|  | | 08.01.40e | Lanreotide(Somatuline®Depot)08.01.40e | Pharmacy (08) | Lanreotide (Somatuline® Depot) | b23324af-17c8-465d-89a2-a53aa831de7b | 4618 | Lanreotide (Somatuline® Depot) | 08.01.40 | {"4619": {"Id":4619,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6756,"PolicyAttachmentPageName":"9e32cf66-6058-4728-8c83-44b05eba44e9"},} |
| | | 11.06.10 | Laparoscopic,Percutaneous,andTranscervicalTechniquesforUterineFibroidMyolysis11.06.10 | Surgery (11) | Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis | 3729b42d-5f69-4566-9e55-579670af00fa | 4268 | Laparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis | 11.06.10 | |
| | | 11.08.03l | LipectomyandLiposuction11.08.03l | Surgery (11) | Lipectomy and Liposuction | 6cc36479-c47c-404c-93f8-1ae85fe79e7d | 4490 | Lipectomy and Liposuction | 11.08.03 | |
| | | 08.00.59a | Loncastuximabtesirine-lpyl(Zynlonta™)08.00.59a | Pharmacy (08) | Loncastuximab tesirine-lpyl (Zynlonta™) | 8d3f871e-99c0-4888-bf2a-c58629e9c9a3 | 4106 | Loncastuximab tesirine-lpyl (Zynlonta™) | 08.00.59 | |
| | | 05.00.59k | LowerLimbProstheses05.00.59k | DME (05) | Lower Limb Prostheses | 95e7ec8f-ea9e-439e-8808-f619b3fb846a | 3578 | Lower Limb Prostheses | 05.00.59 | {"3579": {"Id":3579,"MPAttachmentLetter":"A","Title":"HCPCS Level II Code Number(s) and Narrative(s)","MPPolicyAttachmentInternalSourceId":5873,"PolicyAttachmentPageName":"a634be88-036a-412a-848f-ba1b93b3209f"},} |
| | | 07.00.14g | Low-levelLaserTherapy(LLLT)07.00.14g | Medicine (07) | Low-level Laser Therapy (LLLT) | 821c1131-09eb-4314-b14b-8c160a36e449 | 4231 | Low-level Laser Therapy (LLLT) | 07.00.14 | |
| | | 09.00.31d | LowOsmolarContrastAgents09.00.31d | Radiology (09) | Low Osmolar Contrast Agents | 1b345950-8a8c-4c42-9eac-cb89223eed31 | 3043 | Low Osmolar Contrast Agents | 09.00.31 | |
| | | 08.01.67b | Lurbinectedin(Zepzelca)08.01.67b | Pharmacy (08) | Lurbinectedin (Zepzelca) | 28c5f973-427f-4257-9474-e8f8e1b591c2 | 4162 | Lurbinectedin (Zepzelca) | 08.01.67 | |
| | | 08.00.10b | Luspatercept–aamt(Reblozyl®)08.00.10b | Pharmacy (08) | Luspatercept–aamt (Reblozyl®) | effc7383-610d-4467-af57-6f772be87d5f | 4342 | Luspatercept–aamt (Reblozyl®) | 08.00.10 | |
| | | 08.01.57 | Lutathera®(LutetiumLu177Dotatate)(IndependenceAdministrators)08.01.57 | Pharmacy (08) | Lutathera® (Lutetium Lu 177 Dotatate) (Independence Administrators) | 587ca64c-5670-4915-946a-b3a7c38e6ee6 | 4410 | Lutathera® (Lutetium Lu 177 Dotatate) (Independence Administrators) | 08.01.57 | |
| | | 06.02.01j | LymeDisease:DiagnosisandIntravenous(IV)AntibioticTherapy06.02.01j | Pathology and Laboratory (06) | Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy | dc9cc665-c1f1-4d2d-9657-13778abf42da | 3005 | Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy | 06.02.01 | |
| | | 11.15.13d | LysisofEpiduralAdhesions11.15.13d | Surgery (11) | Lysis of Epidural Adhesions | d932d50c-7af9-4ea5-9681-0ab5022227f4 | 4225 | Lysis of Epidural Adhesions | 11.15.13 | |
| | | 09.00.45i | MagneticResonanceImaging(MRI)ContrastAgents09.00.45i | Radiology (09) | Magnetic Resonance Imaging (MRI) Contrast Agents | d4d87368-119f-4422-92aa-840a1f826610 | 3131 | Magnetic Resonance Imaging (MRI) Contrast Agents | 09.00.45 | |
| | | 11.06.06g | MagneticResonanceImaging(MRI)-GuidedFocusedUltrasoundAblation11.06.06g | Surgery (11) | Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation | 8287f8b2-8716-445d-b2e8-ca6bc054a51b | 4508 | Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation | 11.06.06 | |
| | | 11.14.24b | ManipulationUnderAnesthesia11.14.24b | Surgery (11) | Manipulation Under Anesthesia | d6e16a25-c7d5-4c06-8ad3-ea55a2f0b869 | 4115 | Manipulation Under Anesthesia | 11.14.24 | |
| | | 05.00.12i | ManualWheelchairs05.00.12i | DME (05) | Manual Wheelchairs | e6e4ee3d-9748-42c9-9038-ae92bc2b83f5 | 4235 | Manual Wheelchairs | 05.00.12 | {"4236": {"Id":4236,"MPAttachmentLetter":"A","Title":"HCPCS Codes for Manual Wheelchairs","MPPolicyAttachmentInternalSourceId":6253,"PolicyAttachmentPageName":"7142a3f4-111b-4f89-b4e2-4cca4fd16123"},} |
| | | 08.01.75b | Margetuximab-cmkb(Margenza)08.01.75b | Pharmacy (08) | Margetuximab-cmkb (Margenza) | abeb37e5-c94c-4424-a11c-29b39466749c | 4315 | Margetuximab-cmkb (Margenza) | 08.01.75 | {"4316": {"Id":4316,"MPAttachmentLetter":"A","Title":"ICD 10 Codes","MPPolicyAttachmentInternalSourceId":6385,"PolicyAttachmentPageName":"9604cd08-4550-46f0-82d3-49663b726d51"},} |
