{"Seocs":[{"Seoc":{"id":1864,"seocKey":1,"name":"Acupuncture Initial","seocId":"PMR_ACUPUNCTURE INITIAL_1.0.8","versionNumber":"1.0.8","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"07-23-2020","endDate":null,"duration":60,"REV":false,"PRCT":false,"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.","maxAllowableVisits":null,"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 \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp \r\nfor 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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":5960,"description":"Initial outpatient evaluation for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"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"}]},{"id":5961,"description":"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.","frequency":null,"frequencyType":"","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":13485,"precertRequired":false,"billingCode":"20560","codeType":"CPT"},{"id":13486,"precertRequired":false,"billingCode":"20561","codeType":"CPT"}],"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"}]},{"id":5962,"description":"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.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":8973,"precertRequired":false,"billingCode":"S8930","codeType":"HCPCS"}],"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"}]},{"id":5963,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"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"}]}]}},{"Seoc":{"id":1666,"seocKey":1,"name":"Acupuncture Initial","seocId":"PMR_ACUPUNCTURE INITIAL_1.0.7","versionNumber":"1.0.7","description":"This initial authorization covers services associated with all acupuncture care listed below for the referred condition on the consult.","effectiveDate":"01-24-2020","endDate":"07-23-2020","duration":60,"REV":false,"PRCT":false,"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.","maxAllowableVisits":null,"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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":4685,"description":"Initial outpatient evaluation for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":4686,"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","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":4687,"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","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]},{"id":4688,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":536,"seocKey":1,"name":"Acupuncture Initial","seocId":"PMR_ACUPUNCTURE INITIAL_1.0.6","versionNumber":"1.0.6","description":"This initial authorization covers services associated with all acupuncture care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":"01-24-2020","duration":45,"REV":false,"PRCT":false,"proceduralOverview":"1.   Initial outpatient evaluation for this episode of care\r\n2.   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.\r\n3.  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.\r\n4.  Outpatient re-evaluation during this episode of care as clinically indicated.","maxAllowableVisits":null,"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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":3117,"description":"Initial outpatient evaluation for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":3118,"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","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":3119,"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","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]},{"id":3120,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":414,"seocKey":1,"name":"Acupuncture Initial","seocId":"PMR_ACUPUNCTURE INITIAL_1.0.5","versionNumber":"1.0.5","description":"This initial authorization covers services associated with all acupuncture care listed below for the referred condition on the consult.","effectiveDate":"05-17-2019","endDate":"07-28-2019","duration":45,"REV":false,"PRCT":false,"proceduralOverview":"1.   Initial outpatient evaluation for this episode of care\r\n2.   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.\r\n3.  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.\r\n4.  Outpatient re-evaluation during this episode of care as clinically indicated.","maxAllowableVisits":null,"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*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":2182,"description":"Initial outpatient evaluation for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":2183,"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","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":2184,"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","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]},{"id":2185,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":181,"seocKey":1,"name":"Acupuncture Initial","seocId":"PMR_ACUPUNCTURE INITIAL_1.0.4","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-03-2019","endDate":"05-17-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Intial outpatient evaluation for this episode of care\r\n2. 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\r\n3. If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can incude: 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.","maxAllowableVisits":null,"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  *Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":675,"description":"Intial outpatient evaluation for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":676,"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":"","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":677,"description":"If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can incude: manual therapy and therapeutic exercise procedures including but not limited to:  cupping, myofascial release, and therapeutic exercises.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]},{"id":678,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":122,"seocKey":1,"name":"Acupuncture Initial","seocId":"PMR_ACUPUNCTURE INITIAL_1.0.3","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Intial outpatient evaluation for this episode of care\r\n2. 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\r\n3. If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can incude: 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.","maxAllowableVisits":999,"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  *Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":7,"description":"Intial outpatient evaluation for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":8,"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":"","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":9,"description":"If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can incude: manual therapy and therapeutic exercise procedures including but not limited to:  cupping, myofascial release, and therapeutic exercises.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]},{"id":10,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":18,"seocKey":1,"name":"Acupuncture_PRCT","seocId":"PMR_ACUPUNCTURE_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"11-01-2017","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Nine (9) visits for acupuncture therapy with or without electrical stimulation to include therapeutic exercises, manual therapy and self-care instructions. Not to exceed two visits per week","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1303,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":19,"seocKey":1,"name":"Acupuncture_PRCT","seocId":"PMR_ACUPUNCTURE_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.\r\n","effectiveDate":"11-01-2017","endDate":"12-07-2018","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for specific problem\r\n2. Acupuncture therapy\r\n3. Ten (10) office visits for this episode of care","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1304,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1861,"seocKey":2,"name":"Acupuncture-Chronic Care Management","seocId":"PMR_ACUPUNCTURE-CHRONIC CARE MANAGEMENT_1.2.5","versionNumber":"1.2.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order. This referral is for continued pain management (having already completed the initial trial. This includes cases that have not resolved or plateaued but have shown acupuncture be successful. Possible explanations for need of continued care may include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.\r\nSuccessful acupuncture treatment for chronic pain management includes:\r\no   An initial series of successful acupuncture treatment  [REQUIRED]\r\no   Assessment of patient function after a withdrawal of care [REQUIRED]\r\no   Consideration of other indicated medical, psychological, behavioral, and/or social interventions [REQUIRED]\r\no   Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches [REQUIRED]\r\nMust include one or more of the following: \r\no   Continued durable improvement in condition being treated\r\no   Continued functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living\r\no  Continued documented decreased utilization of medications","effectiveDate":"07-23-2020","endDate":null,"duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1.  Outpatient re-evaluation during this episode of care as clinically indicated.\r\n2.   A maximum of eight (8) 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.\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.","maxAllowableVisits":null,"disclaimer":"*Please visit the VHA Storefront \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp \r\nfor 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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":5953,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"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"}]},{"id":5954,"description":"A maximum of eight (8) 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":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":13485,"precertRequired":false,"billingCode":"20560","codeType":"CPT"},{"id":13486,"precertRequired":false,"billingCode":"20561","codeType":"CPT"}],"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"}]},{"id":5955,"description":"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.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":8973,"precertRequired":false,"billingCode":"S8930","codeType":"HCPCS"}],"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"}]}]}},{"Seoc":{"id":537,"seocKey":2,"name":"Acupuncture-Chronic Care Management","seocId":"PMR_ACUPUNCTURE-CHRONIC CARE MANAGEMENT_1.2.4","versionNumber":"1.2.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.  This referral is for continued pain management (having already completed the initial trial. This includes cases that have not resolved or plateaued but have shown acupuncture be successful. Possible explanations for need of continued care may include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.\r\nSuccessful acupuncture treatment for chronic pain management includes:\r\no   An initial series of successful acupuncture treatment  [REQUIRED]\r\no   Assessment of patient function after a withdrawal of care [REQUIRED]\r\no   Consideration of other indicated medical, psychological, behavioral, and/or social interventions [REQUIRED]\r\no   Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches [REQUIRED]\r\nMust include one or more of the following: \r\no   Continued durable improvement in condition being treated\r\no   Continued functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living\r\no  Continued documented decreased utilization of medications","effectiveDate":"07-28-2019","endDate":"07-23-2020","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1.  Outpatient re-evaluation during this episode of care as clinically indicated.\r\n2.   A maximum of eight (8) 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.\r\n3.  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.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":3121,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":3122,"description":"A maximum of eight (8) 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","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":3123,"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","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":416,"seocKey":2,"name":"Acupuncture-Chronic Care Management","seocId":"PMR_ACUPUNCTURE-CHRONIC CARE MANAGEMENT_1.2.3","versionNumber":"1.2.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.  This referral is for continued pain management (having already completed the initial trial. This includes cases that have not resolved or plateaued but have shown acupuncture be successful. Possible explanations for need of continued care may include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.\r\nSuccessful acupuncture treatment for chronic pain management includes:\r\no   An initial series of successful acupuncture treatment  [REQUIRED]\r\no   Assessment of patient function after a withdrawal of care [REQUIRED]\r\no   Consideration of other indicated medical, psychological, behavioral, and/or social interventions [REQUIRED]\r\no   Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches [REQUIRED]\r\nMust include one or more of the following: \r\no   Continued durable improvement in condition being treated\r\no   Continued functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living\r\no  Continued documented decreased utilization of medications","effectiveDate":"05-17-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1.  Outpatient re-evaluation during this episode of care as clinically indicated.\r\n2.   A maximum of eight (8) 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.\r\n3.  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.","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":2195,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":2196,"description":"A maximum of eight (8) 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","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":2197,"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","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":182,"seocKey":2,"name":"Acupuncture-Chronic Care Management","seocId":"PMR_ACUPUNCTURE-CHRONIC CARE MANAGEMENT_1.2.2","versionNumber":"1.2.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-03-2019","endDate":"05-17-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":" This referral is for continued pain management (having already completed the initial trial). This includes cases that have not resolved or plateaued but have shown acupuncture be successful. Possible explanations for need of continued care may include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.                     \r\nSuccessful acupuncture treatment for chronic pain management includes:                            \r\n-   Assessment of patient function after a withdrawal of care [REQUIRED]                           \r\n-   Consideration of other indicated medical, psychological, behavioral, and/or social interventions [REQUIRED]                          \r\n-   Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches [REQUIRED]                                \r\nMust include one or more of the following:                          \r\n-   Continued durable improvement in condition being treated                                       \r\n-   Continued functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living                                    \r\n-  Continued documented decreased utilization of medications\r\n1. One outpatient re-evaluation during this episode of care (if indicated)\r\n2. A maximum of eight (8) 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\r\n3. If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can incude: manual therapy and therapeutic exercise procedures including but not limited to:  cupping, myofascial release, and therapeutic exercises.","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":679,"description":"One outpatient re-evaluation during this episode of care (if indicated)","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":680,"description":"A maximum of eight (8) 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":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":681,"description":"If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can incude: manual therapy and therapeutic exercise procedures including but not limited to:  cupping, myofascial release, and therapeutic exercises.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":123,"seocKey":2,"name":"Acupuncture-Chronic Care Management","seocId":"PMR_ACUPUNCTURE-CHRONIC CARE MANAGEMENT_1.2.1","versionNumber":"1.2.1","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":" This referral is for continued pain management (having already completed the initial trial). This includes cases that have not resolved or plateaued but have shown acupuncture be successful. Possible explanations for need of continued care may include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.                     \r\nSuccessful acupuncture treatment for chronic pain management includes:                            \r\n-   Assessment of patient function after a withdrawal of care [REQUIRED]                           \r\n-   Consideration of other indicated medical, psychological, behavioral, and/or social interventions [REQUIRED]                          \r\n-   Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches [REQUIRED]                                \r\nMust include one or more of the following:                          \r\n-   Continued durable improvement in condition being treated                                       \r\n-   Continued functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living                                    \r\n-  Continued documented decreased utilization of medications\r\n1. One outpatient re-evaluation during this episode of care (if indicated)\r\n2. A maximum of eight (8) 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\r\n3. If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can incude: manual therapy and therapeutic exercise procedures including but not limited to:  cupping, myofascial release, and therapeutic exercises.","maxAllowableVisits":999,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1,"description":"One outpatient re-evaluation during this episode of care (if indicated)","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":2,"description":"A maximum of eight (8) 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":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":3,"description":"If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can incude: manual therapy and therapeutic exercise procedures including but not limited to:  cupping, myofascial release, and therapeutic exercises.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":1874,"seocKey":3,"name":"Acupuncture-Continuation of Initial Care","seocId":"PMR_ACUPUNCTURE-CONTINUATION OF INITIAL CARE_1.1.6","versionNumber":"1.1.6","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.    This referral is for continuation of the initial 60 day trial and  includes cases that have not resolved or plateaued within the initial 12 visits but have shown acupuncture to be successful. Possible explanations for the need of continued care include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.\r\nSuccessful acupuncture treatment includes:\r\no   Durable improvement in condition being treated, or\r\no   Durable functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living, or\r\no  Documented decreased utilization of medications","effectiveDate":"07-23-2020","endDate":null,"duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1.  Outpatient re-evaluation during this episode of care as clinically indicated.\r\n2.   A maximum of eight (8) 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.\r\nNote: Additional episode of care may be requested by the referring provider after 90 days as clinically necessary. A clinical evaluation and assessment of meaningful clinical improvement is required. \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.","maxAllowableVisits":null,"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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":6011,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"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"}]},{"id":6012,"description":"A maximum of eight (8) 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.\r\nNote: Additional episode of care may be requested by the referring provider after 90 days as clinically necessary. A clinical evaluation and assessment of meaningful clinical improvement is required.","frequency":null,"frequencyType":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":13485,"precertRequired":false,"billingCode":"20560","codeType":"CPT"},{"id":13486,"precertRequired":false,"billingCode":"20561","codeType":"CPT"}],"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"}]},{"id":6013,"description":"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.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":8973,"precertRequired":false,"billingCode":"S8930","codeType":"HCPCS"}],"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"}]}]}},{"Seoc":{"id":1820,"seocKey":3,"name":"Acupuncture-Continuation of Initial Care","seocId":"PMR_ACUPUNCTURE-CONTINUATION OF INITIAL CARE_1.1.5","versionNumber":"1.1.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.   This referral is for continuation of the initial 60 day trial and  includes cases that have not resolved or plateaued within the initial 12 visits but have shown acupuncture to be successful. Possible explanations for the need of continued care include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.\r\nSuccessful acupuncture treatment includes:\r\no   Durable improvement in condition being treated, or\r\no   Durable functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living, or\r\no  Documented decreased utilization of medications","effectiveDate":"06-08-2020","endDate":"07-23-2020","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1.  Outpatient re-evaluation during this episode of care as clinically indicated.\r\n2.   A maximum of eight (8) 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.\r\nNote: Additional episode of care may be requested by the referring provider after 90 days as clinically necessary. A clinical evaluation and assessment of meaningful clinical improvement is required. \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.","maxAllowableVisits":null,"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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":5772,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":5773,"description":"A maximum of eight (8) 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.\r\nNote: Additional episode of care may be requested by the referring provider after 90 days as clinically necessary. A clinical evaluation and assessment of meaningful clinical improvement is required.","frequency":null,"frequencyType":"week","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":5774,"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","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":538,"seocKey":3,"name":"Acupuncture-Continuation of Initial Care","seocId":"PMR_ACUPUNCTURE-CONTINUATION OF INITIAL CARE_1.1.4","versionNumber":"1.1.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.  This referral is for continuation of the initial 45 day trial and  includes cases that have not resolved or plateaued within the initial 12 visits but have shown acupuncture to be successful. Possible explanations for the need of continued care include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.\r\nSuccessful acupuncture treatment includes:\r\no   Durable improvement in condition being treated, or\r\no   Durable functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living, or\r\no  Documented decreased utilization of medications","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1.  Outpatient re-evaluation during this episode of care as clinically indicated.\r\n2.   A maximum of eight (8) 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.\r\nNote: Additional episode of care may be requested by the referring provider after 90 days as clinically necessary. A clinical evaluation and assessment of meaningful clinical improvement is required. \r\n3.  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.","maxAllowableVisits":null,"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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":3124,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":3125,"description":"A maximum of eight (8) 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.\r\nNote: Additional episode of care may be requested by the referring provider after 90 days as clinically necessary. A clinical evaluation and assessment of meaningful clinical improvement is required.","frequency":null,"frequencyType":"week","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":3126,"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","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":415,"seocKey":3,"name":"Acupuncture-Continuation of Initial Care","seocId":"PMR_ACUPUNCTURE-CONTINUATION OF INITIAL CARE_1.1.3","versionNumber":"1.1.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.  This referral is for continuation of the initial 45 day trial and  includes cases that have not resolved or plateaued within the initial 12 visits but have shown acupuncture to be successful. Possible explanations for the need of continued care include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.\r\nSuccessful acupuncture treatment includes:\r\no   Durable improvement in condition being treated, or\r\no   Durable functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living, or\r\no  Documented decreased utilization of medications","effectiveDate":"05-17-2019","endDate":"07-28-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1.  Outpatient re-evaluation during this episode of care as clinically indicated.\r\n2.   A maximum of eight (8) 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.\r\nNote: Additional episode of care may be requested by the referring provider after 90 days as clinically necessary. A clinical evaluation and assessment of meaningful clinical improvement is required. \r\n3.  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.","maxAllowableVisits":null,"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*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":2189,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":2190,"description":"A maximum of eight (8) 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.\r\nNote: Additional episode of care may be requested by the referring provider after 90 days as clinically necessary. A clinical evaluation and assessment of meaningful clinical improvement is required.","frequency":null,"frequencyType":"week","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":2191,"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","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":183,"seocKey":3,"name":"Acupuncture-Continuation of Initial Care","seocId":"PMR_ACUPUNCTURE-CONTINUATION OF INITIAL CARE_1.1.2","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-03-2019","endDate":"05-17-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"This referral is for continuation of the initial trial and includes cases that have not resolved or plateaued within the initial 12 visits but have shown acupuncture to be successful. Possible explanations for the need of continued care include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.                                  \r\nSuccessful acupuncture treatment includes:                     \r\n-  Durable improvement in condition being treated, or                                    \r\n-  Durable functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living, or                   \r\n-  Documented decreased utilization of medications\r\n\r\n1. Outpatient re-evaluation during this episode of care as clinically indicated\r\n2. A maximum of eight (8) 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\r\n3. 