DOCSLIB.ORG

MAP Preauthorization List EFF: 8/1/2017 (Updated 8/24/17)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
MAP Preauthorization List EFF: 8/1/2017 (Updated 8/24/17) MAP Preauthorization List EFF: 8/1/2017 (Updated 8/24/17) CPT, HCPCS Description Comment or Revenue Code Revenue Codes 0100 All inclusive room and board plus ancillary 0101 All inclusive room and board 0110 Room and Board Private (one bed) 0111 Room and Board Private (one bed) - Medical/Surgical/GYN 0113 Room and Board Private (one bed) - Pediatric 0117 Room and Board Private (one bed) - Oncology 0118 Room and Board Private (one bed) - Rehab 0119 Room and Board Private (one bed) - Other 0121 Room and Board Semiprivate (two beds) - Medical/Surgical/GYN 0123 Room and Board Semiprivate (two beds) - Pediatric 0127 Room and Board Semiprivate (two beds) - Oncology 0128 Level 1 Rehab 0129 Level 2 Rehab - acute complex 0130 Room & Board - Three and Four Beds General Classification 0131 Room & Board - Three and Four Beds Medical/Surgical/Gyn 0133 Room & Board - Three and Four Beds Pediatric 0137 Room & Board - Three and Four Beds Oncology 0138 Room & Board - Three and Four Beds Rehabilitation 0139 Room & Board - Three and Four Beds Other 0140 Room & Board - Deluxe Private General Classification 0141 Room & Board - Deluxe Private Medical/Surgical/Gyn 0143 Room & Board - Deluxe Private Pediatric 0147 Room & Board - Deluxe Private Oncology 0148 Room & Board - Deluxe Private Rehabilitation 0149 Room & Board - Deluxe Private Other 0150 Room & Board - Ward General Classification 0151 Room & Board - Ward Medical/Surgical/Gyn 0153 Room & Board - Ward Pediatric 0157 Room & Board - Ward Oncology 0158 Room & Board - Ward Rehabilitation 0159 Room & Board - Ward Other 0160 Room & Board - Other General Classification 0164 Other Room & Board - Sterile Environment 0167 Room & Board - Other Self Care 0169 Room & Board - Other Other 0190 General classification - SNF 0191 Subacute Care - Level I - SNF 0192 Subacute Care - Level II - SNF 0193 Subacute Care - Level III - SNF 0194 Subacute Care - Level IV - SNF 0199 Other Subacute Care - SNF 0413 Hyperbaric Oxygen Therapy outpatient revenue code CPT Codes 00902 Exam Under Anesthesia 00170 Anesthesia for intraoral treatments, including biopsy; not otherwise 01999 Unlistedspecified anesthesia procedure(s) Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) 11008 (List separately in addition to code for primary procedure) Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and 11010 subcutaneous tissues Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, 11011 subcutaneous tissue, muscle fascia, and muscle Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, 11012 subcutaneous tissue, muscle fascia, muscle, and bone 11040 Debridement; skin, partial thickness 11041 Debridement; skin, full thickness Debridement, bone (includes epidermis, dermis, subcutaneous tissue, 11044 muscle and/or fascia, if performed); first 20 sq cm or less Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part 11047 thereof (List separately in addition to code for primary procedure) 11920 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less 11921 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 11960 Insertion of tissue expanders for other than breast 11970 Replacement of tissue expander with permanent prosthesis 11971 Removal of tissue expander(s) without insertion of prosthesis 14000 Adjacent tissue transfer or rearrangement, truck; defect 10 sq cm or less 14001 Adjacent tissue transfer or rearrangement, trunk, defect 10.1 sq cm to 30.0 sq cm 14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less 14061 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm 14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm 14302 Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 15004 1% of body area of infants and children Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants 15005 and children (List separately in addition to code for primary procedure) 15040 Harvest of skin for tissue cultured skin autograft, 100 sq cm or less 15050 Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameter 15100 Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) 15101 Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) 15110 Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children 15111 Epidermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) 15115 Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children 15116 Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) 15120 Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) 15121 Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) 15130 Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children 