| | | 00.01.48d | MarijuanaforMedicalUse00.01.48d | Administrative (00) | Marijuana for Medical Use | 383e59e4-a92b-4bc7-885a-4106604996fa | 3436 | Marijuana for Medical Use | 00.01.48 | |
| | | 07.11.02f | MeasurementofExhaledNitricOxideandBreathCondensateintheDiagnosisandManagementofAsthmaandOtherRespiratoryDisorders07.11.02f | Medicine (07) | Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders | 5303ac94-4891-45ee-8b37-27b66be9552d | 3847 | Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders | 07.11.02 | |
| | | 06.02.39d | MeasurementofSerumAntibodiestoandMeasurementofSerumLevelsofBiologics06.02.39d | Pathology and Laboratory (06) | Measurement of Serum Antibodies to and Measurement of Serum Levels of Biologics | a5a7daba-4abd-42e4-a041-3efbd77c1c79 | 3816 | Measurement of Serum Antibodies to and Measurement of Serum Levels of Biologics | 06.02.39 | |
| | | 05.00.70c | MechanicalStretchingDevicesfortheTreatmentofJointStiffnessorContractures05.00.70c | DME (05) | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | 29b043b6-208e-4400-a817-f838480cec1e | 4126 | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | 05.00.70 | |
| | | 12.01.02a | Medical Necessity | Miscellaneous (12) | Medical Necessity | 85256AA800623D7A85258566004C91B6 | 2400 | Medical Necessity | 12.01.02 | |
| | | 07.08.03g | MedicalandSurgicalTreatmentofTemporomandibularJointDisorder07.08.03g | Medicine (07) | Medical and Surgical Treatment of Temporomandibular Joint Disorder | c6a8b3a5-a31f-4a5d-a85f-3eee9c7ac8b3 | 3302 | Medical and Surgical Treatment of Temporomandibular Joint Disorder | 07.08.03 | |
| | | 07.03.03g | MedicalEvaluationandManagementforAttention-DeficitHyperactivityDisorder(ADHD)07.03.03g | Medicine (07) | Medical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD) | f65084f8-ae09-40ee-bafb-6c5b79167fc5 | 3416 | Medical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD) | 07.03.03 | |
| | | 11.14.03h | MeniscalAllograftTransplantationandMeniscalImplants(IndependenceAdministrators)11.14.03h | Surgery (11) | Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators) | c2b6581a-a4d5-4561-9368-f81dc5c7908a | 4380 | Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators) | 11.14.03 | {"4381": {"Id":4381,"MPAttachmentLetter":"A","Title":"ICD-10-CM codes","MPPolicyAttachmentInternalSourceId":6407,"PolicyAttachmentPageName":"cb4931e0-7a3e-4e16-b2e9-a2fb77b953fd"},} |
| | | 11.14.01g | MentoplastyorGenioplasty11.14.01g | Surgery (11) | Mentoplasty or Genioplasty | 8ff597e5-0dbf-4a5f-a84e-2f6ee37b08ba | 4228 | Mentoplasty or Genioplasty | 11.14.01 | |
| | | 11.14.21i | Microprocessor-ControlledProsthesesforLower-ExtremityAmputees11.14.21i | Surgery (11) | Microprocessor-Controlled Prostheses for Lower-Extremity Amputees | bc4c5498-29e7-4bd2-9c0f-299e58e5fede | 3078 | Microprocessor-Controlled Prostheses for Lower-Extremity Amputees | 11.14.21 | |
| | | 11.15.24a | MigraineDeactivationSurgery11.15.24a | Surgery (11) | Migraine Deactivation Surgery | c696f70d-0184-4427-8768-959ec7f5863f | 4346 | Migraine Deactivation Surgery | 11.15.24 | |
| | | 03.00.15p | Modifier24:UnrelatedEvaluationandManagementServicebytheSamePhysicianorOtherQualifiedHealthCareProfessionalDuringaPostoperativePeriod03.00.15p | Clinical Logic (03) | Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period | f8d7e646-0584-45eb-91dc-27d2c67fb1ab | 3435 | Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period | 03.00.15 | |
| | | 03.00.06v | Modifier25:Significant,SeparatelyIdentifiableEvaluationandManagementServicebytheSamePhysicianorOtherQualifiedHealthCareProfessionalontheSameDayoftheProcedureorOtherService03.00.06v | Clinical Logic (03) | Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service | 068d8103-31c0-4cdd-abc8-a2547a002d5c | 3972 | Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service | 03.00.06 | {"3973": {"Id":3973,"MPAttachmentLetter":"B","Title":"Problem-focused E&M Codes appended with modifier 25 should be reimbursed at 50% of the applicable fee schedule amount when submitted on the same date of service by the same professional provider or other qualified health care provider, as a preventive E&","MPPolicyAttachmentInternalSourceId":6014,"PolicyAttachmentPageName":"4b1cf08c-0831-406c-a9fc-1e900fe14748"},"3974": {"Id":3974,"MPAttachmentLetter":"A","Title":"E&M codes appended with modifier 25 should be reimbursed at 50% of the applicable fee schedule amount when submitted on the same date of service, by the same professional provider or other qualified health care provider, as a minor procedure.","MPPolicyAttachmentInternalSourceId":6015,"PolicyAttachmentPageName":"3173e2fa-17f0-4b9a-aa01-b39439b271eb"},} |