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.","maxAllowableVisits":null,"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*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"171100000X"}],"services":[{"id":682,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":683,"description":"A maximum of eight (8) 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":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":684,"description":"If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can incude: manual therapy and therapeutic exercise procedures including but not limited to:  cupping, myofascial release, and therapeutic exercises.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":124,"seocKey":3,"name":"Acupuncture-Continuation of Initial Care","seocId":"PMR_ACUPUNCTURE-CONTINUATION OF INITIAL CARE_1.1.1","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"This referral is for continuation of the initial trial and includes cases that have not resolved or plateaued within the initial 12 visits but have shown acupuncture to be successful. Possible explanations for the need of continued care include emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.                                  \r\nSuccessful acupuncture treatment includes:                     \r\n-  Durable improvement in condition being treated, or                                    \r\n-  Durable functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living, or                   \r\n-  Documented decreased utilization of medications\r\n\r\n1. Outpatient re-evaluation during this episode of care as clinically indicated\r\n2. A maximum of eight (8) 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\r\n3. 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.","maxAllowableVisits":999,"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*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"ACUPUNCTURE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":4,"description":"Outpatient re-evaluation during this episode of care as clinically indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":5,"description":"A maximum of eight (8) 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":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"}],"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"}]},{"id":6,"description":"If indicated, approved modalities that can be utilized during the approved acupuncture visits noted in no.2 above can incude: manual therapy and therapeutic exercise procedures including but not limited to:  cupping, myofascial release, and therapeutic exercises.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7240,"precertRequired":false,"billingCode":"97016","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7259,"precertRequired":false,"billingCode":"97139","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":1880,"seocKey":4,"name":"Acute Inpatient Psychiatric Services - Involuntary Admission_REV_PRCT","seocId":"MHC_ACUTE INPATIENT PSYCHIATRIC SERVICES - INVOLUNTARY ADMISSION_1.0.5_REV_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"07-23-2020","endDate":null,"duration":30,"REV":true,"PRCT":true,"proceduralOverview":"1. Inpatient mental health services, including ECT","maxAllowableVisits":null,"disclaimer":"*Please visit the VHA Storefront \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp \r\nfor 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","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":6020,"description":"Inpatient mental health services, including ECT","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":6569,"precertRequired":false,"billingCode":"90785","codeType":"CPT"},{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"},{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6581,"precertRequired":false,"billingCode":"90845","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6584,"precertRequired":false,"billingCode":"90849","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":6586,"precertRequired":false,"billingCode":"90863","codeType":"CPT"},{"id":6587,"precertRequired":false,"billingCode":"90867","codeType":"CPT"},{"id":6588,"precertRequired":false,"billingCode":"90868","codeType":"CPT"},{"id":6589,"precertRequired":false,"billingCode":"90869","codeType":"CPT"},{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":6591,"precertRequired":false,"billingCode":"90875","codeType":"CPT"},{"id":6592,"precertRequired":false,"billingCode":"90876","codeType":"CPT"},{"id":6598,"precertRequired":false,"billingCode":"90901","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7173,"precertRequired":true,"billingCode":"96116","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7178,"precertRequired":false,"billingCode":"96127","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7276,"precertRequired":false,"billingCode":"97535","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7315,"precertRequired":false,"billingCode":"98966","codeType":"CPT"},{"id":7316,"precertRequired":false,"billingCode":"98967","codeType":"CPT"},{"id":7317,"precertRequired":false,"billingCode":"98968","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7492,"precertRequired":false,"billingCode":"99492","codeType":"CPT"},{"id":7493,"precertRequired":false,"billingCode":"99493","codeType":"CPT"},{"id":7494,"precertRequired":false,"billingCode":"99494","codeType":"CPT"},{"id":8151,"precertRequired":false,"billingCode":"G0176","codeType":"HCPCS"},{"id":8152,"precertRequired":false,"billingCode":"G0177","codeType":"HCPCS"},{"id":8191,"precertRequired":false,"billingCode":"G0396","codeType":"HCPCS"},{"id":8192,"precertRequired":false,"billingCode":"G0397","codeType":"HCPCS"},{"id":8199,"precertRequired":false,"billingCode":"G0409","codeType":"HCPCS"},{"id":8200,"precertRequired":false,"billingCode":"G0410","codeType":"HCPCS"},{"id":8201,"precertRequired":false,"billingCode":"G0411","codeType":"HCPCS"},{"id":9784,"precertRequired":true,"billingCode":"96132","codeType":"CPT"},{"id":9785,"precertRequired":true,"billingCode":"96133","codeType":"CPT"},{"id":9786,"precertRequired":true,"billingCode":"96136","codeType":"CPT"},{"id":9787,"precertRequired":true,"billingCode":"96137","codeType":"CPT"},{"id":9788,"precertRequired":true,"billingCode":"96138","codeType":"CPT"},{"id":9789,"precertRequired":true,"billingCode":"96139","codeType":"CPT"},{"id":9790,"precertRequired":false,"billingCode":"96146","codeType":"CPT"},{"id":11417,"precertRequired":false,"billingCode":"99484","codeType":"CPT"},{"id":11850,"precertRequired":false,"billingCode":"97151","codeType":"CPT"},{"id":11851,"precertRequired":false,"billingCode":"97152","codeType":"CPT"},{"id":11852,"precertRequired":false,"billingCode":"97153","codeType":"CPT"},{"id":11853,"precertRequired":false,"billingCode":"97154","codeType":"CPT"},{"id":11854,"precertRequired":false,"billingCode":"97155","codeType":"CPT"},{"id":11855,"precertRequired":false,"billingCode":"97156","codeType":"CPT"},{"id":11856,"precertRequired":false,"billingCode":"97157","codeType":"CPT"},{"id":11857,"precertRequired":false,"billingCode":"97158","codeType":"CPT"},{"id":12127,"precertRequired":false,"billingCode":"96121","codeType":"CPT"},{"id":12196,"precertRequired":false,"billingCode":"90865","codeType":"CPT"},{"id":13280,"precertRequired":true,"billingCode":"G0470","codeType":"HCPCS"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"},{"id":13345,"precertRequired":true,"billingCode":"96130","codeType":"CPT"},{"id":13346,"precertRequired":true,"billingCode":"96131","codeType":"CPT"},{"id":13396,"precertRequired":false,"billingCode":"90912","codeType":"CPT"},{"id":13397,"precertRequired":false,"billingCode":"90913","codeType":"CPT"},{"id":13398,"precertRequired":false,"billingCode":"96156","codeType":"CPT"},{"id":13399,"precertRequired":false,"billingCode":"96158","codeType":"CPT"},{"id":13400,"precertRequired":false,"billingCode":"96159","codeType":"CPT"},{"id":13401,"precertRequired":false,"billingCode":"97129","codeType":"CPT"},{"id":13532,"precertRequired":false,"billingCode":"96164","codeType":"CPT"},{"id":13533,"precertRequired":false,"billingCode":"96165","codeType":"CPT"},{"id":13575,"precertRequired":false,"billingCode":"96167","codeType":"CPT"},{"id":13576,"precertRequired":false,"billingCode":"96168","codeType":"CPT"},{"id":13659,"precertRequired":false,"billingCode":"G2023","codeType":"HCPCS"},{"id":13660,"precertRequired":false,"billingCode":"G2024","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":1675,"seocKey":4,"name":"Acute Inpatient Psychiatric Services - Involuntary Admission_REV_PRCT","seocId":"MHC_ACUTE INPATIENT PSYCHIATRIC SERVICES - INVOLUNTARY ADMISSION_1.0.4_REV_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-24-2020","endDate":"07-23-2020","duration":30,"REV":true,"PRCT":true,"proceduralOverview":"1. Inpatient mental health services, including ECT","maxAllowableVisits":null,"disclaimer":"*Please visit the VHA Storefront \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp \r\nfor 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","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":4741,"description":"Inpatient mental health services, including ECT","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5019,"precertRequired":false,"billingCode":"80156","codeType":"CPT"},{"id":5020,"precertRequired":false,"billingCode":"80157","codeType":"CPT"},{"id":5022,"precertRequired":false,"billingCode":"80159","codeType":"CPT"},{"id":5025,"precertRequired":false,"billingCode":"80164","codeType":"CPT"},{"id":5026,"precertRequired":false,"billingCode":"80165","codeType":"CPT"},{"id":5030,"precertRequired":false,"billingCode":"80171","codeType":"CPT"},{"id":5031,"precertRequired":false,"billingCode":"80173","codeType":"CPT"},{"id":5032,"precertRequired":false,"billingCode":"80175","codeType":"CPT"},{"id":5035,"precertRequired":false,"billingCode":"80178","codeType":"CPT"},{"id":5037,"precertRequired":false,"billingCode":"80183","codeType":"CPT"},{"id":5038,"precertRequired":false,"billingCode":"80184","codeType":"CPT"},{"id":5039,"precertRequired":false,"billingCode":"80185","codeType":"CPT"},{"id":5040,"precertRequired":false,"billingCode":"80186","codeType":"CPT"},{"id":5047,"precertRequired":false,"billingCode":"80198","codeType":"CPT"},{"id":5050,"precertRequired":false,"billingCode":"80201","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5060,"precertRequired":false,"billingCode":"80321","codeType":"CPT"},{"id":5061,"precertRequired":false,"billingCode":"80322","codeType":"CPT"},{"id":5063,"precertRequired":false,"billingCode":"80324","codeType":"CPT"},{"id":5064,"precertRequired":false,"billingCode":"80325","codeType":"CPT"},{"id":5065,"precertRequired":false,"billingCode":"80326","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5071,"precertRequired":false,"billingCode":"80332","codeType":"CPT"},{"id":5072,"precertRequired":false,"billingCode":"80333","codeType":"CPT"},{"id":5073,"precertRequired":false,"billingCode":"80334","codeType":"CPT"},{"id":5074,"precertRequired":false,"billingCode":"80335","codeType":"CPT"},{"id":5075,"precertRequired":false,"billingCode":"80336","codeType":"CPT"},{"id":5076,"precertRequired":false,"billingCode":"80337","codeType":"CPT"},{"id":5085,"precertRequired":false,"billingCode":"80346","codeType":"CPT"},{"id":5086,"precertRequired":false,"billingCode":"80347","codeType":"CPT"},{"id":5087,"precertRequired":false,"billingCode":"80348","codeType":"CPT"},{"id":5088,"precertRequired":false,"billingCode":"80349","codeType":"CPT"},{"id":5089,"precertRequired":false,"billingCode":"80350","codeType":"CPT"},{"id":5090,"precertRequired":false,"billingCode":"80351","codeType":"CPT"},{"id":5091,"precertRequired":false,"billingCode":"80352","codeType":"CPT"},{"id":5095,"precertRequired":false,"billingCode":"80356","codeType":"CPT"},{"id":5096,"precertRequired":false,"billingCode":"80357","codeType":"CPT"},{"id":5097,"precertRequired":false,"billingCode":"80358","codeType":"CPT"},{"id":5100,"precertRequired":false,"billingCode":"80361","codeType":"CPT"},{"id":5101,"precertRequired":false,"billingCode":"80362","codeType":"CPT"},{"id":5102,"precertRequired":false,"billingCode":"80363","codeType":"CPT"},{"id":5103,"precertRequired":false,"billingCode":"80364","codeType":"CPT"},{"id":5107,"precertRequired":false,"billingCode":"80368","codeType":"CPT"},{"id":5108,"precertRequired":false,"billingCode":"80369","codeType":"CPT"},{"id":5109,"precertRequired":false,"billingCode":"80370","codeType":"CPT"},{"id":5111,"precertRequired":false,"billingCode":"80372","codeType":"CPT"},{"id":5112,"precertRequired":false,"billingCode":"80373","codeType":"CPT"},{"id":5113,"precertRequired":false,"billingCode":"80374","codeType":"CPT"},{"id":5114,"precertRequired":false,"billingCode":"80375","codeType":"CPT"},{"id":5115,"precertRequired":false,"billingCode":"80376","codeType":"CPT"},{"id":5116,"precertRequired":false,"billingCode":"80377","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5377,"precertRequired":false,"billingCode":"82075","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6569,"precertRequired":false,"billingCode":"90785","codeType":"CPT"},{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"},{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6581,"precertRequired":false,"billingCode":"90845","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6584,"precertRequired":false,"billingCode":"90849","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":6586,"precertRequired":false,"billingCode":"90863","codeType":"CPT"},{"id":6587,"precertRequired":false,"billingCode":"90867","codeType":"CPT"},{"id":6588,"precertRequired":false,"billingCode":"90868","codeType":"CPT"},{"id":6589,"precertRequired":false,"billingCode":"90869","codeType":"CPT"},{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":6591,"precertRequired":false,"billingCode":"90875","codeType":"CPT"},{"id":6592,"precertRequired":false,"billingCode":"90876","codeType":"CPT"},{"id":6598,"precertRequired":false,"billingCode":"90901","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7173,"precertRequired":true,"billingCode":"96116","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7178,"precertRequired":false,"billingCode":"96127","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7276,"precertRequired":false,"billingCode":"97535","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7315,"precertRequired":false,"billingCode":"98966","codeType":"CPT"},{"id":7316,"precertRequired":false,"billingCode":"98967","codeType":"CPT"},{"id":7317,"precertRequired":false,"billingCode":"98968","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7492,"precertRequired":false,"billingCode":"99492","codeType":"CPT"},{"id":7493,"precertRequired":false,"billingCode":"99493","codeType":"CPT"},{"id":7494,"precertRequired":false,"billingCode":"99494","codeType":"CPT"},{"id":8151,"precertRequired":false,"billingCode":"G0176","codeType":"HCPCS"},{"id":8152,"precertRequired":false,"billingCode":"G0177","codeType":"HCPCS"},{"id":8191,"precertRequired":false,"billingCode":"G0396","codeType":"HCPCS"},{"id":8192,"precertRequired":false,"billingCode":"G0397","codeType":"HCPCS"},{"id":8199,"precertRequired":false,"billingCode":"G0409","codeType":"HCPCS"},{"id":8200,"precertRequired":false,"billingCode":"G0410","codeType":"HCPCS"},{"id":8201,"precertRequired":false,"billingCode":"G0411","codeType":"HCPCS"},{"id":8337,"precertRequired":false,"billingCode":"H0001","codeType":"HCPCS"},{"id":8338,"precertRequired":false,"billingCode":"H0003","codeType":"HCPCS"},{"id":8339,"precertRequired":false,"billingCode":"H0004","codeType":"HCPCS"},{"id":8340,"precertRequired":false,"billingCode":"H0005","codeType":"HCPCS"},{"id":8341,"precertRequired":false,"billingCode":"H0006","codeType":"HCPCS"},{"id":8342,"precertRequired":false,"billingCode":"H0014","codeType":"HCPCS"},{"id":8343,"precertRequired":false,"billingCode":"H0020","codeType":"HCPCS"},{"id":8344,"precertRequired":false,"billingCode":"H0021","codeType":"HCPCS"},{"id":8345,"precertRequired":false,"billingCode":"H0022","codeType":"HCPCS"},{"id":8346,"precertRequired":false,"billingCode":"H0033","codeType":"HCPCS"},{"id":8348,"precertRequired":false,"billingCode":"H0048","codeType":"HCPCS"},{"id":8349,"precertRequired":false,"billingCode":"H0049","codeType":"HCPCS"},{"id":9045,"precertRequired":false,"billingCode":"T1016","codeType":"HCPCS"},{"id":9046,"precertRequired":false,"billingCode":"T1017","codeType":"HCPCS"},{"id":9047,"precertRequired":false,"billingCode":"T1019","codeType":"HCPCS"},{"id":9048,"precertRequired":false,"billingCode":"T1020","codeType":"HCPCS"},{"id":9784,"precertRequired":true,"billingCode":"96132","codeType":"CPT"},{"id":9785,"precertRequired":true,"billingCode":"96133","codeType":"CPT"},{"id":9786,"precertRequired":true,"billingCode":"96136","codeType":"CPT"},{"id":9787,"precertRequired":true,"billingCode":"96137","codeType":"CPT"},{"id":9788,"precertRequired":true,"billingCode":"96138","codeType":"CPT"},{"id":9789,"precertRequired":true,"billingCode":"96139","codeType":"CPT"},{"id":9790,"precertRequired":false,"billingCode":"96146","codeType":"CPT"},{"id":11417,"precertRequired":false,"billingCode":"99484","codeType":"CPT"},{"id":11850,"precertRequired":false,"billingCode":"97151","codeType":"CPT"},{"id":11851,"precertRequired":false,"billingCode":"97152","codeType":"CPT"},{"id":11852,"precertRequired":false,"billingCode":"97153","codeType":"CPT"},{"id":11853,"precertRequired":false,"billingCode":"97154","codeType":"CPT"},{"id":11854,"precertRequired":false,"billingCode":"97155","codeType":"CPT"},{"id":11855,"precertRequired":false,"billingCode":"97156","codeType":"CPT"},{"id":11856,"precertRequired":false,"billingCode":"97157","codeType":"CPT"},{"id":11857,"precertRequired":false,"billingCode":"97158","codeType":"CPT"},{"id":12127,"precertRequired":false,"billingCode":"96121","codeType":"CPT"},{"id":12194,"precertRequired":false,"billingCode":"H0031","codeType":"HCPCS"},{"id":12195,"precertRequired":false,"billingCode":"H0002","codeType":"HCPCS"},{"id":12196,"precertRequired":false,"billingCode":"90865","codeType":"CPT"},{"id":12202,"precertRequired":false,"billingCode":"H0016","codeType":"HCPCS"},{"id":12203,"precertRequired":false,"billingCode":"H0032","codeType":"HCPCS"},{"id":12204,"precertRequired":false,"billingCode":"H0036","codeType":"HCPCS"},{"id":12205,"precertRequired":false,"billingCode":"H0037","codeType":"HCPCS"},{"id":12206,"precertRequired":false,"billingCode":"H0039","codeType":"HCPCS"},{"id":12207,"precertRequired":false,"billingCode":"H0040","codeType":"HCPCS"},{"id":12211,"precertRequired":false,"billingCode":"H2011","codeType":"HCPCS"},{"id":12212,"precertRequired":false,"billingCode":"H2012","codeType":"HCPCS"},{"id":12213,"precertRequired":false,"billingCode":"H2015","codeType":"HCPCS"},{"id":12214,"precertRequired":false,"billingCode":"H2016","codeType":"HCPCS"},{"id":12216,"precertRequired":false,"billingCode":"H2018","codeType":"HCPCS"},{"id":12218,"precertRequired":false,"billingCode":"H2020","codeType":"HCPCS"},{"id":12219,"precertRequired":false,"billingCode":"H2027","codeType":"HCPCS"},{"id":12241,"precertRequired":false,"billingCode":"H0023","codeType":"HCPCS"},{"id":12242,"precertRequired":false,"billingCode":"H0024","codeType":"HCPCS"},{"id":12243,"precertRequired":false,"billingCode":"H0025","codeType":"HCPCS"},{"id":12244,"precertRequired":false,"billingCode":"H0026","codeType":"HCPCS"},{"id":12245,"precertRequired":false,"billingCode":"H0027","codeType":"HCPCS"},{"id":12246,"precertRequired":false,"billingCode":"H0028","codeType":"HCPCS"},{"id":12247,"precertRequired":false,"billingCode":"H0029","codeType":"HCPCS"},{"id":12248,"precertRequired":false,"billingCode":"H0035","codeType":"HCPCS"},{"id":12249,"precertRequired":false,"billingCode":"H2013","codeType":"HCPCS"},{"id":12250,"precertRequired":false,"billingCode":"H2021","codeType":"HCPCS"},{"id":12251,"precertRequired":false,"billingCode":"H2022","codeType":"HCPCS"},{"id":12252,"precertRequired":false,"billingCode":"H2035","codeType":"HCPCS"},{"id":12253,"precertRequired":false,"billingCode":"T1012","codeType":"HCPCS"},{"id":13245,"precertRequired":true,"billingCode":"S9485","codeType":"HCPCS"},{"id":13246,"precertRequired":true,"billingCode":"S9484","codeType":"HCPCS"},{"id":13266,"precertRequired":true,"billingCode":"H2036","codeType":"HCPCS"},{"id":13270,"precertRequired":true,"billingCode":"H0047","codeType":"HCPCS"},{"id":13271,"precertRequired":true,"billingCode":"H0050","codeType":"HCPCS"},{"id":13272,"precertRequired":true,"billingCode":"H2017","codeType":"HCPCS"},{"id":13273,"precertRequired":true,"billingCode":"H2019","codeType":"HCPCS"},{"id":13274,"precertRequired":true,"billingCode":"H0013","codeType":"HCPCS"},{"id":13275,"precertRequired":true,"billingCode":"H0015","codeType":"HCPCS"},{"id":13276,"precertRequired":true,"billingCode":"H0017","codeType":"HCPCS"},{"id":13277,"precertRequired":true,"billingCode":"H0018","codeType":"HCPCS"},{"id":13278,"precertRequired":true,"billingCode":"H0019","codeType":"HCPCS"},{"id":13280,"precertRequired":true,"billingCode":"G0470","codeType":"HCPCS"},{"id":13281,"precertRequired":true,"billingCode":"H0007","codeType":"HCPCS"},{"id":13282,"precertRequired":true,"billingCode":"H0008","codeType":"HCPCS"},{"id":13283,"precertRequired":true,"billingCode":"H0009","codeType":"HCPCS"},{"id":13284,"precertRequired":true,"billingCode":"H0010","codeType":"HCPCS"},{"id":13285,"precertRequired":true,"billingCode":"H0011","codeType":"HCPCS"},{"id":13286,"precertRequired":true,"billingCode":"H0012","codeType":"HCPCS"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"},{"id":13345,"precertRequired":true,"billingCode":"96130","codeType":"CPT"},{"id":13346,"precertRequired":true,"billingCode":"96131","codeType":"CPT"},{"id":13396,"precertRequired":false,"billingCode":"90912","codeType":"CPT"},{"id":13397,"precertRequired":false,"billingCode":"90913","codeType":"CPT"},{"id":13398,"precertRequired":false,"billingCode":"96156","codeType":"CPT"},{"id":13399,"precertRequired":false,"billingCode":"96158","codeType":"CPT"},{"id":13400,"precertRequired":false,"billingCode":"96159","codeType":"CPT"},{"id":13401,"precertRequired":false,"billingCode":"97129","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":500,"seocKey":4,"name":"Acute Inpatient Psychiatric Services - Involuntary Admission_PRCT","seocId":"MHC_ACUTE INPATIENT PSYCHIATRIC SERVICES - INVOLUNTARY ADMISSION_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition","effectiveDate":"07-28-2019","endDate":"01-24-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. One inpatient stay for the referred condition indicated on the consult\r\n2. Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization\r\n3. Diagnostic studies, images and labs","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":2916,"description":"One inpatient stay for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7551,"precertRequired":false,"billingCode":"0373T","codeType":"CPT"},{"id":7591,"precertRequired":false,"billingCode":"1022F","codeType":"CPT"},{"id":7592,"precertRequired":false,"billingCode":"1026F","codeType":"CPT"},{"id":7593,"precertRequired":false,"billingCode":"1030F","codeType":"CPT"},{"id":7594,"precertRequired":false,"billingCode":"1032F","codeType":"CPT"},{"id":7595,"precertRequired":false,"billingCode":"1033F","codeType":"CPT"},{"id":7596,"precertRequired":false,"billingCode":"1034F","codeType":"CPT"},{"id":7597,"precertRequired":false,"billingCode":"1035F","codeType":"CPT"},{"id":7598,"precertRequired":false,"billingCode":"1036F","codeType":"CPT"},{"id":7599,"precertRequired":false,"billingCode":"1040F","codeType":"CPT"},{"id":7600,"precertRequired":false,"billingCode":"1070F","codeType":"CPT"},{"id":7601,"precertRequired":false,"billingCode":"1071F","codeType":"CPT"},{"id":7604,"precertRequired":false,"billingCode":"1110F","codeType":"CPT"},{"id":7605,"precertRequired":false,"billingCode":"1111F","codeType":"CPT"},{"id":7606,"precertRequired":false,"billingCode":"1123F","codeType":"CPT"},{"id":7607,"precertRequired":false,"billingCode":"1124F","codeType":"CPT"},{"id":7608,"precertRequired":false,"billingCode":"1159F","codeType":"CPT"},{"id":7609,"precertRequired":false,"billingCode":"1160F","codeType":"CPT"},{"id":7610,"precertRequired":false,"billingCode":"1170F","codeType":"CPT"},{"id":7611,"precertRequired":false,"billingCode":"1175F","codeType":"CPT"},{"id":7612,"precertRequired":false,"billingCode":"1181F","codeType":"CPT"},{"id":7613,"precertRequired":false,"billingCode":"1182F","codeType":"CPT"},{"id":7614,"precertRequired":false,"billingCode":"1183F","codeType":"CPT"},{"id":7615,"precertRequired":false,"billingCode":"1220F","codeType":"CPT"},{"id":7616,"precertRequired":false,"billingCode":"1450F","codeType":"CPT"},{"id":7617,"precertRequired":false,"billingCode":"1451F","codeType":"CPT"},{"id":7618,"precertRequired":false,"billingCode":"1490F","codeType":"CPT"},{"id":7619,"precertRequired":false,"billingCode":"1491F","codeType":"CPT"},{"id":7620,"precertRequired":false,"billingCode":"1493F","codeType":"CPT"},{"id":7621,"precertRequired":false,"billingCode":"1494F","codeType":"CPT"},{"id":7622,"precertRequired":false,"billingCode":"1501F","codeType":"CPT"},{"id":7623,"precertRequired":false,"billingCode":"1502F","codeType":"CPT"},{"id":7625,"precertRequired":false,"billingCode":"2060F","codeType":"CPT"},{"id":7626,"precertRequired":false,"billingCode":"3008F","codeType":"CPT"},{"id":7627,"precertRequired":false,"billingCode":"3011F","codeType":"CPT"},{"id":7633,"precertRequired":false,"billingCode":"3085F","codeType":"CPT"},{"id":7634,"precertRequired":false,"billingCode":"3088F","codeType":"CPT"},{"id":7635,"precertRequired":false,"billingCode":"3089F","codeType":"CPT"},{"id":7636,"precertRequired":false,"billingCode":"3090F","codeType":"CPT"},{"id":7637,"precertRequired":false,"billingCode":"3091F","codeType":"CPT"},{"id":7638,"precertRequired":false,"billingCode":"3093F","codeType":"CPT"},{"id":7650,"precertRequired":false,"billingCode":"4060F","codeType":"CPT"},{"id":7651,"precertRequired":false,"billingCode":"4062F","codeType":"CPT"},{"id":7652,"precertRequired":false,"billingCode":"4063F","codeType":"CPT"},{"id":7653,"precertRequired":false,"billingCode":"4064F","codeType":"CPT"},{"id":7654,"precertRequired":false,"billingCode":"4065F","codeType":"CPT"},{"id":7656,"precertRequired":false,"billingCode":"4067F","codeType":"CPT"},{"id":7665,"precertRequired":false,"billingCode":"6005F","codeType":"CPT"},{"id":7666,"precertRequired":false,"billingCode":"6101F","codeType":"CPT"},{"id":7667,"precertRequired":false,"billingCode":"6102F","codeType":"CPT"},{"id":7668,"precertRequired":false,"billingCode":"6110F","codeType":"CPT"},{"id":9045,"precertRequired":false,"billingCode":"T1016","codeType":"HCPCS"},{"id":9046,"precertRequired":false,"billingCode":"T1017","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":2917,"description":"Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization","frequency":null,"frequencyType":"week","visits":18,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6581,"precertRequired":false,"billingCode":"90845","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6584,"precertRequired":false,"billingCode":"90849","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":6586,"precertRequired":false,"billingCode":"90863","codeType":"CPT"},{"id":6587,"precertRequired":false,"billingCode":"90867","codeType":"CPT"},{"id":6588,"precertRequired":false,"billingCode":"90868","codeType":"CPT"},{"id":6589,"precertRequired":false,"billingCode":"90869","codeType":"CPT"},{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7179,"precertRequired":false,"billingCode":"96150","codeType":"CPT"},{"id":7180,"precertRequired":false,"billingCode":"96151","codeType":"CPT"},{"id":7181,"precertRequired":false,"billingCode":"96152","codeType":"CPT"},{"id":7182,"precertRequired":false,"billingCode":"96153","codeType":"CPT"},{"id":7183,"precertRequired":false,"billingCode":"96154","codeType":"CPT"},{"id":7184,"precertRequired":false,"billingCode":"96155","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"},{"id":8342,"precertRequired":false,"billingCode":"H0014","codeType":"HCPCS"},{"id":8343,"precertRequired":false,"billingCode":"H0020","codeType":"HCPCS"},{"id":8344,"precertRequired":false,"billingCode":"H0021","codeType":"HCPCS"},{"id":8345,"precertRequired":false,"billingCode":"H0022","codeType":"HCPCS"},{"id":8346,"precertRequired":false,"billingCode":"H0033","codeType":"HCPCS"},{"id":8419,"precertRequired":false,"billingCode":"J1230","codeType":"HCPCS"},{"id":8880,"precertRequired":false,"billingCode":"S0109","codeType":"HCPCS"},{"id":9786,"precertRequired":true,"billingCode":"96136","codeType":"CPT"},{"id":9787,"precertRequired":true,"billingCode":"96137","codeType":"CPT"},{"id":9788,"precertRequired":true,"billingCode":"96138","codeType":"CPT"},{"id":9789,"precertRequired":true,"billingCode":"96139","codeType":"CPT"},{"id":9790,"precertRequired":false,"billingCode":"96146","codeType":"CPT"},{"id":11855,"precertRequired":false,"billingCode":"97156","codeType":"CPT"},{"id":11856,"precertRequired":false,"billingCode":"97157","codeType":"CPT"},{"id":11857,"precertRequired":false,"billingCode":"97158","codeType":"CPT"},{"id":12002,"precertRequired":false,"billingCode":"96130","codeType":"CPT"},{"id":12003,"precertRequired":false,"billingCode":"96131","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":2918,"description":"Diagnostic