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159 Gene Therapies for Bladder Cancer.pdf243.72 KB
… Authorization Information • Policy History Policy Number: 159 BCBSA Reference Number: N/A NCD/LCD: N/A Related Policies … … 6961 … Treatments … 06/08/2023 … 159 … application/pdf …
072 Outpatient Prior Authorization Code List prn.pdf546.57 KB
… see policy 158 Prior authorization is required; in effect 159 Gene Therapies for Bladder Cancer Complete Prior … Manager All commercial products For CPT codes see policy 159. Prior authorization is required. Effective 6.8.2023. 168 … al-policies/sites/g/files/csphws2091/files/acquiadam-assets/159%20Gene%20Therapies%20for%20Bladder%20Cancer.pdf …
930 Carelon Abdomen and Pelvic Imaging CPT and Diagnoses Codes prn.pdf6.65 MB
… left pubis subsequent encounter for fracture with nonunion 159 S32.512S Fracture of superior rim of left pubis sequela … right thigh M60.152 Interstitial myositis left thigh M60.159 Interstitial myositis unspecified thigh M60.161 … femur M87.152 Osteonecrosis due to drugs left femur M87.159 Osteonecrosis due to drugs unspecified femur M87.250 …
931 Carelon Brain Imaging CPT and Diagnoses Codes prn.pdf3.06 MB
… hemorrhage affecting left non-dominant side I69.159 Hemiplegia and hemiparesis following nontraumatic … hemorrhage affecting left non-dominant side I69.159 Hemiplegia and hemiparesis following nontraumatic … sensation R20.9 Unspecified disturbances of skin sensation 159 R22.0 Localized swelling mass and lump head R22.1 …
933 Carelon Extremity Imaging CPT and Diagnoses Codes prn.pdf7.35 MB
… Initial Encounter For Open Fracture Type Iiia Iiib Or Iiic 159 S52.345D Nondisplaced Spiral Fracture Of Shaft Of Radius …
934 Carelon Head and Neck Imaging CPT and Diagnoses Codes prn.pdf4.29 MB
… lacrimal gland atrophy bilateral lacrimal glands H04.159 Secondary lacrimal gland atrophy unspecified lacrimal … right hip M00.152 Pneumococcal arthritis left hip M00.159 Pneumococcal arthritis unspecified hip M00.161 … hemorrhage affecting left non-dominant side 135 I69.159 Hemiplegia and hemiparesis following nontraumatic …
935 Carelon Spine Imaging CPT and Diagnoses Codes prn.pdf4.3 MB
… cervical vertebra initial encounter for open fracture 159 S12.591D Other nondisplaced fracture of sixth cervical …
936 Carelon Vascular Imaging CPT and Diagnoses Codes prn.pdf2.47 MB
… greater saphenous vein at lower leg level left leg sequela 159 S85.399A Other specified injury of greater saphenous vein …
411 Directory of Documents.pdf559.77 KB
… Stimulation 636 Gene Therapies for Bladder Cancer 159 Hematopoietic Cell Transplantation for Acute Myeloid … al-policies/sites/g/files/csphws2091/files/acquiadam-assets/159%20Gene%20Therapies%20for%20Bladder%20Cancer.pdf …
132 Medicare Advantage Management.pdf810.79 KB
… Shield of Massachusetts Pre-certification Request Form MP 159 Gene Therapies for Bladder Cancer No LCD or NCD BCBSMA … 0367U from MP #400 and transferred to MP #165. 7/2023 MP #159 Gene Therapies for Bladder Cancer added. Effective …