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4bb5c8fa-bd35-42b0-92e7-c71eba076042.aspx
  
6996IntravitrealInjectionofVascularEndothelialGrowthFactor(VEGF)Antagonists,VEGFBiosimilars,andCombinationVEGF/Angiopoietin-2(Ang-2)Inhibitors08.00.74xPharmacy (08)08.00.74x08.00.74Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) InhibitorsIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors10/8/2024 9:00 AM4bb5c8fa-bd35-42b0-92e7-c71eba076042
1/1/2025
32249dbd-664a-477d-acf0-5bde2ebed298.aspx
  
7000Tofersen(Qalsody®)08.02.06bPharmacy (08)08.02.06b08.02.06Tofersen (Qalsody®)Tofersen (Qalsody®)12/2/2024 9:00 AM32249dbd-664a-477d-acf0-5bde2ebed298
1/1/2025
8db1b232-026d-453f-8459-11c4890b6248.aspx
  
7009MedicalNutritionTherapy(MNT)/NutritionCounseling10.00.04Rehabilitation Services (10)10.00.0410.00.04Medical Nutrition Therapy (MNT)/Nutrition CounselingMedical Nutrition Therapy (MNT)/Nutrition Counseling12/2/2024 2:00 PM8db1b232-026d-453f-8459-11c4890b6248
1/1/2025
63af902b-5e9c-464e-a436-9d72295cf4f6.aspx
  
7013Drugs,Biologics,orGeneTherapieswithanAcceleratedApproval08.02.35Pharmacy (08)08.02.3508.02.35Drugs, Biologics, or Gene Therapies with an Accelerated ApprovalDrugs, Biologics, or Gene Therapies with an Accelerated Approval12/2/2024 2:00 PM63af902b-5e9c-464e-a436-9d72295cf4f6
1/1/2025
949137db-65ac-4593-bcf6-ea89133d52e8.aspx
  
7014MonoclonalAntibodiesDirectedAgainstAmyloidfortheTreatmentofAlzheimerDisease08.01.93ePharmacy (08)08.01.93e08.01.93Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer DiseaseMonoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer Disease12/2/2024 3:00 PM949137db-65ac-4593-bcf6-ea89133d52e8
1/1/2025
24ab7da0-600d-4928-b783-054e2443cd9b.aspx
  
7015ExonSkippingDrugsforDuchenneMuscularDystrophy(DMD)(Eteplirsen(Exondys51),Golodirsen(Vyondys53),Viltolarsen(Viltepso)),Casimersen(Amondys45)08.01.34dPharmacy (08)08.01.34d08.01.34Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)12/2/2024 3:00 PM24ab7da0-600d-4928-b783-054e2443cd9b
1/1/2025
a4c01a68-6969-4746-acf8-f32fc99b1137.aspx
  
7017eviCoreLabManagement(AmeriHealth)06.02.52aiPathology and Laboratory (06)06.02.52ai06.02.52eviCore Lab Management (AmeriHealth)eviCore Lab Management (AmeriHealth)12/2/2024 5:00 PMa4c01a68-6969-4746-acf8-f32fc99b1137
{"7018": {"Id":7018,"MPAttachmentLetter":"B","Title":"Procedure Codes Requiring Prepayment Reviews","MPPolicyAttachmentInternalSourceId":9318,"PolicyAttachmentPageName":"aa8d04fd-dbbc-46db-a1df-f1407127acb7"},"7019": {"Id":7019,"MPAttachmentLetter":"A","Title":"Procedure Codes Requiring Pre-service and Prepayment Reviews","MPPolicyAttachmentInternalSourceId":9319,"PolicyAttachmentPageName":"5c78cced-2085-4f12-a45f-9cce43b47d5e"},}
1/1/2025
6068d1a7-be80-4234-a86b-837838b2cc1f.aspx
  
7020TotalParenteralNutrition(TPN)/IntradialyticParenteralNutrition(IDPN)/IntraperitonealParenteralNutrition(IPN)08.00.17kPharmacy (08)08.00.17k08.00.17Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)12/3/2024 9:00 AM6068d1a7-be80-4234-a86b-837838b2cc1f
1/1/2025
1bb6839b-1e1b-4642-bddf-6aa6ade77ae4.aspx
  
7021Casgevy™(exagamglogeneautotemcel)08.02.14Pharmacy (08)08.02.1408.02.14Casgevy™ (exagamglogene autotemcel)Casgevy™ (exagamglogene autotemcel)12/3/2024 11:00 AM1bb6839b-1e1b-4642-bddf-6aa6ade77ae4
1/1/2025
c1b7e814-6981-48e0-9ed9-ce4d1c7a85fd.aspx
  
7022Lovotibeglogeneautotemcel(Lyfgenia®)08.02.15Pharmacy (08)08.02.1508.02.15Lovotibeglogene autotemcel (Lyfgenia®)Lovotibeglogene autotemcel (Lyfgenia®)12/3/2024 11:00 AMc1b7e814-6981-48e0-9ed9-ce4d1c7a85fd
1/1/2025
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