studies, images and labs","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":5019,"precertRequired":false,"billingCode":"80156","codeType":"CPT"},{"id":5020,"precertRequired":false,"billingCode":"80157","codeType":"CPT"},{"id":5022,"precertRequired":false,"billingCode":"80159","codeType":"CPT"},{"id":5025,"precertRequired":false,"billingCode":"80164","codeType":"CPT"},{"id":5026,"precertRequired":false,"billingCode":"80165","codeType":"CPT"},{"id":5030,"precertRequired":false,"billingCode":"80171","codeType":"CPT"},{"id":5031,"precertRequired":false,"billingCode":"80173","codeType":"CPT"},{"id":5032,"precertRequired":false,"billingCode":"80175","codeType":"CPT"},{"id":5035,"precertRequired":false,"billingCode":"80178","codeType":"CPT"},{"id":5037,"precertRequired":false,"billingCode":"80183","codeType":"CPT"},{"id":5038,"precertRequired":false,"billingCode":"80184","codeType":"CPT"},{"id":5039,"precertRequired":false,"billingCode":"80185","codeType":"CPT"},{"id":5040,"precertRequired":false,"billingCode":"80186","codeType":"CPT"},{"id":5047,"precertRequired":false,"billingCode":"80198","codeType":"CPT"},{"id":5050,"precertRequired":false,"billingCode":"80201","codeType":"CPT"},{"id":5053,"precertRequired":false,"billingCode":"80299","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5063,"precertRequired":false,"billingCode":"80324","codeType":"CPT"},{"id":5064,"precertRequired":false,"billingCode":"80325","codeType":"CPT"},{"id":5065,"precertRequired":false,"billingCode":"80326","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5071,"precertRequired":false,"billingCode":"80332","codeType":"CPT"},{"id":5072,"precertRequired":false,"billingCode":"80333","codeType":"CPT"},{"id":5073,"precertRequired":false,"billingCode":"80334","codeType":"CPT"},{"id":5074,"precertRequired":false,"billingCode":"80335","codeType":"CPT"},{"id":5075,"precertRequired":false,"billingCode":"80336","codeType":"CPT"},{"id":5076,"precertRequired":false,"billingCode":"80337","codeType":"CPT"},{"id":5085,"precertRequired":false,"billingCode":"80346","codeType":"CPT"},{"id":5086,"precertRequired":false,"billingCode":"80347","codeType":"CPT"},{"id":5087,"precertRequired":false,"billingCode":"80348","codeType":"CPT"},{"id":5088,"precertRequired":false,"billingCode":"80349","codeType":"CPT"},{"id":5089,"precertRequired":false,"billingCode":"80350","codeType":"CPT"},{"id":5090,"precertRequired":false,"billingCode":"80351","codeType":"CPT"},{"id":5091,"precertRequired":false,"billingCode":"80352","codeType":"CPT"},{"id":5095,"precertRequired":false,"billingCode":"80356","codeType":"CPT"},{"id":5096,"precertRequired":false,"billingCode":"80357","codeType":"CPT"},{"id":5097,"precertRequired":false,"billingCode":"80358","codeType":"CPT"},{"id":5100,"precertRequired":false,"billingCode":"80361","codeType":"CPT"},{"id":5101,"precertRequired":false,"billingCode":"80362","codeType":"CPT"},{"id":5102,"precertRequired":false,"billingCode":"80363","codeType":"CPT"},{"id":5103,"precertRequired":false,"billingCode":"80364","codeType":"CPT"},{"id":5107,"precertRequired":false,"billingCode":"80368","codeType":"CPT"},{"id":5108,"precertRequired":false,"billingCode":"80369","codeType":"CPT"},{"id":5109,"precertRequired":false,"billingCode":"80370","codeType":"CPT"},{"id":5111,"precertRequired":false,"billingCode":"80372","codeType":"CPT"},{"id":5112,"precertRequired":false,"billingCode":"80373","codeType":"CPT"},{"id":5113,"precertRequired":false,"billingCode":"80374","codeType":"CPT"},{"id":5114,"precertRequired":false,"billingCode":"80375","codeType":"CPT"},{"id":5115,"precertRequired":false,"billingCode":"80376","codeType":"CPT"},{"id":5116,"precertRequired":false,"billingCode":"80377","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":184,"seocKey":4,"name":"Acute Inpatient Psychiatric Services - Involuntary Admission_PRCT","seocId":"MHC_ACUTE INPATIENT PSYCHIATRIC SERVICES - INVOLUNTARY ADMISSION_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. One inpatient stay for the referred condition indicated on the consult\r\n2. Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization\r\n3. Diagnostic studies, images and labs","maxAllowableVisits":null,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":685,"description":"One inpatient stay for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7550,"precertRequired":false,"billingCode":"0372T","codeType":"CPT"},{"id":7551,"precertRequired":false,"billingCode":"0373T","codeType":"CPT"},{"id":7552,"precertRequired":false,"billingCode":"0374T","codeType":"CPT"},{"id":7591,"precertRequired":false,"billingCode":"1022F","codeType":"CPT"},{"id":7592,"precertRequired":false,"billingCode":"1026F","codeType":"CPT"},{"id":7593,"precertRequired":false,"billingCode":"1030F","codeType":"CPT"},{"id":7594,"precertRequired":false,"billingCode":"1032F","codeType":"CPT"},{"id":7595,"precertRequired":false,"billingCode":"1033F","codeType":"CPT"},{"id":7596,"precertRequired":false,"billingCode":"1034F","codeType":"CPT"},{"id":7597,"precertRequired":false,"billingCode":"1035F","codeType":"CPT"},{"id":7598,"precertRequired":false,"billingCode":"1036F","codeType":"CPT"},{"id":7599,"precertRequired":false,"billingCode":"1040F","codeType":"CPT"},{"id":7600,"precertRequired":false,"billingCode":"1070F","codeType":"CPT"},{"id":7601,"precertRequired":false,"billingCode":"1071F","codeType":"CPT"},{"id":7604,"precertRequired":false,"billingCode":"1110F","codeType":"CPT"},{"id":7605,"precertRequired":false,"billingCode":"1111F","codeType":"CPT"},{"id":7606,"precertRequired":false,"billingCode":"1123F","codeType":"CPT"},{"id":7607,"precertRequired":false,"billingCode":"1124F","codeType":"CPT"},{"id":7608,"precertRequired":false,"billingCode":"1159F","codeType":"CPT"},{"id":7609,"precertRequired":false,"billingCode":"1160F","codeType":"CPT"},{"id":7610,"precertRequired":false,"billingCode":"1170F","codeType":"CPT"},{"id":7611,"precertRequired":false,"billingCode":"1175F","codeType":"CPT"},{"id":7612,"precertRequired":false,"billingCode":"1181F","codeType":"CPT"},{"id":7613,"precertRequired":false,"billingCode":"1182F","codeType":"CPT"},{"id":7614,"precertRequired":false,"billingCode":"1183F","codeType":"CPT"},{"id":7615,"precertRequired":false,"billingCode":"1220F","codeType":"CPT"},{"id":7616,"precertRequired":false,"billingCode":"1450F","codeType":"CPT"},{"id":7617,"precertRequired":false,"billingCode":"1451F","codeType":"CPT"},{"id":7618,"precertRequired":false,"billingCode":"1490F","codeType":"CPT"},{"id":7619,"precertRequired":false,"billingCode":"1491F","codeType":"CPT"},{"id":7620,"precertRequired":false,"billingCode":"1493F","codeType":"CPT"},{"id":7621,"precertRequired":false,"billingCode":"1494F","codeType":"CPT"},{"id":7622,"precertRequired":false,"billingCode":"1501F","codeType":"CPT"},{"id":7623,"precertRequired":false,"billingCode":"1502F","codeType":"CPT"},{"id":7625,"precertRequired":false,"billingCode":"2060F","codeType":"CPT"},{"id":7626,"precertRequired":false,"billingCode":"3008F","codeType":"CPT"},{"id":7627,"precertRequired":false,"billingCode":"3011F","codeType":"CPT"},{"id":7633,"precertRequired":false,"billingCode":"3085F","codeType":"CPT"},{"id":7634,"precertRequired":false,"billingCode":"3088F","codeType":"CPT"},{"id":7635,"precertRequired":false,"billingCode":"3089F","codeType":"CPT"},{"id":7636,"precertRequired":false,"billingCode":"3090F","codeType":"CPT"},{"id":7637,"precertRequired":false,"billingCode":"3091F","codeType":"CPT"},{"id":7638,"precertRequired":false,"billingCode":"3093F","codeType":"CPT"},{"id":7650,"precertRequired":false,"billingCode":"4060F","codeType":"CPT"},{"id":7651,"precertRequired":false,"billingCode":"4062F","codeType":"CPT"},{"id":7652,"precertRequired":false,"billingCode":"4063F","codeType":"CPT"},{"id":7653,"precertRequired":false,"billingCode":"4064F","codeType":"CPT"},{"id":7654,"precertRequired":false,"billingCode":"4065F","codeType":"CPT"},{"id":7656,"precertRequired":false,"billingCode":"4067F","codeType":"CPT"},{"id":7665,"precertRequired":false,"billingCode":"6005F","codeType":"CPT"},{"id":7666,"precertRequired":false,"billingCode":"6101F","codeType":"CPT"},{"id":7667,"precertRequired":false,"billingCode":"6102F","codeType":"CPT"},{"id":7668,"precertRequired":false,"billingCode":"6110F","codeType":"CPT"},{"id":9045,"precertRequired":false,"billingCode":"T1016","codeType":"HCPCS"},{"id":9046,"precertRequired":false,"billingCode":"T1017","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":686,"description":"Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization","frequency":null,"frequencyType":"","visits":18,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6581,"precertRequired":false,"billingCode":"90845","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6584,"precertRequired":false,"billingCode":"90849","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":6586,"precertRequired":false,"billingCode":"90863","codeType":"CPT"},{"id":6587,"precertRequired":false,"billingCode":"90867","codeType":"CPT"},{"id":6588,"precertRequired":false,"billingCode":"90868","codeType":"CPT"},{"id":6589,"precertRequired":false,"billingCode":"90869","codeType":"CPT"},{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7179,"precertRequired":false,"billingCode":"96150","codeType":"CPT"},{"id":7180,"precertRequired":false,"billingCode":"96151","codeType":"CPT"},{"id":7181,"precertRequired":false,"billingCode":"96152","codeType":"CPT"},{"id":7182,"precertRequired":false,"billingCode":"96153","codeType":"CPT"},{"id":7183,"precertRequired":false,"billingCode":"96154","codeType":"CPT"},{"id":7184,"precertRequired":false,"billingCode":"96155","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"},{"id":8342,"precertRequired":false,"billingCode":"H0014","codeType":"HCPCS"},{"id":8343,"precertRequired":false,"billingCode":"H0020","codeType":"HCPCS"},{"id":8344,"precertRequired":false,"billingCode":"H0021","codeType":"HCPCS"},{"id":8345,"precertRequired":false,"billingCode":"H0022","codeType":"HCPCS"},{"id":8346,"precertRequired":false,"billingCode":"H0033","codeType":"HCPCS"},{"id":8419,"precertRequired":false,"billingCode":"J1230","codeType":"HCPCS"},{"id":8880,"precertRequired":false,"billingCode":"S0109","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":687,"description":"Diagnostic studies, images and labs","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":5019,"precertRequired":false,"billingCode":"80156","codeType":"CPT"},{"id":5020,"precertRequired":false,"billingCode":"80157","codeType":"CPT"},{"id":5022,"precertRequired":false,"billingCode":"80159","codeType":"CPT"},{"id":5025,"precertRequired":false,"billingCode":"80164","codeType":"CPT"},{"id":5026,"precertRequired":false,"billingCode":"80165","codeType":"CPT"},{"id":5030,"precertRequired":false,"billingCode":"80171","codeType":"CPT"},{"id":5031,"precertRequired":false,"billingCode":"80173","codeType":"CPT"},{"id":5032,"precertRequired":false,"billingCode":"80175","codeType":"CPT"},{"id":5035,"precertRequired":false,"billingCode":"80178","codeType":"CPT"},{"id":5037,"precertRequired":false,"billingCode":"80183","codeType":"CPT"},{"id":5038,"precertRequired":false,"billingCode":"80184","codeType":"CPT"},{"id":5039,"precertRequired":false,"billingCode":"80185","codeType":"CPT"},{"id":5040,"precertRequired":false,"billingCode":"80186","codeType":"CPT"},{"id":5047,"precertRequired":false,"billingCode":"80198","codeType":"CPT"},{"id":5050,"precertRequired":false,"billingCode":"80201","codeType":"CPT"},{"id":5053,"precertRequired":false,"billingCode":"80299","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5063,"precertRequired":false,"billingCode":"80324","codeType":"CPT"},{"id":5064,"precertRequired":false,"billingCode":"80325","codeType":"CPT"},{"id":5065,"precertRequired":false,"billingCode":"80326","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5071,"precertRequired":false,"billingCode":"80332","codeType":"CPT"},{"id":5072,"precertRequired":false,"billingCode":"80333","codeType":"CPT"},{"id":5073,"precertRequired":false,"billingCode":"80334","codeType":"CPT"},{"id":5074,"precertRequired":false,"billingCode":"80335","codeType":"CPT"},{"id":5075,"precertRequired":false,"billingCode":"80336","codeType":"CPT"},{"id":5076,"precertRequired":false,"billingCode":"80337","codeType":"CPT"},{"id":5085,"precertRequired":false,"billingCode":"80346","codeType":"CPT"},{"id":5086,"precertRequired":false,"billingCode":"80347","codeType":"CPT"},{"id":5087,"precertRequired":false,"billingCode":"80348","codeType":"CPT"},{"id":5088,"precertRequired":false,"billingCode":"80349","codeType":"CPT"},{"id":5089,"precertRequired":false,"billingCode":"80350","codeType":"CPT"},{"id":5090,"precertRequired":false,"billingCode":"80351","codeType":"CPT"},{"id":5091,"precertRequired":false,"billingCode":"80352","codeType":"CPT"},{"id":5095,"precertRequired":false,"billingCode":"80356","codeType":"CPT"},{"id":5096,"precertRequired":false,"billingCode":"80357","codeType":"CPT"},{"id":5097,"precertRequired":false,"billingCode":"80358","codeType":"CPT"},{"id":5100,"precertRequired":false,"billingCode":"80361","codeType":"CPT"},{"id":5101,"precertRequired":false,"billingCode":"80362","codeType":"CPT"},{"id":5102,"precertRequired":false,"billingCode":"80363","codeType":"CPT"},{"id":5103,"precertRequired":false,"billingCode":"80364","codeType":"CPT"},{"id":5107,"precertRequired":false,"billingCode":"80368","codeType":"CPT"},{"id":5108,"precertRequired":false,"billingCode":"80369","codeType":"CPT"},{"id":5109,"precertRequired":false,"billingCode":"80370","codeType":"CPT"},{"id":5111,"precertRequired":false,"billingCode":"80372","codeType":"CPT"},{"id":5112,"precertRequired":false,"billingCode":"80373","codeType":"CPT"},{"id":5113,"precertRequired":false,"billingCode":"80374","codeType":"CPT"},{"id":5114,"precertRequired":false,"billingCode":"80375","codeType":"CPT"},{"id":5115,"precertRequired":false,"billingCode":"80376","codeType":"CPT"},{"id":5116,"precertRequired":false,"billingCode":"80377","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":7167,"precertRequired":true,"billingCode":"96101","codeType":"CPT"},{"id":7168,"precertRequired":false,"billingCode":"96102","codeType":"CPT"},{"id":7169,"precertRequired":false,"billingCode":"96103","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":101,"seocKey":4,"name":"Acute Inpatient Psychiatric Services - Involuntary Admission_PRCT","seocId":"MHC_ACUTE INPATIENT PSYCHIATRIC SERVICES - INVOLUNTARY ADMISSION_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition","effectiveDate":"09-21-2018","endDate":"01-02-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. One inpatient stay for the referred condition indicated on the consult\r\n2. Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization\r\n3. Diagnostic studies, images and labs","maxAllowableVisits":999,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":275,"description":"One inpatient stay for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7550,"precertRequired":false,"billingCode":"0372T","codeType":"CPT"},{"id":7551,"precertRequired":false,"billingCode":"0373T","codeType":"CPT"},{"id":7552,"precertRequired":false,"billingCode":"0374T","codeType":"CPT"},{"id":7591,"precertRequired":false,"billingCode":"1022F","codeType":"CPT"},{"id":7592,"precertRequired":false,"billingCode":"1026F","codeType":"CPT"},{"id":7593,"precertRequired":false,"billingCode":"1030F","codeType":"CPT"},{"id":7594,"precertRequired":false,"billingCode":"1032F","codeType":"CPT"},{"id":7595,"precertRequired":false,"billingCode":"1033F","codeType":"CPT"},{"id":7596,"precertRequired":false,"billingCode":"1034F","codeType":"CPT"},{"id":7597,"precertRequired":false,"billingCode":"1035F","codeType":"CPT"},{"id":7598,"precertRequired":false,"billingCode":"1036F","codeType":"CPT"},{"id":7599,"precertRequired":false,"billingCode":"1040F","codeType":"CPT"},{"id":7600,"precertRequired":false,"billingCode":"1070F","codeType":"CPT"},{"id":7601,"precertRequired":false,"billingCode":"1071F","codeType":"CPT"},{"id":7604,"precertRequired":false,"billingCode":"1110F","codeType":"CPT"},{"id":7605,"precertRequired":false,"billingCode":"1111F","codeType":"CPT"},{"id":7606,"precertRequired":false,"billingCode":"1123F","codeType":"CPT"},{"id":7607,"precertRequired":false,"billingCode":"1124F","codeType":"CPT"},{"id":7608,"precertRequired":false,"billingCode":"1159F","codeType":"CPT"},{"id":7609,"precertRequired":false,"billingCode":"1160F","codeType":"CPT"},{"id":7610,"precertRequired":false,"billingCode":"1170F","codeType":"CPT"},{"id":7611,"precertRequired":false,"billingCode":"1175F","codeType":"CPT"},{"id":7612,"precertRequired":false,"billingCode":"1181F","codeType":"CPT"},{"id":7613,"precertRequired":false,"billingCode":"1182F","codeType":"CPT"},{"id":7614,"precertRequired":false,"billingCode":"1183F","codeType":"CPT"},{"id":7615,"precertRequired":false,"billingCode":"1220F","codeType":"CPT"},{"id":7616,"precertRequired":false,"billingCode":"1450F","codeType":"CPT"},{"id":7617,"precertRequired":false,"billingCode":"1451F","codeType":"CPT"},{"id":7618,"precertRequired":false,"billingCode":"1490F","codeType":"CPT"},{"id":7619,"precertRequired":false,"billingCode":"1491F","codeType":"CPT"},{"id":7620,"precertRequired":false,"billingCode":"1493F","codeType":"CPT"},{"id":7621,"precertRequired":false,"billingCode":"1494F","codeType":"CPT"},{"id":7622,"precertRequired":false,"billingCode":"1501F","codeType":"CPT"},{"id":7623,"precertRequired":false,"billingCode":"1502F","codeType":"CPT"},{"id":7625,"precertRequired":false,"billingCode":"2060F","codeType":"CPT"},{"id":7626,"precertRequired":false,"billingCode":"3008F","codeType":"CPT"},{"id":7627,"precertRequired":false,"billingCode":"3011F","codeType":"CPT"},{"id":7633,"precertRequired":false,"billingCode":"3085F","codeType":"CPT"},{"id":7634,"precertRequired":false,"billingCode":"3088F","codeType":"CPT"},{"id":7635,"precertRequired":false,"billingCode":"3089F","codeType":"CPT"},{"id":7636,"precertRequired":false,"billingCode":"3090F","codeType":"CPT"},{"id":7637,"precertRequired":false,"billingCode":"3091F","codeType":"CPT"},{"id":7638,"precertRequired":false,"billingCode":"3093F","codeType":"CPT"},{"id":7650,"precertRequired":false,"billingCode":"4060F","codeType":"CPT"},{"id":7651,"precertRequired":false,"billingCode":"4062F","codeType":"CPT"},{"id":7652,"precertRequired":false,"billingCode":"4063F","codeType":"CPT"},{"id":7653,"precertRequired":false,"billingCode":"4064F","codeType":"CPT"},{"id":7654,"precertRequired":false,"billingCode":"4065F","codeType":"CPT"},{"id":7656,"precertRequired":false,"billingCode":"4067F","codeType":"CPT"},{"id":7665,"precertRequired":false,"billingCode":"6005F","codeType":"CPT"},{"id":7666,"precertRequired":false,"billingCode":"6101F","codeType":"CPT"},{"id":7667,"precertRequired":false,"billingCode":"6102F","codeType":"CPT"},{"id":7668,"precertRequired":false,"billingCode":"6110F","codeType":"CPT"},{"id":9045,"precertRequired":false,"billingCode":"T1016","codeType":"HCPCS"},{"id":9046,"precertRequired":false,"billingCode":"T1017","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":276,"description":"Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization","frequency":null,"frequencyType":"","visits":18,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6581,"precertRequired":false,"billingCode":"90845","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6584,"precertRequired":false,"billingCode":"90849","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":6586,"precertRequired":false,"billingCode":"90863","codeType":"CPT"},{"id":6587,"precertRequired":false,"billingCode":"90867","codeType":"CPT"},{"id":6588,"precertRequired":false,"billingCode":"90868","codeType":"CPT"},{"id":6589,"precertRequired":false,"billingCode":"90869","codeType":"CPT"},{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7179,"precertRequired":false,"billingCode":"96150","codeType":"CPT"},{"id":7180,"precertRequired":false,"billingCode":"96151","codeType":"CPT"},{"id":7181,"precertRequired":false,"billingCode":"96152","codeType":"CPT"},{"id":7182,"precertRequired":false,"billingCode":"96153","codeType":"CPT"},{"id":7183,"precertRequired":false,"billingCode":"96154","codeType":"CPT"},{"id":7184,"precertRequired":false,"billingCode":"96155","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"},{"id":8342,"precertRequired":false,"billingCode":"H0014","codeType":"HCPCS"},{"id":8343,"precertRequired":false,"billingCode":"H0020","codeType":"HCPCS"},{"id":8344,"precertRequired":false,"billingCode":"H0021","codeType":"HCPCS"},{"id":8345,"precertRequired":false,"billingCode":"H0022","codeType":"HCPCS"},{"id":8346,"precertRequired":false,"billingCode":"H0033","codeType":"HCPCS"},{"id":8419,"precertRequired":false,"billingCode":"J1230","codeType":"HCPCS"},{"id":8880,"precertRequired":false,"billingCode":"S0109","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":277,"description":"Diagnostic studies, images and labs","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":5019,"precertRequired":false,"billingCode":"80156","codeType":"CPT"},{"id":5020,"precertRequired":false,"billingCode":"80157","codeType":"CPT"},{"id":5022,"precertRequired":false,"billingCode":"80159","codeType":"CPT"},{"id":5025,"precertRequired":false,"billingCode":"80164","codeType":"CPT"},{"id":5026,"precertRequired":false,"billingCode":"80165","codeType":"CPT"},{"id":5030,"precertRequired":false,"billingCode":"80171","codeType":"CPT"},{"id":5031,"precertRequired":false,"billingCode":"80173","codeType":"CPT"},{"id":5032,"precertRequired":false,"billingCode":"80175","codeType":"CPT"},{"id":5035,"precertRequired":false,"billingCode":"80178","codeType":"CPT"},{"id":5037,"precertRequired":false,"billingCode":"80183","codeType":"CPT"},{"id":5038,"precertRequired":false,"billingCode":"80184","codeType":"CPT"},{"id":5039,"precertRequired":false,"billingCode":"80185","codeType":"CPT"},{"id":5040,"precertRequired":false,"billingCode":"80186","codeType":"CPT"},{"id":5047,"precertRequired":false,"billingCode":"80198","codeType":"CPT"},{"id":5050,"precertRequired":false,"billingCode":"80201","codeType":"CPT"},{"id":5053,"precertRequired":false,"billingCode":"80299","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5063,"precertRequired":false,"billingCode":"80324","codeType":"CPT"},{"id":5064,"precertRequired":false,"billingCode":"80325","codeType":"CPT"},{"id":5065,"precertRequired":false,"billingCode":"80326","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5071,"precertRequired":false,"billingCode":"80332","codeType":"CPT"},{"id":5072,"precertRequired":false,"billingCode":"80333","codeType":"CPT"},{"id":5073,"precertRequired":false,"billingCode":"80334","codeType":"CPT"},{"id":5074,"precertRequired":false,"billingCode":"80335","codeType":"CPT"},{"id":5075,"precertRequired":false,"billingCode":"80336","codeType":"CPT"},{"id":5076,"precertRequired":false,"billingCode":"80337","codeType":"CPT"},{"id":5085,"precertRequired":false,"billingCode":"80346","codeType":"CPT"},{"id":5086,"precertRequired":false,"billingCode":"80347","codeType":"CPT"},{"id":5087,"precertRequired":false,"billingCode":"80348","codeType":"CPT"},{"id":5088,"precertRequired":false,"billingCode":"80349","codeType":"CPT"},{"id":5089,"precertRequired":false,"billingCode":"80350","codeType":"CPT"},{"id":5090,"precertRequired":false,"billingCode":"80351","codeType":"CPT"},{"id":5091,"precertRequired":false,"billingCode":"80352","codeType":"CPT"},{"id":5095,"precertRequired":false,"billingCode":"80356","codeType":"CPT"},{"id":5096,"precertRequired":false,"billingCode":"80357","codeType":"CPT"},{"id":5097,"precertRequired":false,"billingCode":"80358","codeType":"CPT"},{"id":5100,"precertRequired":false,"billingCode":"80361","codeType":"CPT"},{"id":5101,"precertRequired":false,"billingCode":"80362","codeType":"CPT"},{"id":5102,"precertRequired":false,"billingCode":"80363","codeType":"CPT"},{"id":5103,"precertRequired":false,"billingCode":"80364","codeType":"CPT"},{"id":5107,"precertRequired":false,"billingCode":"80368","codeType":"CPT"},{"id":5108,"precertRequired":false,"billingCode":"80369","codeType":"CPT"},{"id":5109,"precertRequired":false,"billingCode":"80370","codeType":"CPT"},{"id":5111,"precertRequired":false,"billingCode":"80372","codeType":"CPT"},{"id":5112,"precertRequired":false,"billingCode":"80373","codeType":"CPT"},{"id":5113,"precertRequired":false,"billingCode":"80374","codeType":"CPT"},{"id":5114,"precertRequired":false,"billingCode":"80375","codeType":"CPT"},{"id":5115,"precertRequired":false,"billingCode":"80376","codeType":"CPT"},{"id":5116,"precertRequired":false,"billingCode":"80377","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":7167,"precertRequired":true,"billingCode":"96101","codeType":"CPT"},{"id":7168,"precertRequired":false,"billingCode":"96102","codeType":"CPT"},{"id":7169,"precertRequired":false,"billingCode":"96103","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":1881,"seocKey":5,"name":"Acute Inpatient Psychiatric Voluntary_REV_PRCT","seocId":"MHC_ACUTE INPATIENT PSYCHIATRIC VOLUNTARY_1.1.5_REV_PRCT","versionNumber":"1.1.