Oregon CPT Preapproval Grid

AI CPT Codes. x x. 70336 MRI Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)

Code Category Description Auth Required Medicaid Medicare 0126T IMT Testing Common carotid intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor

CPT * Codes Included in AIM Preauthorization Program for 2013 With Grouper Numbers

CPT * Codes Included in AIM Preauthorization Program for 2013 With Grouper Numbers Computerized Tomography (CT) CPT Description Abdomen 74150 CT abdomen; w/o contrast 6 74160 CT abdomen; with contrast

Computed Tomography, Head Or Brain; Without Contrast Material, Followed By Contrast Material(S) And Further Sections

1199SEIU BENEFIT AND PENSION FUNDS High Tech Diagnostic Radiology and s # 1 70336 Magnetic Resonance (Eg, Proton) Imaging, Temporomandibular Joint(S) 2 70450 Computed Tomography, Head Or Brain; Without

COMPREHENSIVE PRIOR AUTHORIZATION LISTS NJ FAMILYCARE/MEDICAID & DUAL COMPLETE HMO SNP PRODUCTS EFFECTIVE 7/1/13

TO ALL HEALTHCARE PROFESSIONALS: COMPREHENSIVE PRIOR AUTHORIZATION LISTS NJ FAMILYCARE/MEDICAID & DUAL COMPLETE HMO SNP PRODUCTS EFFECTIVE 7/1/13 BEFORE SEEKING PRIOR AUTHORIZATION, PLEASE VERIFY MEMBER

Diagnostic Imaging Prior Review Code List 3 rd Quarter 2016

Computerized Tomography (CT) Abdomen 6 Abdomen/Pelvis Combination 101 Service 74150 CT abdomen; w/o 74160 CT abdomen; with 74170 CT abdomen; w/o followed by 74176 Computed tomography, abdomen and pelvis;

Prior Authorization List Adults, FHP, CHP

Please verify the member s benefits before requesting prior authorization (PA). Services vary within plans. To check member eligibility, please call Provider Services at 888-362-3368 or visit UnitedHealthcareOnline.com.

CPT Radiology Codes Requiring Review by AIM Effective 01/01/2016

CPT Radiology Codes Requiring Review by AIM Effective 01/01/2016 When a service is authorized only one test per group is payable. *Secondary codes or add-on codes do not require preauthorization or separate

Anthem Blue Cross and Blue Shield in Connecticut Precertification Guidelines

Anthem Blue Cross and Blue Shield in Connecticut Precertification Guidelines The following guidelines apply to Anthem Blue Cross and Blue Shield ( Anthem ) products issued and delivered by Anthem in Connecticut.

Provider Information Guide 2014

MDwise Eskenazi Health Hoosier Healthwise Provider Information Guide 2014 MDwise Eskenazi Health Hoosier Healthwise All members will have an ID card. The Hoosier Healthwise ID card is the standard, state

Anthem Blue Cross and Blue Shield in New Hampshire Precertification Guidelines

Anthem Blue Cross and Blue Shield in New Hampshire Precertification Guidelines The following guidelines apply to Anthem Blue Cross and Blue Shield ( Anthem ) products issued and delivered by Anthem in

UnitedHealthcare Medicare Solutions Notification/Prior Authorization Requirements Effective Jan. 1, 2016

This list represents our advance notification/prior authorization review requirements as referenced in the UnitedHealthcare Physician, Health Care Professional, Facility and Ancillary Provider 2016 Administrative

CPT CODE PROCEDURE DESCRIPTION. CT Scans 70450 CT HEAD/BRAIN W/O CONTRAST 70460 CT HEAD/BRAIN W/ CONTRAST 70470 CT HEAD/BRAIN W/O & W/ CONTRAST

CPT CODE PROCEDURE DESCRIPTION CT Scans 70450 CT HEAD/BRAIN W/O CONTRAST 70460 CT HEAD/BRAIN W/ CONTRAST 70470 CT HEAD/BRAIN W/O & W/ CONTRAST 70480 CT ORBIT W/O CONTRAST 70481 CT ORBIT W/ CONTRAST 70482