15131 Dermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) 15135 Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children 15136 Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) 15150 Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less 15151 Tissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm to 75 15152 Tissuesq cm cultured skin autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part 15155 Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less 15156 Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; additional 1 sq cm to 15157 Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part 15200 Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less 15201 Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 15220 Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less 15221 Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 15240 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less 15241 Full thickness graft, free, including direct closure of donor site,
Load more

Recommended publications
  • Procedure Code List Effective Jan. 1, 2020 for Preauthorization for Blue Cross and Blue Shield of New Mexico Medicare Advantage Members Only
    Procedure Code List Effective Jan. 1, 2020 for Preauthorization for Blue Cross and Blue Shield of New Mexico Medicare Advantage Members only Beginning Jan. 1, 2020, providers will be required to obtain preauthorization through Blue Cross and Blue Shield of New Mexico (BCBSNM), Optum, or eviCore for certain procedures for Blue Cross Medicare Advantage members as noted in the MAPD Benefit Preauthorization Procedure Code List, Effective 1/1/2020, below. For members NOT attributed to Optum, preauthorization should be obtained from BCBSNM unless the applicable entry in the MAPD Benefit Preauthorization Procedure Code List references eviCore. For members attributed to Optum, preauthorization should be obtained from Optum, even if the applicable entry in the MAPD Benefit Preauthorization Procedure Code List references eviCore. Any entry that references eviCore should be preauthorized through eviCore except for members attributed to Optum. The member's ID Card will indicate that the member is attributed to Optum. Services performed without benefit preauthorization may be denied for payment in whole or in part, and you may not seek reimbursement from members. Member eligibility and benefits should be checked prior to every scheduled appointment. Eligibility and benefit quotes include membership status, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. It is strongly recommended that providers ask to see the member's ID card for current information and a photo ID to guard against medical identity theft. A referral to an out-of-plan or out-of-network provider which is necessary due to network inadequacy or continuity of care must be reviewed by the BCBSNM Utilization Management or DMG (if the member is attributed to DMG this information will be reflected on the ID card) prior to a BCBSNM patient receiving care.
    [Show full text]
  • Frequently Asked Questions (Faqs)
    Frequently Asked Questions (FAQs) What is hyperbaric oxygen therapy? Commonly referred to as HBOT, hyperbaric oxygen therapy enhances the body’s natural healing process by delivering oxygen under pressure, which increases the oxygen content in the blood, plasma, cerebral spinal fluid, and other body tissues. There are two basic types of HBOT—hard HBOT and mild HBOT. With hard HBOT, treatments are delivered in a hard-sided chamber typically at pressures greater than 1.5 ATA and using 100% oxygen. 100% oxygen is extremely flammable; therefore, hard HBOT involves managing the risk of explosion. Another concern with hard HBOT is oxygen toxicity. While hard HBOT with 100% oxygen results in greater oxygen saturation in the tissues, many conditions respond better to mild HBOT. In clinical trials to date, there has been virtually no difference in clinical outcome between mild HBOT and hard HBOT. Mild HBOT refers to hyperbaric oxygen therapy at lower pressures, typically 1.5 ATA or below, and the use of an oxygen concentrator delivering 90-95% oxygen inside a portable soft-sided chamber. Mild HBOT has no known safety risks with fire or toxicity, and it is substantially less expensive. Our facility provides concentrated oxygen (90-95%) at 1.3 ATA—(Mild HBOT)a highly effective combination clinically, and without the risk of oxygen toxicity or explosion, as 100% oxygen is avoided. How should I expect mild HBOT to feel? You will be seated or lying down inside the chamber, relaxing comfortably in your own clothing, as you breathe concentrated oxygen (90-95% O2) through a facemask.
