Commercial
  
  
  
  
  
  
  
  
  
  
  
MPattachmentdataPub
  
a48da5cb-7f96-424e-a1d4-d50900588b04.aspx
  
3043Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion PumpAnesthesia (01)01.00.09c01.00.09Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion PumpContinuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump2/26/2021 1:00 PMa48da5cb-7f96-424e-a1d4-d50900588b04
0b8ad072-82e6-43cb-adf1-6c467360dc5c.aspx
  
3028ManualWheelchairs05.00.12hDME (05)05.00.12h05.00.12Manual WheelchairsManual Wheelchairs1/29/2021 12:00 PM0b8ad072-82e6-43cb-adf1-6c467360dc5c
3/1/2021
81f2e063-bd7f-450c-b183-bab407f6fd3f.aspx
  
2756Tocilizumab(Actemra®)forIntravenousInfusion08.00.85kPharmacy (08)08.00.85k08.00.85Tocilizumab (Actemra®) for Intravenous InfusionTocilizumab (Actemra®) for Intravenous Infusion12/8/2020 1:00 PM81f2e063-bd7f-450c-b183-bab407f6fd3f
{"2757": {"Id":2757,"MPAttachmentLetter":"A","Title":"ICD-10 CODES AND NARRATIVES","MPPolicyAttachmentInternalSourceId":4965,"PolicyAttachmentPageName":"de3712f3-bec1-4146-91ec-6f7823201a0f"},}
3/8/2021
79bf2ea2-c896-4994-80c0-11bbe740ef0a.aspx
  
2758Abatacept(Orencia®)forInjectionforIntravenousUse08.00.62lPharmacy (08)08.00.62l08.00.62Abatacept (Orencia®) for Injection for Intravenous UseAbatacept (Orencia®) for Injection for Intravenous Use12/8/2020 1:00 PM79bf2ea2-c896-4994-80c0-11bbe740ef0a
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3/8/2021
3407472f-b4f3-4c34-bd0b-b15d4f3122dc.aspx
  
2760Gonadotropin-ReleasingHormoneAgonist(Eligard®,Fensolvi®,LupronDepot®)08.01.33cPharmacy (08)08.01.33c08.01.33Gonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)Gonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)12/8/2020 1:00 PM3407472f-b4f3-4c34-bd0b-b15d4f3122dc
3/8/2021
8be8052f-8396-4cc1-a49c-a7621fffd6c3.aspx
  
2762PercutaneousCoronaryIntervention,CoronaryAngiographyandArterialUltrasound(AmeriHealth)11.02.27dSurgery (11)11.02.27d11.02.27Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound  (AmeriHealth)Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound (AmeriHealth)12/14/2020 2:00 PM8be8052f-8396-4cc1-a49c-a7621fffd6c3
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3/14/2021
35ee788d-90b0-4ece-8c3f-3cad8fadbbb2.aspx
  
2767High-TechnologyRadiologyServices (AmeriHealth)09.00.46afRadiology (09)09.00.46af09.00.46High-Technology Radiology Services (AmeriHealth)High-Technology Radiology Services (AmeriHealth)12/14/2020 3:00 PM35ee788d-90b0-4ece-8c3f-3cad8fadbbb2
{"2768": {"Id":2768,"MPAttachmentLetter":"A","Title":"High-Technology Radiology Services Code List","MPPolicyAttachmentInternalSourceId":4917,"PolicyAttachmentPageName":"ab191246-9c1f-4a64-810d-c093b902f852"},}
3/14/2021
669b30f4-35c7-4558-ab93-365ebea4d76a.aspx
  
3035KneeOrthoses05.00.47oDME (05)05.00.47o05.00.47Knee OrthosesKnee Orthoses2/12/2021 2:00 PM669b30f4-35c7-4558-ab93-365ebea4d76a
3/15/2021
464d9193-412e-43cb-8a79-49a9bf86c7e6.aspx
  
2822SubcutaneousImplantableCardioverterDefibrillator(S-ICD)forTreatingLife-threateningVentricularTachyarrhythmia05.00.77bDME (05)05.00.77b05.00.77Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular TachyarrhythmiaSubcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia12/22/2020 11:00 AM464d9193-412e-43cb-8a79-49a9bf86c7e6
3/22/2021
57c6264d-c49a-4d42-9b81-50b4a19a7f50.aspx
  
3023ModifiersforAssistant-at-SurgeryServices:80,81,82,andAS00.10.18nAdministrative (00)00.10.18n00.10.18Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and ASModifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS12/29/2020 12:00 AM57c6264d-c49a-4d42-9b81-50b4a19a7f50
3/29/2021
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