Healthcare services requiring prior authorisation

Annex 2 Healthcare requiring prior authorisation This list does not include organ transplants and does also not apply to long-term care and the primary purpose of which is to support people in need of

(FIDA) FIDELIS CARE AUTHORIZATION REQUIREMENTS

Fully Integrated Duals Advantage (FIDA) FIDELIS CARE AUTHORIZATION REQUIREMENTS Benefit/Service Detail SERVICES AND PROCEDURES WHICH REQUIRE AUTHORIZATION 7/1/2016 I. Inpatient Admissions-All inpatient

Prior Authorization Requirements for Florida Effective March 1, 2015

for Florida Effective March 1, 215 General Information The following list represents our prior authorization requirements for UnitedHealthcare in Florida. All services rendered by a non-contracted physician,

Treatment Category Inpatient Treatment Categories DRG (MS DRG) ICD9 [Hip & Knee Only]

NCCT List of Procedures Treatment Category Inpatient Treatment Categories DRG (MS DRG) ICD9 [Hip & Knee Only] Bariatric Surgery - Laparoscopic Gastric Bypass DRG - 288 MS DRG - 621 Cardiac Angioplasty

CT Scan. CT Angiography, Neck, W/O Contrast Matl(s), Followed By Contrast Matl(s), W/Image

CT Scan CPT 70450 CT Scan, Head/Brain; W/O Contrast Matl 70460 CT Scan, Head/Brain; W/Contrast Matl(s) 70470 CT Scan, Head/Brain; W/O Contrast Matl, Then W/Contrast Matl(s) 70480 CT Scan, Orbit/Sella/Posterior

Explanation and Limitations for Plan A. Annual Maximum UNLIMITED UNLIMITED. See page 4 for services that require Carewise Health preauthorization

Page 1 of 6 Benefit Description Individual Deductible Family Deductible Individual OOP Family OOP UFCW LOCAL 711 AND RETAIL STORES GROUP # s S1644 / S1645 SCHEDULE OF MEDICAL BENEFITS FOR PLAN A All benefits

Advance Notification Requirements for New York Effective June 1, 2015

Advance Notification Requirements for New York Effective June 1, 2015 General Information This list represents our prior authorization review requirements for UnitedHealthcare Community Plan of New York.

Iowa Wellness Plan Benefits Coverage List

Iowa Wellness Plan Benefits Coverage List Service Category Covered Duration, Scope, exclusions, and Limitations Excluded Coding 1. Ambulatory Services Primary Care Illness/injury Physician Services Should

HUSKY Health Benefits and Prior Authorization Requirements Grid* Hospital Outpatient Effective: January 1, 2012

Cardiac Rehab 100% covered 100% covered 100% covered Dialysis 100% covered 100% covered 100% covered Emergency Care Covered no co- pays for Emergency Room visits Covered no co- pays for Emergency Room

Procedure. 2 29827 $ 3,560 $ 1,476 Arthroscopy, shoulder, surgical; with rotator cuff repair 5.5% 241.1%

Exhibit 1 Top 50% of Payments for Surgical s (Physician costs) On average, Workers' payments for Surgical s in are 256% the average allowed claim costs for Healthcare in. $6,000 $5,000 $4,000 Allowed Claim

Procedure Codes. RadConsult provides real-time decision support for physicians who order high-cost imaging procedures RADIATION THERAPY

Procedure Codes 2011 RadConsult provides real-time decision support for physicians who order high-cost imaging procedures RADIATION THERAPY 2D3D Therapeutic radiology treatment planning; simple 77261 Therapeutic

I. Out of Network: There are no OON benefits. However for any medically necessary service not available in network, authorization will be provided

The New York State of Health Authorization Grid FIDELIS CARE AUTHORIZATION REQUIREMENTS Benefit/Service Detail SERVICES AND PROCEDURES WHICH REQUIRE AUTHORIZATION EFFECTIVE 7/1/2016 I. Out of Network:

Alaska Workers Compensation Fee Schedule Comparative Survey

Alaska Workers Compensation Fee Comparative Survey As part of the Division s analysis of workers compensation medical costs in Alaska, we asked the National Council on Compensation Insurance (NCCI) to

HUSKY Health Benefits and Prior Authorization Requirements Grid* Hospital Outpatient Effective: January 1, 2012

Cardiac Rehab 100% covered 100% covered 100% covered Dialysis 100% covered 100% covered 100% covered Emergency Care Covered no co-pays for Emergency Room visits Covered no co-pays for Emergency Room visits.