| | | 03.00.05t | Modifier50:BilateralProcedure03.00.05t | Clinical Logic (03) | Modifier 50: Bilateral Procedure | 41922b73-cc56-449b-a8a7-90c5abc95307 | 4516 | Modifier 50: Bilateral Procedure | 03.00.05 | |
| | | 03.00.32b | Modifier52:ReducedServices03.00.32b | Clinical Logic (03) | Modifier 52: Reduced Services | 6492c677-6217-4645-aa98-51b1c2e00d7c | 3835 | Modifier 52: Reduced Services | 03.00.32 | |
| | | 03.00.33b | Modifier53:DiscontinuedProcedure03.00.33b | Clinical Logic (03) | Modifier 53: Discontinued Procedure | 4a23f8b3-7157-4c86-a465-0aa818011060 | 3828 | Modifier 53: Discontinued Procedure | 03.00.33 | |
| | | 03.00.16p | Modifier57:DecisionforSurgery03.00.16p | Clinical Logic (03) | Modifier 57: Decision for Surgery | e7ced3e4-15a1-420e-8929-f0d159ec1670 | 3325 | Modifier 57: Decision for Surgery | 03.00.16 | |
| | | 00.10.11t | Modifier62:TwoSurgeons00.10.11t | Administrative (00) | Modifier 62: Two Surgeons | cda610af-58a4-4e51-8f42-c39f87b85ca7 | 4517 | Modifier 62: Two Surgeons | 00.10.11 | |
| | | 00.10.17m | Modifier66:SurgicalTeam00.10.17m | Administrative (00) | Modifier 66: Surgical Team | fcd892e5-213b-4cbc-9d79-164181bab86b | 4166 | Modifier 66: Surgical Team | 00.10.17 | {"4167": {"Id":4167,"MPAttachmentLetter":"A","Title":"Team Surgery Review Form","MPPolicyAttachmentInternalSourceId":6341,"PolicyAttachmentPageName":"4f84702c-daf6-45af-a4cc-ffd6a5c6851c"},} |
| | | 03.00.02c | Modifier76:RepeatProcedureorServicebySamePhysicianorOtherQualifiedHealthCareProfessional03.00.02c | Clinical Logic (03) | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional | 3f390070-f6ea-4ccc-b8e9-dbc89fffb1ab | 3327 | Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional | 03.00.02 | |
| | | 03.00.11c | Modifier77:RepeatProcedureorServicebyAnotherPhysicianorOtherQualifiedHealthCareProfessional03.00.11c | Clinical Logic (03) | Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional | e47367e6-a014-4f26-b8a3-eded6b029b5b | 3328 | Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional | 03.00.11 | |
| | | 03.00.12g | Modifier78:UnplannedReturntotheOperating/ProcedureRoombytheSamePhysicianorOtherQualifiedHealthCareProfessionalFollowingtheInitialProcedureforaRelatedProcedureDuringthePostoperativePeriod03.00.12g | Clinical Logic (03) | Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative Period | 24cabd61-2a54-4eda-bcd2-8049fafc5e73 | 3525 | Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative Period | 03.00.12 | |
| | | 03.00.28n | Modifier79:UnrelatedProcedureorServicebytheSamePhysicianorOtherQualifiedHealthCareProfessionalDuringthePostoperativePeriod03.00.28n | Clinical Logic (03) | Modifier 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period | 99b98586-29b5-497a-b30c-28b14bef62a5 | 3526 | Modifier 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period | 03.00.28 | |
| | | 03.00.20o | Modifiers26(ProfessionalComponent)andTC(TechnicalComponent)03.00.20o | Clinical Logic (03) | Modifiers 26 (Professional Component) and TC (Technical Component) | 4a96f7b9-2cb0-44da-83e0-d73a09cd9d32 | 4518 | Modifiers 26 (Professional Component) and TC (Technical Component) | 03.00.20 | |
| | | 00.10.18s | ModifiersforAssistant-at-SurgeryServices:80,81,82,andAS00.10.18s | Administrative (00) | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 006c2e8e-0cb5-482b-9d50-83154da54fe4 | 4174 | Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS | 00.10.18 | |
| | | 03.00.31g | ModifiersforSplitorSharedSurgicalServices(Modifiers54,55,and56)03.00.31g | Clinical Logic (03) | Modifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56) | 7748849d-668f-44a3-b385-64d7e4b3a018 | 3725 | Modifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56) | 03.00.31 | |
| | | 03.00.08f | ModifiersXE,XS,XP,XU,and5903.00.08f | Clinical Logic (03) | Modifiers XE, XS, XP, XU, and 59 | d0e4489b-c807-4e43-9abb-a90f6f1cebdd | 4018 | Modifiers XE, XS, XP, XU, and 59 | 03.00.08 | |
| | | 08.01.52d | Mogamulizumab-kpkc(Poteligeo®)08.01.52d | Pharmacy (08) | Mogamulizumab-kpkc (Poteligeo®) | 5ad79e01-f20d-4edd-93a6-e9211bfab048 | 4469 | Mogamulizumab-kpkc (Poteligeo®) | 08.01.52 | |
| | | 11.08.23j | Mohs'MicrographicSurgery11.08.23j | Surgery (11) | Mohs' Micrographic Surgery | 2af498eb-f6e4-4e26-9f63-f30ad42b2ff3 | 4191 | Mohs' Micrographic Surgery | 11.08.23 | {"4192": {"Id":4192,"MPAttachmentLetter":"A","Title":"ICD 10 Codes","MPPolicyAttachmentInternalSourceId":6293,"PolicyAttachmentPageName":"f9e3b0d9-b4f1-49b3-ad07-a047b0c20c89"},} |
