Policy Bulletins
The Policy Bulletins listed below represent our catalogue of medical and claim payment policies. If you are looking for a specific type of policy, choose a category from the menu on the right. You may also use the search function in the top menu to search for policies by word or phrase.
 
   


Policy #
Policy Bulletin Title

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00.01.14r
Reporting and Documentation Requirements for Anesthesia Services
00.01.14r
Attachment A (ASA Anesthesia Procedure Codes) to 00.01.14r Reporting and Documentation Requirements for Anesthesia Services
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00.01.18d
Reimbursement for Associated Services Performed in Conjunction with Dental Care
00.01.18d
Attachment A (Diagnosis Codes) to 00.01.18d Reimbursement for Associated Services Performed in Conjunction with Dental Care
00.01.19d
Facility Reporting of Observation Services
00.01.24h
Obsolete or Unreliable Diagnostic Tests and Medical Services
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00.01.25ax
PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
00.01.25ax
Attachment A1 (DME Network Rules and Limited Circumstances) to 00.01.25ax PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
00.01.25ax
Attachment A2 (DME Network Rules and Limited Circumstances cont'd.) to 00.01.25ax PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
00.01.25ax
Attachment A3 (DME Network Rules and Limited Circumstances) to 00.01.25ax PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
00.01.25ax
Attachment B1 (Laboratory Network Rules and Limited Circumstances) to 00.01.25ax PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
00.01.25ax
Attachment B2 (Laboratory Network Rules and Limited Circumstances cont'd.) to 00.01.25ax PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
00.01.25ax
Attachment B3 (Laboratory Network Rules and Limited Circumstances cont'd.) to 00.01.25ax PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
00.01.25ax
Attachment C1 (Radiology Network Rules and Limited Circumstances) to 00.01.25ax PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
00.01.25ax
Attachment C2 (Radiology Network Rules and Limited Circumstances cont'd.) to 00.01.25ax PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
00.01.25ax
Attachment D (Physical Medicine & Rehabilitation Network Rules and Limited Circumstances) to 00.01.25ax PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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00.01.41b
STAT Laboratory Tests Performed in the Outpatient Hospital Setting for Health Maintenance Organization (HMO) and Point of Service (POS) Products
00.01.41b
Attachment A to 00.01.41b STAT Laboratory Tests Performed in the Outpatient Hospital Setting for Health Maintenance Organization (HMO) and Point of Service (POS) Products
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00.01.44h
Never Events and Preventable Adverse Events
00.01.44h
Attachment A (Appendix I Hospital Acquired Conditions (HACS) List ) to 00.01.44h Never Events and Preventable Adverse Events
00.01.44h
Attachment B (Pennsylvania House Bill No. 84 addressing Never Events and Preventable Adverse Events) to 00.01.44h Never Events and Preventable Adverse Events
00.01.44h
Attachment C ( New Jersey Act No. 2471 ) to 00.01.44h Never Events and Preventable Adverse Events
00.01.44h
Attachment D (Never Event or Preventable Adverse Event Reporting Form ) to 00.01.44h Never Events and Preventable Adverse Events
00.01.45
Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances
00.01.47c
Inpatient Hospital Readmission
00.01.48c
Marijuana for Medical Use
00.01.49c
Reporting Requirements for Drugs and Biologics
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00.01.52i
Always Bundled Procedure Codes
00.01.52i
Attachment A (CPT Codes and HCPCS Codes) to 00.01.52i Always Bundled Procedure Codes
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00.01.55o
New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances
00.01.55o
Attachment A1 (NJ HMO & HMO-POS RADIOLOGY NETWORK RULES) to 00.01.55o New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances
00.01.55o
Attachment A2 (NJ HMO & HMO-POS RADIOLOGY LIMITED CIRCUMSTANCES) to 00.01.55o New Jersey Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Radiology Network Rules and Limited Circumstances
00.01.56a
National Correct Coding Initiative (NCCI) Code Pair Edits
00.01.59f
Care Management and Care Planning Services
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00.01.60d
Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services
00.01.60d
Attachment A (Multiple Reduction Diagnostic Services) to 00.01.60d Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services
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00.01.61a
Reimbursement for Components of Comprehensive Laboratory Panels
00.01.61a
Attachment A (CPT Codes) to 00.01.61a Reimbursement for Components of Comprehensive Laboratory Panels
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00.01.66b
Musculoskeletal Services (AmeriHealth)
00.01.66b
Attachment A (Procedure Codes for Spinal Surgery) to 00.01.66b Musculoskeletal Services (AmeriHealth)
00.01.66b
Attachment B (Procedure Codes for Joint Surgery) to 00.01.66b Musculoskeletal Services (AmeriHealth)