Michigan Electrical Employees Health Plan Benefits & Eligibility-at-a Glance Supplement to Medicare - Medicare Enrollees

Medicare Coverage BCBSM Supp Coverage Preventive Services 12 months, if age 50 and older Colonoscopy - one per calendar year 1 0 years (if at high risk every 24 months) approved amount**, once per flu

SURGICAL SERVICES. Touching Lives

SURGICAL SERVICES Touching Lives with MODERN TOOLS of EXPERT PHYSICIANS in the Hands and Staff FROM DISCOVERY TO RECOVERY St. Mary s Health System offers a full range of surgical services in almost every

2015 Medicare Advantage Summary of Benefits

2015 Medicare Advantage Summary of Benefits HNE Medicare Premium No Rx and HNE Medicare Basic No Rx January 1, 2015 - December 31, 2015 H8578_2015_034 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2015

2016 CPT Radiology, ECHO, and PET Codes Requiring Review Modality Body Part Group # CPT Description Default CPT "1"

26 CPT Radiology, ECHO, and PET Codes Requiring Review (Please Note: Group # and Default CPT "" are for internal claims processing use only) Modality Body Part Default CPT "" CT Head 748 CT orbit, sella

Aetna Required Data Elements, Clean Claim Elements, and Attachments

Texas Physicians, Practitioners and Other Professional Providers Claims Submitted Using HCFA 1500 Forms DISCLOSURE OF CLEAN CLAIM ELEMENTS; DISCLOSURE OF NECESSARY ATTACHMENTS; DISCLOSURE OF ADDITIONAL

NATIONWIDE INSURANCE $20-40 / 250A NATIONAL MANAGED CARE SCHEDULE OF BENEFITS

WASHINGTON NATIONWIDE INSURANCE $20-40 / 250A NATIONAL MANAGED CARE SCHEDULE OF BENEFITS General Features Calendar Year Deductible Lifetime Benefit Maximum (Does not apply to Chemical Dependency) ($5,000.00

Application for a Medical Impairment Rating (MIR)

STATE OF TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT Workers Compensation Division Medical Impairment Rating Program 220 French Landing Drive Nashville, TN 37243-1002 Phone (615) 253-1613 Fax

Hawaii Benchmarks Benefits under the Affordable Care Act (ACA)

Hawaii Benchmarks Benefits under the Affordable Care Act (ACA) 10/2012 Coverage for Newborn and Foster Children Coverage Outside the Provider Network Adult Routine Physical Exams Well-Baby and Well-Child

Benefit Summary - A, G, C, E, Y, J and M

Benefit Summary - A, G, C, E, Y, J and M Benefit Year: Calendar Year Payment for Services Deductible Individual $600 $1,200 Family (Embedded*) $1,200 $2,400 Coinsurance (the percentage amount the Covered

REFERRALS CPT CODES COMMENTS

Gundersen Health Plan (GHP) Procedures & Services Requiring Prior Authorization Benefits and eligibility must be verified with the Health Plan Customer Service. Self-funded and Fully Insured Employer Group

Radiation therapy involves using many terms you may have never heard before. Below is a list of words you could hear during your treatment.

Dictionary Radiation therapy involves using many terms you may have never heard before. Below is a list of words you could hear during your treatment. Applicator A device used to hold a radioactive source

Workers Compensation Medical Costs in NH Significantly Higher

EMBARGOED: FOR RELEASE THURSDAY, MAY 22, 10 AM NOT FOR RELEASE UNTIL: May 22, 2014 Contact: Danielle Barrick, director of communications, (603) 271-7973, ext. 336, [email protected]; Deb Stone,

CMS Imaging Efficiency Measures Included in Hospital Outpatient Quality Data Reporting Program (HOP QDRP) 2009

CMS Imaging Efficiency Measures Included in Hospital Outpatient Quality Data Reporting Program (HOP QDRP) 2009 OP 8: MRI LUMBAR SPINE FOR LOW BACK PAIN Measure Description: This measure estimates the percentage

Effective: July 28, 2015. Arizona Prior Authorization Requirements Health Net Access, Inc.