    [Show full text]
  • Stratus 5 Oxygen Concentrator User Manual
    USER MANUAL OXYGEN CONCENTRATOR CE 0123 v2.1 STR1005 User Manual Symbol Key MARK DEFINITION II Power on Power off Follow Instruction for Use No smoking Caution, consult accompanying documents. Class Ⅱ (Double Insulated) Type BF Applied Part CE certification mark 0123 AC Power Stacking Limit by Number This Way Up Fragile, handle with care Keep dry Temperature limit No open flames IIPP2211 IP21 Drip Proof Equipment Consult instructions for use Stand-by Warning, electricity 2 v2.1 STR1005 User Manual 3 v2.1 STR1005 User Manual SPECIAL NOTES • Please read this manual carefully before using this product and save it for future reference. • If you need assistance with this manual, Please contact your local DME or home health provider • The Stratus 5 is a prescription device. Use only the liter setting prescribed for you. • It is always recommended for critically ill patients to have a backup oxygen source in case of malfunction. • If patient experiences an adverse reaction contact physician or call 911 immediately. • In case of machine malfunction, contact the home medical equipment provider; do not attempt to disassemble the Stratus 5. • The Stratus 5 is not intended as life support, it is for supplemental oxygen use only. Patients with special needs may be unable to understand the alarm features and should be well supervised while using an oxygen concentrator. • The Stratus 5 is for single patient use. • Do not adjust the flowmeter float beyond the red line position. Long-term use out of range will reduce the efficiency of the oxygen generator. SAFETY NOTICE Please read the following information carefully before Operating the oxygen concentrator Warning Special attention should be paid to reducing the risk of fire when using oxygen therapy.
    [Show full text]
  • PT/OT Therapy Intake Form Required for All MSK Conditions (Including Hand) Please Use This Fax Form for NON-URGENT Requests Only
    Musculoskeletal Program: PT/OT Therapy Intake Form Required for all MSK Conditions (Including Hand) Please use this fax form for NON-URGENT requests only. Failure to provide all relevant information may delay the determination. Phone and fax numbers may be found on eviCore.com under the Guidelines and Forms section. You may also log into the provider portal located on the site to submit an authorization request. URGENT (same day) REQUESTS MUST BE SUBMITTED BY PHONE Previous Reference/Auth Number (If Continued Care): Date of Submission: Place of Service: ****** Note: This is REQUIRED for WellCare Submissions ******* Service Type Requested: Physical Therapy Occupational Therapy First Name: MI: Last Name: Member ID: DOB (mm/dd/yyyy): Gender: Male Female Street Address: Apt #: City: State: Zip: PATIENT Home Phone: Cell Phone: Primary: Home Cell Member Health Plan/Insurer: First Name: Last Name: Primary Specialty: TIN: NPI: Physician Phone: Physician Fax: Address: Suite #: City: State: Zip: PROVIDER Office Contact: Ext: Email: Diagnoses: Code Description Code Description Start Date for this Request: This is a (select the most appropriate): New condition not previously treated Same/previous condition Date of initial evaluation: Date of onset of condition: Date of current findings: Primary Treatment Area: Spine: Cervical / Upper Thoracic Lower Thoracic / Lumbar / Pelvis Upper Extremity: Shoulder / Arm Elbow / Wrist / Forearm Hand Lower Extremity: Hip / Thigh Knee Ankle / Foot Other: Pelvic Pain / Incontinence Secondary Treatment Area: Spine:
    [Show full text]
  • 114.3 Cmr: Division of Health Care Finance and Policy Ambulatory Care
    114.3 CMR: DIVISION OF HEALTH CARE FINANCE AND POLICY AMBULATORY CARE 114.3 CMR 40.00: RATES FOR SERVICES UNDER M.G.L. c. 152, WORKERS’ COMPENSATION ACT Section 40.01: General Provisions 40.02: General Definitions 40.03: Service and Rate Coverage Provisions 40.04: Provisions Affecting Eligible Providers 40.05: Policies for Individual Service Types 40.06: Fees 40.07: Appendices 40.08: Severability 40.01: General Provisions (1) Scope, Purpose and Effective Date. 114.3 CMR 40.00 governs the payment rates effective April 1, 2009 for purchasers of health care services under M.G.L. c. 152, the Workers’ Compensation Act. Payment rates for services provided by hospitals are set forth in 114.1 CMR 41.00. Program policies relating to medical necessity and clinical appropriateness are determined pursuant to M.G.L. c. 152 and 452 CMR 6.00. (2) Coverage. The payment rates set forth in 114.3 CMR 40.06 are full payment for services provided under M.G.L. c. 152, § 13, including any related administrative or overhead costs. The insurer, employer and health care service provider may agree upon a different payment rate for any service set forth in the fee schedule in 114.3 CMR 40.00. No employee may be held liable for the payment for health care services determined compensable under M.G.L. c. 152, § 13. (3) Administrative Bulletins. The Division may issue administrative bulletins to clarify substantive provisions of 114.3 CMR 40.00, or to publish procedure code updates and corrections. For coding updates and correction, the bulletin will list: (a) new code numbers for existing codes, with the corresponding cross references between existing and new codes numbers; (b) deleted codes for which there are no corresponding new codes; and (c) codes for entirely new services that require pricing.