| | | 06.02.36c | MolecularTestingfortheManagementofPancreaticCystsorBarrett'sEsophagus(IndependenceAdministrators)06.02.36c | Pathology and Laboratory (06) | Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators) | d15cd425-f061-4fbc-a119-14d64d51bcb8 | 4420 | Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators) | 06.02.36 | |
| | | 08.01.53b | MoxetumomabPasudotox-tdfk(Lumoxiti™)08.01.53b | Pharmacy (08) | Moxetumomab Pasudotox-tdfk (Lumoxiti™) | f4a173bd-a9ca-4582-9357-b941c3ae36ba | 4493 | Moxetumomab Pasudotox-tdfk (Lumoxiti™) | 08.01.53 | |
| | | 06.02.32d | MultigeneExpressionAssaysforPredictingRecurrenceinColonCancer(IndependenceAdministrators)06.02.32d | Pathology and Laboratory (06) | Multigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators) | 56cef71d-72dd-45ed-ab0c-e989f8be35a9 | 4419 | Multigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators) | 06.02.32 | |
| | | 00.01.68 | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | Administrative (00) | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | 5A317727AACA768F8525846600442DF8 | 2131 | Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services | 00.01.68 | {"2217": {"Id":2217,"MPAttachmentLetter":"A","Title":"Multiple Reduction Always Therapy Procedure Codes","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"7B54F250C0C278DE8525846600442E03"},} |
| | | 00.01.60h | MultipleProcedurePaymentReduction(MPPR)onCertainDiagnosticServices00.01.60h | Administrative (00) | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services | 5a4ae1ad-0ca0-4ecd-bf79-ff4a1156bec3 | 4024 | Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services | 00.01.60 | {"4025": {"Id":4025,"MPAttachmentLetter":"A","Title":"Multiple Reduction Diagnostic Services","MPPolicyAttachmentInternalSourceId":6182,"PolicyAttachmentPageName":"b861da60-72f7-4f31-9db5-ad04a9a7e901"},} |
| | | 11.00.10x | MultipleSurgeryPaymentReduction11.00.10x | Surgery (11) | Multiple Surgery Payment Reduction | f192767b-6f0c-4518-abac-46230420b92d | 2937 | Multiple Surgery Payment Reduction | 11.00.10 | {"2938": {"Id":2938,"MPAttachmentLetter":"B","Title":"Healthcare Common Procedure Coding System (HCPCS) Codes To Which Multiple Surgery Payment Reduction Applies","MPPolicyAttachmentInternalSourceId":5197,"PolicyAttachmentPageName":"7cdc50d8-8a3b-4511-800d-74d883cb223c"},"2939": {"Id":2939,"MPAttachmentLetter":"A1","Title":"Current Procedural Terminology (CPT) Codes To Which Multiple Surgery Payment Reduction Applies","MPPolicyAttachmentInternalSourceId":5198,"PolicyAttachmentPageName":"882acf66-ed50-47d8-b25b-a6a311e83631"},"2940": {"Id":2940,"MPAttachmentLetter":"A2","Title":"Current Procedural Terminology (CPT) Codes To Which Multiple Surgery Payment Reduction Applies","MPPolicyAttachmentInternalSourceId":5199,"PolicyAttachmentPageName":"41c34fc9-ad83-417b-acff-ce9f97ab00b5"},} |
| | | 00.01.66f | MusculoskeletalServices(Independence)00.01.66f | Administrative (00) | Musculoskeletal Services (Independence) | 0f8ad31b-d5a8-4b9c-8db3-d202c109b363 | 4520 | Musculoskeletal Services (Independence) | 00.01.66 | {"4521": {"Id":4521,"MPAttachmentLetter":"C","Title":"Procedures Codes for Interventional Pain Management","MPPolicyAttachmentInternalSourceId":6270,"PolicyAttachmentPageName":"d2ea2019-ff85-4aec-a895-bfaff7862860"},"4522": {"Id":4522,"MPAttachmentLetter":"B","Title":"Procedure Codes for Joint Surgery","MPPolicyAttachmentInternalSourceId":6271,"PolicyAttachmentPageName":"6196bbce-d9e2-495e-b755-fab5d8d546f2"},"4523": {"Id":4523,"MPAttachmentLetter":"A","Title":"Procedure Codes for Spinal Surgery","MPPolicyAttachmentInternalSourceId":6273,"PolicyAttachmentPageName":"3760d5e2-ac31-41ff-a0b8-30d60cbd89e3"},} |
| | | 08.00.64g | Natalizumab(Tysabri®)08.00.64g | Pharmacy (08) | Natalizumab (Tysabri®) | 54ab77b9-f40a-4e10-bb27-cba214f22cdf | 4252 | Natalizumab (Tysabri®) | 08.00.64 | |
| | | 00.01.56b | NationalCorrectCodingInitiative(NCCI)CodePairEdits00.01.56b | Administrative (00) | National Correct Coding Initiative (NCCI) Code Pair Edits | d70ca358-985e-4b3e-840b-31c37761debd | 3943 | National Correct Coding Initiative (NCCI) Code Pair Edits | 00.01.56 | |
| | | 05.00.15s | NebulizersandInhalationSolutions05.00.15s | DME (05) | Nebulizers and Inhalation Solutions | be715324-88fe-46a4-b541-f79e6f52f5a7 | 4479 | Nebulizers and Inhalation Solutions | 05.00.15 | |