Effective: July 28, 2015 Arizona Prior Authorization Requirements Health Net Access, Inc. The following services, procedures and equipment are subject to prior authorization requirements (unless noted

Covered Service Description

Advanced registered nurse practitioner (ARNP) Ambulatory surgical center (ASC) These are given by an ARNP who s licensed to practice in the State of Florida The ARNP and a doctor must make decisions about

HNE Premier 1 (HMO) and HNE Premier 2 (HMO)

2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I

Exhibit 4 Effective January 1, 2009. Outpatient Surgery Facility Groupers and Fees 1/1/09 Group Description 1/1/09 1/1/09 Dollar Value

Exhibit 4 Effective January 1, 2009 Outpatient Surgery Facility s and Fees 1 Level I Photochemotherapy 2 Level I Fine Needle Biopsy/Aspiration 3 Bone Marrow Biopsy/Aspiration $335.75 4 Level I Needle Biopsy/

Workers Compensation Insurance

Workers Compensation Insurance New Hampshire Insurance Department Detailed Medical Cost Comparison The following exhibits compare the cost of Workers Compensation Medical services in New Hampshire to our

I. Out of Network: Any Medicaid, CHP and HealthierLife service provided by a nonparticipating provider/facility/physician requires authorization.

Medicaid, Child Health and HealthierLife (HARP) Plus Authorization Grid FIDELIS CARE AUTHORIZATION REQUIREMENTS Benefit/Service Detail SERVICES AND PROCEDURES WHICH REQUIRE AUTHORIZATION REVISED 1/1/2016

[2015] SUMMARY OF BENEFITS H1189_2015SB

[2015] SUMMARY OF BENEFITS H1189_2015SB Section I You have choices in your health care One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare). Original Medicare

BOARD MEETING: March 27-28, 2007. Silver Cross Hospital and Medical Center, Joliet STATE AGENCY REPORT

DOCKET ITEM NUMBER: NA BUSINESS ITEM: REQUESTING ENTITY and LOCATION: BOARD MEETING: March 27-28, 27 Declaratory Ruling Request Silver Cross Hospital and Medical Center, Joliet PROJECT NUMBER: NA I. Request

HUSKY Health Benefits and Prior Authorization Requirements Grid* Inpatient Hospital Effective: January 1, 2012

100% covered 100% covered 100% covered Prior Authorization Required For all non- maternity, non- emergent admissions. Maternity Admits: CHNCT requests the hospital to notify us of all deliveries. Emergency

UnitedHealthcare Choice Plus. UnitedHealthcare Insurance Company. Certificate of Coverage

UnitedHealthcare Choice Plus UnitedHealthcare Insurance Company Certificate of Coverage For the Plan 7EG of Educators Benefit Services, Inc. Enrolling Group Number: 717578 Effective Date: January 1, 2012

UnitedHealthcare Choice Plus. UnitedHealthcare Insurance Company. Certificate of Coverage

UnitedHealthcare Choice Plus UnitedHealthcare Insurance Company Certificate of Coverage For the Health Savings Account (HSA) Plan 7PD of Educators Benefit Services, Inc. Enrolling Group Number: 717578

SERVICES IN-NETWORK COVERAGE OUT-OF-NETWORK COVERAGE

COVENTRY HEALTH AND LIFE INSURANCE COMPANY 3838 N. Causeway Blvd. Suite 3350 Metairie, LA 70002 1-800-341-6613 SCHEDULE OF BENEFITS BENEFITS AND PRIOR AUTHORIZATION REQUIREMENTS ARE SET FORTH IN ARTICLES

P R E S E N T S Dr. Mufa T. Ghadiali is skilled in all aspects of General Surgery. His General Surgery Services include: General Surgery Advanced Laparoscopic Surgery Surgical Oncology Gastrointestinal

TABLE OF CONTENTS CPT

TABLE OF CONTENTS CPT Coding Basics...1 National Correct Coding Initiative Edits...1 How to Use NCCI Edits...2 Evaluation and Management...3 Integumentary System... 20 Debridement... 20 Surgery/Musculoskeletal...

