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… • Authorization Information • Policy History Policy Number: 159 BCBSA Reference Number: N/A NCD/LCD: N/A Related … … 6961 … Treatments … 06/08/2023 … 159 … application/pdf …
… subsequent encounter for fracture with delayed healing 159 S32.609K Unspecified fracture of unspecified ischium, … 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 …
… alcohol-induced psychotic disorder with hallucinations F10.159 Alcohol abuse with alcohol-induced psychotic disorder, … opioid-induced psychotic disorder with hallucinations F11.159 Opioid abuse with opioid-induced psychotic disorder, … abuse with psychotic disorder with hallucinations F12.159 Cannabis abuse with psychotic disorder, unspecified …
… † I1027T R117H * S977F * A120T F1052V I1139V R117L S1159F A234D F1074L K1060T R117P S1159P A349V G178E L206W * R170H S1251N * A455E * G178R * … L1335P R170H S977F* A120T E822K G1244E L1480P R258G S1159F A234D E831X G1249R M152V R334L S1159P A349V F191V …
… Lesion At C8 Level Of Cervical Spinal Cord, Sequela S14.159A Other Incomplete Lesion At Unspecified Level Of Cervical Spinal Cord, Initial Encounter S14.159D Other Incomplete Lesion At Unspecified Level Of Cervical Spinal Cord, Subsequent Encounter S14.159S Other Incomplete Lesion At Unspecified Level Of …
… Lesion at C8 Level of Cervical Spinal Cord, Sequela S14.159A Other Incomplete Lesion at Unspecified Level of Cervical Spinal Cord, Initial Encounter S14.159D Other Incomplete Lesion at Unspecified Level of Cervical Spinal Cord, Subsequent Encounter S14.159S Other Incomplete Lesion at Unspecified Level of …
310 Immunoglobulins Policy.pdf454.54 KB
1 Pharmacy Medical Policy Immunoglobulins Policy Table of Contents • Policy: Commercial • Policy History • Endnotes • Policy: Medicare • Information Pertaining to All Policies • Forms • Coding Information • References Policy Number: 310 BCBSA Reference …
… injury of anterior tibial artery, left leg, sequela S85.159A Other specified injury of anterior tibial artery, unspecified leg, initial encounter S85.159D Other specified injury of anterior tibial artery, unspecified leg, subsequent encounter S85.159S Other specified injury of anterior tibial artery, …
… 9d95ebd8e5b139b9/BCBSA/html/_w_a35a73ee6248862883ad358107a98a159d95ebd8e5b139b9/#reference-1 … 9d95ebd8e5b139b9/BCBSA/html/_w_a35a73ee6248862883ad358107a98a159d95ebd8e5b139b9/#reference-1 … 9d95ebd8e5b139b9/BCBSA/html/_w_a35a73ee6248862883ad358107a98a159d95ebd8e5b139b9/#reference-2 5 For individuals who have …
… 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 I69.159 Hemiplegia and hemiparesis following nontraumatic …
… hemorrhage affecting left non-dominant side I69.159 Hemiplegia and hemiparesis following nontraumatic … injury of anterior tibial artery, left leg, sequela S85.159S Other specified injury of anterior tibial artery, … hemorrhage affecting left non-dominant side I69.159 Hemiplegia and hemiparesis following nontraumatic …
… Treatment Effect at 18 Months. Sleep. Oct 01 2015; 38(10): 1593-8. PMID 26158895 22. Woodson BT, Strohl KP, Soose RJ, … 5- Year Outcomes. Otolaryngol Head Neck Surg. Jul 2018; 159(1): 194-202. PMID 29582703 23. Schwartz AR, Jacobowitz … the ADHERE Registry. Otolaryngol Head Neck Surg. Aug 2018; 159(2): 379-385. PMID 29557280 40. Kent DT, Carden KA, Wang …
… lung disease with rheumatoid arthritis of left hip M05.159 Rheumatoid lung disease with rheumatoid arthritis of … lung disease with rheumatoid arthritis of left hip M05.159 Rheumatoid lung disease with rheumatoid arthritis of …
… 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. … cal-policies/sites/g/files/csphws2091/files/acquiadam-assets/159%20Gene%20Therapies%20for%20Bladder%20Cancer.pdf …
… therapy-drugs-work.html?_ga=2.40006177.2071377565.1547216139-1593852916.1547216139 Accessed on January 10, 2019. 4. … therapy-drugs-work.html?_ga=2.40006177.2071377565.1547216139-1593852916.1547216139 … therapy-drugs-work.html?_ga=2.40006177.2071377565.1547216139-1593852916.1547216139 …
… J1561; J1562; J1568; J1569; J1571; J1572; J1573; J1575; J1599; J1670; J1566; J2791: Prior authorization is required … Shield of Massachusetts Pre-certification Request Form MP 159 Gene Therapies for Bladder Cancer No LCD or NCD BCBSMA … lower extremity Trachea Shave/Thyroid Cartilage Reduction 31599 Unlisted procedure, larynx Chest and Genital Surgery …
… Nodule Plasma Proteomic Classifier) Trial. Chest. Mar 2021; 159(3): 1283-1287. PMID 33171158 8. Vachani A, Pass HI, Rom … in a Multicenter Prospective Study. Chest. Jan 2021; 159(1): 401-412. PMID 32758562 16. Detterbeck FC, Lewis SZ, …
… randomized, placebo-controlled study. Am J Psychiatr. 2002;159:1896-1901. 13. Biederman J, Heiligenstein JH, Faries DE, … syndrome: a pilot study in 6 patients. Respiration 1997; 64:159-161. 21. Bastuji H & Jouvet M: Successful treatment of …
… Controlled Trial. J Arthroplasty. May 2021; 36(5): 1590-1598. PMID 33279353 28. Lung BE, Karasavvidis T, Sharma AK, …
466 Plasma Exchange prn.pdf252.45 KB
… in stiff-man syndrome. Neurology. Oct 1991;41(10):1588-1592. PMID 1922799 17. Harding AE, Thompson PD, Kocen RS, et … J Am Soc Nephrol. Jul 2007;18(7):21802188. PMID 17582159 42. Walsh M, Casian A, Flossmann O, et al. Long-term … rejection. Pediatr Transplant. Jun 2005;9(3):408-415. PMID 15910400 45. Lehrich RW, Rocha PN, Reinsmoen N, et al. …