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"07-23-2020","endDate":null,"duration":30,"REV":true,"PRCT":true,"proceduralOverview":"1. Inpatient mental health services, including ECT","maxAllowableVisits":null,"disclaimer":"*Please visit the VHA Storefront \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp \r\nfor 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","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":6022,"description":"Inpatient mental health services, including ECT","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":6569,"precertRequired":false,"billingCode":"90785","codeType":"CPT"},{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"},{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6581,"precertRequired":false,"billingCode":"90845","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6584,"precertRequired":false,"billingCode":"90849","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":6586,"precertRequired":false,"billingCode":"90863","codeType":"CPT"},{"id":6587,"precertRequired":false,"billingCode":"90867","codeType":"CPT"},{"id":6588,"precertRequired":false,"billingCode":"90868","codeType":"CPT"},{"id":6589,"precertRequired":false,"billingCode":"90869","codeType":"CPT"},{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":6591,"precertRequired":false,"billingCode":"90875","codeType":"CPT"},{"id":6592,"precertRequired":false,"billingCode":"90876","codeType":"CPT"},{"id":6598,"precertRequired":false,"billingCode":"90901","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7173,"precertRequired":true,"billingCode":"96116","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7178,"precertRequired":false,"billingCode":"96127","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7276,"precertRequired":false,"billingCode":"97535","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7315,"precertRequired":false,"billingCode":"98966","codeType":"CPT"},{"id":7316,"precertRequired":false,"billingCode":"98967","codeType":"CPT"},{"id":7317,"precertRequired":false,"billingCode":"98968","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7492,"precertRequired":false,"billingCode":"99492","codeType":"CPT"},{"id":7493,"precertRequired":false,"billingCode":"99493","codeType":"CPT"},{"id":7494,"precertRequired":false,"billingCode":"99494","codeType":"CPT"},{"id":8151,"precertRequired":false,"billingCode":"G0176","codeType":"HCPCS"},{"id":8152,"precertRequired":false,"billingCode":"G0177","codeType":"HCPCS"},{"id":8191,"precertRequired":false,"billingCode":"G0396","codeType":"HCPCS"},{"id":8192,"precertRequired":false,"billingCode":"G0397","codeType":"HCPCS"},{"id":8199,"precertRequired":false,"billingCode":"G0409","codeType":"HCPCS"},{"id":8200,"precertRequired":false,"billingCode":"G0410","codeType":"HCPCS"},{"id":8201,"precertRequired":false,"billingCode":"G0411","codeType":"HCPCS"},{"id":9784,"precertRequired":true,"billingCode":"96132","codeType":"CPT"},{"id":9785,"precertRequired":true,"billingCode":"96133","codeType":"CPT"},{"id":9786,"precertRequired":true,"billingCode":"96136","codeType":"CPT"},{"id":9787,"precertRequired":true,"billingCode":"96137","codeType":"CPT"},{"id":9788,"precertRequired":true,"billingCode":"96138","codeType":"CPT"},{"id":9789,"precertRequired":true,"billingCode":"96139","codeType":"CPT"},{"id":9790,"precertRequired":false,"billingCode":"96146","codeType":"CPT"},{"id":11417,"precertRequired":false,"billingCode":"99484","codeType":"CPT"},{"id":11850,"precertRequired":false,"billingCode":"97151","codeType":"CPT"},{"id":11851,"precertRequired":false,"billingCode":"97152","codeType":"CPT"},{"id":11852,"precertRequired":false,"billingCode":"97153","codeType":"CPT"},{"id":11853,"precertRequired":false,"billingCode":"97154","codeType":"CPT"},{"id":11854,"precertRequired":false,"billingCode":"97155","codeType":"CPT"},{"id":11855,"precertRequired":false,"billingCode":"97156","codeType":"CPT"},{"id":11856,"precertRequired":false,"billingCode":"97157","codeType":"CPT"},{"id":11857,"precertRequired":false,"billingCode":"97158","codeType":"CPT"},{"id":12127,"precertRequired":false,"billingCode":"96121","codeType":"CPT"},{"id":12196,"precertRequired":false,"billingCode":"90865","codeType":"CPT"},{"id":13280,"precertRequired":true,"billingCode":"G0470","codeType":"HCPCS"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"},{"id":13345,"precertRequired":true,"billingCode":"96130","codeType":"CPT"},{"id":13346,"precertRequired":true,"billingCode":"96131","codeType":"CPT"},{"id":13396,"precertRequired":false,"billingCode":"90912","codeType":"CPT"},{"id":13397,"precertRequired":false,"billingCode":"90913","codeType":"CPT"},{"id":13398,"precertRequired":false,"billingCode":"96156","codeType":"CPT"},{"id":13399,"precertRequired":false,"billingCode":"96158","codeType":"CPT"},{"id":13400,"precertRequired":false,"billingCode":"96159","codeType":"CPT"},{"id":13401,"precertRequired":false,"billingCode":"97129","codeType":"CPT"},{"id":13532,"precertRequired":false,"billingCode":"96164","codeType":"CPT"},{"id":13533,"precertRequired":false,"billingCode":"96165","codeType":"CPT"},{"id":13575,"precertRequired":false,"billingCode":"96167","codeType":"CPT"},{"id":13576,"precertRequired":false,"billingCode":"96168","codeType":"CPT"},{"id":13659,"precertRequired":false,"billingCode":"G2023","codeType":"HCPCS"},{"id":13660,"precertRequired":false,"billingCode":"G2024","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":1676,"seocKey":5,"name":"Acute Inpatient Psychiatric Voluntary_REV_PRCT","seocId":"MHC_ACUTE INPATIENT PSYCHIATRIC VOLUNTARY_1.1.4_REV_PRCT","versionNumber":"1.1.4","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-24-2020","endDate":"07-23-2020","duration":30,"REV":true,"PRCT":true,"proceduralOverview":"1. Inpatient mental health services, including ECT","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":4745,"description":"Inpatient mental health services, including ECT","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5019,"precertRequired":false,"billingCode":"80156","codeType":"CPT"},{"id":5020,"precertRequired":false,"billingCode":"80157","codeType":"CPT"},{"id":5022,"precertRequired":false,"billingCode":"80159","codeType":"CPT"},{"id":5025,"precertRequired":false,"billingCode":"80164","codeType":"CPT"},{"id":5026,"precertRequired":false,"billingCode":"80165","codeType":"CPT"},{"id":5030,"precertRequired":false,"billingCode":"80171","codeType":"CPT"},{"id":5031,"precertRequired":false,"billingCode":"80173","codeType":"CPT"},{"id":5032,"precertRequired":false,"billingCode":"80175","codeType":"CPT"},{"id":5035,"precertRequired":false,"billingCode":"80178","codeType":"CPT"},{"id":5037,"precertRequired":false,"billingCode":"80183","codeType":"CPT"},{"id":5038,"precertRequired":false,"billingCode":"80184","codeType":"CPT"},{"id":5039,"precertRequired":false,"billingCode":"80185","codeType":"CPT"},{"id":5040,"precertRequired":false,"billingCode":"80186","codeType":"CPT"},{"id":5047,"precertRequired":false,"billingCode":"80198","codeType":"CPT"},{"id":5050,"precertRequired":false,"billingCode":"80201","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5060,"precertRequired":false,"billingCode":"80321","codeType":"CPT"},{"id":5061,"precertRequired":false,"billingCode":"80322","codeType":"CPT"},{"id":5063,"precertRequired":false,"billingCode":"80324","codeType":"CPT"},{"id":5064,"precertRequired":false,"billingCode":"80325","codeType":"CPT"},{"id":5065,"precertRequired":false,"billingCode":"80326","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5071,"precertRequired":false,"billingCode":"80332","codeType":"CPT"},{"id":5072,"precertRequired":false,"billingCode":"80333","codeType":"CPT"},{"id":5073,"precertRequired":false,"billingCode":"80334","codeType":"CPT"},{"id":5074,"precertRequired":false,"billingCode":"80335","codeType":"CPT"},{"id":5075,"precertRequired":false,"billingCode":"80336","codeType":"CPT"},{"id":5076,"precertRequired":false,"billingCode":"80337","codeType":"CPT"},{"id":5085,"precertRequired":false,"billingCode":"80346","codeType":"CPT"},{"id":5086,"precertRequired":false,"billingCode":"80347","codeType":"CPT"},{"id":5087,"precertRequired":false,"billingCode":"80348","codeType":"CPT"},{"id":5088,"precertRequired":false,"billingCode":"80349","codeType":"CPT"},{"id":5089,"precertRequired":false,"billingCode":"80350","codeType":"CPT"},{"id":5090,"precertRequired":false,"billingCode":"80351","codeType":"CPT"},{"id":5091,"precertRequired":false,"billingCode":"80352","codeType":"CPT"},{"id":5095,"precertRequired":false,"billingCode":"80356","codeType":"CPT"},{"id":5096,"precertRequired":false,"billingCode":"80357","codeType":"CPT"},{"id":5097,"precertRequired":false,"billingCode":"80358","codeType":"CPT"},{"id":5100,"precertRequired":false,"billingCode":"80361","codeType":"CPT"},{"id":5101,"precertRequired":false,"billingCode":"80362","codeType":"CPT"},{"id":5102,"precertRequired":false,"billingCode":"80363","codeType":"CPT"},{"id":5103,"precertRequired":false,"billingCode":"80364","codeType":"CPT"},{"id":5107,"precertRequired":false,"billingCode":"80368","codeType":"CPT"},{"id":5108,"precertRequired":false,"billingCode":"80369","codeType":"CPT"},{"id":5109,"precertRequired":false,"billingCode":"80370","codeType":"CPT"},{"id":5111,"precertRequired":false,"billingCode":"80372","codeType":"CPT"},{"id":5112,"precertRequired":false,"billingCode":"80373","codeType":"CPT"},{"id":5113,"precertRequired":false,"billingCode":"80374","codeType":"CPT"},{"id":5114,"precertRequired":false,"billingCode":"80375","codeType":"CPT"},{"id":5115,"precertRequired":false,"billingCode":"80376","codeType":"CPT"},{"id":5116,"precertRequired":false,"billingCode":"80377","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5377,"precertRequired":false,"billingCode":"82075","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6569,"precertRequired":false,"billingCode":"90785","codeType":"CPT"},{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"},{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6581,"precertRequired":false,"billingCode":"90845","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6584,"precertRequired":false,"billingCode":"90849","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":6586,"precertRequired":false,"billingCode":"90863","codeType":"CPT"},{"id":6587,"precertRequired":false,"billingCode":"90867","codeType":"CPT"},{"id":6588,"precertRequired":false,"billingCode":"90868","codeType":"CPT"},{"id":6589,"precertRequired":false,"billingCode":"90869","codeType":"CPT"},{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":6591,"precertRequired":false,"billingCode":"90875","codeType":"CPT"},{"id":6592,"precertRequired":false,"billingCode":"90876","codeType":"CPT"},{"id":6598,"precertRequired":false,"billingCode":"90901","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7173,"precertRequired":true,"billingCode":"96116","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7178,"precertRequired":false,"billingCode":"96127","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7276,"precertRequired":false,"billingCode":"97535","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7315,"precertRequired":false,"billingCode":"98966","codeType":"CPT"},{"id":7316,"precertRequired":false,"billingCode":"98967","codeType":"CPT"},{"id":7317,"precertRequired":false,"billingCode":"98968","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7492,"precertRequired":false,"billingCode":"99492","codeType":"CPT"},{"id":7493,"precertRequired":false,"billingCode":"99493","codeType":"CPT"},{"id":7494,"precertRequired":false,"billingCode":"99494","codeType":"CPT"},{"id":8151,"precertRequired":false,"billingCode":"G0176","codeType":"HCPCS"},{"id":8152,"precertRequired":false,"billingCode":"G0177","codeType":"HCPCS"},{"id":8191,"precertRequired":false,"billingCode":"G0396","codeType":"HCPCS"},{"id":8192,"precertRequired":false,"billingCode":"G0397","codeType":"HCPCS"},{"id":8199,"precertRequired":false,"billingCode":"G0409","codeType":"HCPCS"},{"id":8200,"precertRequired":false,"billingCode":"G0410","codeType":"HCPCS"},{"id":8201,"precertRequired":false,"billingCode":"G0411","codeType":"HCPCS"},{"id":8337,"precertRequired":false,"billingCode":"H0001","codeType":"HCPCS"},{"id":8338,"precertRequired":false,"billingCode":"H0003","codeType":"HCPCS"},{"id":8339,"precertRequired":false,"billingCode":"H0004","codeType":"HCPCS"},{"id":8340,"precertRequired":false,"billingCode":"H0005","codeType":"HCPCS"},{"id":8341,"precertRequired":false,"billingCode":"H0006","codeType":"HCPCS"},{"id":8342,"precertRequired":false,"billingCode":"H0014","codeType":"HCPCS"},{"id":8343,"precertRequired":false,"billingCode":"H0020","codeType":"HCPCS"},{"id":8344,"precertRequired":false,"billingCode":"H0021","codeType":"HCPCS"},{"id":8345,"precertRequired":false,"billingCode":"H0022","codeType":"HCPCS"},{"id":8346,"precertRequired":false,"billingCode":"H0033","codeType":"HCPCS"},{"id":8348,"precertRequired":false,"billingCode":"H0048","codeType":"HCPCS"},{"id":8349,"precertRequired":false,"billingCode":"H0049","codeType":"HCPCS"},{"id":9045,"precertRequired":false,"billingCode":"T1016","codeType":"HCPCS"},{"id":9046,"precertRequired":false,"billingCode":"T1017","codeType":"HCPCS"},{"id":9047,"precertRequired":false,"billingCode":"T1019","codeType":"HCPCS"},{"id":9048,"precertRequired":false,"billingCode":"T1020","codeType":"HCPCS"},{"id":9784,"precertRequired":true,"billingCode":"96132","codeType":"CPT"},{"id":9785,"precertRequired":true,"billingCode":"96133","codeType":"CPT"},{"id":9786,"precertRequired":true,"billingCode":"96136","codeType":"CPT"},{"id":9787,"precertRequired":true,"billingCode":"96137","codeType":"CPT"},{"id":9788,"precertRequired":true,"billingCode":"96138","codeType":"CPT"},{"id":9789,"precertRequired":true,"billingCode":"96139","codeType":"CPT"},{"id":9790,"precertRequired":false,"billingCode":"96146","codeType":"CPT"},{"id":11417,"precertRequired":false,"billingCode":"99484","codeType":"CPT"},{"id":11850,"precertRequired":false,"billingCode":"97151","codeType":"CPT"},{"id":11851,"precertRequired":false,"billingCode":"97152","codeType":"CPT"},{"id":11852,"precertRequired":false,"billingCode":"97153","codeType":"CPT"},{"id":11853,"precertRequired":false,"billingCode":"97154","codeType":"CPT"},{"id":11854,"precertRequired":false,"billingCode":"97155","codeType":"CPT"},{"id":11855,"precertRequired":false,"billingCode":"97156","codeType":"CPT"},{"id":11856,"precertRequired":false,"billingCode":"97157","codeType":"CPT"},{"id":11857,"precertRequired":false,"billingCode":"97158","codeType":"CPT"},{"id":12127,"precertRequired":false,"billingCode":"96121","codeType":"CPT"},{"id":12194,"precertRequired":false,"billingCode":"H0031","codeType":"HCPCS"},{"id":12195,"precertRequired":false,"billingCode":"H0002","codeType":"HCPCS"},{"id":12196,"precertRequired":false,"billingCode":"90865","codeType":"CPT"},{"id":12202,"precertRequired":false,"billingCode":"H0016","codeType":"HCPCS"},{"id":12203,"precertRequired":false,"billingCode":"H0032","codeType":"HCPCS"},{"id":12204,"precertRequired":false,"billingCode":"H0036","codeType":"HCPCS"},{"id":12205,"precertRequired":false,"billingCode":"H0037","codeType":"HCPCS"},{"id":12206,"precertRequired":false,"billingCode":"H0039","codeType":"HCPCS"},{"id":12207,"precertRequired":false,"billingCode":"H0040","codeType":"HCPCS"},{"id":12211,"precertRequired":false,"billingCode":"H2011","codeType":"HCPCS"},{"id":12212,"precertRequired":false,"billingCode":"H2012","codeType":"HCPCS"},{"id":12213,"precertRequired":false,"billingCode":"H2015","codeType":"HCPCS"},{"id":12214,"precertRequired":false,"billingCode":"H2016","codeType":"HCPCS"},{"id":12216,"precertRequired":false,"billingCode":"H2018","codeType":"HCPCS"},{"id":12218,"precertRequired":false,"billingCode":"H2020","codeType":"HCPCS"},{"id":12219,"precertRequired":false,"billingCode":"H2027","codeType":"HCPCS"},{"id":12241,"precertRequired":false,"billingCode":"H0023","codeType":"HCPCS"},{"id":12242,"precertRequired":false,"billingCode":"H0024","codeType":"HCPCS"},{"id":12243,"precertRequired":false,"billingCode":"H0025","codeType":"HCPCS"},{"id":12244,"precertRequired":false,"billingCode":"H0026","codeType":"HCPCS"},{"id":12245,"precertRequired":false,"billingCode":"H0027","codeType":"HCPCS"},{"id":12246,"precertRequired":false,"billingCode":"H0028","codeType":"HCPCS"},{"id":12247,"precertRequired":false,"billingCode":"H0029","codeType":"HCPCS"},{"id":12248,"precertRequired":false,"billingCode":"H0035","codeType":"HCPCS"},{"id":12249,"precertRequired":false,"billingCode":"H2013","codeType":"HCPCS"},{"id":12250,"precertRequired":false,"billingCode":"H2021","codeType":"HCPCS"},{"id":12251,"precertRequired":false,"billingCode":"H2022","codeType":"HCPCS"},{"id":12252,"precertRequired":false,"billingCode":"H2035","codeType":"HCPCS"},{"id":12253,"precertRequired":false,"billingCode":"T1012","codeType":"HCPCS"},{"id":13245,"precertRequired":true,"billingCode":"S9485","codeType":"HCPCS"},{"id":13246,"precertRequired":true,"billingCode":"S9484","codeType":"HCPCS"},{"id":13266,"precertRequired":true,"billingCode":"H2036","codeType":"HCPCS"},{"id":13270,"precertRequired":true,"billingCode":"H0047","codeType":"HCPCS"},{"id":13271,"precertRequired":true,"billingCode":"H0050","codeType":"HCPCS"},{"id":13272,"precertRequired":true,"billingCode":"H2017","codeType":"HCPCS"},{"id":13273,"precertRequired":true,"billingCode":"H2019","codeType":"HCPCS"},{"id":13274,"precertRequired":true,"billingCode":"H0013","codeType":"HCPCS"},{"id":13275,"precertRequired":true,"billingCode":"H0015","codeType":"HCPCS"},{"id":13276,"precertRequired":true,"billingCode":"H0017","codeType":"HCPCS"},{"id":13277,"precertRequired":true,"billingCode":"H0018","codeType":"HCPCS"},{"id":13278,"precertRequired":true,"billingCode":"H0019","codeType":"HCPCS"},{"id":13280,"precertRequired":true,"billingCode":"G0470","codeType":"HCPCS"},{"id":13281,"precertRequired":true,"billingCode":"H0007","codeType":"HCPCS"},{"id":13282,"precertRequired":true,"billingCode":"H0008","codeType":"HCPCS"},{"id":13283,"precertRequired":true,"billingCode":"H0009","codeType":"HCPCS"},{"id":13284,"precertRequired":true,"billingCode":"H0010","codeType":"HCPCS"},{"id":13285,"precertRequired":true,"billingCode":"H0011","codeType":"HCPCS"},{"id":13286,"precertRequired":true,"billingCode":"H0012","codeType":"HCPCS"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"},{"id":13345,"precertRequired":true,"billingCode":"96130","codeType":"CPT"},{"id":13346,"precertRequired":true,"billingCode":"96131","codeType":"CPT"},{"id":13396,"precertRequired":false,"billingCode":"90912","codeType":"CPT"},{"id":13397,"precertRequired":false,"billingCode":"90913","codeType":"CPT"},{"id":13398,"precertRequired":false,"billingCode":"96156","codeType":"CPT"},{"id":13399,"precertRequired":false,"billingCode":"96158","codeType":"CPT"},{"id":13400,"precertRequired":false,"billingCode":"96159","codeType":"CPT"},{"id":13401,"precertRequired":false,"billingCode":"97129","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":507,"seocKey":5,"name":"Acute Inpatient Psychiatric Services - Voluntary Admission","seocId":"MHC_ACUTE INPATIENT PSYCHIATRIC SERVICES - VOLUNTARY ADMISSION_1.1.3","versionNumber":"1.1.3","description":"This authorization covers services associated with all medical care listed below for the referred condition","effectiveDate":"07-28-2019","endDate":"01-24-2020","duration":365,"REV":false,"PRCT":false,"proceduralOverview":"1. One inpatient stay for the referred condition indicated on the consult\r\n2. Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization\r\n3. Diagnostic studies, images and labs","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":2937,"description":"One inpatient stay for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":7181,"precertRequired":false,"billingCode":"96152","codeType":"CPT"},{"id":7182,"precertRequired":false,"billingCode":"96153","codeType":"CPT"},{"id":7183,"precertRequired":false,"billingCode":"96154","codeType":"CPT"},{"id":7184,"precertRequired":false,"billingCode":"96155","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7551,"precertRequired":false,"billingCode":"0373T","codeType":"CPT"},{"id":7591,"precertRequired":false,"billingCode":"1022F","codeType":"CPT"},{"id":7592,"precertRequired":false,"billingCode":"1026F","codeType":"CPT"},{"id":7593,"precertRequired":false,"billingCode":"1030F","codeType":"CPT"},{"id":7594,"precertRequired":false,"billingCode":"1032F","codeType":"CPT"},{"id":7595,"precertRequired":false,"billingCode":"1033F","codeType":"CPT"},{"id":7596,"precertRequired":false,"billingCode":"1034F","codeType":"CPT"},{"id":7597,"precertRequired":false,"billingCode":"1035F","codeType":"CPT"},{"id":7598,"precertRequired":false,"billingCode":"1036F","codeType":"CPT"},{"id":7599,"precertRequired":false,"billingCode":"1040F","codeType":"CPT"},{"id":7604,"precertRequired":false,"billingCode":"1110F","codeType":"CPT"},{"id":7605,"precertRequired":false,"billingCode":"1111F","codeType":"CPT"},{"id":7606,"precertRequired":false,"billingCode":"1123F","codeType":"CPT"},{"id":7607,"precertRequired":false,"billingCode":"1124F","codeType":"CPT"},{"id":7608,"precertRequired":false,"billingCode":"1159F","codeType":"CPT"},{"id":7609,"precertRequired":false,"billingCode":"1160F","codeType":"CPT"},{"id":7610,"precertRequired":false,"billingCode":"1170F","codeType":"CPT"},{"id":7611,"precertRequired":false,"billingCode":"1175F","codeType":"CPT"},{"id":7612,"precertRequired":false,"billingCode":"1181F","codeType":"CPT"},{"id":7613,"precertRequired":false,"billingCode":"1182F","codeType":"CPT"},{"id":7614,"precertRequired":false,"billingCode":"1183F","codeType":"CPT"},{"id":7615,"precertRequired":false,"billingCode":"1220F","codeType":"CPT"},{"id":7616,"precertRequired":false,"billingCode":"1450F","codeType":"CPT"},{"id":7617,"precertRequired":false,"billingCode":"1451F","codeType":"CPT"},{"id":7618,"precertRequired":false,"billingCode":"1490F","codeType":"CPT"},{"id":7619,"precertRequired":false,"billingCode":"1491F","codeType":"CPT"},{"id":7620,"precertRequired":false,"billingCode":"1493F","codeType":"CPT"},{"id":7621,"precertRequired":false,"billingCode":"1494F","codeType":"CPT"},{"id":7622,"precertRequired":false,"billingCode":"1501F","codeType":"CPT"},{"id":7623,"precertRequired":false,"billingCode":"1502F","codeType":"CPT"},{"id":7625,"precertRequired":false,"billingCode":"2060F","codeType":"CPT"},{"id":7626,"precertRequired":false,"billingCode":"3008F","codeType":"CPT"},{"id":7627,"precertRequired":false,"billingCode":"3011F","codeType":"CPT"},{"id":7633,"precertRequired":false,"billingCode":"3085F","codeType":"CPT"},{"id":7634,"precertRequired":false,"billingCode":"3088F","codeType":"CPT"},{"id":7635,"precertRequired":false,"billingCode":"3089F","codeType":"CPT"},{"id":7636,"precertRequired":false,"billingCode":"3090F","codeType":"CPT"},{"id":7637,"precertRequired":false,"billingCode":"3091F","codeType":"CPT"},{"id":7638,"precertRequired":false,"billingCode":"3093F","codeType":"CPT"},{"id":7650,"precertRequired":false,"billingCode":"4060F","codeType":"CPT"},{"id":7651,"precertRequired":false,"billingCode":"4062F","codeType":"CPT"},{"id":7652,"precertRequired":false,"billingCode":"4063F","codeType":"CPT"},{"id":7653,"precertRequired":false,"billingCode":"4064F","codeType":"CPT"},{"id":7654,"precertRequired":false,"billingCode":"4065F","codeType":"CPT"},{"id":7656,"precertRequired":false,"billingCode":"4067F","codeType":"CPT"},{"id":7665,"precertRequired":false,"billingCode":"6005F","codeType":"CPT"},{"id":7666,"precertRequired":false,"billingCode":"6101F","codeType":"CPT"},{"id":7667,"precertRequired":false,"billingCode":"6102F","codeType":"CPT"},{"id":7668,"precertRequired":false,"billingCode":"6110F","codeType":"CPT"},{"id":11852,"precertRequired":false,"billingCode":"97153","codeType":"CPT"},{"id":11853,"precertRequired":false,"billingCode":"97154","codeType":"CPT"},{"id":11854,"precertRequired":false,"billingCode":"97155","codeType":"CPT"},{"id":11855,"precertRequired":false,"billingCode":"97156","codeType":"CPT"},{"id":11856,"precertRequired":false,"billingCode":"97157","codeType":"CPT"},{"id":11857,"precertRequired":false,"billingCode":"97158","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":2938,"description":"Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization","frequency":null,"frequencyType":"","visits":18,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6584,"precertRequired":false,"billingCode":"90849","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":6586,"precertRequired":false,"billingCode":"90863","codeType":"CPT"},{"id":6587,"precertRequired":false,"billingCode":"90867","codeType":"CPT"},{"id":6588,"precertRequired":false,"billingCode":"90868","codeType":"CPT"},{"id":6589,"precertRequired":false,"billingCode":"90869","codeType":"CPT"},{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7179,"precertRequired":false,"billingCode":"96150","codeType":"CPT"},{"id":7180,"precertRequired":false,"billingCode":"96151","codeType":"CPT"},{"id":7181,"precertRequired":false,"billingCode":"96152","codeType":"CPT"},{"id":7182,"precertRequired":false,"billingCode":"96153","codeType":"CPT"},{"id":7183,"precertRequired":false,"billingCode":"96154","codeType":"CPT"},{"id":7184,"precertRequired":false,"billingCode":"96155","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":2939,"description":"Diagnostic studies, images and labs","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":5019,"precertRequired":false,"billingCode":"80156","codeType":"CPT"},{"id":5020,"precertRequired":false,"billingCode":"80157","codeType":"CPT"},{"id":5022,"precertRequired":false,"billingCode":"80159","codeType":"CPT"},{"id":5025,"precertRequired":false,"billingCode":"80164","codeType":"CPT"},{"id":5026,"precertRequired":false,"billingCode":"80165","codeType":"CPT"},{"id":5030,"precertRequired":false,"billingCode":"80171","codeType":"CPT"},{"id":5031,"precertRequired":false,"billingCode":"80173","codeType":"CPT"},{"id":5032,"precertRequired":false,"billingCode":"80175","codeType":"CPT"},{"id":5035,"precertRequired":false,"billingCode":"80178","codeType":"CPT"},{"id":5037,"precertRequired":false,"billingCode":"80183","codeType":"CPT"},{"id":5038,"precertRequired":false,"billingCode":"80184","codeType":"CPT"},{"id":5039,"precertRequired":false,"billingCode":"80185","codeType":"CPT"},{"id":5040,"precertRequired":false,"billingCode":"80186","codeType":"CPT"},{"id":5047,"precertRequired":false,"billingCode":"80198","codeType":"CPT"},{"id":5050,"precertRequired":false,"billingCode":"80201","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5063,"precertRequired":false,"billingCode":"80324","codeType":"CPT"},{"id":5064,"precertRequired":false,"billingCode":"80325","codeType":"CPT"},{"id":5065,"precertRequired":false,"billingCode":"80326","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5074,"precertRequired":false,"billingCode":"80335","codeType":"CPT"},{"id":5075,"precertRequired":false,"billingCode":"80336","codeType":"CPT"},{"id":5076,"precertRequired":false,"billingCode":"80337","codeType":"CPT"},{"id":5085,"precertRequired":false,"billingCode":"80346","codeType":"CPT"},{"id":5086,"precertRequired":false,"billingCode":"80347","codeType":"CPT"},{"id":5087,"precertRequired":false,"billingCode":"80348","codeType":"CPT"},{"id":5088,"precertRequired":false,"billingCode":"80349","codeType":"CPT"},{"id":5089,"precertRequired":false,"billingCode":"80350","codeType":"CPT"},{"id":5090,"precertRequired":false,"billingCode":"80351","codeType":"CPT"},{"id":5091,"precertRequired":false,"billingCode":"80352","codeType":"CPT"},{"id":5095,"precertRequired":false,"billingCode":"80356","codeType":"CPT"},{"id":5096,"precertRequired":false,"billingCode":"80357","codeType":"CPT"},{"id":5097,"precertRequired":false,"billingCode":"80358","codeType":"CPT"},{"id":5100,"precertRequired":false,"billingCode":"80361","codeType":"CPT"},{"id":5101,"precertRequired":false,"billingCode":"80362","codeType":"CPT"},{"id":5102,"precertRequired":false,"billingCode":"80363","codeType":"CPT"},{"id":5103,"precertRequired":false,"billingCode":"80364","codeType":"CPT"},{"id":5112,"precertRequired":false,"billingCode":"80373","codeType":"CPT"},{"id":5113,"precertRequired":false,"billingCode":"80374","codeType":"CPT"},{"id":5114,"precertRequired":false,"billingCode":"80375","codeType":"CPT"},{"id":5115,"precertRequired":false,"billingCode":"80376","codeType":"CPT"},{"id":5116,"precertRequired":false,"billingCode":"80377","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":8880,"precertRequired":false,"billingCode":"S0109","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":185,"seocKey":5,"name":"Acute Inpatient Psychiatric Services - Voluntary Admission","seocId":"MHC_ACUTE INPATIENT PSYCHIATRIC SERVICES - VOLUNTARY ADMISSION_1.1.2","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below for the referred condition","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":false,"proceduralOverview":"1. One inpatient stay for the referred condition indicated on the consult\r\n2. Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization\r\n3. Diagnostic studies, images and labs","maxAllowableVisits":null,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n* All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":688,"description":"One inpatient stay for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":7181,"precertRequired":false,"billingCode":"96152","codeType":"CPT"},{"id":7182,"precertRequired":false,"billingCode":"96153","codeType":"CPT"},{"id":7183,"precertRequired":false,"billingCode":"96154","codeType":"CPT"},{"id":7184,"precertRequired":false,"billingCode":"96155","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7550,"precertRequired":false,"billingCode":"0372T","codeType":"CPT"},{"id":7551,"precertRequired":false,"billingCode":"0373T","codeType":"CPT"},{"id":7552,"precertRequired":false,"billingCode":"0374T","codeType":"CPT"},{"id":7591,"precertRequired":false,"billingCode":"1022F","codeType":"CPT"},{"id":7592,"precertRequired":false,"billingCode":"1026F","codeType":"CPT"},{"id":7593,"precertRequired":false,"billingCode":"1030F","codeType":"CPT"},{"id":7594,"precertRequired":false,"billingCode":"1032F","codeType":"CPT"},{"id":7595,"precertRequired":false,"billingCode":"1033F","codeType":"CPT"},{"id":7596,"precertRequired":false,"billingCode":"1034F","codeType":"CPT"},{"id":7597,"precertRequired":false,"billingCode":"1035F","codeType":"CPT"},{"id":7598,"precertRequired":false,"billingCode":"1036F","codeType":"CPT"},{"id":7599,"precertRequired":false,"billingCode":"1040F","codeType":"CPT"},{"id":7604,"precertRequired":false,"billingCode":"1110F","codeType":"CPT"},{"id":7605,"precertRequired":false,"billingCode":"1111F","codeType":"CPT"},{"id":7606,"precertRequired":false,"billingCode":"1123F","codeType":"CPT"},{"id":7607,"precertRequired":false,"billingCode":"1124F","codeType":"CPT"},{"id":7608,"precertRequired":false,"billingCode":"1159F","codeType":"CPT"},{"id":7609,"precertRequired":false,"billingCode":"1160F","codeType":"CPT"},{"id":7610,"precertRequired":false,"billingCode":"1170F","codeType":"CPT"},{"id":7611,"precertRequired":false,"billingCode":"1175F","codeType":"CPT"},{"id":7612,"precertRequired":false,"billingCode":"1181F","codeType":"CPT"},{"id":7613,"precertRequired":false,"billingCode":"1182F","codeType":"CPT"},{"id":7614,"precertRequired":false,"billingCode":"1183F","codeType":"CPT"},{"id":7615,"precertRequired":false,"billingCode":"1220F","codeType":"CPT"},{"id":7616,"precertRequired":false,"billingCode":"1450F","codeType":"CPT"},{"id":7617,"precertRequired":false,"billingCode":"1451F","codeType":"CPT"},{"id":7618,"precertRequired":false,"billingCode":"1490F","codeType":"CPT"},{"id":7619,"precertRequired":false,"billingCode":"1491F","codeType":"CPT"},{"id":7620,"precertRequired":false,"billingCode":"1493F","codeType":"CPT"},{"id":7621,"precertRequired":false,"billingCode":"1494F","codeType":"CPT"},{"id":7622,"precertRequired":false,"billingCode":"1501F","codeType":"CPT"},{"id":7623,"precertRequired":false,"billingCode":"1502F","codeType":"CPT"},{"id":7625,"precertRequired":false,"billingCode":"2060F","codeType":"CPT"},{"id":7626,"precertRequired":false,"billingCode":"3008F","codeType":"CPT"},{"id":7627,"precertRequired":false,"billingCode":"3011F","codeType":"CPT"},{"id":7633,"precertRequired":false,"billingCode":"3085F","codeType":"CPT"},{"id":7634,"precertRequired":false,"billingCode":"3088F","codeType":"CPT"},{"id":7635,"precertRequired":false,"billingCode":"3089F","codeType":"CPT"},{"id":7636,"precertRequired":false,"billingCode":"3090F","codeType":"CPT"},{"id":7637,"precertRequired":false,"billingCode":"3091F","codeType":"CPT"},{"id":7638,"precertRequired":false,"billingCode":"3093F","codeType":"CPT"},{"id":7650,"precertRequired":false,"billingCode":"4060F","codeType":"CPT"},{"id":7651,"precertRequired":false,"billingCode":"4062F","codeType":"CPT"},{"id":7652,"precertRequired":false,"billingCode":"4063F","codeType":"CPT"},{"id":7653,"precertRequired":false,"billingCode":"4064F","codeType":"CPT"},{"id":7654,"precertRequired":false,"billingCode":"4065F","codeType":"CPT"},{"id":7656,"precertRequired":false,"billingCode":"4067F","codeType":"CPT"},{"id":7665,"precertRequired":false,"billingCode":"6005F","codeType":"CPT"},{"id":7666,"precertRequired":false,"billingCode":"6101F","codeType":"CPT"},{"id":7667,"precertRequired":false,"billingCode":"6102F","codeType":"CPT"},{"id":7668,"precertRequired":false,"billingCode":"6110F","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":689,"description":"Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization","frequency":null,"frequencyType":"","visits":18,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6584,"precertRequired":false,"billingCode":"90849","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":6586,"precertRequired":false,"billingCode":"90863","codeType":"CPT"},{"id":6587,"precertRequired":false,"billingCode":"90867","codeType":"CPT"},{"id":6588,"precertRequired":false,"billingCode":"90868","codeType":"CPT"},{"id":6589,"precertRequired":false,"billingCode":"90869","codeType":"CPT"},{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7179,"precertRequired":false,"billingCode":"96150","codeType":"CPT"},{"id":7180,"precertRequired":false,"billingCode":"96151","codeType":"CPT"},{"id":7181,"precertRequired":false,"billingCode":"96152","codeType":"CPT"},{"id":7182,"precertRequired":false,"billingCode":"96153","codeType":"CPT"},{"id":7183,"precertRequired":false,"billingCode":"96154","codeType":"CPT"},{"id":7184,"precertRequired":false,"billingCode":"96155","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":690,"description":"Diagnostic studies, images and labs","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":5019,"precertRequired":false,"billingCode":"80156","codeType":"CPT"},{"id":5020,"precertRequired":false,"billingCode":"80157","codeType":"CPT"},{"id":5022,"precertRequired":false,"billingCode":"80159","codeType":"CPT"},{"id":5025,"precertRequired":false,"billingCode":"80164","codeType":"CPT"},{"id":5026,"precertRequired":false,"billingCode":"80165","codeType":"CPT"},{"id":5030,"precertRequired":false,"billingCode":"80171","codeType":"CPT"},{"id":5031,"precertRequired":false,"billingCode":"80173","codeType":"CPT"},{"id":5032,"precertRequired":false,"billingCode":"80175","codeType":"CPT"},{"id":5035,"precertRequired":false,"billingCode":"80178","codeType":"CPT"},{"id":5037,"precertRequired":false,"billingCode":"80183","codeType":"CPT"},{"id":5038,"precertRequired":false,"billingCode":"80184","codeType":"CPT"},{"id":5039,"precertRequired":false,"billingCode":"80185","codeType":"CPT"},{"id":5040,"precertRequired":false,"billingCode":"80186","codeType":"CPT"},{"id":5047,"precertRequired":false,"billingCode":"80198","codeType":"CPT"},{"id":5050,"precertRequired":false,"billingCode":"80201","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5063,"precertRequired":false,"billingCode":"80324","codeType":"CPT"},{"id":5064,"precertRequired":false,"billingCode":"80325","codeType":"CPT"},{"id":5065,"precertRequired":false,"billingCode":"80326","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5074,"precertRequired":false,"billingCode":"80335","codeType":"CPT"},{"id":5075,"precertRequired":false,"billingCode":"80336","codeType":"CPT"},{"id":5076,"precertRequired":false,"billingCode":"80337","codeType":"CPT"},{"id":5085,"precertRequired":false,"billingCode":"80346","codeType":"CPT"},{"id":5086,"precertRequired":false,"billingCode":"80347","codeType":"CPT"},{"id":5087,"precertRequired":false,"billingCode":"80348","codeType":"CPT"},{"id":5088,"precertRequired":false,"billingCode":"80349","codeType":"CPT"},{"id":5089,"precertRequired":false,"billingCode":"80350","codeType":"CPT"},{"id":5090,"precertRequired":false,"billingCode":"80351","codeType":"CPT"},{"id":5091,"precertRequired":false,"billingCode":"80352","codeType":"CPT"},{"id":5095,"precertRequired":false,"billingCode":"80356","codeType":"CPT"},{"id":5096,"precertRequired":false,"billingCode":"80357","codeType":"CPT"},{"id":5097,"precertRequired":false,"billingCode":"80358","codeType":"CPT"},{"id":5100,"precertRequired":false,"billingCode":"80361","codeType":"CPT"},{"id":5101,"precertRequired":false,"billingCode":"80362","codeType":"CPT"},{"id":5102,"precertRequired":false,"billingCode":"80363","codeType":"CPT"},{"id":5103,"precertRequired":false,"billingCode":"80364","codeType":"CPT"},{"id":5112,"precertRequired":false,"billingCode":"80373","codeType":"CPT"},{"id":5113,"precertRequired":false,"billingCode":"80374","codeType":"CPT"},{"id":5114,"precertRequired":false,"billingCode":"80375","codeType":"CPT"},{"id":5115,"precertRequired":false,"billingCode":"80376","codeType":"CPT"},{"id":5116,"precertRequired":false,"billingCode":"80377","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":8880,"precertRequired":false,"billingCode":"S0109","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":102,"seocKey":5,"name":"Acute Inpatient Psychiatric Services - Voluntary Admission","seocId":"MHC_ACUTE INPATIENT PSYCHIATRIC SERVICES - VOLUNTARY ADMISSION_1.1.1","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below for the referred condition","effectiveDate":"09-21-2018","endDate":"01-02-2019","duration":365,"REV":false,"PRCT":false,"proceduralOverview":"1. One inpatient stay for the referred condition indicated on the consult\r\n2. Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization\r\n3. Diagnostic studies, images and labs","maxAllowableVisits":999,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n* All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":278,"description":"One inpatient stay for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":7181,"precertRequired":false,"billingCode":"96152","codeType":"CPT"},{"id":7182,"precertRequired":false,"billingCode":"96153","codeType":"CPT"},{"id":7183,"precertRequired":false,"billingCode":"96154","codeType":"CPT"},{"id":7184,"precertRequired":false,"billingCode":"96155","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7550,"precertRequired":false,"billingCode":"0372T","codeType":"CPT"},{"id":7551,"precertRequired":false,"billingCode":"0373T","codeType":"CPT"},{"id":7552,"precertRequired":false,"billingCode":"0374T","codeType":"CPT"},{"id":7591,"precertRequired":false,"billingCode":"1022F","codeType":"CPT"},{"id":7592,"precertRequired":false,"billingCode":"1026F","codeType":"CPT"},{"id":7593,"precertRequired":false,"billingCode":"1030F","codeType":"CPT"},{"id":7594,"precertRequired":false,"billingCode":"1032F","codeType":"CPT"},{"id":7595,"precertRequired":false,"billingCode":"1033F","codeType":"CPT"},{"id":7596,"precertRequired":false,"billingCode":"1034F","codeType":"CPT"},{"id":7597,"precertRequired":false,"billingCode":"1035F","codeType":"CPT"},{"id":7598,"precertRequired":false,"billingCode":"1036F","codeType":"CPT"},{"id":7599,"precertRequired":false,"billingCode":"1040F","codeType":"CPT"},{"id":7604,"precertRequired":false,"billingCode":"1110F","codeType":"CPT"},{"id":7605,"precertRequired":false,"billingCode":"1111F","codeType":"CPT"},{"id":7606,"precertRequired":false,"billingCode":"1123F","codeType":"CPT"},{"id":7607,"precertRequired":false,"billingCode":"1124F","codeType":"CPT"},{"id":7608,"precertRequired":false,"billingCode":"1159F","codeType":"CPT"},{"id":7609,"precertRequired":false,"billingCode":"1160F","codeType":"CPT"},{"id":7610,"precertRequired":false,"billingCode":"1170F","codeType":"CPT"},{"id":7611,"precertRequired":false,"billingCode":"1175F","codeType":"CPT"},{"id":7612,"precertRequired":false,"billingCode":"1181F","codeType":"CPT"},{"id":7613,"precertRequired":false,"billingCode":"1182F","codeType":"CPT"},{"id":7614,"precertRequired":false,"billingCode":"1183F","codeType":"CPT"},{"id":7615,"precertRequired":false,"billingCode":"1220F","codeType":"CPT"},{"id":7616,"precertRequired":false,"billingCode":"1450F","codeType":"CPT"},{"id":7617,"precertRequired":false,"billingCode":"1451F","codeType":"CPT"},{"id":7618,"precertRequired":false,"billingCode":"1490F","codeType":"CPT"},{"id":7619,"precertRequired":false,"billingCode":"1491F","codeType":"CPT"},{"id":7620,"precertRequired":false,"billingCode":"1493F","codeType":"CPT"},{"id":7621,"precertRequired":false,"billingCode":"1494F","codeType":"CPT"},{"id":7622,"precertRequired":false,"billingCode":"1501F","codeType":"CPT"},{"id":7623,"precertRequired":false,"billingCode":"1502F","codeType":"CPT"},{"id":7625,"precertRequired":false,"billingCode":"2060F","codeType":"CPT"},{"id":7626,"precertRequired":false,"billingCode":"3008F","codeType":"CPT"},{"id":7627,"precertRequired":false,"billingCode":"3011F","codeType":"CPT"},{"id":7633,"precertRequired":false,"billingCode":"3085F","codeType":"CPT"},{"id":7634,"precertRequired":false,"billingCode":"3088F","codeType":"CPT"},{"id":7635,"precertRequired":false,"billingCode":"3089F","codeType":"CPT"},{"id":7636,"precertRequired":false,"billingCode":"3090F","codeType":"CPT"},{"id":7637,"precertRequired":false,"billingCode":"3091F","codeType":"CPT"},{"id":7638,"precertRequired":false,"billingCode":"3093F","codeType":"CPT"},{"id":7650,"precertRequired":false,"billingCode":"4060F","codeType":"CPT"},{"id":7651,"precertRequired":false,"billingCode":"4062F","codeType":"CPT"},{"id":7652,"precertRequired":false,"billingCode":"4063F","codeType":"CPT"},{"id":7653,"precertRequired":false,"billingCode":"4064F","codeType":"CPT"},{"id":7654,"precertRequired":false,"billingCode":"4065F","codeType":"CPT"},{"id":7656,"precertRequired":false,"billingCode":"4067F","codeType":"CPT"},{"id":7665,"precertRequired":false,"billingCode":"6005F","codeType":"CPT"},{"id":7666,"precertRequired":false,"billingCode":"6101F","codeType":"CPT"},{"id":7667,"precertRequired":false,"billingCode":"6102F","codeType":"CPT"},{"id":7668,"precertRequired":false,"billingCode":"6110F","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":279,"description":"Inpatient mental health services, including ECT (up to 18 treatments) Note: TMS is not covered and will require separate VA authorization","frequency":null,"frequencyType":"","visits":18,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6584,"precertRequired":false,"billingCode":"90849","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":6586,"precertRequired":false,"billingCode":"90863","codeType":"CPT"},{"id":6587,"precertRequired":false,"billingCode":"90867","codeType":"CPT"},{"id":6588,"precertRequired":false,"billingCode":"90868","codeType":"CPT"},{"id":6589,"precertRequired":false,"billingCode":"90869","codeType":"CPT"},{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7179,"precertRequired":false,"billingCode":"96150","codeType":"CPT"},{"id":7180,"precertRequired":false,"billingCode":"96151","codeType":"CPT"},{"id":7181,"precertRequired":false,"billingCode":"96152","codeType":"CPT"},{"id":7182,"precertRequired":false,"billingCode":"96153","codeType":"CPT"},{"id":7183,"precertRequired":false,"billingCode":"96154","codeType":"CPT"},{"id":7184,"precertRequired":false,"billingCode":"96155","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":280,"description":"Diagnostic studies, images and labs","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":5019,"precertRequired":false,"billingCode":"80156","codeType":"CPT"},{"id":5020,"precertRequired":false,"billingCode":"80157","codeType":"CPT"},{"id":5022,"precertRequired":false,"billingCode":"80159","codeType":"CPT"},{"id":5025,"precertRequired":false,"billingCode":"80164","codeType":"CPT"},{"id":5026,"precertRequired":false,"billingCode":"80165","codeType":"CPT"},{"id":5030,"precertRequired":false,"billingCode":"80171","codeType":"CPT"},{"id":5031,"precertRequired":false,"billingCode":"80173","codeType":"CPT"},{"id":5032,"precertRequired":false,"billingCode":"80175","codeType":"CPT"},{"id":5035,"precertRequired":false,"billingCode":"80178","codeType":"CPT"},{"id":5037,"precertRequired":false,"billingCode":"80183","codeType":"CPT"},{"id":5038,"precertRequired":false,"billingCode":"80184","codeType":"CPT"},{"id":5039,"precertRequired":false,"billingCode":"80185","codeType":"CPT"},{"id":5040,"precertRequired":false,"billingCode":"80186","codeType":"CPT"},{"id":5047,"precertRequired":false,"billingCode":"80198","codeType":"CPT"},{"id":5050,"precertRequired":false,"billingCode":"80201","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5063,"precertRequired":false,"billingCode":"80324","codeType":"CPT"},{"id":5064,"precertRequired":false,"billingCode":"80325","codeType":"CPT"},{"id":5065,"precertRequired":false,"billingCode":"80326","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5074,"precertRequired":false,"billingCode":"80335","codeType":"CPT"},{"id":5075,"precertRequired":false,"billingCode":"80336","codeType":"CPT"},{"id":5076,"precertRequired":false,"billingCode":"80337","codeType":"CPT"},{"id":5085,"precertRequired":false,"billingCode":"80346","codeType":"CPT"},{"id":5086,"precertRequired":false,"billingCode":"80347","codeType":"CPT"},{"id":5087,"precertRequired":false,"billingCode":"80348","codeType":"CPT"},{"id":5088,"precertRequired":false,"billingCode":"80349","codeType":"CPT"},{"id":5089,"precertRequired":false,"billingCode":"80350","codeType":"CPT"},{"id":5090,"precertRequired":false,"billingCode":"80351","codeType":"CPT"},{"id":5091,"precertRequired":false,"billingCode":"80352","codeType":"CPT"},{"id":5095,"precertRequired":false,"billingCode":"80356","codeType":"CPT"},{"id":5096,"precertRequired":false,"billingCode":"80357","codeType":"CPT"},{"id":5097,"precertRequired":false,"billingCode":"80358","codeType":"CPT"},{"id":5100,"precertRequired":false,"billingCode":"80361","codeType":"CPT"},{"id":5101,"precertRequired":false,"billingCode":"80362","codeType":"CPT"},{"id":5102,"precertRequired":false,"billingCode":"80363","codeType":"CPT"},{"id":5103,"precertRequired":false,"billingCode":"80364","codeType":"CPT"},{"id":5112,"precertRequired":false,"billingCode":"80373","codeType":"CPT"},{"id":5113,"precertRequired":false,"billingCode":"80374","codeType":"CPT"},{"id":5114,"precertRequired":false,"billingCode":"80375","codeType":"CPT"},{"id":5115,"precertRequired":false,"billingCode":"80376","codeType":"CPT"},{"id":5116,"precertRequired":false,"billingCode":"80377","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":8880,"precertRequired":false,"billingCode":"S0109","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":529,"seocKey":6,"name":"Acute Outpatient Center Based Assisted Hemodialysis_PRCT","seocId":"DIA_ACUTE OUTPATIENT CENTER BASED ASSISTED HEMODIALYSIS_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"07-28-2019","endDate":null,"duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. All outpatient dialysis services for treatment of non-recovered  acute-kidney injury (AKI) as clinically necessary\r\n2. All necessary dialysis equipment\r\n3. All required dialysis supplies\r\n4. Dialysis nursing services required for center assisted dialysis care\r\n5. All bundled ESRD ( end stage renal disease) dialysis labs and medications\r\n6. Additional labs as required for appropriate monitoring of resolution of AKI\r\n7. Patient education related to renal replacement therapy options and related surgical procedures","maxAllowableVisits":null,"disclaimer":"Community dialysis facility must be and remain CMS certified and meet CMS conditions for coverage for dialysis.\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","QASP":"General Care","categoryOfCare":"DIALYSIS","serviceLine":"Dialysis","hptcs":[{"hptc":"261QE0700X"}],"services":[{"id":3068,"description":"All outpatient dialysis services for treatment of non-recovered  acute-kidney injury (AKI) as clinically necessary","frequency":null,"frequencyType":"","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2598,"precertRequired":true,"billingCode":"36800","codeType":"CPT"},{"id":2604,"precertRequired":true,"billingCode":"36821","codeType":"CPT"},{"id":2607,"precertRequired":true,"billingCode":"36831","codeType":"CPT"},{"id":2608,"precertRequired":true,"billingCode":"36832","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"},{"id":6512,"precertRequired":false,"billingCode":"90371","codeType":"CPT"},{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":6532,"precertRequired":false,"billingCode":"90632","codeType":"CPT"},{"id":6533,"precertRequired":false,"billingCode":"90636","codeType":"CPT"},{"id":6541,"precertRequired":false,"billingCode":"90662","codeType":"CPT"},{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6547,"precertRequired":false,"billingCode":"90686","codeType":"CPT"},{"id":6548,"precertRequired":false,"billingCode":"90688","codeType":"CPT"},{"id":6549,"precertRequired":false,"billingCode":"90697","codeType":"CPT"},{"id":6550,"precertRequired":false,"billingCode":"90698","codeType":"CPT"},{"id":6551,"precertRequired":false,"billingCode":"90707","codeType":"CPT"},{"id":6554,"precertRequired":false,"billingCode":"90715","codeType":"CPT"},{"id":6557,"precertRequired":false,"billingCode":"90723","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":6561,"precertRequired":false,"billingCode":"90736","codeType":"CPT"},{"id":6562,"precertRequired":false,"billingCode":"90739","codeType":"CPT"},{"id":6563,"precertRequired":false,"billingCode":"90740","codeType":"CPT"},{"id":6564,"precertRequired":false,"billingCode":"90746","codeType":"CPT"},{"id":6565,"precertRequired":false,"billingCode":"90747","codeType":"CPT"},{"id":6566,"precertRequired":false,"billingCode":"90748","codeType":"CPT"},{"id":6600,"precertRequired":true,"billingCode":"90935","codeType":"CPT"},{"id":6601,"precertRequired":true,"billingCode":"90937","codeType":"CPT"},{"id":6602,"precertRequired":true,"billingCode":"90940","codeType":"CPT"},{"id":6604,"precertRequired":true,"billingCode":"90947","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6956,"precertRequired":false,"billingCode":"93784","codeType":"CPT"},{"id":6989,"precertRequired":false,"billingCode":"93990","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7658,"precertRequired":false,"billingCode":"4148F","codeType":"CPT"},{"id":7659,"precertRequired":false,"billingCode":"4149F","codeType":"CPT"},{"id":7660,"precertRequired":false,"billingCode":"4155F","codeType":"CPT"},{"id":7661,"precertRequired":false,"billingCode":"4157F","codeType":"CPT"},{"id":8112,"precertRequired":false,"billingCode":"G0008","codeType":"HCPCS"},{"id":8113,"precertRequired":false,"billingCode":"G0009","codeType":"HCPCS"},{"id":8114,"precertRequired":false,"billingCode":"G0010","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":3069,"description":"All necessary dialysis equipment","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7781,"precertRequired":true,"billingCode":"A4660","codeType":"HCPCS"},{"id":7789,"precertRequired":true,"billingCode":"A4690","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":3070,"description":"All required dialysis supplies","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7670,"precertRequired":true,"billingCode":"A4215","codeType":"HCPCS"},{"id":7671,"precertRequired":false,"billingCode":"A4216","codeType":"HCPCS"},{"id":7672,"precertRequired":true,"billingCode":"A4217","codeType":"HCPCS"},{"id":7673,"precertRequired":true,"billingCode":"A4218","codeType":"HCPCS"},{"id":7678,"precertRequired":true,"billingCode":"A4244","codeType":"HCPCS"},{"id":7679,"precertRequired":false,"billingCode":"A4245","codeType":"HCPCS"},{"id":7680,"precertRequired":true,"billingCode":"A4246","codeType":"HCPCS"},{"id":7681,"precertRequired":true,"billingCode":"A4247","codeType":"HCPCS"},{"id":7682,"precertRequired":true,"billingCode":"A4248","codeType":"HCPCS"},{"id":7770,"precertRequired":true,"billingCode":"A4450","codeType":"HCPCS"},{"id":7771,"precertRequired":true,"billingCode":"A4452","codeType":"HCPCS"},{"id":7777,"precertRequired":true,"billingCode":"A4651","codeType":"HCPCS"},{"id":7778,"precertRequired":true,"billingCode":"A4652","codeType":"HCPCS"},{"id":7780,"precertRequired":true,"billingCode":"A4657","codeType":"HCPCS"},{"id":7782,"precertRequired":false,"billingCode":"A4663","codeType":"HCPCS"},{"id":7783,"precertRequired":true,"billingCode":"A4670","codeType":"HCPCS"},{"id":7784,"precertRequired":true,"billingCode":"A4671","codeType":"HCPCS"},{"id":7785,"precertRequired":false,"billingCode":"A4672","codeType":"HCPCS"},{"id":7786,"precertRequired":false,"billingCode":"A4673","codeType":"HCPCS"},{"id":7787,"precertRequired":true,"billingCode":"A4674","codeType":"HCPCS"},{"id":7788,"precertRequired":true,"billingCode":"A4680","codeType":"HCPCS"},{"id":7790,"precertRequired":false,"billingCode":"A4706","codeType":"HCPCS"},{"id":7791,"precertRequired":true,"billingCode":"A4707","codeType":"HCPCS"},{"id":7792,"precertRequired":false,"billingCode":"A4708","codeType":"HCPCS"},{"id":7793,"precertRequired":true,"billingCode":"A4709","codeType":"HCPCS"},{"id":7803,"precertRequired":true,"billingCode":"A4728","codeType":"HCPCS"},{"id":7804,"precertRequired":false,"billingCode":"A4730","codeType":"HCPCS"},{"id":7805,"precertRequired":false,"billingCode":"A4736","codeType":"HCPCS"},{"id":7806,"precertRequired":false,"billingCode":"A4737","codeType":"HCPCS"},{"id":7807,"precertRequired":false,"billingCode":"A4740","codeType":"HCPCS"},{"id":7808,"precertRequired":false,"billingCode":"A4750","codeType":"HCPCS"},{"id":7809,"precertRequired":false,"billingCode":"A4755","codeType":"HCPCS"},{"id":7813,"precertRequired":false,"billingCode":"A4770","codeType":"HCPCS"},{"id":7814,"precertRequired":false,"billingCode":"A4771","codeType":"HCPCS"},{"id":7815,"precertRequired":false,"billingCode":"A4772","codeType":"HCPCS"},{"id":7817,"precertRequired":false,"billingCode":"A4774","codeType":"HCPCS"},{"id":7818,"precertRequired":true,"billingCode":"A4802","codeType":"HCPCS"},{"id":7843,"precertRequired":true,"billingCode":"A6215","codeType":"HCPCS"},{"id":7845,"precertRequired":true,"billingCode":"A6402","codeType":"HCPCS"},{"id":7939,"precertRequired":true,"billingCode":"C1750","codeType":"HCPCS"},{"id":7940,"precertRequired":true,"billingCode":"C1752","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8524,"precertRequired":false,"billingCode":"J7042","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8527,"precertRequired":false,"billingCode":"J7070","codeType":"HCPCS"},{"id":8530,"precertRequired":false,"billingCode":"J7120","codeType":"HCPCS"},{"id":8531,"precertRequired":false,"billingCode":"J7131","codeType":"HCPCS"},{"id":8748,"precertRequired":false,"billingCode":"P9047","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8775,"precertRequired":false,"billingCode":"Q0163","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":3071,"description":"Dialysis nursing services required for center assisted dialysis care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"},{"id":8235,"precertRequired":true,"billingCode":"G0491","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":3072,"description":"All bundled ESRD ( end stage renal disease) dialysis labs and medications","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":8381,"precertRequired":true,"billingCode":"J0606","codeType":"HCPCS"},{"id":8382,"precertRequired":false,"billingCode":"J0610","codeType":"HCPCS"},{"id":8383,"precertRequired":false,"billingCode":"J0620","codeType":"HCPCS"},{"id":8384,"precertRequired":true,"billingCode":"J0630","codeType":"HCPCS"},{"id":8385,"precertRequired":false,"billingCode":"J0636","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8388,"precertRequired":true,"billingCode":"J0670","codeType":"HCPCS"},{"id":8391,"precertRequired":false,"billingCode":"J0713","codeType":"HCPCS"},{"id":8393,"precertRequired":false,"billingCode":"J0735","codeType":"HCPCS"},{"id":8396,"precertRequired":false,"billingCode":"J0878","codeType":"HCPCS"},{"id":8402,"precertRequired":false,"billingCode":"J0895","codeType":"HCPCS"},{"id":8404,"precertRequired":true,"billingCode":"J0945","codeType":"HCPCS"},{"id":8414,"precertRequired":false,"billingCode":"J1160","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8417,"precertRequired":false,"billingCode":"J1205","codeType":"HCPCS"},{"id":8420,"precertRequired":false,"billingCode":"J1240","codeType":"HCPCS"},{"id":8424,"precertRequired":false,"billingCode":"J1270","codeType":"HCPCS"},{"id":8435,"precertRequired":false,"billingCode":"J1580","codeType":"HCPCS"},{"id":8441,"precertRequired":false,"billingCode":"J1642","codeType":"HCPCS"},{"id":8442,"precertRequired":false,"billingCode":"J1644","codeType":"HCPCS"},{"id":8447,"precertRequired":false,"billingCode":"J1740","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8450,"precertRequired":false,"billingCode":"J1756","codeType":"HCPCS"},{"id":8451,"precertRequired":false,"billingCode":"J1815","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8457,"precertRequired":false,"billingCode":"J1955","codeType":"HCPCS"},{"id":8459,"precertRequired":true,"billingCode":"J2001","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8461,"precertRequired":false,"billingCode":"J2150","codeType":"HCPCS"},{"id":8467,"precertRequired":false,"billingCode":"J2320","codeType":"HCPCS"},{"id":8470,"precertRequired":false,"billingCode":"J2360","codeType":"HCPCS"},{"id":8472,"precertRequired":true,"billingCode":"J2405","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8476,"precertRequired":false,"billingCode":"J2501","codeType":"HCPCS"},{"id":8482,"precertRequired":false,"billingCode":"J2720","codeType":"HCPCS"},{"id":8493,"precertRequired":false,"billingCode":"J2795","codeType":"HCPCS"},{"id":8495,"precertRequired":false,"billingCode":"J2916","codeType":"HCPCS"},{"id":8498,"precertRequired":false,"billingCode":"J2997","codeType":"HCPCS"},{"id":8501,"precertRequired":false,"billingCode":"J3260","codeType":"HCPCS"},{"id":8502,"precertRequired":false,"billingCode":"J3265","codeType":"HCPCS"},{"id":8511,"precertRequired":false,"billingCode":"J3370","codeType":"HCPCS"},{"id":8513,"precertRequired":false,"billingCode":"J3410","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":3073,"description":"Additional labs as required for appropriate monitoring of resolution of AKI","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5451,"precertRequired":false,"billingCode":"82507","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"},{"id":7670,"precertRequired":true,"billingCode":"A4215","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":3074,"description":"Patient education related to renal replacement therapy options and related surgical procedures","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]}]}},{"Seoc":{"id":176,"seocKey":6,"name":"Acute Outpatient Center Based Assisted Hemodialysis_PRCT","seocId":"DIA_ACUTE OUTPATIENT CENTER BASED ASSISTED HEMODIALYSIS_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. All outpatient dialysis services for treatment of non-recovered  acute-kidney injury (AKI) as clinically necessary\r\n2. All necessary dialysis equipment\r\n3. All required dialysis supplies\r\n4. Dialysis nursing services required for center assisted dialysis care\r\n5. All bundled ESRD ( end stage renal disease) dialysis labs and medications\r\n6. Additional labs as required for appropriate monitoring of resolution of AKI\r\n7. Patient education related to renal replacement therapy options and related surgical procedures","maxAllowableVisits":null,"disclaimer":"* All routine non-bundled  medications will be provided by the VA as prescribed by the community nephrologist in accordance with the VA national formulary and non-formulary request process.