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0c6e1f8b-9eb7-4fcf-9e55-88f408e4d4cb.aspx
  
3962CochlearImplantationMA11.039eSurgery (11)MA11.039eMA11.0390c6e1f8b-9eb7-4fcf-9e55-88f408e4d4cbCochlear ImplantationCochlear Implantation11/7/2022 10:00 AM
11/7/2022
9d0c07fa-3ad7-415f-a668-0ccadc656155.aspx
  
3959OstomySuppliesMA05.014dDME (05)MA05.014dMA05.0149d0c07fa-3ad7-415f-a668-0ccadc656155Ostomy SuppliesOstomy Supplies11/4/2022 9:00 AM
{"3960": {"Id":3960,"MPAttachmentLetter":"A","Title":"Ostomy Supply Codes","MPPolicyAttachmentInternalSourceId":6785,"PolicyAttachmentPageName":"4ec05dae-973f-424e-9aec-463e65f538fb"},}
12/5/2022
cef4d604-2d01-4a90-8a57-9780080e7a9b.aspx
  
4008HomeBloodGlucoseMonitorsandSuppliesMA05.015dDME (05)MA05.015dMA05.015cef4d604-2d01-4a90-8a57-9780080e7a9bHome Blood Glucose Monitors and SuppliesHome Blood Glucose Monitors and Supplies11/16/2022 11:00 AM
{"4009": {"Id":4009,"MPAttachmentLetter":"A","Title":"ICD-10 diagnosis codes","MPPolicyAttachmentInternalSourceId":5503,"PolicyAttachmentPageName":"0de0a719-f74f-46ed-8ca9-e39cf9b3dbe7"},}
12/5/2022
faaaec04-b9fb-4119-9362-7725b156db87.aspx
  
4017Eflapegrastim-xnst(Rolvedon™),Pegfilgrastim(Neulasta®)andRelatedBiosimilarsMA08.082iPharmacy (08)MA08.082iMA08.082faaaec04-b9fb-4119-9362-7725b156db87Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related BiosimilarsEflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars11/18/2022 9:00 AM
{"4018": {"Id":4018,"MPAttachmentLetter":"A","Title":"EXAMPLES OF DISEASE SETTINGS AND CHEMOTHERAPY REGIMENS WITH A HIGH (>20%) OR INTERMEDIATE (10-20%) RISK FOR FEBRILE NEUTROPENIA","MPPolicyAttachmentInternalSourceId":6593,"PolicyAttachmentPageName":"ef81d4cd-efe9-4e4a-bb12-b87cbd538c23"},}
12/19/2022
932bc7aa-7c56-466a-bf40-1dc4b0e96105.aspx
  
4019InVitroAllergyTestingMA06.002cPathology and Laboratory (06)MA06.002cMA06.002932bc7aa-7c56-466a-bf40-1dc4b0e96105In Vitro Allergy TestingIn Vitro Allergy Testing11/18/2022 10:00 AM
12/19/2022
b89e88bc-c37b-4819-a4ea-af219a5cf05d.aspx
  
3787ChemicalPeelsMA11.103bSurgery (11)MA11.103bMA11.103b89e88bc-c37b-4819-a4ea-af219a5cf05dChemical PeelsChemical Peels9/26/2022 2:00 PM
12/26/2022
2ac11705-dea9-4863-94df-cfc558d617d5.aspx
  
3931IntravenousKetamine(Ketalar®)andIntranasalEsketamine(Spravato®)MA08.137aPharmacy (08)MA08.137aMA08.1372ac11705-dea9-4863-94df-cfc558d617d5Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)11/1/2022 9:00 AM
1/1/2023
9edc99a8-dbad-46d3-ae7c-b22ea166c2f6.aspx
  
3932PsychologicalTestingMA14.002Behavioral Health (14)MA14.002MA14.0029edc99a8-dbad-46d3-ae7c-b22ea166c2f6Psychological TestingPsychological Testing11/1/2022 9:00 AM
1/1/2023
354f5190-a4e2-4320-879b-eca730486225.aspx
  
3933Home-UseLightBoxfortheTreatmentofSeasonalAffectiveDisorder(SAD)MA05.022aDME (05)MA05.022aMA05.022354f5190-a4e2-4320-879b-eca730486225Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)11/1/2022 10:00 AM
1/1/2023
2f116557-7b8d-443a-8fbe-3d3b744b7f4c.aspx
  
3934TranscranialMagneticStimulation(TMS)MA07.035dMedicine (07)MA07.035dMA07.0352f116557-7b8d-443a-8fbe-3d3b744b7f4cTranscranial Magnetic Stimulation (TMS)Transcranial Magnetic Stimulation (TMS)11/1/2022 10:00 AM
1/1/2023
14ef6470-44f4-4099-881a-21521d12fec8.aspx
  