Range of Injury Scale Values

Range of Injury Scale Values Civil Liability Regulations 2014 SCHEDULE 4 Range of Injury Scale Values (summary) Item Injury ISV Range Part 1-Central Nervous System and Head Injuries 1 Quadriplegia 75 100

Objective of This Lecture

Component 2: The Culture of Health Care Unit 3: Health Care Settings The Places Where Care Is Delivered Lecture 5 This material was developed by Oregon Health & Science University, funded by the Department

Member Services: 800-859-9889 Authorizations: 800-440-5071 Option #2 Authorization Fax: 203-265-3994

Allergy 100% covered Office visit $10 co-pay 100% covered Allergy injections no co-pay Immunotherapy or other therapy -no co-pay Cardiac Rehab 100% covered 100% covered 100% covered Contraceptives Covered

Height FT IN Weight Married? Y / N Employed? Y / N

Name Patient # (PLEASE PRINT) Signature Date Height FT IN Weight Married? Y / N Employed? Y / N Previous Illnesses: Check all that apply AIDS, HIV, STD Epilepsy Pacemaker Alcoholism Eye/vision problems

First Year. PT7040- Clinical Skills and Examination II

First Year Summer PT7010 Anatomical Dissection for Physical Therapists This is a dissection-based, radiographic anatomical study of the spine, lower extremity, and upper extremity as related to physical

Spine University s Guide to Vertebral Osteonecrosis (Kummel's Disease)

Spine University s Guide to Vertebral Osteonecrosis (Kummel's Disease) 2 Introduction Kummel's disease is a collapse of the vertebrae (the bones that make up the spine). It is also called vertebral osteonecrosis.

Preauthorization Requirements * (as of January 1, 2016)

OFFICE VISITS Primary Care Office Visits Primary Care Home Visits Specialist Office Visits No Specialist Home Visits PREVENTIVE CARE Well Child Visits and Immunizations Adult Annual Physical Examinations

A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH)

A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH) Introduction Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a phenomenon that more commonly affects older males. It is associated

Recognizing and Understanding Pain

Because multiple myeloma is a cancer involving the bone marrow, a common myeloma symptom is bone pain. But the good news is that most pain can be managed. This resource can help you better understand pain

www.backandspinefl.com Back and Spine Center 509 Riverside Dr., Suite 203 Stuart, FL 34994 Phone: (772) 288-5862

Non-Profit ORG. U.S. Postage PAID West Palm BCH. FL. PERMIT NO. 4709 www.backandspinefl.com Back and Spine Center 509 Riverside Dr., Suite 203 Stuart, FL 34994 Phone: (772) 288-5862 The evolution of neurosurgery

Services and supplies required by Health Care Reform Age and frequency guidelines apply to covered preventive care Not subject to deductible if PPO

Page 1 of 5 Individual Deductible Calendar year $400 COMBINED Individual / Family OOP Calendar year $4,800 Individual $12,700 per family UNLIMITED Annual Maximum July 1 st to June 30 th UNLIMITED UNLIMITED

Schedule of Benefits for the MoDOT/MSHP Medical Plan Medicare ASO PPO 20088 Effective 1/1/2016

Schedule of Benefits for the MoDOT/MSHP Medical Plan Medicare ASO PPO 20088 Effective 1/1/2016 This Schedule of Benefits summarizes your obligation towards the cost of certain covered services. Refer to

Summary of Benefits Community Advantage (HMO)

Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list

How To Get Health Net From Health Net

INDIVIDUAL & FAMILY PLANS QUICK NET SHORT-TERM COVERAGE BY THE DAY OR MONTH Health coverage made easy. Effective April 15, 2007 IT S A FAST-MOVING WORLD. Keep up with Quick Net from Health Net. TWO KINDS

Kaiser Permanente 2015 Sample Fee List 1 Members in any deductible plan can use this list to help estimate their charges.

