{
  "Seocs": [
    {
      "Seoc": {
        "PRCT": false,
        "QASP": "Complementary & Integrative HC Services",
        "REV": false,
        "categoryOfCare": "ACUPUNCTURE",
        "description": "This initial authorization covers services associated with all acupuncture care listed below for the referred condition on the consult.",
        "disclaimer": "*Additional acupuncture care beyond this trial must provide documentation of:  Objective measures demonstrating the extent of meaningful clinical improvement to date; and rationale for the additional treatment requested (e.g. to reach further durable improvement, or for ongoing pain management); and any further information supporting the need for additional care\r\n*Please visit the VHA Storefront www.va.gov/COMMUNITYCARE/providers/index.asp for additional resources and requirements pertaining to the following\r\n* Pharmacy prescribing requirements\r\n* Durable Medical Equipment (DME), Prosthetics, and Orthotics prescribing requirements\r\n* Precertification (PRCT) process requirements\r\n* Request for Services (RFS) requirements",
        "duration": 60,
        "effectiveDate": "01-24-2020",
        "endDate": null,
        "hptcs": [
          {
            "hptc": "171100000X"
          }
        ],
        "id": 1666,
        "maxAllowableVisits": null,
        "name": "Acupuncture Initial",
        "proceduralOverview": "1.   Initial outpatient evaluation for this episode of care\r\n2.   Twelve (12) acupuncture visits maximum is approved for this episode of care. Approved services include acupuncture with or without electrostimulation. A maximum of one additional unit of acupuncture (with or without electrostimulation) is allowed when the re-insertion of needles is supported in medical documentation.\r\n3.   If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in #2 above can include: manual therapy and therapeutic exercise procedures including but not limited to:  cupping, myofascial release, and therapeutic exercises.\r\n4.  Outpatient re-evaluation during this episode of care as clinically indicated.",
        "seocId": "PMR_ACUPUNCTURE INITIAL_1.0.7",
        "seocKey": 1,
        "serviceLine": "Physical Medicine and Rehabilitation",
        "services": [
          {
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                "billingCode": "99201",
                "codeType": "CPT",
                "id": 7345,
                "precertRequired": false
              },
              {
                "billingCode": "99202",
                "codeType": "CPT",
                "id": 7346,
                "precertRequired": false
              },
              {
                "billingCode": "99203",
                "codeType": "CPT",
                "id": 7347,
                "precertRequired": false
              },
              {
                "billingCode": "99204",
                "codeType": "CPT",
                "id": 7348,
                "precertRequired": false
              },
              {
                "billingCode": "99205",
                "codeType": "CPT",
                "id": 7349,
                "precertRequired": false
              },
              {
                "billingCode": "99211",
                "codeType": "CPT",
                "id": 7350,
                "precertRequired": false
              },
              {
                "billingCode": "99212",
                "codeType": "CPT",
                "id": 7351,
                "precertRequired": false
              },
              {
                "billingCode": "99213",
                "codeType": "CPT",
                "id": 7352,
                "precertRequired": false
              },
              {
                "billingCode": "99214",
                "codeType": "CPT",
                "id": 7353,
                "precertRequired": false
              },
              {
                "billingCode": "99215",
                "codeType": "CPT",
                "id": 7354,
                "precertRequired": false
              }
            ],
            "clinicalServices": [
              {
                "clinicalService": "35-Chiropractic"
              }
            ],
            "codeRequired": "YES",
            "description": "Initial outpatient evaluation for this episode of care",
            "frequency": null,
            "frequencyType": "week",
            "id": 4685,
            "serviceHptcs": [
              {
                "HPTC": "111NR0200X"
              },
              {
                "HPTC": "111NX0100X"
              },
              {
                "HPTC": "111NX0800X"
              },
              {
                "HPTC": "111NP0017X"
              },
              {
                "HPTC": "111NS0005X"
              },
              {
                "HPTC": "111NT0100X"
              },
              {
                "HPTC": "111NI0900X"
              },
              {
                "HPTC": "111NN0400X"
              },
              {
                "HPTC": "111NN1001X"
              },
              {
                "HPTC": "111N00000X"
              },
              {
                "HPTC": "111NI0013X"
              },
              {
                "HPTC": "111NR0400X"
              }
            ],
            "visits": 999
          },
          {
            "billingCodes": [
              {
                "billingCode": "97810",
                "codeType": "CPT",
                "id": 7299,
                "precertRequired": false
              },
              {
                "billingCode": "97811",
                "codeType": "CPT",
                "id": 7300,
                "precertRequired": false
              },
              {
                "billingCode": "97813",
                "codeType": "CPT",
                "id": 7301,
                "precertRequired": false
              },
              {
                "billingCode": "97814",
                "codeType": "CPT",
                "id": 7302,
                "precertRequired": false
              }
            ],
            "clinicalServices": [
              {
                "clinicalService": "35-Chiropractic"
              }
            ],
            "codeRequired": "YES",
            "description": "A maximum of twelve (12) acupuncture visits is approved for this episode of care. Approved services include acupuncture with or without electrostimulation. A maximum of one additional unit of acupuncture (with or without electrostimulation) is allowed when the re-insertion of needles is supported in medical documentation.",
