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eaee22e2-f496-4e36-b849-7ff5bc066272.aspx
  
4301PsychiatricCollaborativeCareManagement(CoCM)(AmeriHealth)00.01.70Administrative (00)00.01.7000.01.70Psychiatric Collaborative Care Management (CoCM) (AmeriHealth)Psychiatric Collaborative Care Management (CoCM) (AmeriHealth)4/29/2022 11:00 AMeaee22e2-f496-4e36-b849-7ff5bc066272
5/30/2022
1002e8fe-a49d-49be-8dbd-c619d51b0916.aspx
  
4268TelemedicineServices00.10.41jAdministrative (00)00.10.41j00.10.41Telemedicine ServicesTelemedicine Services3/1/2022 9:00 AM1002e8fe-a49d-49be-8dbd-c619d51b0916
6/1/2022
88ca9862-7373-4145-85c3-3e1ab29f765f.aspx
  
4105IntravenousKetamine(Ketalar®)andIntranasalEsketamine(Spravato®)08.01.80Pharmacy (08)08.01.8008.01.80Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)2/25/2022 1:00 PM88ca9862-7373-4145-85c3-3e1ab29f765f
6/6/2022
ce021563-7a1d-4749-9323-a9c1bdc6c5e0.aspx
  
4169ProtonBeamRadiationTherapy09.00.49mRadiology (09)09.00.49m09.00.49Proton Beam Radiation TherapyProton Beam Radiation Therapy4/6/2022 10:00 AMce021563-7a1d-4749-9323-a9c1bdc6c5e0
{"4170": {"Id":4170,"MPAttachmentLetter":"A","Title":"MEDICALLY NECESSARY ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":6030,"PolicyAttachmentPageName":"ab936509-ae2d-4c04-876d-4bbb10c8dbd3"},"4171": {"Id":4171,"MPAttachmentLetter":"B","Title":"NOT MEDICALLY NECESSARY ICD-10 Diagnosis Codes","MPPolicyAttachmentInternalSourceId":6186,"PolicyAttachmentPageName":"9361cc23-a3a8-4141-8d28-add143d5b403"},}
7/5/2022
3ae85f92-c6af-41cc-9e35-536bb22f2d38.aspx
  
4190SelectivePhotothermolysisUsingPulsed-DyeLasers(PDL)11.08.04iSurgery (11)11.08.04i11.08.04Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)4/11/2022 10:00 AM3ae85f92-c6af-41cc-9e35-536bb22f2d38
7/11/2022
102d2dc1-cff5-448c-a1b2-28f48b900cc6.aspx
  
4192Stem-CellTherapy/Platelet-RichPlasmaforOrthopedicApplicationsand​Platelet-RichPlasma/Platelet-DerivedGrowthFactorforWoundHealingandOtherMiscellaneousNon-OrthopedicConditions07.07.09iMedicine (07)07.07.09i07.07.09Stem-Cell Therapy/Platelet-Rich Plasma for Orthopedic Applications and ​Platelet-Rich Plasma/Platelet-Derived Growth Factor for Wound Healing and Other Miscellaneous Non-Orthopedic ConditionsStem-Cell Therapy/Platelet-Rich Plasma for Orthopedic Applications and ​Platelet-Rich Plasma/Platelet-Derived Growth Factor for Wound Healing and Other Miscellaneous Non-Orthopedic Conditions4/11/2022 12:00 PM102d2dc1-cff5-448c-a1b2-28f48b900cc6
7/11/2022