00.01.66b
Attachment C (Procedures Codes for Interventional Pain Management) to 00.01.66b Musculoskeletal Services (AmeriHealth)
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00.01.68
Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services
00.01.68
Attachment A (Multiple Reduction Always Therapy Procedure Codes) to 00.01.68 Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services
00.01.69
Consultation Services
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00.03.02aa
Diagnostic Radiology Services Included in Capitation
00.03.02aa
Attachment A (Diagnostic Radiology Procedure Codes Included in Capitation for Pennsylvania (PA) Health Maintenance Organization (HMO) Members ) to 00.03.02aa Diagnostic Radiology Services Included in Capitation
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00.03.03h
Outpatient Short-Term Rehabilitation Services Included in Capitation
00.03.03h
Attachment A to 00.03.03h Outpatient Short-Term Rehabilitation Services Included in Capitation
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00.03.06f
Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.03.06f
Attachment A1 (HAND THERAPY SERVICES) to 00.03.06f Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.03.06f
Attachment A2 (HAND THERAPY SERVICES) to 00.03.06f Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.03.06f
Attachment B (LYMPHEDEMA THERAPY SERVICES) to 00.03.06f Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.03.06f
Attachment C (PELVIC FLOOR THERAPY SERVICES) to 00.03.06f Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.03.06f
Attachment D (VESTIBULAR REHABILIATION SERVICES) to 00.03.06f Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
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00.03.07y
Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.03.07y
Attachment A1 (CPT CODES INCLUDED IN CAPITATION TO THE PCP'S DESIGNATED LABORATORY SITE) to 00.03.07y Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.03.07y
Attachment A2 (HCPCS CODES INCLUDED IN CAPITATION TO THE PCP'S DESIGNATED LABORATORY SITE) to 00.03.07y Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.03.07y
Attachment B1 (SERVICES ELIGIBLE FOR REIMBURSEMENT WHEN PERFORMED IN THE SPECIALIST OFFICE (THIS INCLUDES THE CERTIFIED REGISTERED NURSE PRACTITIONER (CRNP) AND PHYSICIAN ASSISTANT (PA) PRACTICING WITHIN THE SCOPE OF THEIR SPECIALTY) ) to 00.03.07y Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.03.07y
Attachment B2 (SERVICES ELIGIBLE FOR REIMBURSEMENT IN THE OUTPATIENT HOSPITAL LABORATORY) to 00.03.07y Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
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00.03.09d
X-rays Associated with Fractures in the Office Setting
00.03.09d
Attachment A (Codes Eligible for Reimbursement by Hand Surgeons, Orthopedic Surgeons, or Sports Medicine Specialists) to 00.03.09d X-rays Associated with Fractures in the Office Setting
00.03.09d
Attachment B (Codes Eligible for Reimbursement by Podiatrists) to 00.03.09d X-rays Associated with Fractures in the Office Setting
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00.03.10e
Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
00.03.10e
Attachment A (High Risk Pregnancy) to 00.03.10e Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
00.03.10e
Attachment B (Rule out Ectopic Pregnancy) to 00.03.10e Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
00.03.10e
Attachment C (Rule out intrauterine pathology and Screening for Fetal abnormalities) to 00.03.10e Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
00.03.10e
Attachment D (First-trimester screening and Ovarian Dysfunction) to 00.03.10e Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
00.05.01f
Guidelines for Home Care Visits Following Inpatient Maternity Stay
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00.06.02ac
Preventive Care Services (AmeriHealth)
00.06.02ac
Attachment A (Adult Preventive Services) to 00.06.02ac Preventive Care Services (AmeriHealth)
00.06.02ac
Attachment B (Female Preventive Care Services) to 00.06.02ac Preventive Care Services (AmeriHealth)
00.06.02ac
Attachment C (Pediatric Preventive Care Services) to 00.06.02ac Preventive Care Services (AmeriHealth)
00.06.02ac
Attachment D (ADDITIONAL PREVENTIVE SERVICES FOR MEMBERS ENROLLED IN NJ PLANS) to 00.06.02ac Preventive Care Services (AmeriHealth)
00.09.01f
Direct Access to Obstetrics/Gynecology (OB/GYN) Services
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00.10.01ab
Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
00.10.01ab
Attachment A (Pennsylvania Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers ) to 00.10.01ab Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
00.10.01ab
Attachment B (New Jersey Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers) to 00.10.01ab Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
00.10.03j
Criteria for Reimbursement of Emergency Room Services
00.10.11l
Modifier 62: Two Surgeons
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00.10.15c
Cast and Splint Applications and Associated Supplies Provided in the Office Setting
00.10.15c
Attachment A to 00.10.15c Cast and Splint Applications and Associated Supplies Provided in the Office Setting
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00.10.17i