| | | 05.00.38k | Negative-PressureWoundTherapy(NPWT)Systems05.00.38k | DME (05) | Negative-Pressure Wound Therapy (NPWT) Systems | 159c53f8-0a84-40ca-b3a4-1446f3b09768 | 3196 | Negative-Pressure Wound Therapy (NPWT) Systems | 05.00.38 | |
| | | 07.03.18s | NerveConductionStudies(NCS)andRelatedElectrodiagnosticStudies07.03.18s | Medicine (07) | Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies | ca9473cb-2af2-4f32-8a12-c17ae37696af | 4593 | Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies | 07.03.18 | {"4594": {"Id":4594,"MPAttachmentLetter":"A","Title":"Recommended Guidelines for Electrodiagnostic Studies","MPPolicyAttachmentInternalSourceId":6703,"PolicyAttachmentPageName":"1e59dff7-f609-40f8-be9e-97eb6a85ac91"},"4595": {"Id":4595,"MPAttachmentLetter":"F","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6704,"PolicyAttachmentPageName":"681898fa-6a4c-470e-8443-2d1bec142a37"},"4596": {"Id":4596,"MPAttachmentLetter":"D","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6705,"PolicyAttachmentPageName":"b26c17e5-1216-4b2e-8e64-e4005137ba93"},"4597": {"Id":4597,"MPAttachmentLetter":"C","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6706,"PolicyAttachmentPageName":"2c789206-81ed-4b39-a383-7deb8b2aa996"},"4598": {"Id":4598,"MPAttachmentLetter":"E","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6707,"PolicyAttachmentPageName":"60e8c428-c3e5-4f79-9521-65edc399fd71"},"4599": {"Id":4599,"MPAttachmentLetter":"B","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6708,"PolicyAttachmentPageName":"7a0ba8cb-b8ed-43d7-9d11-cec6f54c330c"},"4600": {"Id":4600,"MPAttachmentLetter":"K","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6709,"PolicyAttachmentPageName":"309ecf08-40d8-4bb5-89b7-3d46c717b283"},"4601": {"Id":4601,"MPAttachmentLetter":"J","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6710,"PolicyAttachmentPageName":"eb8db8cb-de53-49ca-a70c-10264e680314"},"4602": {"Id":4602,"MPAttachmentLetter":"G","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6711,"PolicyAttachmentPageName":"3c829525-c628-441b-8d34-62e09a789110"},"4603": {"Id":4603,"MPAttachmentLetter":"H","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6712,"PolicyAttachmentPageName":"7a976fc6-58d9-4a3a-ac8a-311487a24487"},"4604": {"Id":4604,"MPAttachmentLetter":"I","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6713,"PolicyAttachmentPageName":"4f868168-055a-474b-a136-33a14ace61bd"},} |
| | | 06.02.38d | NerveFiberDensityTesting06.02.38d | Pathology and Laboratory (06) | Nerve Fiber Density Testing | 8876de80-e4d6-4a1b-b87f-9287276acb7b | 4138 | Nerve Fiber Density Testing | 06.02.38 | |
| | | 05.00.73e | NeuromuscularElectricalStimulators(NMES)andFunctionalElectricalStimulators(FES)05.00.73e | DME (05) | Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES) | d78a376e-2f92-40be-b501-e986eabb779a | 3285 | Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES) | 05.00.73 | |
| | | 07.03.08k | NeuropsychologicalTestingforNeurologicallyBasedConditions07.03.08k | Medicine (07) | Neuropsychological Testing for Neurologically Based Conditions | b7e5882e-7f1a-4809-b5b1-4e8306f1d33b | 3607 | Neuropsychological Testing for Neurologically Based Conditions | 07.03.08 | {"3608": {"Id":3608,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":5828,"PolicyAttachmentPageName":"12d80eb0-d5c8-492d-a55c-dc6e8ebf8490"},} |
| | | 00.01.44i | NeverEventsandPreventableSeriousAdverseEvents00.01.44i | Administrative (00) | Never Events and Preventable Serious Adverse Events | e53f0c1c-d1ba-4fc3-9382-3a6b25f6b15b | 2784 | Never Events and Preventable Serious Adverse Events | 00.01.44 | {"2785": {"Id":2785,"MPAttachmentLetter":"B","Title":"New Jersey Act No. 2471","MPPolicyAttachmentInternalSourceId":4980,"PolicyAttachmentPageName":"2cc417b7-90e2-4fca-9c89-0afb68f1fb15"},"2786": {"Id":2786,"MPAttachmentLetter":"C","Title":"Never Event or Preventable Serious Adverse Event Reporting Form","MPPolicyAttachmentInternalSourceId":4981,"PolicyAttachmentPageName":"dce90ca5-7682-45dd-9418-c1fcc3eb932f"},"2787": {"Id":2787,"MPAttachmentLetter":"A","Title":"Pennsylvania House Bill No. 84 addressing Never Events and Preventable Serious Adverse Events","MPPolicyAttachmentInternalSourceId":4982,"PolicyAttachmentPageName":"3c0d6d43-531b-49bb-9247-6e0dd7489975"},} |
| | | 08.01.62a | Nivolumab(Opdivo®)08.01.62a | Pharmacy (08) | Nivolumab (Opdivo®) | 1195973a-3232-4f79-af3d-bfbb02be1d60 | 3506 | Nivolumab (Opdivo®) | 08.01.62 | {"3507": {"Id":3507,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":5652,"PolicyAttachmentPageName":"dd7c070c-1263-4419-8741-ca43e1cc5421"},} |