    [Show full text]
  • Artificial Finger Joint Replacement Due to a Giant Cell Tumor of the Tendon Sheath with Bone Destruction: a Case Report
    3502 ONCOLOGY LETTERS 10: 3502-3504, 2015 Artificial finger joint replacement due to a giant cell tumor of the tendon sheath with bone destruction: A case report HUI LU, HUI SHEN, QIANG CHEN, XIANG-QIAN SHEN and SHOU-CHENG WU Department of Hand Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China Received October 24, 2014; Accepted September 25, 2015 DOI: 10.3892/ol.2015.3813 Abstract. The current study presents the case of a 25-year-old excised completely and the function of the joints was recov- male who developed tumor recurrence of the proximal ered. phalange of the ring finger on the right hand 4 years after partial tumor resection surgery. An X-ray of the right hand Case report showed that the distal bone of the proximal phalange on the ring finger was destroyed. An artificial finger joint replace- A 25-year-old male was admitted to The First Affiliated ment was performed using a silicone joint for this unusual Hospital, College of Meicine, ZheJiang University (Hangzhou, tumor recurrence. The pathological findings were indicative of Zhejiang, China) with tumor recurrence of the proximal a giant cell tumor of the tendon sheath. As a result of surgery, phalange of the ring finger on the right hand 4 years after the patient's proximal interphalangeal point motion recovered partial tumor resection surgery. The patient had no history to the pre-operative level. The pre-operative and post-operative of trauma or infection and was previously healthy. A physical disabilities of the arm, at shoulder and hand and total activity examination revealed swelling of the proximal phalange of the measurement values were 1.67 and 3.33, and 255 and 243˚, finger without clear cause, multiple nodules in the local areas respectively.
    [Show full text]
  • E-Cigarette Use in Patients Receiving Home Oxygen Therapy
    FOCUSED REVIEW E-cigarette use in patients receiving home oxygen therapy Yves Lacasse MD MSc FRCP1,2, Martin Légaré MD FRCP3, François Maltais MD FRCP1,2 Y Lacasse, M Légaré, F Maltais. E-cigarette use in patients receiving La cigarette électronique chez les patients sous home oxygen therapy. Can Respir J 2015;22(2):83-85. oxygénothérapie à domicile Current smokers who are prescribed home oxygen may not benefit from the therapy. In addition to being an obvious fire hazard, there is some evi- Il se peut que les fumeurs qui se font prescrire une oxygénothérapie à domi- dence that the physiological mechanisms by which home oxygen is cile ne profitent pas de ce traitement. Sans compter que le tabagisme pose believed to operate are inhibited by smoking. Although their effectiveness un risque d’incendie évident, certaines données probantes indiquent qu’il is yet to be demonstrated, electronic cigarettes (e-cigarettes) are often inhibe les mécanismes physiologiques par lesquels l’oxygénothérapie à regarded as an aid to smoking cessation. However, several burn accidents domicile fonctionnerait. Même si son efficacité reste à démontrer, la ciga- in e-cigarette smokers receiving home oxygen therapy have also been rette électronique (vapoteuse) est souvent perçue comme une aide au reported, leading Health Canada to release a warning of fire risk to oxygen sevrage du tabagisme. Cependant, plusieurs incidents de brûlure chez des therapy patients from e-cigarettes. It is the authors’ position that patients vapoteurs sous oxygénothérapie à domicile ont été déclarés, ce qui a incité receiving oxygen should definitely not use e-cigarettes.
