Medicare Advantage
  
  
  
  
  
  
  
  
  
  
  
  
MPattachmentdataPub
  
0e485b1a-6dba-4d26-9c00-c5002a49f559.aspx
  
3190pegfilgrastim(Neulasta®)andrelatedbiosimilarsMA08.082gPharmacy (08)MA08.082gMA08.0820e485b1a-6dba-4d26-9c00-c5002a49f559pegfilgrastim (Neulasta®) and related biosimilarspegfilgrastim (Neulasta®) and related biosimilars11/9/2021 11:00 AM
{"3191": {"Id":3191,"MPAttachmentLetter":"A","Title":"EXAMPLES OF DISEASE SETTINGS AND CHEMOTHERAPY REGIMENS WITH A HIGH (>20%) OR INTERMEDIATE (10-20%) RISK FOR FEBRILE NEUTROPENIA","MPPolicyAttachmentInternalSourceId":5733,"PolicyAttachmentPageName":"aac270b6-2ac0-47e7-a42b-6a8c8e105c7b"},}
2/7/2022
ded10760-eca8-41d4-a36b-323ed089f397.aspx
  
3113ModifiersforAssistant-at-SurgeryServices:80,81,82,andASMA00.015kAdministrative (00)MA00.015kMA00.015ded10760-eca8-41d4-a36b-323ed089f397Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and ASModifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS11/5/2021 2:00 PM
2/14/2022
93ee1465-f44b-4c23-89d8-b92cdb22194c.aspx
  
3207Electromyography(EMG)Studies:NeedleEMG,SurfaceEMG(SEMG)MA07.050iMedicine (07)MA07.050iMA07.05093ee1465-f44b-4c23-89d8-b92cdb22194cElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)12/20/2021 12:00 PM
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3/21/2022
7046c3cb-0000-494e-a4bf-0043dd165d72.aspx
  
3219NerveConductionStudies(NCS)andRelatedElectrodiagnosticStudiesMA07.033iMedicine (07)MA07.033iMA07.0337046c3cb-0000-494e-a4bf-0043dd165d72Nerve Conduction Studies (NCS) and Related Electrodiagnostic StudiesNerve Conduction Studies (NCS) and Related Electrodiagnostic Studies12/20/2021 12:00 PM
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3/21/2022
60ee139f-4c06-40b5-8678-4c46cb1dcf1c.aspx
  
3237Pertuzumab,Trastuzumab,andHyaluronidase-zzxf(Phesgo®)MA08.129aPharmacy (08)MA08.129aMA08.12960ee139f-4c06-40b5-8678-4c46cb1dcf1cPertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)12/21/2021 7:00 AM
3/21/2022
6a25a209-c7c3-450b-8d93-c36e1907170a.aspx
  
3242Pegfilgrastim(Neulasta®)andRelatedBiosimilarsMA08.082hPharmacy (08)MA08.082hMA08.0826a25a209-c7c3-450b-8d93-c36e1907170aPegfilgrastim (Neulasta®) and Related BiosimilarsPegfilgrastim (Neulasta®) and Related Biosimilars12/31/2021 9:00 AM
{"3243": {"Id":3243,"MPAttachmentLetter":"A","Title":"EXAMPLES OF DISEASE SETTINGS AND CHEMOTHERAPY REGIMENS WITH A HIGH (>20%) OR INTERMEDIATE (10-20%) RISK FOR FEBRILE NEUTROPENIA","MPPolicyAttachmentInternalSourceId":6059,"PolicyAttachmentPageName":"c7d9a44d-1ae3-46f2-87f8-11c10007b621"},}
4/1/2022
c1a0d414-4eab-4f6d-95bc-887f0f1274dd.aspx
  
3244Rituximab(Rituxan®)InfusionandRelatedBiosimilars,andRituximab/HyaluronidaseHumanforSubcutaneousInjection(RituxanHycela®)MA08.022nPharmacy (08)MA08.022nMA08.022c1a0d414-4eab-4f6d-95bc-887f0f1274ddRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)12/31/2021 9:00 AM
{"3245": {"Id":3245,"MPAttachmentLetter":"A","Title":"Dosing and Frequency Requirements For Rituximab (Rituxan®) infusion and related biosimilars, and rituximab/hyaluronidase human for subcutaneous injection (Rituxan Hycela®)","MPPolicyAttachmentInternalSourceId":6062,"PolicyAttachmentPageName":"f3dbcc64-89cd-41d9-8dfb-53960969abf0"},"3246": {"Id":3246,"MPAttachmentLetter":"B","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":6063,"PolicyAttachmentPageName":"1b6f5d62-5db1-4b6d-9c87-88747f646940"},}
4/1/2022
bfaee28c-9325-4cb1-8a8c-38d91f39760c.aspx
  
3320IntravenousKetamine(Ketalar®)andIntranasalEsketamine(Spravato®)MA08.137Pharmacy (08)MA08.137MA08.137bfaee28c-9325-4cb1-8a8c-38d91f39760cIntravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)1/4/2022 3:00 PM
4/4/2022