| | | 08.01.94a | nivolumabandrelatlimab-rmbw(Opdualag™)08.01.94a | Pharmacy (08) | nivolumab and relatlimab-rmbw (Opdualag™) | e5b2c1be-952b-4cd2-8fc7-d5e6c328d066 | 4616 | nivolumab and relatlimab-rmbw (Opdualag™) | 08.01.94 | |
| | | 07.10.05m | NoncontraceptiveUseoftheLevonorgestrel-ReleasingIntrauterineSystem07.10.05m | Medicine (07) | Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System | fbbbe67b-67e3-4cde-a2f6-dccbf4d43a71 | 4284 | Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System | 07.10.05 | |
| | | 07.03.25a | NonemergentInpatientVideoElectroencephalogram(EEG)MonitoringandAmbulatoryEEGMonitoringintheHome07.03.25a | Medicine (07) | Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home | 369fa8c0-8b27-4feb-9880-530f102e96b4 | 4497 | Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home | 07.03.25 | |
| | | 06.02.47e | NoninvasivePrenatalScreeningforFetalAneuploidiesUsingCell-FreeFetalDNA(IndependenceAdministrators)06.02.47e | Pathology and Laboratory (06) | Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators) | 941759b1-d9d2-4c67-88d4-21206c3f3884 | 3650 | Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators) | 06.02.47 | |
| | | 05.00.30m | NoninvasiveRespiratoryAssistDevices(RADs):ContinuousPositiveAirwayPressure(CPAP)DevicesandBi-LevelDevices05.00.30m | DME (05) | Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices and Bi-Level Devices | a135f8f7-aedb-49e6-9e1c-51d56ba662e8 | 3455 | Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices and Bi-Level Devices | 05.00.30 | |
| | | 06.02.56f | NoninvasiveTechniquesfortheEvaluationandMonitoringofIndividualswithChronicLiverDisease06.02.56f | Pathology and Laboratory (06) | Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease | b3972369-eed8-4bdc-8f0b-549cf51ea701 | 4074 | Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease | 06.02.56 | |
| | | 07.08.01f | Non-SurgicalSpinalDecompressionTherapy07.08.01f | Medicine (07) | Non-Surgical Spinal Decompression Therapy | bb423d59-af89-4dc1-a448-6594d114df6b | 4234 | Non-Surgical Spinal Decompression Therapy | 07.08.01 | |
| | | 11.15.19e | Nucleoplasty11.15.19e | Surgery (11) | Nucleoplasty | 79a17d97-b7a9-468e-8cf8-f8c018ca8546 | 4345 | Nucleoplasty | 11.15.19 | |
| | | 08.00.18o | NutritionalFormulas,EnteralNutrition,MedicalFoods,Low-ProteinModifiedFoodProducts,andDonatedBreastMilk08.00.18o | Pharmacy (08) | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | a263dde5-5d39-4200-8cdf-4547b6c4c409 | 3797 | Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk | 08.00.18 | {"3798": {"Id":3798,"MPAttachmentLetter":"A","Title":"PA Mandates","MPPolicyAttachmentInternalSourceId":5188,"PolicyAttachmentPageName":"3a508c6e-ec18-4d13-b908-c0acd2550f2f"},"3799": {"Id":3799,"MPAttachmentLetter":"B","Title":"NJ Mandates","MPPolicyAttachmentInternalSourceId":5189,"PolicyAttachmentPageName":"5793a914-9f04-4ccc-8828-4f683d205be1"},"3800": {"Id":3800,"MPAttachmentLetter":"C","Title":"Caloric Requirements","MPPolicyAttachmentInternalSourceId":5190,"PolicyAttachmentPageName":"53cfa3f9-2549-4753-afae-4658fe0432dd"},} |
| | | 00.01.24h | ObsoleteorUnreliableDiagnosticTestsandMedicalServices00.01.24h | Administrative (00) | Obsolete or Unreliable Diagnostic Tests and Medical Services | 181138c5-1577-4d32-9b16-1b2e9f678fcf | 3417 | Obsolete or Unreliable Diagnostic Tests and Medical Services | 00.01.24 | |
| | | 00.03.10e | Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product | Administrative (00) | Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product | F44DE201290B17FD852581E90055D650 | 2118 | Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product | 00.03.10 | {"2180": {"Id":2180,"MPAttachmentLetter":"A","Title":"High Risk Pregnancy","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"B8C1CA1F2EF44F8E852581E90055D662"},"2181": {"Id":2181,"MPAttachmentLetter":"B","Title":"Rule out Ectopic Pregnancy","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"0C9817EDC55BF784852581E90055D670"},"2182": {"Id":2182,"MPAttachmentLetter":"C","Title":"Rule out intrauterine pathology and Screening for Fetal abnormalities","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"2523EE16188C5ABE852581E90055D67D"},"2183": {"Id":2183,"MPAttachmentLetter":"D","Title":"First-trimester screening and Ovarian Dysfunction","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"289DB16C035AE79A852581E90055D688"},} |