    [Show full text]
  • MAP Prior Authorization List EFF: 11/01/2017 (Updated 11/7/2017)
    MAP Prior Authorization List EFF: 11/01/2017 (Updated 11/7/2017) CPT, HCPCS Description Comment or Revenue Code Inpatient All Inpatient admissions require authorization Revenue Codes 0100 All inclusive room and board plus ancillary 0101 All inclusive room and board 0110 Room and Board Private (one bed) 0111 Room and Board Private (one bed) - Medical/Surgical/GYN 0113 Room and Board Private (one bed) - Pediatric 0117 Room and Board Private (one bed) - Oncology 0119 Room and Board Private (one bed) - Other 0121 Room and Board Semiprivate (two beds) - Medical/Surgical/GYN 0123 Room and Board Semiprivate (two beds) - Pediatric 0127 Room and Board Semiprivate (two beds) - Oncology 0130 Room & Board - Three and Four Beds General Classification 0131 Room & Board - Three and Four Beds Medical/Surgical/Gyn 0133 Room & Board - Three and Four Beds Pediatric 0137 Room & Board - Three and Four Beds Oncology 0139 Room & Board - Three and Four Beds Other 0140 Room & Board - Deluxe Private General Classification 0141 Room & Board - Deluxe Private Medical/Surgical/Gyn 0143 Room & Board - Deluxe Private Pediatric 0147 Room & Board - Deluxe Private Oncology 0149 Room & Board - Deluxe Private Other 0150 Room & Board - Ward General Classification 0151 Room & Board - Ward Medical/Surgical/Gyn 0153 Room & Board - Ward Pediatric 0157 Room & Board - Ward Oncology 0159 Room & Board - Ward Other 0160 Room & Board - Other General Classification 0164 Other Room & Board - Sterile Environment 0167 Room & Board - Other Self Care 0169 Room & Board - Other Other 0190 General
    [Show full text]
  • 184591/2021/Estt-Ne Hr
    168 184591/2021/ESTT-NE_HR PUSHPAWATI SINGHANIA HOSPITAL & RESEARCH INSTITUTE A MULTISPECIALITY HOSPITAL (formally known as Puspawati Singhania Research Institute for liver,Renal & Digestive Diseases) (w.e.f. 01.04.2020) OPD CHARGES FEES (Rs) SR. NO. CONSULTANT NAME FIRST SUBS. GASTROENTEROLOGY 1PROF.(DR). R.K.TANDON 20001500 2LT. COL. (DR) ARUN KUMAR 12001200 3DR. DINESH SINGHAL 10001000 4DR. MANOJ KUMAR 10001000 5DR. NRIPEN SAIKIA 10001000 6DR. RAJIV BAIJAL 10001000 7DR. RAHUL GUPTA 20002000 8DR. SHUBHAM VATSYA 900900 SURGICAL GASTROENTEROLOGY & LIVER TRANSPLANT 1DR. K.R VASUDEVAN 12001200 2DR. MANOJ GUPTA 10001000 3DR. BHUSHAN P. BHOLA 12001200 NEPHROLOGY 1DR. SANJEEV SAXENA 12001200 2DR. RAVI BANSAL 10001000 3DR. RAJESH GOEL 800800 UROLOGY 1DR. P.P.SINGH 12001200 2DR. JAGDEEP BALYAN 11001100 3DR. A.S.MALHOTRA 11001100 CARDIOLOGIST 1DR. T.S.KLER 10001000 2DR. VINAYAK AGRAWAL 12001200 3DR. AVINASH VERMA 10001000 4DR. S. N. PATHAK 10001000 5DR. ABHINAV AGGARWAL 10001000 CARDIO SURGERY 1DR. BALRAM AIRAN 10001000 2DR. VIJAY MOHAN KOHLI 12501250 3DR GAURAV GUPTA 10001000 NEUROLOGOY 1DR. SHAMSHER DWIVEDEE 20001800 NEURO SURGERY 1DR. SUMIT GOYAL 10001000 ENDOCRINOLOGY 1DR. MONIKA SHARMA 1001000 PULMONOLOGY 1DR. G.C. KHILNANI 15001500 2DR. NEETU JAIN 10001000 G.I SURGERY 1DR. SANJAY CHAUREY 15001500 2DR. RAJEEV KHANNA 12001000 3DR. HARISH KAPILA 15001500 ONCOLOGY (SURGERY) 1DR. ARVIND KUMAR 15001500 2DR. SALEEM NAYAK 15001500 3DR. VIVEK GUPTA 15001500 4DR. VIKRANT SHARMA 15001500 ONCOLOGY 1DR. AMISH VORA 15001500 2DR. AMIT UPADHYAY 15001500 ORTHOPEDICS 1DR. P.P. KOTWAL 15001500 2DR. GAURAV PRAKASH BHARDWAJ 12001200 Page 1 169 184591/2021/ESTT-NE_HR 3DR. U.K.SADHOO 12001200 4DR. G.S.TUCKER 12001200 5DR. ANIL MISHRA 10001000 6DR.