Modifier 66: Surgical Team
00.10.17i
Attachment A (Team Surgery Review Form) to 00.10.17i Modifier 66: Surgical Team
00.10.17i
Attachment B (Eligible Indicators 1 and 2 Procedure Codes) to 00.10.17i Modifier 66: Surgical Team
00.10.18k
Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
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00.10.36q
Radiologic Guidance of a Procedure
00.10.36q
Attachment A (Radiologic Guidance and Supervision and Interpretation Procedure Codes) to 00.10.36q Radiologic Guidance of a Procedure
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00.10.38a
Billing Requirements for Multiple Births for Professional Providers
00.10.38a
Attachment A (MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ROUTINE OBSTETRIC (GLOBALE MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED) to 00.10.38a Billing Requirements for Multiple Births for Professional Providers
00.10.38a
Attachment B (MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF TWINS WHEN ANETEPARTUM CARE IS NOT PROVIDED) to 00.10.38a Billing Requirements for Multiple Births for Professional Providers
00.10.38a
Attachment C (CODING SCENARIOS FOR REPORTING HIGH-ORDER MULTIPLE (TRIPLETS, QUADRUPLETS, ETC) BIRTHS WHEN ROUTINE OBSTETRIC (GLOBAL MATERNITY/OBSTETRIC [OB]) CARE WAS PROVIDED) to 00.10.38a Billing Requirements for Multiple Births for Professional Providers
00.10.38a
Attachment D (MULTIPLE BIRTH CODING SCENARIOS FOR DELIVERY OF HIGH-ORDER MULTIPLES WHEN ANTEPARTUM CARE IS NOT PROVIDED) to 00.10.38a Billing Requirements for Multiple Births for Professional Providers
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00.10.39l
Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
00.10.39l
Attachment A to 00.10.39l Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
00.10.40d
Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs)
01.00.09c
Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump
02.01.01d
Home Health Care Services
02.01.02c
Private Duty Nursing
02.02.01g
Hospice Care
03.00.02b
Modifier 76: Repeat Procedure or Service by Same Physician or Qualified Health Professional
03.00.05k
Modifier 50: Bilateral Procedure
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03.00.06r
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
03.00.06r
Attachment A (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.) to 03.00.06r 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
03.00.06r
Attachment B (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&M.) to 03.00.06r 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
03.00.08e
Modifiers XE, XS, XP, XU, and 59
03.00.11b
Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional
03.00.12f
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
03.00.15o
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
03.00.16o
Modifier 57 Decision for Surgery
03.00.20j
Modifiers 26 (Professional Component) and TC (Technical Component)
03.00.28m
Modifier 79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
03.00.31f
Modifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56)
03.00.32a
Modifier 52 Reduced Services
03.00.33a
Modifier 53 Discontinued Procedure
04.00.05d
Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth
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05.00.01l
Pneumatic Compression Therapy Devices
05.00.01l
Attachment A (ICD-10 Codes) to 05.00.01l Pneumatic Compression Therapy Devices
05.00.04e
Coverage of Medical Devices
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05.00.05l
Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes
05.00.05l
Attachment A (ICD 10 Codes) to 05.00.05l Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes
05.00.05l
Attachment B (HCPCS Codes) to 05.00.05l Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes
05.00.08e
Continuous Passive Motion (CPM) Devices in the Home Setting
05.00.09h
Electrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System
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05.00.11i
Therapeutic Shoes and Orthopedic Shoes
05.00.11i
Attachment A (ICD-10 Coding) to 05.00.11i Therapeutic Shoes and Orthopedic Shoes
05.00.12g
Manual Wheelchairs
05.00.14j
High-Frequency Chest Wall Oscillation Devices
05.00.15q
Nebulizers and Inhalation Solutions
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05.00.21u
Durable Medical Equipment (DME) and Consumable Medical Supplies
05.00.21u
Attachment A1 (Equipment that Meets the Definition of Durable Medical Equipment (DME)) to 05.00.21u Durable Medical Equipment (DME) and Consumable Medical Supplies
05.00.21u
Attachment A2 (Equipment that Meets the Definition of Durable Medical Equipment (DME)) to 05.00.21u Durable Medical Equipment (DME) and Consumable Medical Supplies
05.00.21u
Attachment B (Items that Do Not Meet the Definition of Durable Medical Equipment (DME)) to 05.00.21u Durable Medical Equipment (DME) and Consumable Medical Supplies
Hide details for
05.00.24q
Short-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)
05.00.24q
Attachment A (ICD-10 Diagnosis Codes for Short-term Interstitial Continuous Glucose Monitoring System) to 05.00.24q Short-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)
05.00.25i
Cranial Remolding Orthoses (Helmets)
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05.00.26i
Home Prothrombin Time Monitoring
05.00.26i
