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ab43fb4f-a3ea-4467-8e69-17c7708fb511.aspx
  
4725WheelchairOptionsandAccessoriesMA05.046hDME (05)MA05.046hMA05.046ab43fb4f-a3ea-4467-8e69-17c7708fb511Wheelchair Options and AccessoriesWheelchair Options and Accessories9/21/2023 11:00 AM
{"4726": {"Id":4726,"MPAttachmentLetter":"A","Title":"HCPCS LEVEL II CODES FOR WHEELCHAIR OPTIONS AND ACCESSORIES","MPPolicyAttachmentInternalSourceId":7561,"PolicyAttachmentPageName":"3cef7624-a8d8-45da-8783-68d72685908d"},}
5/16/2023
57bef676-5fe7-47be-a3aa-ecc365c157d3.aspx
  
4727PowerWheelchairs(PWCs),Power-OperatedVehicles(POVs),andPush-Rim-ActivatedPower-AssistDevicesMA05.032cDME (05)MA05.032cMA05.03257bef676-5fe7-47be-a3aa-ecc365c157d3Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist DevicesPower Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist Devices9/21/2023 11:00 AM
5/16/2023
1ec4b471-3e0a-43d3-a9ca-2f434b14e461.aspx
  
4646Golimumab(SimponiAria®)Intravenous(IV)InjectionMA08.070fPharmacy (08)MA08.070fMA08.0701ec4b471-3e0a-43d3-a9ca-2f434b14e461Golimumab (Simponi Aria®) Intravenous (IV) InjectionGolimumab (Simponi Aria®) Intravenous (IV) Injection8/1/2023 10:00 AM
{"4647": {"Id":4647,"MPAttachmentLetter":"A","Title":"Medically Necessary ICD-10 Codes","MPPolicyAttachmentInternalSourceId":7467,"PolicyAttachmentPageName":"6229bd69-1f26-47f3-ba23-1a1cb224a44c"},}
10/30/2023
1c41a922-fd1d-4422-90a2-6a5246b5d072.aspx
  
4654Tocilizumab(Actemra®)forIntravenousInfusionandSubcutaneousInjectionMA08.045jPharmacy (08)MA08.045jMA08.0451c41a922-fd1d-4422-90a2-6a5246b5d072Tocilizumab (Actemra®) for Intravenous Infusion and Subcutaneous InjectionTocilizumab (Actemra®) for Intravenous Infusion and Subcutaneous Injection8/16/2023 10:00 AM
{"4655": {"Id":4655,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":7470,"PolicyAttachmentPageName":"cb592efc-3aaa-432e-ade8-2f71da3ca95d"},}
11/13/2023
143087a4-01b2-4afb-a001-eb8ba9423773.aspx
  
4683Daratumumab(Darzalex®),Daratumumab,andHyaluronidase-fihj(DarzalexFaspro®)MA08.079kPharmacy (08)MA08.079kMA08.079143087a4-01b2-4afb-a001-eb8ba9423773Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®)Daratumumab (Darzalex®), Daratumumab, and Hyaluronidase-fihj (Darzalex Faspro®)8/29/2023 3:00 PM
11/27/2023
81aa888e-296c-422d-8ba8-e81243f8f744.aspx
  
4712Abatacept(Orencia®)forInjectionforIntravenousUseMA08.028iPharmacy (08)MA08.028iMA08.02881aa888e-296c-422d-8ba8-e81243f8f744Abatacept (Orencia®) for Injection for Intravenous UseAbatacept (Orencia®) for Injection for Intravenous Use9/12/2023 10:00 AM
{"4713": {"Id":4713,"MPAttachmentLetter":"A","Title":"ICD-10 codes","MPPolicyAttachmentInternalSourceId":7523,"PolicyAttachmentPageName":"318fe192-3131-44ee-b3d3-7f823167322c"},}
12/11/2023
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