| | | 08.01.38c | Ocrelizumab(Ocrevus®)08.01.38c | Pharmacy (08) | Ocrelizumab (Ocrevus®) | 0e8bb45a-3cfb-4fe3-80ee-02539435722f | 4288 | Ocrelizumab (Ocrevus®) | 08.01.38 | |
| | | 08.01.10g | OctreotideAcetate(Sandostatin®LARDepot)08.01.10g | Pharmacy (08) | Octreotide Acetate (Sandostatin® LAR Depot) | b26b48dc-dc2f-4913-a6d1-22d7002d8fdf | 4197 | Octreotide Acetate (Sandostatin® LAR Depot) | 08.01.10 | {"4198": {"Id":4198,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6307,"PolicyAttachmentPageName":"96366a40-de06-4dd0-9105-5efe1fc50ff1"},} |
| | | 08.00.15f | Off-labelCoverageforPrescriptionDrugsand/orBiologics08.00.15f | Pharmacy (08) | Off-label Coverage for Prescription Drugs and/or Biologics | 449f9a31-dfca-4df0-bde5-0116da43c523 | 4040 | Off-label Coverage for Prescription Drugs and/or Biologics | 08.00.15 | |
| | | 08.00.55i | Omalizumab(Xolair®)08.00.55i | Pharmacy (08) | Omalizumab (Xolair®) | 208cd07c-a1d6-437f-b06b-f35616f8ea87 | 4160 | Omalizumab (Xolair®) | 08.00.55 | {"4161": {"Id":4161,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements for Omalizumab (Xolair®)","MPPolicyAttachmentInternalSourceId":6249,"PolicyAttachmentPageName":"b2612a29-72fd-46f8-b260-4487e063ddae"},} |
| | | 11.14.08d | OrthognathicSurgery11.14.08d | Surgery (11) | Orthognathic Surgery | d113ee7c-e492-4a6e-880c-b5016bf9d26d | 4344 | Orthognathic Surgery | 11.14.08 | |
| | | 07.13.01i | Orthoptic/PleopticTraining07.13.01i | Medicine (07) | Orthoptic/Pleoptic Training | 90f84713-006a-4bdb-a566-64db224dc91c | 4278 | Orthoptic/Pleoptic Training | 07.13.01 | |
| | | 11.14.12f | OsteochondralAllograftTransplantation(IndependenceAdministrators)11.14.12f | Surgery (11) | Osteochondral Allograft Transplantation (Independence Administrators) | 664c9ac1-2b22-4997-ad52-fd481397ad95 | 4382 | Osteochondral Allograft Transplantation (Independence Administrators) | 11.14.12 | |
| | | 11.14.09h | OsteochondralAutograftTransplantation(IndependenceAdministrators)11.14.09h | Surgery (11) | Osteochondral Autograft Transplantation (Independence Administrators) | a96371c5-f45b-4fdf-82fa-bbbbbfcef067 | 4383 | Osteochondral Autograft Transplantation (Independence Administrators) | 11.14.09 | |
| | | 05.00.81 | OsteogenicStimulators(non-invasive,invasive/semi-invasive,electricalandultrasound)05.00.81 | DME (05) | Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound) | e3966c68-64e6-4065-8391-f03f764ae9de | 4515 | Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound) | 05.00.81 | |
| | | 05.00.50m | OstomySupplies05.00.50m | DME (05) | Ostomy Supplies | 61fe67d0-8a64-41e5-bc7c-2a6a61beb410 | 3965 | Ostomy Supplies | 05.00.50 | {"3966": {"Id":3966,"MPAttachmentLetter":"A","Title":"HCPCS Codes for Ostomy Supplies","MPPolicyAttachmentInternalSourceId":6106,"PolicyAttachmentPageName":"df1ccb61-331b-44e6-a2ff-e38c4c334d7e"},} |
| | | 11.01.01j | OtoplastyorNon-SurgicalExternalEarMolding11.01.01j | Surgery (11) | Otoplasty or Non-Surgical External Ear Molding | 13dfa92a-36ee-40ca-accc-5ffa9d72f96c | 4339 | Otoplasty or Non-Surgical External Ear Molding | 11.01.01 | |
| | | 00.03.03h | Outpatient Short-Term Rehabilitation Services Included in Capitation | Administrative (00) | Outpatient Short-Term Rehabilitation Services Included in Capitation | 85256AA800623D7A852584D60053FD92 | 2160 | Outpatient Short-Term Rehabilitation Services Included in Capitation | 00.03.03 | {"2299": {"Id":2299,"MPAttachmentLetter":"A","Title":"No Title","MPPolicyAttachmentInternalSourceId":0,"PolicyAttachmentPageName":"85256AA800623D7A852584D60053FD9A"},} |
| | | 12.05.01j | OutpatientDiabetesEducationandSelf-ManagementTraining12.05.01j | Miscellaneous (12) | Outpatient Diabetes Education and Self-Management Training | 14e4a1df-d766-40d5-b280-eace3f7f69d1 | 2625 | Outpatient Diabetes Education and Self-Management Training | 12.05.01 | {"2626": {"Id":2626,"MPAttachmentLetter":"A","Title":"ICD-10 CM Codes Eligible to be Reported for Outpatient Diabetes Education and Self-Management Training (E08.00- E10.3491)","MPPolicyAttachmentInternalSourceId":2371,"PolicyAttachmentPageName":"ed035dfc-85f7-4a19-b93a-5a68d1226e03"},"2627": {"Id":2627,"MPAttachmentLetter":"B","Title":"ICD-10 CM Codes Eligible to be Reported for Outpatient Diabetes Education and Self-Management Training (E10.3492- E13.37X2), Continued","MPPolicyAttachmentInternalSourceId":2372,"PolicyAttachmentPageName":"bd6c3245-6e36-47c4-b728-9b5efac2262f"},"2628": {"Id":2628,"MPAttachmentLetter":"C","Title":"ICD-10 CM Codes Eligible to be Reported for Outpatient Diabetes Education and Self-Management Training (E13.37X3- P70.2), Continued","MPPolicyAttachmentInternalSourceId":2373,"PolicyAttachmentPageName":"a903e29d-10c8-4b14-a150-f61bffb56003"},} |
