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3f223e2e-8b21-479a-bb77-5c350f2780f1.aspx
  
5626Abatacept(Orencia®)forInjectionforIntravenousUse08.00.62pPharmacy (08)08.00.62p08.00.62Abatacept (Orencia®) for Injection for Intravenous UseAbatacept (Orencia®) for Injection for Intravenous Use9/12/2023 11:00 AM3f223e2e-8b21-479a-bb77-5c350f2780f1
{"5627": {"Id":5627,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":7512,"PolicyAttachmentPageName":"49fc5dbf-d8fb-4372-874b-0d7bf976dcf2"},}
12/11/2023
42955b78-39ba-4b98-a299-2ec3d7bae7ce.aspx
  
5943PreventiveCareServices00.06.02aoAdministrative (00)00.06.02ao00.06.02Preventive Care ServicesPreventive Care Services10/3/2023 10:00 AM42955b78-39ba-4b98-a299-2ec3d7bae7ce
{"5944": {"Id":5944,"MPAttachmentLetter":"D","Title":"ADDITIONAL PREVENTIVE SERVICES FOR MEMBERS ENROLLED IN NJ PLANS","MPPolicyAttachmentInternalSourceId":7516,"PolicyAttachmentPageName":"d8cfae31-5dbc-4891-93d8-bf50c8979eeb"},"5945": {"Id":5945,"MPAttachmentLetter":"C","Title":"Pediatric Preventive Care Services","MPPolicyAttachmentInternalSourceId":7518,"PolicyAttachmentPageName":"7df7473e-1bcf-4cd5-abc4-05f08aa589ed"},"5946": {"Id":5946,"MPAttachmentLetter":"A","Title":"Adult Preventive Services","MPPolicyAttachmentInternalSourceId":7519,"PolicyAttachmentPageName":"15caa50e-fed9-45da-9fb3-7d345fddf81f"},"5947": {"Id":5947,"MPAttachmentLetter":"B","Title":"Female Preventive Care Services","MPPolicyAttachmentInternalSourceId":7520,"PolicyAttachmentPageName":"cbfd28d7-4853-480d-9d55-2da09b7a2f54"},}
1/1/2024
bb577318-153e-4e7b-b6da-b75f12848058.aspx
  
5675NebulizersandInhalationSolutions05.00.15tDME (05)05.00.15t05.00.15Nebulizers and Inhalation SolutionsNebulizers and Inhalation Solutions9/29/2023 11:00 AMbb577318-153e-4e7b-b6da-b75f12848058
1/1/2024
17629095-8a76-49df-a82f-0e3eaec03467.aspx
  
5848WoundCare:SkinSubstitutesfortheTreatmentofBurnsandChronic,Non-HealingWounds11.08.20aiSurgery (11)11.08.20ai11.08.20Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing WoundsWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds10/20/2023 2:00 PM17629095-8a76-49df-a82f-0e3eaec03467
{"5849": {"Id":5849,"MPAttachmentLetter":"A","Title":"Skin substitutes and their approved indications.","MPPolicyAttachmentInternalSourceId":7789,"PolicyAttachmentPageName":"e810b192-a629-4e84-8d76-ee3ea75d66a0"},}
1/1/2024
b933746c-ef68-4dbc-a61a-b25ea704a4dd.aspx
  
5934Edaravone(Radicava®)08.01.42aPharmacy (08)08.01.42a08.01.42Edaravone (Radicava®)Edaravone (Radicava®)11/15/2023 9:00 AMb933746c-ef68-4dbc-a61a-b25ea704a4dd
1/2/2024
9bc18481-522a-4ddf-b0c8-c24019878db2.aspx
  
5935Bortezomib(BortezomibforInjection,Velcade®)08.00.73pPharmacy (08)08.00.73p08.00.73Bortezomib (Bortezomib for Injection, Velcade®)Bortezomib (Bortezomib for Injection, Velcade®)11/15/2023 9:00 AM9bc18481-522a-4ddf-b0c8-c24019878db2
{"5936": {"Id":5936,"MPAttachmentLetter":"A","Title":"ICD-10 Codes and Narratives","MPPolicyAttachmentInternalSourceId":7708,"PolicyAttachmentPageName":"ff1f4e7c-d484-46e0-ad78-45083dbb5612"},}
1/2/2024
a32cd836-ce84-448b-b102-a5760f4dcf34.aspx
  
5868NegativePressureWoundTherapySystems05.00.38mDME (05)05.00.38m05.00.38Negative Pressure Wound Therapy SystemsNegative Pressure Wound Therapy Systems10/24/2023 12:00 PMa32cd836-ce84-448b-b102-a5760f4dcf34
1/22/2024