Costs Associated with Qualifying Clinical Trials64a87ebe-6da1-41d2-8cb7-94a7b69a56313103Routine Costs Associated with Qualifying Clinical Trials07.00.204/6/2021 2:00 PM
7/5/2021
d2bdb241-a05c-4982-9de5-6650f38d18a2.aspx
  
Experimental/InvestigationalServices12.01.01ba12.01.01baMiscellaneous (12)Experimental/Investigational Servicesd2bdb241-a05c-4982-9de5-6650f38d18a23125Experimental/Investigational Services12.01.014/12/2021 12:00 PM
{"3126": {"Id":3126,"MPAttachmentLetter":"C","Title":"Experimental/Investigational services with a specific Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Code, that are reported for other services.","MPPolicyAttachmentInternalSourceId":5375,"PolicyAttachmentPageName":"f0f44f5b-9cd1-49f9-9f2a-7496aeef5576"},"3127": {"Id":3127,"MPAttachmentLetter":"B","Title":"Experimental/Investigational Services without a Specific Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Code.","MPPolicyAttachmentInternalSourceId":5376,"PolicyAttachmentPageName":"6a14c096-aade-4eae-8e47-13a6b341a19b"},"3128": {"Id":3128,"MPAttachmentLetter":"A","Title":"Experimental/Investigational Services Represented by a Specific Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Code.","MPPolicyAttachmentInternalSourceId":5377,"PolicyAttachmentPageName":"ad1fee97-c2f0-4c83-86d6-153aae584734"},}
7/12/2021
47f227fe-6c60-405d-bb5b-999f5f0fc990.aspx
  
Enfortumabvedotin-ejfv(Padcev®)08.00.43b08.00.43bPharmacy (08)Enfortumab vedotin-ejfv (Padcev®)47f227fe-6c60-405d-bb5b-999f5f0fc9903281Enfortumab vedotin-ejfv (Padcev®)08.00.436/4/2021 1:00 PM
7/12/2021
a8c826d3-169d-46c7-acbc-29f6f8a02142.aspx
  
TranscutaneousElectricalNerveStimulators(TENS)andAssociatedSupplies05.00.74f05.00.74fDME (05)Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Suppliesa8c826d3-169d-46c7-acbc-29f6f8a021423294Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies05.00.746/10/2021 2:00 PM
{"3295": {"Id":3295,"MPAttachmentLetter":"A","Title":"ICD 10 Codes","MPPolicyAttachmentInternalSourceId":5307,"PolicyAttachmentPageName":"467db2c9-76cf-4a3d-a6ed-e3940479f7f3"},"3296": {"Id":3296,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5482,"PolicyAttachmentPageName":"3578045c-4f13-41c9-9bc1-e6e6a7a7402f"},}
7/12/2021
60179f41-07d0-4f08-9b6f-69c4c1a089b4.aspx
  
Inebilizumab-cdon(Uplizna)08.01.68b08.01.68bPharmacy (08)Inebilizumab-cdon (Uplizna)60179f41-07d0-4f08-9b6f-69c4c1a089b43190Inebilizumab-cdon (Uplizna)08.01.685/11/2021 1:00 PM
8/9/2021
6f6fec38-15e8-45d6-a756-7ff3232a6ee5.aspx
  
MultipleProcedurePaymentReduction(MPPR)onCertainDiagnosticServices00.01.60f00.01.60fAdministrative (00)Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services6f6fec38-15e8-45d6-a756-7ff3232a6ee53218Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services00.01.606/1/2021 1:00 PM
{"3219": {"Id":3219,"MPAttachmentLetter":"A","Title":"Multiple Reduction Diagnostic Services","MPPolicyAttachmentInternalSourceId":5483,"PolicyAttachmentPageName":"b0b066d1-447f-46c3-b47c-56957ca0f1a9"},}
9/1/2021
f17807dd-a80e-4611-a611-2ad2ab40654a.aspx
  
EvaluationandTreatmentofErectileDysfunction(ED)11.11.01j11.11.01jSurgery (11)Evaluation and Treatment of Erectile Dysfunction (ED)f17807dd-a80e-4611-a611-2ad2ab40654a3293Evaluation and Treatment of Erectile Dysfunction (ED)11.11.016/8/2021 11:00 AM
9/13/2021