    [Show full text]
  • Florida Special Needs Registry Registration Information - Osceola County
    Florida Special Needs Registry Registration Information - Osceola County Instructions: Complete this form and fax or mail it to Osceola County to register an individual for the Florida Special Needs Registry. This form is not required if you have already registered on line. Required fields are indicated with an asterisk (*). Mail: Osceola County Special Needs Registry Fax: (407) 742-9022 2586 Partin Settlement Road Kissimmee, FL 34744 PERSONAL INFORMATION ABOUT THE REGISTRANT *First Name Middle Name *Last Name Suffix *Birth Date *Gender (select only one) Male Female Transgender Non-Binary Prefer Not To Provide *Height Feet: Inches: *Weight (pounds) Living Situation (select only one) Live alone Live with relative or Other living situation caregiver *Primary Language Secondary Language Veteran Yes No Last 4 digits of SSN Email Address Are you completing this form on behalf of the Family Member Caregiver Neighbor Friend registrant? If so, please indicate your relationship to the registrant (select only Home Health Care County Emergency County Health DOH State Staff one) Provider Management Staff Department Staff ADDRESS FOR THE REGISTRANT (physical address is required) *Physical Address (cannot be a PO Box) *Physical City *Physical State FL *Physical Zip Code Name of Complex, Subdivision or Mobile Home Park Is the home at this address a mobile home? Yes No Is the home at this address a highrise or Yes No multi-story home? Does this home have stairs? Yes No Is there a gate that requires a code to enter? Yes No Do you live at this address
    [Show full text]
  • Sentinel Report Cder Mpl1r Wp155
    Disclaimer The following report(s) provides findings from an FDA‐initiated query using Sentinel. While Sentinel queries may be undertaken to assess potential medical product safety risks, they may also be initiated for various other reasons. Some examples include determining a rate or count of an identified health outcome of interest, examining medical product use, exploring the feasibility of future, more detailed analyses within Sentinel, and seeking to better understand Sentinel capabilities. Data obtained through Sentinel are intended to complement other types of evidence such as preclinical studies, clinical trials, postmarket studies, and adverse event reports, all of which are used by FDA to inform regulatory decisions regarding medical product safety. The information contained in this report is provided as part of FDA’s commitment to place knowledge acquired from Sentinel in the public domain as soon as possible. Any public health actions taken by FDA regarding products involved in Sentinel queries will continue to be communicated through existing channels. FDA wants to emphasize that the fact that FDA has initiated a query involving a medical product and is reporting findings related to that query does not mean that FDA is suggesting health care practitioners should change their prescribing practices for the medical product or that patients taking the medical product should stop using it. Patients who have questions about the use of an identified medical product should contact their health care practitioners. The following report contains a description of the request, request specifications, and results from the modular program run(s). If you are using a web page screen reader and are unable to access this document, please contact the Sentinel Operations Center for assistance at [email protected].
    [Show full text]
  • Emblemhealth's Pre-Authorization List
    EmblemHealth's Pre-authorization List This is a complete list of all services requiring a Prior Approval for HIP members or a Pre-Certification for GHI members* (jointly referred to as "pre-authorization") subject to their benefit plan's coverage for all places of service, including Office (POS 11). The list accounts for EmblemHealth's medical policies, medical technology database, provider manual, and special utilization management programs. Pre-authorization is not a guarantee of payment. Payment is subject to a member's eligibility for benefits on the date of service. Emergency services do not require a pre-authorization. *GHI PPO City of New York employees and non-Medicare eligible retirees with GHI PPO benefits will be managed by Empire BCBS for inpatient and outpatient services. To see what needs authorization, use their look-up tool: https://www.empireblue.com/wps/portal/ehpprovider. CPT/ HCPCS Description Code 0008M Oncology (breast), mRNA analysis of 58 genes using hybrid capture, on formalin-fixed paraffin- embedded (FFPE) tissue, prognostic algorithm reported as a risk score 00640 Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic or lumbar spine 0085T Breath test for heart transplant rejection 0100T Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy 0195T Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without instrumentation, with image guidance, includes
    [Show full text]