Kaiser Permanente 2015 Sample Fee List 1 Members in any deductible plan can use this list to help estimate their charges. COLORADO As your partner in health, we want to help you manage your health care

MyHPN Solutions HMO Silver 4

MyHPN Solutions HMO Silver 4 Attachment A Schedule Calendar Year Deductible (CYD): $2,250 of EME per Member and $4,500 of EME per family. The Calendar Year Out of Pocket Maximum includes the CYD and is

How To Become A Physio And Rehabilitation Medicine Specialist

EUROPEAN BOARD OF PHYSICAL AND REHABILITATION MEDICINE LOGBOOK EUROPEAN UNION OF MEDICAL SPECIALISTS UEMS IDENTIFICATION... 2 INSTRUCTIONS FOR USE... 3 THE TRAINING COURSE... 3 TRAINING PROGRAMME... 4

UTILIZATION MANAGEMENT AT A GLANCE

Cigna Payer Solutions UTILIZATION MANAGEMENT AT A GLANCE Features. Specifications. Requirements. This at-a-glance reference tool provides the features, specifications and requirements to deliver the Cigna

Chapter 7: Inpatient & Outpatient Hospital Care

7 Inpatient & Outpatient Hospital Care ACUTE INPATIENT ADMISSIONS All elective and emergent admissions require prior authorization and/or notification for all Health Choice Generations Members admissions.

Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease.

Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease. Memory loss and changes in mood and behavior are some signs that you or a family member may have Alzheimer s disease. If you have

2015 Summary of Benefits

2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3952 Y0041_H3952_KS_15_18734 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how

Elenco dei periodici elettronici in Ovid Full text

Academic Medicine Addictive Disorders & Their Treatment Advances in Anatomic Pathology Age & Ageing AIDS AIDS Patient Care & Stds AJN, American Journal of Nursing Alzheimer Disease & Associated Disorders

MS CAN - Mississippi Coordinated Access Network Benefit Summary Prior Auth is necessary for all NON-Par Providers MS - Houston

MS CAN - Mississippi Coordinated Access Network Benefit Summary Prior Auth is necessary for all NON-Par Providers (Revised 3/08/2011 - FINAL) Benefit Limitation Prior Authorization Contact for Prior Authorization

Oregon Health Authority Division of Medical Assistance Programs Revenue Center Code Table

11X ROOM AND BOARD PRIVATE (MEDICAL OR GENERAL) 110# 111# 112# 113# 114# 115 116# 117# 118# 119# Medical/Surgical/Gyn OB Pediatric Psychiatric Hospice (Not Covered) Detoxification Oncology Rehab/Private

2015 Summary of Benefits

2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3909 Y0041_H3909_PC_15_18889 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how

INPATIENT SERVICES Commercial Medicare. Notification required only, as soon as possible, but no later than 24 hours

Effective: January 1, 2016 Arizona Prior Authorization Requirements HMO (including CommunityCare HMO) Point-of-Service (POS) PPO Advantage (MA) HMO The following services, procedures or equipment are subject

January 1, 2015 December 31, 2015

BLUESHIELD FOREVER BLUE MEDICARE PPO VALUE AND BLUESHIELD MEDICARE PPO 750 (PPO) (a Medicare Advantage Preferred Provider Organization (PPO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract)

January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1

January, 205 December 3, 205 Summary of Benefits H3928-00 80.06.360.-LA Y0022_205_H3928_00_LA Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what we

The Deductible is applicable to all covered services except for flat dollar Copayment services.

PRIORITY HEALTH www.priorityhealth.com/mpsers PRIORITYHMO SM PLUS PLAN MICHIGAN PUBLIC SCHOOL EMPLOYEES RETIREMENT SYSTEM (MPSERS) Effective January 1, 2016 through December 31, 2016 The HMO Plus plan

2015 Summary of Benefits

2015 Summary of Benefits Plans 003 and 004 H6298_14_027 accepted Summary of Benefits January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list

RADIOLOGY SERVICES. By Dr Lim Eng Kok 1

INTRODUCTION RADIOLOGY SERVICES By Dr Lim Eng Kok 1 Radiology is the branch of medicine that deals with the use of ionising (e.g. x- rays and radio-isotopes) and non-ionising radiation (e.g. ultrasound