| | | 10.03.01n | OutpatientPhysicalMedicine,Rehabilitation,andHabilitationServices10.03.01n | Rehabilitation Services (10) | Outpatient Physical Medicine, Rehabilitation, and Habilitation Services | 76d186c0-c542-43dd-8e33-3aaea42e5b7e | 4506 | Outpatient Physical Medicine, Rehabilitation, and Habilitation Services | 10.03.01 | |
| | | 11.06.07d | OvarianandInternalIliacVeinEmbolizationasTreatmentforPelvicCongestionSyndrome11.06.07d | Surgery (11) | Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome | 2d051ca8-5db2-4e85-9748-490e65879567 | 3334 | Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome | 11.06.07 | |
| | | 08.00.90n | PaclitaxelProtein-BoundParticlesforInjectableSuspension(Albumin-Bound)/(Abraxane®forInjectableSuspension)08.00.90n | Pharmacy (08) | Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension) | 43d77fe7-54b4-4d0a-81da-d5b56212e00a | 4504 | Paclitaxel Protein-Bound Particles for Injectable Suspension (Albumin-Bound)/(Abraxane® for Injectable Suspension) | 08.00.90 | {"4505": {"Id":4505,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":6471,"PolicyAttachmentPageName":"bf3d2e46-bd61-4844-965c-616a2676fd03"},} |
| | | 07.03.27 | PainManagementofPeripheralNervesbyInjection07.03.27 | Medicine (07) | Pain Management of Peripheral Nerves by Injection | 50efa1a4-b418-436b-96af-ddb337a3d794 | 4181 | Pain Management of Peripheral Nerves by Injection | 07.03.27 | |
| | | 11.08.06j | Panniculectomy,Abdominoplasty,AbdominalLipectomy,andOtherExcisionsofRedundantSkin11.08.06j | Surgery (11) | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 1018d313-6208-49eb-bacc-c6c8c2bf3ffa | 4281 | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 11.08.06 | {"4282": {"Id":4282,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":6343,"PolicyAttachmentPageName":"910a2b28-f343-4568-b67f-0afb59acd9e4"},} |
| | | 07.10.04c | ParenterallyAdministeredTerbutalineSulfateforthePreventionorTreatmentofPre-TermLabor07.10.04c | Medicine (07) | Parenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor | a7ac860f-25cd-450e-a665-d346cba3fa5b | 4283 | Parenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor | 07.10.04 | |
| | | 07.13.08e | PartialCoherenceInterferometry07.13.08e | Medicine (07) | Partial Coherence Interferometry | 5e213089-7669-4f39-ad66-d169e55dd350 | 4226 | Partial Coherence Interferometry | 07.13.08 | {"4227": {"Id":4227,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6287,"PolicyAttachmentPageName":"943756cc-c0d7-446a-9980-936a7aadacfe"},} |
| | | 05.00.42h | PatientLifts05.00.42h | DME (05) | Patient Lifts | e91cf7a6-87c6-45da-937c-e6ad99367011 | 4355 | Patient Lifts | 05.00.42 | |
| | | 08.01.50b | Patisiran(Onpattro™)08.01.50b | Pharmacy (08) | Patisiran (Onpattro™) | b8644700-3263-440b-8fab-0c5dae0b6d8e | 3844 | Patisiran (Onpattro™) | 08.01.50 | |
| | | 10.00.03 | PediatricIntensiveDayFeedingProgram10.00.03 | Rehabilitation Services (10) | Pediatric Intensive Day Feeding Program | cd5bc3c5-c5c7-4cfb-b4b4-596113cc11a0 | 4334 | Pediatric Intensive Day Feeding Program | 10.00.03 | |
| | | 08.01.32h | pegfilgrastim(Neulasta®)andrelatedbiosimilars08.01.32h | Pharmacy (08) | pegfilgrastim (Neulasta®) and related biosimilars | 5f331758-7796-43ae-a766-3d54fe77664a | 3897 | pegfilgrastim (Neulasta®) and related biosimilars | 08.01.32 | {"3898": {"Id":3898,"MPAttachmentLetter":"A","Title":"EXAMPLES OF DISEASE SETTINGS AND CHEMOTHERAPY REGIMENS WITH A HIGH (>20%) OR INTERMEDIATE (10-20%) RISK FOR FEBRILE NEUTROPENIA","MPPolicyAttachmentInternalSourceId":6058,"PolicyAttachmentPageName":"9151992b-8300-4f11-a49e-444181230040"},} |
| | | 08.01.02g | Pegloticase(Krystexxa®)08.01.02g | Pharmacy (08) | Pegloticase (Krystexxa®) | fc36adfc-16ee-4df5-92af-0447fc45ae6a | 4035 | Pegloticase (Krystexxa®) | 08.01.02 | {"4036": {"Id":4036,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":6066,"PolicyAttachmentPageName":"e467e12d-1404-4be4-b61f-e7c36dafe8f2"},} |
| | | 07.12.01e | Pelvic Floor Stimulation as a Treatment of Incontinence | Medicine (07) | Pelvic Floor Stimulation as a Treatment of Incontinence | 85256AA800623D7A85258596007D8BBB | 1777 | Pelvic Floor Stimulation as a Treatment of Incontinence | 07.12.01 | |