Attachment A (ICD-10-CODING) to 05.00.26i Home Prothrombin Time Monitoring
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05.00.29k
Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
05.00.29k
Attachment A (ICD-10 Codes used to represent the Wearable Automatic External Defibrillator (AED):) to 05.00.29k Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
05.00.29k
Attachment B (ICD-10 codes used to represent the Nonwearable Automatic External Defibrillator (AED):) to 05.00.29k Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
05.00.30m
Noninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices and Bi-Level Devices (AmeriHealth Adminstrators)
05.00.31e
Pulse Oximetry Devices in the Home Setting
05.00.32i
Speech and Non-Speech Generating Devices
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05.00.35f
Foot Orthotics and Other Podiatric Appliances
05.00.35f
Attachment A (ICD-10 Codes) to 05.00.35f Foot Orthotics and Other Podiatric Appliances
05.00.37f
Compression Garments
05.00.38j
Negative-Pressure Wound Therapy (NPWT) Systems
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05.00.39o
Ankle-Foot/Knee-Ankle-Foot Orthoses
05.00.39o
Attachment A (HCPCS Codes) to 05.00.39o Ankle-Foot/Knee-Ankle-Foot Orthoses
05.00.42g
Patient Lifts
05.00.43f
Seat Lift Mechanisms
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05.00.44k
Repair and Replacement of Durable Medical Equipment (DME)
05.00.44k
Attachment A (HCPCS Codes For Repair and Replacment DME) to 05.00.44k Repair and Replacement of Durable Medical Equipment (DME)
05.00.45k
Repair or Replacement of an External Prosthetic Device
05.00.47n
Knee Orthoses
05.00.48j
Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum
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05.00.50k
Ostomy Supplies
05.00.50k
Attachment A (HCPCS Codes for Ostomy Supplies) to 05.00.50k Ostomy Supplies
05.00.54g
Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices
05.00.55i
Wheelchair Cushions and Seating
05.00.56i
Hospital Beds and Accessories
05.00.58l
Home Oxygen Therapy
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05.00.59j
Lower Limb Prostheses
05.00.59j
Attachment A (HCPCS Level II Code Number(s) and Narrative(s)) to 05.00.59j Lower Limb Prostheses
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05.00.60h
Pressure-Reducing Support Surfaces
05.00.60h
Attachment A (ICD-10 Codes) to 05.00.60h Pressure-Reducing Support Surfaces
05.00.61f
Cervical Traction Devices for In-home Use
05.00.62h
Injectable Dermal Fillers
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05.00.67p
Wheelchair Options and Accessories
05.00.67p
Attachment A (HCPCS Level II Codes For Wheelchair Options And Accessories) to 05.00.67p Wheelchair Options and Accessories
05.00.69b
Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)
05.00.70b
Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures
05.00.71c
Standing Frames
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05.00.72f
Upper Limb Prostheses
05.00.72f
Attachment A (HCPCS Codes) to 05.00.72f Upper Limb Prostheses
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05.00.73c
Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
05.00.73c
Attachment A (ICD 10 Codes) to 05.00.73c Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
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05.00.74d
Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
05.00.74d
Attachment A (ICD 10 Codes) to 05.00.74d Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
05.00.75
Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
05.00.76c
Breast Pumps
05.00.77a
Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia
05.00.78
Transtympanic Micropressure Device as a Treatment of Meniere's Disease
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05.00.79b
Insulin Pumps and Long term Interstitial Continuous Glucose Monitoring Systems
05.00.79b
Attachment A (ICD-10 Diagnosis Codes for Insulin Pumps) to 05.00.79b Insulin Pumps and Long term Interstitial Continuous Glucose Monitoring Systems
05.00.79b
Attachment B (ICD-10 Diagnosis Codes for the CGM supplies used in conjunction with the threshold suspend (low glucose) device system ) to 05.00.79b Insulin Pumps and Long term Interstitial Continuous Glucose Monitoring Systems
05.00.80a
Cranial Electrotherapy Stimulation
06.02.01j
Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy
06.02.04d
Fetal Fibronectin Enzyme (fFN) Immunoassay
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06.02.06q
Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (AmeriHealth Administrators)
06.02.06q
Attachment A (ICD-10 codes) to 06.02.06q Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (AmeriHealth Administrators)
06.02.09g
Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (AmeriHealth Administrators)
06.02.10q
Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (AmeriHealth Administrators)
06.02.14i
In Vitro Chemosensitivity and Chemoresistance Assays
06.02.17h
Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
06.02.18l
Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (AmeriHealth Administrators)
06.02.24j
Preimplantation Genetic Testing (AmeriHealth Administrators)
06.02.26d
In Vitro Allergy Testing
06.02.27l
Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (AmeriHealth Administrators)