Specialty Clinic Phone Listing

Adult Specialties Addiction Services (see Behavioral Health & Recovery/AODA) Allergy/Immunology 451 Junction Rd., Madison (West ) 263-6180 (local) 800-489-6008 (outreach clinics) 20 S. Park St., Madison

FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct PPO Plus (PPO)

FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties 1 P age SECTION I - INTRODUCTION TO SUMMARY

2016 Summary of Benefits

2016 Summary of Benefits Health Net Violet Option 3 (PPO) Douglas and Josephine counties, OR Benefits effective January 1, 2016 H5520 Health Net Life Insurance Company H5520_2016_0202 CMS Accepted 09162015

Summary of Benefits. King, Pierce, Snohomish, Spokane and Thurston Counties. premera.com/ma

Summary of Benefits 2016 HMO King, Pierce, Snohomish, Spokane and Thurston Counties premera.com/ma Plus Section 1 Introduction to the and Plus This booklet gives you a summary of what we cover and what

.org. Fractures of the Thoracic and Lumbar Spine. Cause. Description

Fractures of the Thoracic and Lumbar Spine Page ( 1 ) Spinal fractures can vary widely in severity. While some fractures are very serious injuries that require emergency treatment, other fractures can

CARDIA 288 MONTH FOLLOW-UP SUPPLEMENTAL FORM (FORM B) HOSPITALIZATION CASE #: INTERVIEWER ID FY288BIVID2. Page 1 of 6 FY288BH4CN

HOSPITALIZATION CASE #: 2 8 8 0 H FY288BH4CN Has the participant indicated any of the following reasons for being admitted overnight for this case? 1. Suspected or confirmed problems with the heart, circulation,

The Lewin Group undertook the following steps to identify the guidelines relevant to the 11 targeted procedures:

Guidelines The following is a list of proposed medical specialty guidelines that have been found for the 11 targeted procedures to be included in the Medicare Imaging Demonstration. The list includes only

Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies

Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies 1 Journal of the American Osteopathic Association April 2005, Vol. 105, No. 4 supplement, pp. 16-22 David M. Biondi, DO FROM ABSTRACT:

AG CancerCare Platinum Plus Initial Diagnosis Benefit First occurrence Internal cancer only (one-time payment)

AG CancerCare from American General Life Insurance Company (American General Life) is a specified disease policy that pays benefits for expenses related to the diagnosis and treatment of cancer, as well

PRIORITY HEALTH priorityhealth.com HealthbyChoice Incentives Summary of Benefits TRINITY HEALTH -HbCI 2 1/1/13 12/31/13

PRIORITY HEALTH priorityhealth.com Healthby Incentives Summary of Benefits TRINITY HEALTH -HbCI 2 1/1/13 12/31/13 The Healthby Incentives HMO plan is a Consumer Engaged Health plan that offers a choice

Smoking and misuse of certain pain medicines can affect the risk of developing renal cell cancer.

Renal cell cancer Renal cell cancer is a disease in which malignant (cancer) cells form in tubules of the kidney. Renal cell cancer (also called kidney cancer or renal adenocarcinoma) is a disease in which

DRAKE UNIVERSITY HEALTH PLAN

DRAKE UNIVERSITY HEALTH PLAN Effective Date: 1/1/2015 This is a general description of coverage. It is not a statement of contract. Actual coverage is subject to terms and the conditions specified in the

Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide

Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide 2007/2008 October 20, 2007 Part 1 M.D.IPA and Optimum Choice....................................1 medical identification

MEDICAL CERTAINTY WITHIN YOUR REACH PLANS COMPARATIVES EFECTIVE MARCH 1, 2015

MEDICAL CERTAINTY WITHIN YOUR REACH PLANS COMPARATIVES EFECTIVE MARCH 1, 2015 BENEFITS Maximum Annual Benefit USD$10 million USD$5 million USD$2 million USD$1 million USD$1.5 million (benefit available

National Government Services Local Coverage Determinations and Medical Policy Articles for Jurisdiction 6

Local Coverage Determinations and Medical Policy Articles for Jurisdiction 6 Have Been Posted Courtesy of J6 Medicare News National Government Services Local Coverage Determinations and Medical Policy