\r\nCommunity dialysis facility must be and remain CMS certified and meet CMS conditions for coverage for dialysis.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.","QASP":"General Care","categoryOfCare":"DIALYSIS","serviceLine":"Dialysis","hptcs":[{"hptc":"261QE0700X"}],"services":[{"id":647,"description":"All outpatient dialysis services for treatment of non-recovered  acute-kidney injury (AKI) as clinically necessary","frequency":null,"frequencyType":"","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2598,"precertRequired":true,"billingCode":"36800","codeType":"CPT"},{"id":2604,"precertRequired":true,"billingCode":"36821","codeType":"CPT"},{"id":2607,"precertRequired":true,"billingCode":"36831","codeType":"CPT"},{"id":2608,"precertRequired":true,"billingCode":"36832","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"},{"id":6512,"precertRequired":false,"billingCode":"90371","codeType":"CPT"},{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":6532,"precertRequired":false,"billingCode":"90632","codeType":"CPT"},{"id":6533,"precertRequired":false,"billingCode":"90636","codeType":"CPT"},{"id":6541,"precertRequired":false,"billingCode":"90662","codeType":"CPT"},{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6547,"precertRequired":false,"billingCode":"90686","codeType":"CPT"},{"id":6548,"precertRequired":false,"billingCode":"90688","codeType":"CPT"},{"id":6549,"precertRequired":false,"billingCode":"90697","codeType":"CPT"},{"id":6550,"precertRequired":false,"billingCode":"90698","codeType":"CPT"},{"id":6551,"precertRequired":false,"billingCode":"90707","codeType":"CPT"},{"id":6554,"precertRequired":false,"billingCode":"90715","codeType":"CPT"},{"id":6557,"precertRequired":false,"billingCode":"90723","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":6561,"precertRequired":false,"billingCode":"90736","codeType":"CPT"},{"id":6562,"precertRequired":false,"billingCode":"90739","codeType":"CPT"},{"id":6563,"precertRequired":false,"billingCode":"90740","codeType":"CPT"},{"id":6564,"precertRequired":false,"billingCode":"90746","codeType":"CPT"},{"id":6565,"precertRequired":false,"billingCode":"90747","codeType":"CPT"},{"id":6566,"precertRequired":false,"billingCode":"90748","codeType":"CPT"},{"id":6600,"precertRequired":true,"billingCode":"90935","codeType":"CPT"},{"id":6601,"precertRequired":true,"billingCode":"90937","codeType":"CPT"},{"id":6602,"precertRequired":true,"billingCode":"90940","codeType":"CPT"},{"id":6604,"precertRequired":true,"billingCode":"90947","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6956,"precertRequired":false,"billingCode":"93784","codeType":"CPT"},{"id":6989,"precertRequired":false,"billingCode":"93990","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7658,"precertRequired":false,"billingCode":"4148F","codeType":"CPT"},{"id":7659,"precertRequired":false,"billingCode":"4149F","codeType":"CPT"},{"id":7660,"precertRequired":false,"billingCode":"4155F","codeType":"CPT"},{"id":7661,"precertRequired":false,"billingCode":"4157F","codeType":"CPT"},{"id":8112,"precertRequired":false,"billingCode":"G0008","codeType":"HCPCS"},{"id":8113,"precertRequired":false,"billingCode":"G0009","codeType":"HCPCS"},{"id":8114,"precertRequired":false,"billingCode":"G0010","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":648,"description":"All necessary dialysis equipment","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7781,"precertRequired":true,"billingCode":"A4660","codeType":"HCPCS"},{"id":7789,"precertRequired":true,"billingCode":"A4690","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":649,"description":"All required dialysis supplies","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7670,"precertRequired":true,"billingCode":"A4215","codeType":"HCPCS"},{"id":7671,"precertRequired":false,"billingCode":"A4216","codeType":"HCPCS"},{"id":7672,"precertRequired":true,"billingCode":"A4217","codeType":"HCPCS"},{"id":7673,"precertRequired":true,"billingCode":"A4218","codeType":"HCPCS"},{"id":7678,"precertRequired":true,"billingCode":"A4244","codeType":"HCPCS"},{"id":7679,"precertRequired":false,"billingCode":"A4245","codeType":"HCPCS"},{"id":7680,"precertRequired":true,"billingCode":"A4246","codeType":"HCPCS"},{"id":7681,"precertRequired":true,"billingCode":"A4247","codeType":"HCPCS"},{"id":7682,"precertRequired":true,"billingCode":"A4248","codeType":"HCPCS"},{"id":7770,"precertRequired":true,"billingCode":"A4450","codeType":"HCPCS"},{"id":7771,"precertRequired":true,"billingCode":"A4452","codeType":"HCPCS"},{"id":7777,"precertRequired":true,"billingCode":"A4651","codeType":"HCPCS"},{"id":7778,"precertRequired":true,"billingCode":"A4652","codeType":"HCPCS"},{"id":7780,"precertRequired":true,"billingCode":"A4657","codeType":"HCPCS"},{"id":7782,"precertRequired":false,"billingCode":"A4663","codeType":"HCPCS"},{"id":7783,"precertRequired":true,"billingCode":"A4670","codeType":"HCPCS"},{"id":7784,"precertRequired":true,"billingCode":"A4671","codeType":"HCPCS"},{"id":7785,"precertRequired":false,"billingCode":"A4672","codeType":"HCPCS"},{"id":7786,"precertRequired":false,"billingCode":"A4673","codeType":"HCPCS"},{"id":7787,"precertRequired":true,"billingCode":"A4674","codeType":"HCPCS"},{"id":7788,"precertRequired":true,"billingCode":"A4680","codeType":"HCPCS"},{"id":7790,"precertRequired":false,"billingCode":"A4706","codeType":"HCPCS"},{"id":7791,"precertRequired":true,"billingCode":"A4707","codeType":"HCPCS"},{"id":7792,"precertRequired":false,"billingCode":"A4708","codeType":"HCPCS"},{"id":7793,"precertRequired":true,"billingCode":"A4709","codeType":"HCPCS"},{"id":7803,"precertRequired":true,"billingCode":"A4728","codeType":"HCPCS"},{"id":7804,"precertRequired":false,"billingCode":"A4730","codeType":"HCPCS"},{"id":7805,"precertRequired":false,"billingCode":"A4736","codeType":"HCPCS"},{"id":7806,"precertRequired":false,"billingCode":"A4737","codeType":"HCPCS"},{"id":7807,"precertRequired":false,"billingCode":"A4740","codeType":"HCPCS"},{"id":7808,"precertRequired":false,"billingCode":"A4750","codeType":"HCPCS"},{"id":7809,"precertRequired":false,"billingCode":"A4755","codeType":"HCPCS"},{"id":7813,"precertRequired":false,"billingCode":"A4770","codeType":"HCPCS"},{"id":7814,"precertRequired":false,"billingCode":"A4771","codeType":"HCPCS"},{"id":7815,"precertRequired":false,"billingCode":"A4772","codeType":"HCPCS"},{"id":7817,"precertRequired":false,"billingCode":"A4774","codeType":"HCPCS"},{"id":7818,"precertRequired":true,"billingCode":"A4802","codeType":"HCPCS"},{"id":7843,"precertRequired":true,"billingCode":"A6215","codeType":"HCPCS"},{"id":7845,"precertRequired":true,"billingCode":"A6402","codeType":"HCPCS"},{"id":7939,"precertRequired":true,"billingCode":"C1750","codeType":"HCPCS"},{"id":7940,"precertRequired":true,"billingCode":"C1752","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8524,"precertRequired":false,"billingCode":"J7042","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8527,"precertRequired":false,"billingCode":"J7070","codeType":"HCPCS"},{"id":8530,"precertRequired":false,"billingCode":"J7120","codeType":"HCPCS"},{"id":8531,"precertRequired":false,"billingCode":"J7131","codeType":"HCPCS"},{"id":8748,"precertRequired":false,"billingCode":"P9047","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8775,"precertRequired":false,"billingCode":"Q0163","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":650,"description":"Dialysis nursing services required for center assisted dialysis care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"},{"id":8235,"precertRequired":true,"billingCode":"G0491","codeType":"HCPCS"},{"id":8328,"precertRequired":true,"billingCode":"G9523","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":651,"description":"All bundled ESRD ( end stage renal disease) dialysis labs and medications","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":8381,"precertRequired":true,"billingCode":"J0606","codeType":"HCPCS"},{"id":8382,"precertRequired":false,"billingCode":"J0610","codeType":"HCPCS"},{"id":8383,"precertRequired":false,"billingCode":"J0620","codeType":"HCPCS"},{"id":8384,"precertRequired":true,"billingCode":"J0630","codeType":"HCPCS"},{"id":8385,"precertRequired":false,"billingCode":"J0636","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8388,"precertRequired":true,"billingCode":"J0670","codeType":"HCPCS"},{"id":8391,"precertRequired":false,"billingCode":"J0713","codeType":"HCPCS"},{"id":8393,"precertRequired":false,"billingCode":"J0735","codeType":"HCPCS"},{"id":8396,"precertRequired":false,"billingCode":"J0878","codeType":"HCPCS"},{"id":8402,"precertRequired":false,"billingCode":"J0895","codeType":"HCPCS"},{"id":8404,"precertRequired":true,"billingCode":"J0945","codeType":"HCPCS"},{"id":8414,"precertRequired":false,"billingCode":"J1160","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8417,"precertRequired":false,"billingCode":"J1205","codeType":"HCPCS"},{"id":8420,"precertRequired":false,"billingCode":"J1240","codeType":"HCPCS"},{"id":8424,"precertRequired":false,"billingCode":"J1270","codeType":"HCPCS"},{"id":8435,"precertRequired":false,"billingCode":"J1580","codeType":"HCPCS"},{"id":8441,"precertRequired":false,"billingCode":"J1642","codeType":"HCPCS"},{"id":8442,"precertRequired":false,"billingCode":"J1644","codeType":"HCPCS"},{"id":8447,"precertRequired":false,"billingCode":"J1740","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8450,"precertRequired":false,"billingCode":"J1756","codeType":"HCPCS"},{"id":8451,"precertRequired":false,"billingCode":"J1815","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8457,"precertRequired":false,"billingCode":"J1955","codeType":"HCPCS"},{"id":8459,"precertRequired":true,"billingCode":"J2001","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8461,"precertRequired":false,"billingCode":"J2150","codeType":"HCPCS"},{"id":8467,"precertRequired":false,"billingCode":"J2320","codeType":"HCPCS"},{"id":8470,"precertRequired":false,"billingCode":"J2360","codeType":"HCPCS"},{"id":8472,"precertRequired":true,"billingCode":"J2405","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8476,"precertRequired":false,"billingCode":"J2501","codeType":"HCPCS"},{"id":8482,"precertRequired":false,"billingCode":"J2720","codeType":"HCPCS"},{"id":8493,"precertRequired":false,"billingCode":"J2795","codeType":"HCPCS"},{"id":8495,"precertRequired":false,"billingCode":"J2916","codeType":"HCPCS"},{"id":8498,"precertRequired":false,"billingCode":"J2997","codeType":"HCPCS"},{"id":8501,"precertRequired":false,"billingCode":"J3260","codeType":"HCPCS"},{"id":8502,"precertRequired":false,"billingCode":"J3265","codeType":"HCPCS"},{"id":8511,"precertRequired":false,"billingCode":"J3370","codeType":"HCPCS"},{"id":8513,"precertRequired":false,"billingCode":"J3410","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":652,"description":"Additional labs as required for appropriate monitoring of resolution of AKI","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5451,"precertRequired":false,"billingCode":"82507","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"},{"id":7670,"precertRequired":true,"billingCode":"A4215","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":653,"description":"Patient education related to renal replacement therapy options and related surgical procedures","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]}]}},{"Seoc":{"id":103,"seocKey":6,"name":"Acute Outpatient Center Based Assisted Hemodialysis_PRCT","seocId":"MSC_ACUTE OUTPATIENT CENTER BASED ASSISTED HEMODIALYSIS_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"09-21-2018","endDate":"01-02-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. All outpatient dialysis services for treatment of non-recovered  acute-kidney injury (AKI) as clinically necessary\r\n2. All necessary dialysis equipment\r\n3. All required dialysis supplies\r\n4. Dialysis nursing services required for center assisted dialysis care\r\n5. All bundled ESRD ( end stage renal disease) dialysis labs and medications\r\n6. Additional labs as required for appropriate monitoring of resolution of AKI\r\n7. Patient education related to renal replacement therapy options and related surgical procedures","maxAllowableVisits":999,"disclaimer":"* All routine non-bundled  medications will be provided by the VA as prescribed by the community nephrologist in accordance with the VA national formulary and non-formulary request process.\r\nCommunity dialysis facility must be and remain CMS certified and meet CMS conditions for coverage for dialysis.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.","QASP":"General Care","categoryOfCare":"DIALYSIS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":11,"description":"All outpatient dialysis services for treatment of non-recovered  acute-kidney injury (AKI) as clinically necessary","frequency":null,"frequencyType":"","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2598,"precertRequired":true,"billingCode":"36800","codeType":"CPT"},{"id":2604,"precertRequired":true,"billingCode":"36821","codeType":"CPT"},{"id":2607,"precertRequired":true,"billingCode":"36831","codeType":"CPT"},{"id":2608,"precertRequired":true,"billingCode":"36832","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"},{"id":6512,"precertRequired":false,"billingCode":"90371","codeType":"CPT"},{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":6532,"precertRequired":false,"billingCode":"90632","codeType":"CPT"},{"id":6533,"precertRequired":false,"billingCode":"90636","codeType":"CPT"},{"id":6541,"precertRequired":false,"billingCode":"90662","codeType":"CPT"},{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6547,"precertRequired":false,"billingCode":"90686","codeType":"CPT"},{"id":6548,"precertRequired":false,"billingCode":"90688","codeType":"CPT"},{"id":6549,"precertRequired":false,"billingCode":"90697","codeType":"CPT"},{"id":6550,"precertRequired":false,"billingCode":"90698","codeType":"CPT"},{"id":6551,"precertRequired":false,"billingCode":"90707","codeType":"CPT"},{"id":6554,"precertRequired":false,"billingCode":"90715","codeType":"CPT"},{"id":6557,"precertRequired":false,"billingCode":"90723","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":6561,"precertRequired":false,"billingCode":"90736","codeType":"CPT"},{"id":6562,"precertRequired":false,"billingCode":"90739","codeType":"CPT"},{"id":6563,"precertRequired":false,"billingCode":"90740","codeType":"CPT"},{"id":6564,"precertRequired":false,"billingCode":"90746","codeType":"CPT"},{"id":6565,"precertRequired":false,"billingCode":"90747","codeType":"CPT"},{"id":6566,"precertRequired":false,"billingCode":"90748","codeType":"CPT"},{"id":6600,"precertRequired":true,"billingCode":"90935","codeType":"CPT"},{"id":6601,"precertRequired":true,"billingCode":"90937","codeType":"CPT"},{"id":6602,"precertRequired":true,"billingCode":"90940","codeType":"CPT"},{"id":6604,"precertRequired":true,"billingCode":"90947","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6956,"precertRequired":false,"billingCode":"93784","codeType":"CPT"},{"id":6989,"precertRequired":false,"billingCode":"93990","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7658,"precertRequired":false,"billingCode":"4148F","codeType":"CPT"},{"id":7659,"precertRequired":false,"billingCode":"4149F","codeType":"CPT"},{"id":7660,"precertRequired":false,"billingCode":"4155F","codeType":"CPT"},{"id":7661,"precertRequired":false,"billingCode":"4157F","codeType":"CPT"},{"id":8112,"precertRequired":false,"billingCode":"G0008","codeType":"HCPCS"},{"id":8113,"precertRequired":false,"billingCode":"G0009","codeType":"HCPCS"},{"id":8114,"precertRequired":false,"billingCode":"G0010","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":12,"description":"All necessary dialysis equipment","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7781,"precertRequired":true,"billingCode":"A4660","codeType":"HCPCS"},{"id":7789,"precertRequired":true,"billingCode":"A4690","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":13,"description":"All required dialysis supplies","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7670,"precertRequired":true,"billingCode":"A4215","codeType":"HCPCS"},{"id":7671,"precertRequired":false,"billingCode":"A4216","codeType":"HCPCS"},{"id":7672,"precertRequired":true,"billingCode":"A4217","codeType":"HCPCS"},{"id":7673,"precertRequired":true,"billingCode":"A4218","codeType":"HCPCS"},{"id":7678,"precertRequired":true,"billingCode":"A4244","codeType":"HCPCS"},{"id":7679,"precertRequired":false,"billingCode":"A4245","codeType":"HCPCS"},{"id":7680,"precertRequired":true,"billingCode":"A4246","codeType":"HCPCS"},{"id":7681,"precertRequired":true,"billingCode":"A4247","codeType":"HCPCS"},{"id":7682,"precertRequired":true,"billingCode":"A4248","codeType":"HCPCS"},{"id":7770,"precertRequired":true,"billingCode":"A4450","codeType":"HCPCS"},{"id":7771,"precertRequired":true,"billingCode":"A4452","codeType":"HCPCS"},{"id":7777,"precertRequired":true,"billingCode":"A4651","codeType":"HCPCS"},{"id":7778,"precertRequired":true,"billingCode":"A4652","codeType":"HCPCS"},{"id":7780,"precertRequired":true,"billingCode":"A4657","codeType":"HCPCS"},{"id":7782,"precertRequired":false,"billingCode":"A4663","codeType":"HCPCS"},{"id":7783,"precertRequired":true,"billingCode":"A4670","codeType":"HCPCS"},{"id":7784,"precertRequired":true,"billingCode":"A4671","codeType":"HCPCS"},{"id":7785,"precertRequired":false,"billingCode":"A4672","codeType":"HCPCS"},{"id":7786,"precertRequired":false,"billingCode":"A4673","codeType":"HCPCS"},{"id":7787,"precertRequired":true,"billingCode":"A4674","codeType":"HCPCS"},{"id":7788,"precertRequired":true,"billingCode":"A4680","codeType":"HCPCS"},{"id":7790,"precertRequired":false,"billingCode":"A4706","codeType":"HCPCS"},{"id":7791,"precertRequired":true,"billingCode":"A4707","codeType":"HCPCS"},{"id":7792,"precertRequired":false,"billingCode":"A4708","codeType":"HCPCS"},{"id":7793,"precertRequired":true,"billingCode":"A4709","codeType":"HCPCS"},{"id":7803,"precertRequired":true,"billingCode":"A4728","codeType":"HCPCS"},{"id":7804,"precertRequired":false,"billingCode":"A4730","codeType":"HCPCS"},{"id":7805,"precertRequired":false,"billingCode":"A4736","codeType":"HCPCS"},{"id":7806,"precertRequired":false,"billingCode":"A4737","codeType":"HCPCS"},{"id":7807,"precertRequired":false,"billingCode":"A4740","codeType":"HCPCS"},{"id":7808,"precertRequired":false,"billingCode":"A4750","codeType":"HCPCS"},{"id":7809,"precertRequired":false,"billingCode":"A4755","codeType":"HCPCS"},{"id":7813,"precertRequired":false,"billingCode":"A4770","codeType":"HCPCS"},{"id":7814,"precertRequired":false,"billingCode":"A4771","codeType":"HCPCS"},{"id":7815,"precertRequired":false,"billingCode":"A4772","codeType":"HCPCS"},{"id":7817,"precertRequired":false,"billingCode":"A4774","codeType":"HCPCS"},{"id":7818,"precertRequired":true,"billingCode":"A4802","codeType":"HCPCS"},{"id":7843,"precertRequired":true,"billingCode":"A6215","codeType":"HCPCS"},{"id":7845,"precertRequired":true,"billingCode":"A6402","codeType":"HCPCS"},{"id":7939,"precertRequired":true,"billingCode":"C1750","codeType":"HCPCS"},{"id":7940,"precertRequired":true,"billingCode":"C1752","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8524,"precertRequired":false,"billingCode":"J7042","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8527,"precertRequired":false,"billingCode":"J7070","codeType":"HCPCS"},{"id":8530,"precertRequired":false,"billingCode":"J7120","codeType":"HCPCS"},{"id":8531,"precertRequired":false,"billingCode":"J7131","codeType":"HCPCS"},{"id":8748,"precertRequired":false,"billingCode":"P9047","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8775,"precertRequired":false,"billingCode":"Q0163","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":14,"description":"Dialysis nursing services required for center assisted dialysis care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"},{"id":8235,"precertRequired":true,"billingCode":"G0491","codeType":"HCPCS"},{"id":8328,"precertRequired":true,"billingCode":"G9523","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":15,"description":"All bundled ESRD ( end stage renal disease) dialysis labs and medications","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":8381,"precertRequired":true,"billingCode":"J0606","codeType":"HCPCS"},{"id":8382,"precertRequired":false,"billingCode":"J0610","codeType":"HCPCS"},{"id":8383,"precertRequired":false,"billingCode":"J0620","codeType":"HCPCS"},{"id":8384,"precertRequired":true,"billingCode":"J0630","codeType":"HCPCS"},{"id":8385,"precertRequired":false,"billingCode":"J0636","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8388,"precertRequired":true,"billingCode":"J0670","codeType":"HCPCS"},{"id":8391,"precertRequired":false,"billingCode":"J0713","codeType":"HCPCS"},{"id":8393,"precertRequired":false,"billingCode":"J0735","codeType":"HCPCS"},{"id":8396,"precertRequired":false,"billingCode":"J0878","codeType":"HCPCS"},{"id":8402,"precertRequired":false,"billingCode":"J0895","codeType":"HCPCS"},{"id":8404,"precertRequired":true,"billingCode":"J0945","codeType":"HCPCS"},{"id":8414,"precertRequired":false,"billingCode":"J1160","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8417,"precertRequired":false,"billingCode":"J1205","codeType":"HCPCS"},{"id":8420,"precertRequired":false,"billingCode":"J1240","codeType":"HCPCS"},{"id":8424,"precertRequired":false,"billingCode":"J1270","codeType":"HCPCS"},{"id":8435,"precertRequired":false,"billingCode":"J1580","codeType":"HCPCS"},{"id":8441,"precertRequired":false,"billingCode":"J1642","codeType":"HCPCS"},{"id":8442,"precertRequired":false,"billingCode":"J1644","codeType":"HCPCS"},{"id":8447,"precertRequired":false,"billingCode":"J1740","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8450,"precertRequired":false,"billingCode":"J1756","codeType":"HCPCS"},{"id":8451,"precertRequired":false,"billingCode":"J1815","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8457,"precertRequired":false,"billingCode":"J1955","codeType":"HCPCS"},{"id":8459,"precertRequired":true,"billingCode":"J2001","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8461,"precertRequired":false,"billingCode":"J2150","codeType":"HCPCS"},{"id":8467,"precertRequired":false,"billingCode":"J2320","codeType":"HCPCS"},{"id":8470,"precertRequired":false,"billingCode":"J2360","codeType":"HCPCS"},{"id":8472,"precertRequired":true,"billingCode":"J2405","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8476,"precertRequired":false,"billingCode":"J2501","codeType":"HCPCS"},{"id":8482,"precertRequired":false,"billingCode":"J2720","codeType":"HCPCS"},{"id":8493,"precertRequired":false,"billingCode":"J2795","codeType":"HCPCS"},{"id":8495,"precertRequired":false,"billingCode":"J2916","codeType":"HCPCS"},{"id":8498,"precertRequired":false,"billingCode":"J2997","codeType":"HCPCS"},{"id":8501,"precertRequired":false,"billingCode":"J3260","codeType":"HCPCS"},{"id":8502,"precertRequired":false,"billingCode":"J3265","codeType":"HCPCS"},{"id":8511,"precertRequired":false,"billingCode":"J3370","codeType":"HCPCS"},{"id":8513,"precertRequired":false,"billingCode":"J3410","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":16,"description":"Additional labs as required for appropriate monitoring of resolution of AKI","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5451,"precertRequired":false,"billingCode":"82507","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"},{"id":7670,"precertRequired":true,"billingCode":"A4215","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":17,"description":"Patient education related to renal replacement therapy options and related surgical procedures","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]}]}},{"Seoc":{"id":60,"seocKey":6,"name":"Acute Outpatient Center Based Assisted Hemodialysis_PRCT","seocId":"DIA_ACUTE OUTPATIENT CENTER BASED ASSISTED HEMODIALYSIS_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"05-31-2018","endDate":"09-21-2018","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. All outpatient dialysis services for treatment of non-recovered  acute-kidney injury (AKI) as clinically necessary\r\n2. All necessary dialysis equipment\r\n3. All required dialysis supplies\r\n4. Dialysis nursing services required for center assisted dialysis care\r\n5. All bundled ESRD ( end stage renal disease) dialysis labs and medications\r\n6. Additional labs as required for appropriate monitoring of resolution of AKI\r\n7. Patient education related to renal replacement therapy options and related surgical procedures","maxAllowableVisits":999,"disclaimer":"** All routine non-bundled  medications will be provided by the VA as prescribed by the community nephrologist in accordance with the VA national formulary and non-formulary request process.\r\n** Community dialysis facility must be and remain CMS certified and meet CMS conditions for coverage for dialysis.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.","QASP":"General Care","categoryOfCare":"DIALYSIS","serviceLine":"Dialysis","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1322,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":186,"seocKey":7,"name":"Adult Day Health Care_PRCT","seocId":"NIC_ADULT DAY HEALTH CARE_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"01-02-2019","endDate":"05-10-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Adult day health care services for the referred patient condition per consult\r\n2. Duration and frequency of visits as necessary on the consult","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the referred patient condition require VA review and approval.","QASP":"General Care","categoryOfCare":"NIC ADULT DAY CARE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"261QA0600X"}],"services":[{"id":691,"description":"Adult day health care services for the referred patient condition per consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"89-Certified clinical nurse specialist"}],"billingCodes":[{"id":8943,"precertRequired":false,"billingCode":"S5101","codeType":"HCPCS"},{"id":8944,"precertRequired":true,"billingCode":"S5102","codeType":"HCPCS"},{"id":8945,"precertRequired":false,"billingCode":"S5105","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"364SX0106X"},{"HPTC":"364SN0000X"},{"HPTC":"364SE1400X"},{"HPTC":"364SA2200X"},{"HPTC":"364SN0800X"},{"HPTC":"364SP0808X"},{"HPTC":"364SF0001X"},{"HPTC":"364SP0813X"},{"HPTC":"364SP2800X"},{"HPTC":"364SP0811X"},{"HPTC":"364SR0400X"},{"HPTC":"364SX0200X"},{"HPTC":"364SH0200X"},{"HPTC":"364SC1501X"},{"HPTC":"364SW0102X"},{"HPTC":"364SX0204X"},{"HPTC":"364ST0500X"},{"HPTC":"364SP1700X"},{"HPTC":"364SL0600X"},{"HPTC":"364SI0800X"},{"HPTC":"364SH1100X"},{"HPTC":"364SP0809X"},{"HPTC":"364SP0807X"},{"HPTC":"364SA2100X"},{"HPTC":"364SG0600X"},{"HPTC":"364SP0812X"},{"HPTC":"364SS0200X"},{"HPTC":"364SC0200X"},{"HPTC":"364SC2300X"},{"HPTC":"364SP0810X"},{"HPTC":"364SM0705X"},{"HPTC":"364SP0200X"},{"HPTC":"364S00000X"},{"HPTC":"364SE0003X"}]},{"id":692,"description":" Duration and frequency of visits as necessary on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"89-Certified clinical nurse specialist"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"364SX0106X"},{"HPTC":"364SN0000X"},{"HPTC":"364SE1400X"},{"HPTC":"364SA2200X"},{"HPTC":"364SN0800X"},{"HPTC":"364SP0808X"},{"HPTC":"364SF0001X"},{"HPTC":"364SP0813X"},{"HPTC":"364SP2800X"},{"HPTC":"364SP0811X"},{"HPTC":"364SR0400X"},{"HPTC":"364SX0200X"},{"HPTC":"364SH0200X"},{"HPTC":"364SC1501X"},{"HPTC":"364SW0102X"},{"HPTC":"364SX0204X"},{"HPTC":"364ST0500X"},{"HPTC":"364SP1700X"},{"HPTC":"364SL0600X"},{"HPTC":"364SI0800X"},{"HPTC":"364SH1100X"},{"HPTC":"364SP0809X"},{"HPTC":"364SP0807X"},{"HPTC":"364SA2100X"},{"HPTC":"364SG0600X"},{"HPTC":"364SP0812X"},{"HPTC":"364SS0200X"},{"HPTC":"364SC0200X"},{"HPTC":"364SC2300X"},{"HPTC":"364SP0810X"},{"HPTC":"364SM0705X"},{"HPTC":"364SP0200X"},{"HPTC":"364S00000X"},{"HPTC":"364SE0003X"}]}]}},{"Seoc":{"id":61,"seocKey":7,"name":"Adult Day Health Care_PRCT","seocId":"NIC_ADULT DAY HEALTH CARE_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"05-31-2018","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Adult day health care services for the referred patient condition per consult\r\n2. Duration and frequency of visits as necessary on the consult","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the referred patient condition require VA review and approval.","QASP":"General Care","categoryOfCare":"NIC ADULT DAY CARE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":363,"description":"Adult day health care services for the referred patient condition per consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"89-Certified clinical nurse specialist"}],"billingCodes":[{"id":8943,"precertRequired":false,"billingCode":"S5101","codeType":"HCPCS"},{"id":8944,"precertRequired":true,"billingCode":"S5102","codeType":"HCPCS"},{"id":8945,"precertRequired":false,"billingCode":"S5105","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"364SX0106X"},{"HPTC":"364SN0000X"},{"HPTC":"364SE1400X"},{"HPTC":"364SA2200X"},{"HPTC":"364SN0800X"},{"HPTC":"364SP0808X"},{"HPTC":"364SF0001X"},{"HPTC":"364SP0813X"},{"HPTC":"364SP2800X"},{"HPTC":"364SP0811X"},{"HPTC":"364SR0400X"},{"HPTC":"364SX0200X"},{"HPTC":"364SH0200X"},{"HPTC":"364SC1501X"},{"HPTC":"364SW0102X"},{"HPTC":"364SX0204X"},{"HPTC":"364ST0500X"},{"HPTC":"364SP1700X"},{"HPTC":"364SL0600X"},{"HPTC":"364SI0800X"},{"HPTC":"364SH1100X"},{"HPTC":"364SP0809X"},{"HPTC":"364SP0807X"},{"HPTC":"364SA2100X"},{"HPTC":"364SG0600X"},{"HPTC":"364SP0812X"},{"HPTC":"364SS0200X"},{"HPTC":"364SC0200X"},{"HPTC":"364SC2300X"},{"HPTC":"364SP0810X"},{"HPTC":"364SM0705X"},{"HPTC":"364SP0200X"},{"HPTC":"364S00000X"},{"HPTC":"364SE0003X"}]},{"id":364,"description":" Duration and frequency of visits as necessary on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"89-Certified clinical nurse specialist"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"364SX0106X"},{"HPTC":"364SN0000X"},{"HPTC":"364SE1400X"},{"HPTC":"364SA2200X"},{"HPTC":"364SN0800X"},{"HPTC":"364SP0808X"},{"HPTC":"364SF0001X"},{"HPTC":"364SP0813X"},{"HPTC":"364SP2800X"},{"HPTC":"364SP0811X"},{"HPTC":"364SR0400X"},{"HPTC":"364SX0200X"},{"HPTC":"364SH0200X"},{"HPTC":"364SC1501X"},{"HPTC":"364SW0102X"},{"HPTC":"364SX0204X"},{"HPTC":"364ST0500X"},{"HPTC":"364SP1700X"},{"HPTC":"364SL0600X"},{"HPTC":"364SI0800X"},{"HPTC":"364SH1100X"},{"HPTC":"364SP0809X"},{"HPTC":"364SP0807X"},{"HPTC":"364SA2100X"},{"HPTC":"364SG0600X"},{"HPTC":"364SP0812X"},{"HPTC":"364SS0200X"},{"HPTC":"364SC0200X"},{"HPTC":"364SC2300X"},{"HPTC":"364SP0810X"},{"HPTC":"364SM0705X"},{"HPTC":"364SP0200X"},{"HPTC":"364S00000X"},{"HPTC":"364SE0003X"}]}]}},{"Seoc":{"id":1746,"seocKey":8,"name":"Allergy and Immunology_PRCT","seocId":"MSC_ALLERGY AND IMMUNOLOGY_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation and treatment for the referred condition indicated on the consult order\r\n2.   