3935CranialElectrotherapyStimulationMA05.066cDME (05)MA05.066cMA05.06614ef6470-44f4-4099-881a-21521d12fec8Cranial Electrotherapy StimulationCranial Electrotherapy Stimulation11/1/2022 10:00 AM
1/1/2023
2dd8737a-eb29-4514-acbd-7186ea78b680.aspx
  
3936AcuteCareFacilityInpatientTransfersMA12.003bMiscellaneous (12)MA12.003bMA12.0032dd8737a-eb29-4514-acbd-7186ea78b680Acute Care Facility Inpatient TransfersAcute Care Facility Inpatient Transfers11/1/2022 11:00 AM
1/1/2023
78280621-f992-4f8a-9825-368ec185cde4.aspx
  
3937ElectroconvulsiveTherapy(ECT)MA14.001Behavioral Health (14)MA14.001MA14.00178280621-f992-4f8a-9825-368ec185cde4Electroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT)11/1/2022 12:00 PM
1/1/2023
5a409467-85aa-468c-9303-c7e6fde255eb.aspx
  
3938VagusNerveStimulation(VNS)MA11.019hSurgery (11)MA11.019hMA11.0195a409467-85aa-468c-9303-c7e6fde255ebVagus Nerve Stimulation (VNS)Vagus Nerve Stimulation (VNS)11/1/2022 12:00 PM
{"3939": {"Id":3939,"MPAttachmentLetter":"A","Title":"Experimental/Investigational ICD-10 Diagnosis Codes for Implantable Vagus Nerve Stimulation","MPPolicyAttachmentInternalSourceId":6544,"PolicyAttachmentPageName":"5774d4f3-2cfa-439e-a4bb-e241811fb596"},"3940": {"Id":3940,"MPAttachmentLetter":"B","Title":"Experimental/Investigational ICD-10 Diagnosis Codes for Non-Implantable Vagus Nerve Stimulation","MPPolicyAttachmentInternalSourceId":6545,"PolicyAttachmentPageName":"6be1afa0-9fca-45ef-a2d0-2aee35979319"},}
1/1/2023
fa45f706-4ac4-436e-9728-ae8a125450df.aspx
  
3941DeepBrainStimulation(DBS)MA11.005eSurgery (11)MA11.005eMA11.005fa45f706-4ac4-436e-9728-ae8a125450dfDeep Brain Stimulation (DBS)Deep Brain Stimulation (DBS)11/1/2022 12:00 PM
1/1/2023
e0825b40-f8d3-4d6e-9105-dc40ff103923.aspx
  
3942PresumptiveandDefinitiveDrugTestinginSubstanceAbuseandPainManagementTreatmentsMA06.025pPathology and Laboratory (06)MA06.025pMA06.025e0825b40-f8d3-4d6e-9105-dc40ff103923Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management TreatmentsPresumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments11/1/2022 2:00 PM
1/1/2023
e03a9b3b-a11d-4af2-b922-5ed9ad5fbcc9.aspx
  
3943TherapeuticDrugMonitoringforAntidepressants,Antipsychotics,andAntiepilepticsMA06.029aPathology and Laboratory (06)MA06.029aMA06.029e03a9b3b-a11d-4af2-b922-5ed9ad5fbcc9Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, and AntiepilepticsTherapeutic Drug Monitoring for Antidepressants, Antipsychotics, and Antiepileptics11/1/2022 2:00 PM
1/1/2023
d41bb043-6ad3-46d0-9f90-3618bfbe7c37.aspx
  
3963NeuropsychologicalTestingforNeurologicallyBasedConditionsMA07.038iMedicine (07)MA07.038iMA07.038d41bb043-6ad3-46d0-9f90-3618bfbe7c37Neuropsychological Testing for Neurologically Based ConditionsNeuropsychological Testing for Neurologically Based Conditions11/7/2022 10:00 AM
{"3964": {"Id":3964,"MPAttachmentLetter":"A","Title":"ICD-10 Codes","MPPolicyAttachmentInternalSourceId":6548,"PolicyAttachmentPageName":"29a2fca6-ee6f-4c91-a87b-e2a04031da20"},}
2/6/2023
ef71eb89-f8f9-49f5-aaf8-4c4772cfe4be.aspx
  
4021InVivoAllergySensitivityTestingMA06.004cPathology and Laboratory (06)MA06.004cMA06.004ef71eb89-f8f9-49f5-aaf8-4c4772cfe4beIn Vivo Allergy Sensitivity TestingIn Vivo Allergy Sensitivity Testing11/21/2022 10:00 AM
2/20/2023