            "frequency": null,
            "frequencyType": "week",
            "id": 4686,
            "serviceHptcs": [
              {
                "HPTC": "111NR0200X"
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              {
                "HPTC": "111NX0100X"
              },
              {
                "HPTC": "111NX0800X"
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              {
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              },
              {
                "HPTC": "111NS0005X"
              },
              {
                "HPTC": "111NT0100X"
              },
              {
                "HPTC": "111NI0900X"
              },
              {
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              },
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              },
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                "HPTC": "111N00000X"
              },
              {
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              },
              {
                "HPTC": "111NR0400X"
              }
            ],
            "visits": 12
          },
          {
            "billingCodes": [
              {
                "billingCode": "97016",
                "codeType": "CPT",
                "id": 7240,
                "precertRequired": false
              },
              {
                "billingCode": "97110",
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                "id": 7252,
                "precertRequired": false
              },
              {
                "billingCode": "97112",
                "codeType": "CPT",
                "id": 7253,
                "precertRequired": false
              },
              {
                "billingCode": "97124",
                "codeType": "CPT",
                "id": 7257,
                "precertRequired": false
              },
              {
                "billingCode": "97139",
                "codeType": "CPT",
                "id": 7259,
                "precertRequired": false
              },
              {
                "billingCode": "97140",
                "codeType": "CPT",
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                "precertRequired": false
              },
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                "billingCode": "97530",
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                "precertRequired": false
              }
            ],
            "clinicalServices": [
              {
                "clinicalService": "35-Chiropractic"
              }
            ],
            "codeRequired": "YES",
            "description": "If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can include: manual therapy and therapeutic exercise procedures including but not limited to:  cupping, myofascial release, and therapeutic exercises.",
            "frequency": null,
            "frequencyType": "week",
            "id": 4687,
            "serviceHptcs": [
              {
                "HPTC": "111NR0200X"
              },
              {
                "HPTC": "111NX0100X"
              },
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                "HPTC": "111NX0800X"
              },
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              },
              {
                "HPTC": "111NS0005X"
              },
              {
                "HPTC": "111NT0100X"
              },
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              },
              {
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              },
              {
                "HPTC": "111NN1001X"
              },
              {
                "HPTC": "111N00000X"
              },
              {
                "HPTC": "111NI0013X"
              },
              {
                "HPTC": "111NR0400X"
              }
            ],
            "visits": 999
          },
          {
            "billingCodes": [
              {
                "billingCode": "99211",
                "codeType": "CPT",
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                "precertRequired": false
              },
              {
                "billingCode": "99212",
                "codeType": "CPT",
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                "precertRequired": false
              },
              {
                "billingCode": "99213",
                "codeType": "CPT",
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                "precertRequired": false
              },
              {
                "billingCode": "99214",
                "codeType": "CPT",
                "id": 7353,
                "precertRequired": false
              },
              {
                "billingCode": "99215",
                "codeType": "CPT",
                "id": 7354,
                "precertRequired": false
              }
            ],
            "clinicalServices": [
              {
                "clinicalService": "35-Chiropractic"
              }
            ],
            "codeRequired": "YES",
            "description": "Outpatient re-evaluation during this episode of care as clinically indicated.",
            "frequency": null,
            "frequencyType": "week",
            "id": 4688,
            "serviceHptcs": [
              {
                "HPTC": "111NR0200X"
              },
              {
                "HPTC": "111NX0100X"
              },
              {
                "HPTC": "111NX0800X"
              },
              {
                "HPTC": "111NP0017X"
              },
              {
                "HPTC": "111NS0005X"
              },
              {
                "HPTC": "111NT0100X"
              },
              {
                "HPTC": "111NI0900X"
              },
              {
                "HPTC": "111NN0400X"
              },
              {
                "HPTC": "111NN1001X"
              },
              {
                "HPTC": "111N00000X"
              },
              {
                "HPTC": "111NI0013X"
              },
              {
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              }
            ],
            "visits": 999
          }
        ],
        "versionNumber": "1.0.7"
      }
    }
  ]
}