Labs (including RAST testing) and pathology relevant to the referred condition on the consult order\r\n3.   Diagnostic imaging relevant to the referred condition on the consult order\r\n4.   Procedures/diagnostic studies relevant to the referred condition including but not limited to:  allergen skin testing, drug testing, chemical patch testing, methacholine challenge, PFT\r\n5.   Standard immunotherapy and RUSH immunotherapy, including nurse visits.\r\n6.   Creation of serum for injections\r\n7.   Infusion therapy, in clinic, to include IV Fluids during infusion as relevant to the referred condition on the consult order\r\n8.   Follow-up visits for this episode of care relevant to the referred condition on the consult order\r\n9.   Follow up biopsy if clinically indicated\r\n10. Desensitization (antibiotics and chemotherapeutic agents)\r\n** It is highly recommended that Provider performing the desensitization treatment is affiliated with a hospital\r\n11. Inpatient admission or observation admission as related to referred condition on the consult order\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","maxAllowableVisits":null,"disclaimer":"*Please visit the VHA Storefront \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp \r\nfor 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","QASP":"General Care","categoryOfCare":"ALLERGY AND IMMUNOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207KA0200X"},{"hptc":"207RA0201X"}],"services":[{"id":5181,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":5182,"description":"Labs (including RAST testing) and pathology relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5045,"precertRequired":false,"billingCode":"80195","codeType":"CPT"},{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5372,"precertRequired":false,"billingCode":"82040","codeType":"CPT"},{"id":5374,"precertRequired":false,"billingCode":"82043","codeType":"CPT"},{"id":5380,"precertRequired":false,"billingCode":"82103","codeType":"CPT"},{"id":5408,"precertRequired":false,"billingCode":"82247","codeType":"CPT"},{"id":5409,"precertRequired":false,"billingCode":"82248","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5437,"precertRequired":false,"billingCode":"82384","codeType":"CPT"},{"id":5458,"precertRequired":false,"billingCode":"82542","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5469,"precertRequired":false,"billingCode":"82607","codeType":"CPT"},{"id":5478,"precertRequired":false,"billingCode":"82652","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5499,"precertRequired":false,"billingCode":"82746","codeType":"CPT"},{"id":5507,"precertRequired":false,"billingCode":"82784","codeType":"CPT"},{"id":5508,"precertRequired":false,"billingCode":"82785","codeType":"CPT"},{"id":5509,"precertRequired":false,"billingCode":"82787","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5526,"precertRequired":false,"billingCode":"82955","codeType":"CPT"},{"id":5528,"precertRequired":false,"billingCode":"82962","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5562,"precertRequired":false,"billingCode":"83088","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5566,"precertRequired":false,"billingCode":"83497","codeType":"CPT"},{"id":5570,"precertRequired":false,"billingCode":"83516","codeType":"CPT"},{"id":5573,"precertRequired":false,"billingCode":"83520","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5578,"precertRequired":false,"billingCode":"83550","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5602,"precertRequired":false,"billingCode":"83704","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5610,"precertRequired":false,"billingCode":"83789","codeType":"CPT"},{"id":5612,"precertRequired":false,"billingCode":"83835","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5621,"precertRequired":false,"billingCode":"83883","codeType":"CPT"},{"id":5646,"precertRequired":false,"billingCode":"84081","codeType":"CPT"},{"id":5649,"precertRequired":false,"billingCode":"84100","codeType":"CPT"},{"id":5652,"precertRequired":false,"billingCode":"84110","codeType":"CPT"},{"id":5655,"precertRequired":false,"billingCode":"84120","codeType":"CPT"},{"id":5667,"precertRequired":false,"billingCode":"84150","codeType":"CPT"},{"id":5671,"precertRequired":false,"billingCode":"84155","codeType":"CPT"},{"id":5672,"precertRequired":false,"billingCode":"84156","codeType":"CPT"},{"id":5674,"precertRequired":false,"billingCode":"84160","codeType":"CPT"},{"id":5676,"precertRequired":false,"billingCode":"84165","codeType":"CPT"},{"id":5677,"precertRequired":false,"billingCode":"84166","codeType":"CPT"},{"id":5678,"precertRequired":false,"billingCode":"84181","codeType":"CPT"},{"id":5679,"precertRequired":false,"billingCode":"84182","codeType":"CPT"},{"id":5693,"precertRequired":false,"billingCode":"84255","codeType":"CPT"},{"id":5694,"precertRequired":false,"billingCode":"84260","codeType":"CPT"},{"id":5698,"precertRequired":false,"billingCode":"84295","codeType":"CPT"},{"id":5702,"precertRequired":false,"billingCode":"84307","codeType":"CPT"},{"id":5703,"precertRequired":false,"billingCode":"84311","codeType":"CPT"},{"id":5711,"precertRequired":false,"billingCode":"84402","codeType":"CPT"},{"id":5712,"precertRequired":false,"billingCode":"84403","codeType":"CPT"},{"id":5717,"precertRequired":false,"billingCode":"84432","codeType":"CPT"},{"id":5718,"precertRequired":false,"billingCode":"84436","codeType":"CPT"},{"id":5720,"precertRequired":false,"billingCode":"84439","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5726,"precertRequired":false,"billingCode":"84450","codeType":"CPT"},{"id":5727,"precertRequired":false,"billingCode":"84460","codeType":"CPT"},{"id":5728,"precertRequired":false,"billingCode":"84466","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5732,"precertRequired":false,"billingCode":"84481","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5740,"precertRequired":false,"billingCode":"84520","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5783,"precertRequired":false,"billingCode":"85060","codeType":"CPT"},{"id":5784,"precertRequired":false,"billingCode":"85097","codeType":"CPT"},{"id":5789,"precertRequired":false,"billingCode":"85220","codeType":"CPT"},{"id":5791,"precertRequired":false,"billingCode":"85240","codeType":"CPT"},{"id":5805,"precertRequired":false,"billingCode":"85301","codeType":"CPT"},{"id":5806,"precertRequired":false,"billingCode":"85302","codeType":"CPT"},{"id":5808,"precertRequired":false,"billingCode":"85305","codeType":"CPT"},{"id":5821,"precertRequired":false,"billingCode":"85379","codeType":"CPT"},{"id":5838,"precertRequired":false,"billingCode":"85520","codeType":"CPT"},{"id":5849,"precertRequired":false,"billingCode":"85598","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5853,"precertRequired":false,"billingCode":"85613","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5866,"precertRequired":false,"billingCode":"86001","codeType":"CPT"},{"id":5867,"precertRequired":false,"billingCode":"86003","codeType":"CPT"},{"id":5868,"precertRequired":false,"billingCode":"86005","codeType":"CPT"},{"id":5869,"precertRequired":false,"billingCode":"86008","codeType":"CPT"},{"id":5870,"precertRequired":false,"billingCode":"86021","codeType":"CPT"},{"id":5873,"precertRequired":false,"billingCode":"86038","codeType":"CPT"},{"id":5874,"precertRequired":false,"billingCode":"86039","codeType":"CPT"},{"id":5875,"precertRequired":false,"billingCode":"86060","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5881,"precertRequired":false,"billingCode":"86141","codeType":"CPT"},{"id":5882,"precertRequired":false,"billingCode":"86146","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5884,"precertRequired":false,"billingCode":"86148","codeType":"CPT"},{"id":5885,"precertRequired":false,"billingCode":"86152","codeType":"CPT"},{"id":5886,"precertRequired":false,"billingCode":"86153","codeType":"CPT"},{"id":5890,"precertRequired":false,"billingCode":"86160","codeType":"CPT"},{"id":5891,"precertRequired":false,"billingCode":"86161","codeType":"CPT"},{"id":5892,"precertRequired":false,"billingCode":"86162","codeType":"CPT"},{"id":5895,"precertRequired":false,"billingCode":"86200","codeType":"CPT"},{"id":5897,"precertRequired":false,"billingCode":"86225","codeType":"CPT"},{"id":5899,"precertRequired":false,"billingCode":"86235","codeType":"CPT"},{"id":5900,"precertRequired":false,"billingCode":"86255","codeType":"CPT"},{"id":5901,"precertRequired":false,"billingCode":"86256","codeType":"CPT"},{"id":5912,"precertRequired":false,"billingCode":"86316","codeType":"CPT"},{"id":5913,"precertRequired":false,"billingCode":"86317","codeType":"CPT"},{"id":5915,"precertRequired":false,"billingCode":"86320","codeType":"CPT"},{"id":5916,"precertRequired":false,"billingCode":"86325","codeType":"CPT"},{"id":5917,"precertRequired":false,"billingCode":"86327","codeType":"CPT"},{"id":5918,"precertRequired":false,"billingCode":"86329","codeType":"CPT"},{"id":5919,"precertRequired":false,"billingCode":"86331","codeType":"CPT"},{"id":5920,"precertRequired":false,"billingCode":"86332","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5922,"precertRequired":false,"billingCode":"86335","codeType":"CPT"},{"id":5924,"precertRequired":false,"billingCode":"86337","codeType":"CPT"},{"id":5925,"precertRequired":false,"billingCode":"86340","codeType":"CPT"},{"id":5926,"precertRequired":false,"billingCode":"86341","codeType":"CPT"},{"id":5927,"precertRequired":false,"billingCode":"86343","codeType":"CPT"},{"id":5928,"precertRequired":false,"billingCode":"86344","codeType":"CPT"},{"id":5929,"precertRequired":false,"billingCode":"86352","codeType":"CPT"},{"id":5931,"precertRequired":false,"billingCode":"86355","codeType":"CPT"},{"id":5932,"precertRequired":false,"billingCode":"86356","codeType":"CPT"},{"id":5933,"precertRequired":false,"billingCode":"86357","codeType":"CPT"},{"id":5934,"precertRequired":false,"billingCode":"86359","codeType":"CPT"},{"id":5935,"precertRequired":false,"billingCode":"86360","codeType":"CPT"},{"id":5936,"precertRequired":false,"billingCode":"86361","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":5944,"precertRequired":false,"billingCode":"86430","codeType":"CPT"},{"id":5945,"precertRequired":false,"billingCode":"86431","codeType":"CPT"},{"id":5947,"precertRequired":false,"billingCode":"86481","codeType":"CPT"},{"id":5956,"precertRequired":false,"billingCode":"86602","codeType":"CPT"},{"id":5957,"precertRequired":false,"billingCode":"86603","codeType":"CPT"},{"id":5958,"precertRequired":false,"billingCode":"86606","codeType":"CPT"},{"id":5959,"precertRequired":false,"billingCode":"86609","codeType":"CPT"},{"id":5961,"precertRequired":false,"billingCode":"86612","codeType":"CPT"},{"id":5964,"precertRequired":false,"billingCode":"86618","codeType":"CPT"},{"id":5971,"precertRequired":false,"billingCode":"86635","codeType":"CPT"},{"id":5972,"precertRequired":false,"billingCode":"86638","codeType":"CPT"},{"id":5973,"precertRequired":false,"billingCode":"86641","codeType":"CPT"},{"id":5974,"precertRequired":false,"billingCode":"86644","codeType":"CPT"},{"id":5975,"precertRequired":false,"billingCode":"86645","codeType":"CPT"},{"id":5976,"precertRequired":false,"billingCode":"86648","codeType":"CPT"},{"id":5990,"precertRequired":false,"billingCode":"86682","codeType":"CPT"},{"id":5991,"precertRequired":false,"billingCode":"86684","codeType":"CPT"},{"id":5992,"precertRequired":false,"billingCode":"86687","codeType":"CPT"},{"id":5993,"precertRequired":false,"billingCode":"86688","codeType":"CPT"},{"id":5999,"precertRequired":false,"billingCode":"86698","codeType":"CPT"},{"id":6003,"precertRequired":false,"billingCode":"86704","codeType":"CPT"},{"id":6004,"precertRequired":false,"billingCode":"86705","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6007,"precertRequired":false,"billingCode":"86708","codeType":"CPT"},{"id":6009,"precertRequired":false,"billingCode":"86710","codeType":"CPT"},{"id":6010,"precertRequired":false,"billingCode":"86711","codeType":"CPT"},{"id":6011,"precertRequired":false,"billingCode":"86713","codeType":"CPT"},{"id":6012,"precertRequired":false,"billingCode":"86717","codeType":"CPT"},{"id":6013,"precertRequired":false,"billingCode":"86720","codeType":"CPT"},{"id":6014,"precertRequired":false,"billingCode":"86723","codeType":"CPT"},{"id":6015,"precertRequired":false,"billingCode":"86727","codeType":"CPT"},{"id":6016,"precertRequired":false,"billingCode":"86732","codeType":"CPT"},{"id":6017,"precertRequired":false,"billingCode":"86735","codeType":"CPT"},{"id":6018,"precertRequired":false,"billingCode":"86738","codeType":"CPT"},{"id":6019,"precertRequired":false,"billingCode":"86741","codeType":"CPT"},{"id":6020,"precertRequired":false,"billingCode":"86744","codeType":"CPT"},{"id":6021,"precertRequired":false,"billingCode":"86747","codeType":"CPT"},{"id":6022,"precertRequired":false,"billingCode":"86750","codeType":"CPT"},{"id":6023,"precertRequired":false,"billingCode":"86753","codeType":"CPT"},{"id":6024,"precertRequired":false,"billingCode":"86756","codeType":"CPT"},{"id":6025,"precertRequired":false,"billingCode":"86757","codeType":"CPT"},{"id":6026,"precertRequired":false,"billingCode":"86759","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6028,"precertRequired":false,"billingCode":"86765","codeType":"CPT"},{"id":6030,"precertRequired":false,"billingCode":"86771","codeType":"CPT"},{"id":6032,"precertRequired":false,"billingCode":"86777","codeType":"CPT"},{"id":6033,"precertRequired":false,"billingCode":"86778","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6037,"precertRequired":false,"billingCode":"86788","codeType":"CPT"},{"id":6038,"precertRequired":false,"billingCode":"86789","codeType":"CPT"},{"id":6039,"precertRequired":false,"billingCode":"86790","codeType":"CPT"},{"id":6040,"precertRequired":false,"billingCode":"86793","codeType":"CPT"},{"id":6041,"precertRequired":false,"billingCode":"86794","codeType":"CPT"},{"id":6042,"precertRequired":false,"billingCode":"86800","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6044,"precertRequired":false,"billingCode":"86804","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6099,"precertRequired":false,"billingCode":"86975","codeType":"CPT"},{"id":6100,"precertRequired":false,"billingCode":"86976","codeType":"CPT"},{"id":6101,"precertRequired":false,"billingCode":"86977","codeType":"CPT"},{"id":6102,"precertRequired":false,"billingCode":"86978","codeType":"CPT"},{"id":6106,"precertRequired":false,"billingCode":"87015","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6114,"precertRequired":false,"billingCode":"87076","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6127,"precertRequired":false,"billingCode":"87116","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6135,"precertRequired":false,"billingCode":"87153","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6153,"precertRequired":false,"billingCode":"87206","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6163,"precertRequired":false,"billingCode":"87255","codeType":"CPT"},{"id":6164,"precertRequired":false,"billingCode":"87260","codeType":"CPT"},{"id":6167,"precertRequired":false,"billingCode":"87269","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6173,"precertRequired":false,"billingCode":"87275","codeType":"CPT"},{"id":6174,"precertRequired":false,"billingCode":"87276","codeType":"CPT"},{"id":6175,"precertRequired":false,"billingCode":"87278","codeType":"CPT"},{"id":6176,"precertRequired":false,"billingCode":"87279","codeType":"CPT"},{"id":6177,"precertRequired":false,"billingCode":"87280","codeType":"CPT"},{"id":6178,"precertRequired":false,"billingCode":"87281","codeType":"CPT"},{"id":6179,"precertRequired":false,"billingCode":"87283","codeType":"CPT"},{"id":6180,"precertRequired":false,"billingCode":"87285","codeType":"CPT"},{"id":6181,"precertRequired":false,"billingCode":"87290","codeType":"CPT"},{"id":6182,"precertRequired":false,"billingCode":"87299","codeType":"CPT"},{"id":6183,"precertRequired":false,"billingCode":"87300","codeType":"CPT"},{"id":6184,"precertRequired":false,"billingCode":"87301","codeType":"CPT"},{"id":6185,"precertRequired":false,"billingCode":"87305","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6191,"precertRequired":false,"billingCode":"87332","codeType":"CPT"},{"id":6192,"precertRequired":false,"billingCode":"87335","codeType":"CPT"},{"id":6193,"precertRequired":false,"billingCode":"87336","codeType":"CPT"},{"id":6194,"precertRequired":false,"billingCode":"87337","codeType":"CPT"},{"id":6195,"precertRequired":false,"billingCode":"87338","codeType":"CPT"},{"id":6196,"precertRequired":false,"billingCode":"87339","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6198,"precertRequired":false,"billingCode":"87341","codeType":"CPT"},{"id":6199,"precertRequired":false,"billingCode":"87350","codeType":"CPT"},{"id":6200,"precertRequired":false,"billingCode":"87380","codeType":"CPT"},{"id":6201,"precertRequired":false,"billingCode":"87385","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6203,"precertRequired":false,"billingCode":"87390","codeType":"CPT"},{"id":6204,"precertRequired":false,"billingCode":"87391","codeType":"CPT"},{"id":6205,"precertRequired":false,"billingCode":"87400","codeType":"CPT"},{"id":6206,"precertRequired":false,"billingCode":"87420","codeType":"CPT"},{"id":6207,"precertRequired":false,"billingCode":"87425","codeType":"CPT"},{"id":6208,"precertRequired":false,"billingCode":"87427","codeType":"CPT"},{"id":6209,"precertRequired":false,"billingCode":"87430","codeType":"CPT"},{"id":6210,"precertRequired":false,"billingCode":"87449","codeType":"CPT"},{"id":6211,"precertRequired":false,"billingCode":"87450","codeType":"CPT"},{"id":6212,"precertRequired":false,"billingCode":"87451","codeType":"CPT"},{"id":6303,"precertRequired":false,"billingCode":"87804","codeType":"CPT"},{"id":6310,"precertRequired":false,"billingCode":"87880","codeType":"CPT"},{"id":6317,"precertRequired":false,"billingCode":"87905","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6440,"precertRequired":false,"billingCode":"88371","codeType":"CPT"},{"id":6441,"precertRequired":false,"billingCode":"88372","codeType":"CPT"},{"id":6443,"precertRequired":false,"billingCode":"88374","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":9791,"precertRequired":false,"billingCode":"99001","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5183,"description":"Diagnostic imaging relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"},{"id":13656,"precertRequired":true,"billingCode":"71260","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5184,"description":"Procedures/diagnostic studies relevant to the referred condition including but not limited to:  allergen skin testing, drug testing, chemical patch testing, methacholine challenge, PFT","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7185,"precertRequired":false,"billingCode":"96160","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":5185,"description":"Standard immunotherapy and RUSH immunotherapy, including Nurse Visits","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7019,"precertRequired":false,"billingCode":"94664","codeType":"CPT"},{"id":7020,"precertRequired":false,"billingCode":"94667","codeType":"CPT"},{"id":7021,"precertRequired":false,"billingCode":"94668","codeType":"CPT"},{"id":7022,"precertRequired":false,"billingCode":"94669","codeType":"CPT"},{"id":7053,"precertRequired":false,"billingCode":"95115","codeType":"CPT"},{"id":7054,"precertRequired":false,"billingCode":"95117","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7069,"precertRequired":false,"billingCode":"95170","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7225,"precertRequired":false,"billingCode":"96900","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":5186,"description":"Creation of serum for injections","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":5187,"description":"Infusion therapy, in clinic, to include IV Fluids during infusion as relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":5188,"description":"Follow-up visits for this episode of care relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":5189,"description":"Follow Up Biopsy if Clinically Indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":5190,"description":"Desensitization (antibiotics and chemotherapeutic agents)\r\n** It is highly recommended that Provider performing the desensitization treatment is affiliated with a hospital","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":6056,"precertRequired":false,"billingCode":"86828","codeType":"CPT"},{"id":6057,"precertRequired":false,"billingCode":"86829","codeType":"CPT"},{"id":6058,"precertRequired":false,"billingCode":"86830","codeType":"CPT"},{"id":6059,"precertRequired":false,"billingCode":"86831","codeType":"CPT"},{"id":6060,"precertRequired":false,"billingCode":"86832","codeType":"CPT"},{"id":6061,"precertRequired":false,"billingCode":"86833","codeType":"CPT"},{"id":6062,"precertRequired":false,"billingCode":"86834","codeType":"CPT"},{"id":6063,"precertRequired":false,"billingCode":"86835","codeType":"CPT"},{"id":7053,"precertRequired":false,"billingCode":"95115","codeType":"CPT"},{"id":7054,"precertRequired":false,"billingCode":"95117","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7069,"precertRequired":false,"billingCode":"95170","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":8775,"precertRequired":false,"billingCode":"Q0163","codeType":"HCPCS"},{"id":8783,"precertRequired":false,"billingCode":"Q0177","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":5191,"description":"Inpatient admission or observation admission as related to referred condition on the consult order\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7322,"precertRequired":false,"billingCode":"99060","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]}]}},{"Seoc":{"id":492,"seocKey":8,"name":"Allergy and Immunology_PRCT","seocId":"MSC_ALLERGY AND IMMUNOLOGY_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.    Labs (including RAST testing) and pathology relevant to the referred condition on the consult\r\n3.   Diagnostic imaging relevant to the referred condition on the consult\r\n4.    Procedures/diagnostic studies relevant to the referred condition including but not limited to:  allergen skin testing, drug testing, chemical patch testing, methacholine challenge, PFT\r\n5.  Standard immunotherapy and RUSH immunotherapy, including nurse visits.\r\n6.  Creation of serum for injections\r\n7.  Infusion therapy, in clinic, to include IV Fluids during infusion as relevant to the referred condition on the consult\r\n8.    Follow-up visits for this episode of care relevant to the referred condition on the consult\r\n9.    Follow up biopsy if clinically indicated\r\n10.  Desensitization (antibiotics and chemotherapeutic agents)\r\n** It is highly recommended that Provider performing the desensitization treatment is affiliated with a hospital\r\n11. Inpatient admission or observation admission as related to referred condition on the consult\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for procedure or treatment complications related to the initial referral","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"ALLERGY AND IMMUNOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207KA0200X"},{"hptc":"207RA0201X"}],"services":[{"id":2849,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":2850,"description":"Labs (including RAST testing) and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5045,"precertRequired":false,"billingCode":"80195","codeType":"CPT"},{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5372,"precertRequired":false,"billingCode":"82040","codeType":"CPT"},{"id":5374,"precertRequired":false,"billingCode":"82043","codeType":"CPT"},{"id":5380,"precertRequired":false,"billingCode":"82103","codeType":"CPT"},{"id":5408,"precertRequired":false,"billingCode":"82247","codeType":"CPT"},{"id":5409,"precertRequired":false,"billingCode":"82248","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5437,"precertRequired":false,"billingCode":"82384","codeType":"CPT"},{"id":5458,"precertRequired":false,"billingCode":"82542","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5469,"precertRequired":false,"billingCode":"82607","codeType":"CPT"},{"id":5478,"precertRequired":false,"billingCode":"82652","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5499,"precertRequired":false,"billingCode":"82746","codeType":"CPT"},{"id":5507,"precertRequired":false,"billingCode":"82784","codeType":"CPT"},{"id":5508,"precertRequired":false,"billingCode":"82785","codeType":"CPT"},{"id":5509,"precertRequired":false,"billingCode":"82787","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5526,"precertRequired":false,"billingCode":"82955","codeType":"CPT"},{"id":5528,"precertRequired":false,"billingCode":"82962","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5562,"precertRequired":false,"billingCode":"83088","codeType":"CPT"},{"id":5566,"precertRequired":false,"billingCode":"83497","codeType":"CPT"},{"id":5570,"precertRequired":false,"billingCode":"83516","codeType":"CPT"},{"id":5573,"precertRequired":false,"billingCode":"83520","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5578,"precertRequired":false,"billingCode":"83550","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5602,"precertRequired":false,"billingCode":"83704","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5610,"precertRequired":false,"billingCode":"83789","codeType":"CPT"},{"id":5612,"precertRequired":false,"billingCode":"83835","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5621,"precertRequired":false,"billingCode":"83883","codeType":"CPT"},{"id":5646,"precertRequired":false,"billingCode":"84081","codeType":"CPT"},{"id":5649,"precertRequired":false,"billingCode":"84100","codeType":"CPT"},{"id":5652,"precertRequired":false,"billingCode":"84110","codeType":"CPT"},{"id":5655,"precertRequired":false,"billingCode":"84120","codeType":"CPT"},{"id":5667,"precertRequired":false,"billingCode":"84150","codeType":"CPT"},{"id":5671,"precertRequired":false,"billingCode":"84155","codeType":"CPT"},{"id":5672,"precertRequired":false,"billingCode":"84156","codeType":"CPT"},{"id":5674,"precertRequired":false,"billingCode":"84160","codeType":"CPT"},{"id":5676,"precertRequired":false,"billingCode":"84165","codeType":"CPT"},{"id":5677,"precertRequired":false,"billingCode":"84166","codeType":"CPT"},{"id":5678,"precertRequired":false,"billingCode":"84181","codeType":"CPT"},{"id":5679,"precertRequired":false,"billingCode":"84182","codeType":"CPT"},{"id":5693,"precertRequired":false,"billingCode":"84255","codeType":"CPT"},{"id":5694,"precertRequired":false,"billingCode":"84260","codeType":"CPT"},{"id":5698,"precertRequired":false,"billingCode":"84295","codeType":"CPT"},{"id":5702,"precertRequired":false,"billingCode":"84307","codeType":"CPT"},{"id":5703,"precertRequired":false,"billingCode":"84311","codeType":"CPT"},{"id":5711,"precertRequired":false,"billingCode":"84402","codeType":"CPT"},{"id":5712,"precertRequired":false,"billingCode":"84403","codeType":"CPT"},{"id":5717,"precertRequired":false,"billingCode":"84432","codeType":"CPT"},{"id":5718,"precertRequired":false,"billingCode":"84436","codeType":"CPT"},{"id":5720,"precertRequired":false,"billingCode":"84439","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5726,"precertRequired":false,"billingCode":"84450","codeType":"CPT"},{"id":5727,"precertRequired":false,"billingCode":"84460","codeType":"CPT"},{"id":5728,"precertRequired":false,"billingCode":"84466","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5732,"precertRequired":false,"billingCode":"84481","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5740,"precertRequired":false,"billingCode":"84520","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5783,"precertRequired":false,"billingCode":"85060","codeType":"CPT"},{"id":5784,"precertRequired":false,"billingCode":"85097","codeType":"CPT"},{"id":5789,"precertRequired":false,"billingCode":"85220","codeType":"CPT"},{"id":5791,"precertRequired":false,"billingCode":"85240","codeType":"CPT"},{"id":5805,"precertRequired":false,"billingCode":"85301","codeType":"CPT"},{"id":5806,"precertRequired":false,"billingCode":"85302","codeType":"CPT"},{"id":5808,"precertRequired":false,"billingCode":"85305","codeType":"CPT"},{"id":5821,"precertRequired":false,"billingCode":"85379","codeType":"CPT"},{"id":5838,"precertRequired":false,"billingCode":"85520","codeType":"CPT"},{"id":5849,"precertRequired":false,"billingCode":"85598","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5853,"precertRequired":false,"billingCode":"85613","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5866,"precertRequired":false,"billingCode":"86001","codeType":"CPT"},{"id":5867,"precertRequired":false,"billingCode":"86003","codeType":"CPT"},{"id":5868,"precertRequired":false,"billingCode":"86005","codeType":"CPT"},{"id":5869,"precertRequired":false,"billingCode":"86008","codeType":"CPT"},{"id":5870,"precertRequired":false,"billingCode":"86021","codeType":"CPT"},{"id":5873,"precertRequired":false,"billingCode":"86038","codeType":"CPT"},{"id":5874,"precertRequired":false,"billingCode":"86039","codeType":"CPT"},{"id":5875,"precertRequired":false,"billingCode":"86060","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5881,"precertRequired":false,"billingCode":"86141","codeType":"CPT"},{"id":5882,"precertRequired":false,"billingCode":"86146","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5884,"precertRequired":false,"billingCode":"86148","codeType":"CPT"},{"id":5885,"precertRequired":false,"billingCode":"86152","codeType":"CPT"},{"id":5886,"precertRequired":false,"billingCode":"86153","codeType":"CPT"},{"id":5890,"precertRequired":false,"billingCode":"86160","codeType":"CPT"},{"id":5891,"precertRequired":false,"billingCode":"86161","codeType":"CPT"},{"id":5892,"precertRequired":false,"billingCode":"86162","codeType":"CPT"},{"id":5895,"precertRequired":false,"billingCode":"86200","codeType":"CPT"},{"id":5897,"precertRequired":false,"billingCode":"86225","codeType":"CPT"},{"id":5899,"precertRequired":false,"billingCode":"86235","codeType":"CPT"},{"id":5900,"precertRequired":false,"billingCode":"86255","codeType":"CPT"},{"id":5901,"precertRequired":false,"billingCode":"86256","codeType":"CPT"},{"id":5912,"precertRequired":false,"billingCode":"86316","codeType":"CPT"},{"id":5913,"precertRequired":false,"billingCode":"86317","codeType":"CPT"},{"id":5915,"precertRequired":false,"billingCode":"86320","codeType":"CPT"},{"id":5916,"precertRequired":false,"billingCode":"86325","codeType":"CPT"},{"id":5917,"precertRequired":false,"billingCode":"86327","codeType":"CPT"},{"id":5918,"precertRequired":false,"billingCode":"86329","codeType":"CPT"},{"id":5919,"precertRequired":false,"billingCode":"86331","codeType":"CPT"},{"id":5920,"precertRequired":false,"billingCode":"86332","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5922,"precertRequired":false,"billingCode":"86335","codeType":"CPT"},{"id":5924,"precertRequired":false,"billingCode":"86337","codeType":"CPT"},{"id":5925,"precertRequired":false,"billingCode":"86340","codeType":"CPT"},{"id":5926,"precertRequired":false,"billingCode":"86341","codeType":"CPT"},{"id":5927,"precertRequired":false,"billingCode":"86343","codeType":"CPT"},{"id":5928,"precertRequired":false,"billingCode":"86344","codeType":"CPT"},{"id":5929,"precertRequired":false,"billingCode":"86352","codeType":"CPT"},{"id":5931,"precertRequired":false,"billingCode":"86355","codeType":"CPT"},{"id":5932,"precertRequired":false,"billingCode":"86356","codeType":"CPT"},{"id":5933,"precertRequired":false,"billingCode":"86357","codeType":"CPT"},{"id":5934,"precertRequired":false,"billingCode":"86359","codeType":"CPT"},{"id":5935,"precertRequired":false,"billingCode":"86360","codeType":"CPT"},{"id":5936,"precertRequired":false,"billingCode":"86361","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":5944,"precertRequired":false,"billingCode":"86430","codeType":"CPT"},{"id":5945,"precertRequired":false,"billingCode":"86431","codeType":"CPT"},{"id":5947,"precertRequired":false,"billingCode":"86481","codeType":"CPT"},{"id":5956,"precertRequired":false,"billingCode":"86602","codeType":"CPT"},{"id":5957,"precertRequired":false,"billingCode":"86603","codeType":"CPT"},{"id":5958,"precertRequired":false,"billingCode":"86606","codeType":"CPT"},{"id":5959,"precertRequired":false,"billingCode":"86609","codeType":"CPT"},{"id":5961,"precertRequired":false,"billingCode":"86612","codeType":"CPT"},{"id":5964,"precertRequired":false,"billingCode":"86618","codeType":"CPT"},{"id":5971,"precertRequired":false,"billingCode":"86635","codeType":"CPT"},{"id":5972,"precertRequired":false,"billingCode":"86638","codeType":"CPT"},{"id":5973,"precertRequired":false,"billingCode":"86641","codeType":"CPT"},{"id":5974,"precertRequired":false,"billingCode":"86644","codeType":"CPT"},{"id":5975,"precertRequired":false,"billingCode":"86645","codeType":"CPT"},{"id":5976,"precertRequired":false,"billingCode":"86648","codeType":"CPT"},{"id":5990,"precertRequired":false,"billingCode":"86682","codeType":"CPT"},{"id":5991,"precertRequired":false,"billingCode":"86684","codeType":"CPT"},{"id":5992,"precertRequired":false,"billingCode":"86687","codeType":"CPT"},{"id":5993,"precertRequired":false,"billingCode":"86688","codeType":"CPT"},{"id":5999,"precertRequired":false,"billingCode":"86698","codeType":"CPT"},{"id":6003,"precertRequired":false,"billingCode":"86704","codeType":"CPT"},{"id":6004,"precertRequired":false,"billingCode":"86705","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6007,"precertRequired":false,"billingCode":"86708","codeType":"CPT"},{"id":6009,"precertRequired":false,"billingCode":"86710","codeType":"CPT"},{"id":6010,"precertRequired":false,"billingCode":"86711","codeType":"CPT"},{"id":6011,"precertRequired":false,"billingCode":"86713","codeType":"CPT"},{"id":6012,"precertRequired":false,"billingCode":"86717","codeType":"CPT"},{"id":6013,"precertRequired":false,"billingCode":"86720","codeType":"CPT"},{"id":6014,"precertRequired":false,"billingCode":"86723","codeType":"CPT"},{"id":6015,"precertRequired":false,"billingCode":"86727","codeType":"CPT"},{"id":6016,"precertRequired":false,"billingCode":"86732","codeType":"CPT"},{"id":6017,"precertRequired":false,"billingCode":"86735","codeType":"CPT"},{"id":6018,"precertRequired":false,"billingCode":"86738","codeType":"CPT"},{"id":6019,"precertRequired":false,"billingCode":"86741","codeType":"CPT"},{"id":6020,"precertRequired":false,"billingCode":"86744","codeType":"CPT"},{"id":6021,"precertRequired":false,"billingCode":"86747","codeType":"CPT"},{"id":6022,"precertRequired":false,"billingCode":"86750","codeType":"CPT"},{"id":6023,"precertRequired":false,"billingCode":"86753","codeType":"CPT"},{"id":6024,"precertRequired":false,"billingCode":"86756","codeType":"CPT"},{"id":6025,"precertRequired":false,"billingCode":"86757","codeType":"CPT"},{"id":6026,"precertRequired":false,"billingCode":"86759","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6028,"precertRequired":false,"billingCode":"86765","codeType":"CPT"},{"id":6030,"precertRequired":false,"billingCode":"86771","codeType":"CPT"},{"id":6032,"precertRequired":false,"billingCode":"86777","codeType":"CPT"},{"id":6033,"precertRequired":false,"billingCode":"86778","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6037,"precertRequired":false,"billingCode":"86788","codeType":"CPT"},{"id":6038,"precertRequired":false,"billingCode":"86789","codeType":"CPT"},{"id":6039,"precertRequired":false,"billingCode":"86790","codeType":"CPT"},{"id":6040,"precertRequired":false,"billingCode":"86793","codeType":"CPT"},{"id":6041,"precertRequired":false,"billingCode":"86794","codeType":"CPT"},{"id":6042,"precertRequired":false,"billingCode":"86800","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6044,"precertRequired":false,"billingCode":"86804","codeType":"CPT"},{"id":6099,"precertRequired":false,"billingCode":"86975","codeType":"CPT"},{"id":6100,"precertRequired":false,"billingCode":"86976","codeType":"CPT"},{"id":6101,"precertRequired":false,"billingCode":"86977","codeType":"CPT"},{"id":6102,"precertRequired":false,"billingCode":"86978","codeType":"CPT"},{"id":6106,"precertRequired":false,"billingCode":"87015","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6114,"precertRequired":false,"billingCode":"87076","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6127,"precertRequired":false,"billingCode":"87116","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6135,"precertRequired":false,"billingCode":"87153","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6153,"precertRequired":false,"billingCode":"87206","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6163,"precertRequired":false,"billingCode":"87255","codeType":"CPT"},{"id":6164,"precertRequired":false,"billingCode":"87260","codeType":"CPT"},{"id":6167,"precertRequired":false,"billingCode":"87269","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6173,"precertRequired":false,"billingCode":"87275","codeType":"CPT"},{"id":6174,"precertRequired":false,"billingCode":"87276","codeType":"CPT"},{"id":6175,"precertRequired":false,"billingCode":"87278","codeType":"CPT"},{"id":6176,"precertRequired":false,"billingCode":"87279","codeType":"CPT"},{"id":6177,"precertRequired":false,"billingCode":"87280","codeType":"CPT"},{"id":6178,"precertRequired":false,"billingCode":"87281","codeType":"CPT"},{"id":6179,"precertRequired":false,"billingCode":"87283","codeType":"CPT"},{"id":6180,"precertRequired":false,"billingCode":"87285","codeType":"CPT"},{"id":6181,"precertRequired":false,"billingCode":"87290","codeType":"CPT"},{"id":6182,"precertRequired":false,"billingCode":"87299","codeType":"CPT"},{"id":6183,"precertRequired":false,"billingCode":"87300","codeType":"CPT"},{"id":6184,"precertRequired":false,"billingCode":"87301","codeType":"CPT"},{"id":6185,"precertRequired":false,"billingCode":"87305","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6191,"precertRequired":false,"billingCode":"87332","codeType":"CPT"},{"id":6192,"precertRequired":false,"billingCode":"87335","codeType":"CPT"},{"id":6193,"precertRequired":false,"billingCode":"87336","codeType":"CPT"},{"id":6194,"precertRequired":false,"billingCode":"87337","codeType":"CPT"},{"id":6195,"precertRequired":false,"billingCode":"87338","codeType":"CPT"},{"id":6196,"precertRequired":false,"billingCode":"87339","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6198,"precertRequired":false,"billingCode":"87341","codeType":"CPT"},{"id":6199,"precertRequired":false,"billingCode":"87350","codeType":"CPT"},{"id":6200,"precertRequired":false,"billingCode":"87380","codeType":"CPT"},{"id":6201,"precertRequired":false,"billingCode":"87385","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6203,"precertRequired":false,"billingCode":"87390","codeType":"CPT"},{"id":6204,"precertRequired":false,"billingCode":"87391","codeType":"CPT"},{"id":6205,"precertRequired":false,"billingCode":"87400","codeType":"CPT"},{"id":6206,"precertRequired":false,"billingCode":"87420","codeType":"CPT"},{"id":6207,"precertRequired":false,"billingCode":"87425","codeType":"CPT"},{"id":6208,"precertRequired":false,"billingCode":"87427","codeType":"CPT"},{"id":6209,"precertRequired":false,"billingCode":"87430","codeType":"CPT"},{"id":6210,"precertRequired":false,"billingCode":"87449","codeType":"CPT"},{"id":6211,"precertRequired":false,"billingCode":"87450","codeType":"CPT"},{"id":6212,"precertRequired":false,"billingCode":"87451","codeType":"CPT"},{"id":6303,"precertRequired":false,"billingCode":"87804","codeType":"CPT"},{"id":6310,"precertRequired":false,"billingCode":"87880","codeType":"CPT"},{"id":6317,"precertRequired":false,"billingCode":"87905","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6440,"precertRequired":false,"billingCode":"88371","codeType":"CPT"},{"id":6441,"precertRequired":false,"billingCode":"88372","codeType":"CPT"},{"id":6443,"precertRequired":false,"billingCode":"88374","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":9791,"precertRequired":false,"billingCode":"99001","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":2851,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2852,"description":"Procedures/diagnostic studies relevant to the referred condition including but not limited to:  allergen skin testing, drug testing, chemical patch testing, methacholine challenge, PFT","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7185,"precertRequired":false,"billingCode":"96160","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":2853,"description":"Standard immunotherapy and RUSH immunotherapy, including Nurse Visits","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7019,"precertRequired":false,"billingCode":"94664","codeType":"CPT"},{"id":7020,"precertRequired":false,"billingCode":"94667","codeType":"CPT"},{"id":7021,"precertRequired":false,"billingCode":"94668","codeType":"CPT"},{"id":7022,"precertRequired":false,"billingCode":"94669","codeType":"CPT"},{"id":7053,"precertRequired":false,"billingCode":"95115","codeType":"CPT"},{"id":7054,"precertRequired":false,"billingCode":"95117","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7069,"precertRequired":false,"billingCode":"95170","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7225,"precertRequired":false,"billingCode":"96900","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":2854,"description":"Creation of serum for injections","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":8361,"precertRequired":false,"billingCode":"J0171","codeType":"HCPCS"},{"id":8396,"precertRequired":false,"billingCode":"J0878","codeType":"HCPCS"},{"id":8404,"precertRequired":true,"billingCode":"J0945","codeType":"HCPCS"},{"id":8406,"precertRequired":true,"billingCode":"J1020","codeType":"HCPCS"},{"id":8407,"precertRequired":true,"billingCode":"J1030","codeType":"HCPCS"},{"id":8408,"precertRequired":true,"billingCode":"J1040","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8431,"precertRequired":false,"billingCode":"J1559","codeType":"HCPCS"},{"id":8432,"precertRequired":true,"billingCode":"J1566","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8434,"precertRequired":true,"billingCode":"J1569","codeType":"HCPCS"},{"id":8451,"precertRequired":false,"billingCode":"J1815","codeType":"HCPCS"},{"id":8452,"precertRequired":false,"billingCode":"J1817","codeType":"HCPCS"},{"id":8453,"precertRequired":false,"billingCode":"J1885","codeType":"HCPCS"},{"id":8468,"precertRequired":false,"billingCode":"J2357","codeType":"HCPCS"},{"id":8480,"precertRequired":false,"billingCode":"J2650","codeType":"HCPCS"},{"id":8504,"precertRequired":true,"billingCode":"J3301","codeType":"HCPCS"},{"id":8513,"precertRequired":false,"billingCode":"J3410","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8552,"precertRequired":false,"billingCode":"J7509","codeType":"HCPCS"},{"id":8553,"precertRequired":false,"billingCode":"J7510","codeType":"HCPCS"},{"id":8554,"precertRequired":false,"billingCode":"J7512","codeType":"HCPCS"},{"id":8555,"precertRequired":false,"billingCode":"J7613","codeType":"HCPCS"},{"id":8557,"precertRequired":false,"billingCode":"J7644","codeType":"HCPCS"},{"id":9805,"precertRequired":false,"billingCode":"J0280","codeType":"HCPCS"},{"id":9808,"precertRequired":false,"billingCode":"J0295","codeType":"HCPCS"},{"id":9819,"precertRequired":false,"billingCode":"J1459","codeType":"HCPCS"},{"id":9821,"precertRequired":false,"billingCode":"J1556","codeType":"HCPCS"},{"id":9823,"precertRequired":false,"billingCode":"J1561","codeType":"HCPCS"},{"id":9826,"precertRequired":false,"billingCode":"J1575","codeType":"HCPCS"},{"id":9847,"precertRequired":false,"billingCode":"J7609","codeType":"HCPCS"},{"id":9848,"precertRequired":false,"billingCode":"J7610","codeType":"HCPCS"},{"id":9849,"precertRequired":false,"billingCode":"J7611","codeType":"HCPCS"},{"id":9850,"precertRequired":false,"billingCode":"J7620","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":2855,"description":"Infusion therapy, in clinic, to include IV Fluids during infusion as relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":2856,"description":"Follow up Visits for this Episode of Care Revelant to the Referred Condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":2857,"description":"Follow Up Biopsy if Clinically Indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":2858,"description":"Desensitization (Antibiotics and Chemotherapeutic Agents)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":6056,"precertRequired":false,"billingCode":"86828","codeType":"CPT"},{"id":6057,"precertRequired":false,"billingCode":"86829","codeType":"CPT"},{"id":6058,"precertRequired":false,"billingCode":"86830","codeType":"CPT"},{"id":6059,"precertRequired":false,"billingCode":"86831","codeType":"CPT"},{"id":6060,"precertRequired":false,"billingCode":"86832","codeType":"CPT"},{"id":6061,"precertRequired":false,"billingCode":"86833","codeType":"CPT"},{"id":6062,"precertRequired":false,"billingCode":"86834","codeType":"CPT"},{"id":6063,"precertRequired":false,"billingCode":"86835","codeType":"CPT"},{"id":7053,"precertRequired":false,"billingCode":"95115","codeType":"CPT"},{"id":7054,"precertRequired":false,"billingCode":"95117","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7069,"precertRequired":false,"billingCode":"95170","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":8468,"precertRequired":false,"billingCode":"J2357","codeType":"HCPCS"},{"id":8556,"precertRequired":false,"billingCode":"J7641","codeType":"HCPCS"},{"id":8775,"precertRequired":false,"billingCode":"Q0163","codeType":"HCPCS"},{"id":8783,"precertRequired":false,"billingCode":"Q0177","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":2859,"description":"Inpatient Admission or Observation admission as related to referred condition on the consult.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7322,"precertRequired":false,"billingCode":"99060","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]}]}},{"Seoc":{"id":312,"seocKey":8,"name":"Allergy and Immunology_PRCT","seocId":"MSC_ALLERGY AND IMMUNOLOGY_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"03-12-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.    Labs (including RAST testing) and pathology relevant to the referred condition on the consult\r\n3.   Diagnostic imaging relevant to the referred condition on the consult\r\n4.    Procedures/diagnostic studies relevant to the referred condition including but not limited to:  allergen skin testing, drug testing, chemical patch testing, methacholine challenge, PFT\r\n5.  Standard immunotherapy and RUSH immunotherapy, including nurse visits.\r\n6.  Creation of serum for injections\r\n7.  Infusion therapy, in clinic, to include IV Fluids during infusion as relevant to the referred condition on the consult\r\n8.    Follow-up visits for this episode of care relevant to the referred condition on the consult\r\n9.    Follow up biopsy if clinically indicated\r\n10.  Desensitization (antibiotics and chemotherapeutic agents)\r\n** It is highly recommended that Provider performing the desensitization treatment is affiliated with a hospital\r\n11. Inpatient admission or observation admission as related to referred condition on the consult\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for procedure or treatment complications related to the initial referral","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ALLERGY AND IMMUNOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207KA0200X"},{"hptc":"207RA0201X"}],"services":[{"id":1391,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9856,"precertRequired":false,"billingCode":"G0466","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1392,"description":"Labs (including RAST testing) and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5045,"precertRequired":false,"billingCode":"80195","codeType":"CPT"},{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5372,"precertRequired":false,"billingCode":"82040","codeType":"CPT"},{"id":5374,"precertRequired":false,"billingCode":"82043","codeType":"CPT"},{"id":5380,"precertRequired":false,"billingCode":"82103","codeType":"CPT"},{"id":5408,"precertRequired":false,"billingCode":"82247","codeType":"CPT"},{"id":5409,"precertRequired":false,"billingCode":"82248","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5437,"precertRequired":false,"billingCode":"82384","codeType":"CPT"},{"id":5458,"precertRequired":false,"billingCode":"82542","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5469,"precertRequired":false,"billingCode":"82607","codeType":"CPT"},{"id":5478,"precertRequired":false,"billingCode":"82652","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5499,"precertRequired":false,"billingCode":"82746","codeType":"CPT"},{"id":5507,"precertRequired":false,"billingCode":"82784","codeType":"CPT"},{"id":5508,"precertRequired":false,"billingCode":"82785","codeType":"CPT"},{"id":5509,"precertRequired":false,"billingCode":"82787","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5526,"precertRequired":false,"billingCode":"82955","codeType":"CPT"},{"id":5528,"precertRequired":false,"billingCode":"82962","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5562,"precertRequired":false,"billingCode":"83088","codeType":"CPT"},{"id":5566,"precertRequired":false,"billingCode":"83497","codeType":"CPT"},{"id":5570,"precertRequired":false,"billingCode":"83516","codeType":"CPT"},{"id":5573,"precertRequired":false,"billingCode":"83520","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5578,"precertRequired":false,"billingCode":"83550","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5602,"precertRequired":false,"billingCode":"83704","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5610,"precertRequired":false,"billingCode":"83789","codeType":"CPT"},{"id":5612,"precertRequired":false,"billingCode":"83835","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5621,"precertRequired":false,"billingCode":"83883","codeType":"CPT"},{"id":5646,"precertRequired":false,"billingCode":"84081","codeType":"CPT"},{"id":5649,"precertRequired":false,"billingCode":"84100","codeType":"CPT"},{"id":5652,"precertRequired":false,"billingCode":"84110","codeType":"CPT"},{"id":5655,"precertRequired":false,"billingCode":"84120","codeType":"CPT"},{"id":5667,"precertRequired":false,"billingCode":"84150","codeType":"CPT"},{"id":5671,"precertRequired":false,"billingCode":"84155","codeType":"CPT"},{"id":5672,"precertRequired":false,"billingCode":"84156","codeType":"CPT"},{"id":5674,"precertRequired":false,"billingCode":"84160","codeType":"CPT"},{"id":5676,"precertRequired":false,"billingCode":"84165","codeType":"CPT"},{"id":5677,"precertRequired":false,"billingCode":"84166","codeType":"CPT"},{"id":5678,"precertRequired":false,"billingCode":"84181","codeType":"CPT"},{"id":5679,"precertRequired":false,"billingCode":"84182","codeType":"CPT"},{"id":5693,"precertRequired":false,"billingCode":"84255","codeType":"CPT"},{"id":5694,"precertRequired":false,"billingCode":"84260","codeType":"CPT"},{"id":5698,"precertRequired":false,"billingCode":"84295","codeType":"CPT"},{"id":5702,"precertRequired":false,"billingCode":"84307","codeType":"CPT"},{"id":5703,"precertRequired":false,"billingCode":"84311","codeType":"CPT"},{"id":5711,"precertRequired":false,"billingCode":"84402","codeType":"CPT"},{"id":5712,"precertRequired":false,"billingCode":"84403","codeType":"CPT"},{"id":5717,"precertRequired":false,"billingCode":"84432","codeType":"CPT"},{"id":5718,"precertRequired":false,"billingCode":"84436","codeType":"CPT"},{"id":5720,"precertRequired":false,"billingCode":"84439","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5726,"precertRequired":false,"billingCode":"84450","codeType":"CPT"},{"id":5727,"precertRequired":false,"billingCode":"84460","codeType":"CPT"},{"id":5728,"precertRequired":false,"billingCode":"84466","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5732,"precertRequired":false,"billingCode":"84481","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5740,"precertRequired":false,"billingCode":"84520","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5783,"precertRequired":false,"billingCode":"85060","codeType":"CPT"},{"id":5784,"precertRequired":false,"billingCode":"85097","codeType":"CPT"},{"id":5789,"precertRequired":false,"billingCode":"85220","codeType":"CPT"},{"id":5791,"precertRequired":false,"billingCode":"85240","codeType":"CPT"},{"id":5805,"precertRequired":false,"billingCode":"85301","codeType":"CPT"},{"id":5806,"precertRequired":false,"billingCode":"85302","codeType":"CPT"},{"id":5808,"precertRequired":false,"billingCode":"85305","codeType":"CPT"},{"id":5821,"precertRequired":false,"billingCode":"85379","codeType":"CPT"},{"id":5838,"precertRequired":false,"billingCode":"85520","codeType":"CPT"},{"id":5849,"precertRequired":false,"billingCode":"85598","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5853,"precertRequired":false,"billingCode":"85613","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5866,"precertRequired":false,"billingCode":"86001","codeType":"CPT"},{"id":5867,"precertRequired":false,"billingCode":"86003","codeType":"CPT"},{"id":5868,"precertRequired":false,"billingCode":"86005","codeType":"CPT"},{"id":5869,"precertRequired":false,"billingCode":"86008","codeType":"CPT"},{"id":5870,"precertRequired":false,"billingCode":"86021","codeType":"CPT"},{"id":5873,"precertRequired":false,"billingCode":"86038","codeType":"CPT"},{"id":5874,"precertRequired":false,"billingCode":"86039","codeType":"CPT"},{"id":5875,"precertRequired":false,"billingCode":"86060","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5881,"precertRequired":false,"billingCode":"86141","codeType":"CPT"},{"id":5882,"precertRequired":false,"billingCode":"86146","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5884,"precertRequired":false,"billingCode":"86148","codeType":"CPT"},{"id":5885,"precertRequired":false,"billingCode":"86152","codeType":"CPT"},{"id":5886,"precertRequired":false,"billingCode":"86153","codeType":"CPT"},{"id":5890,"precertRequired":false,"billingCode":"86160","codeType":"CPT"},{"id":5891,"precertRequired":false,"billingCode":"86161","codeType":"CPT"},{"id":5892,"precertRequired":false,"billingCode":"86162","codeType":"CPT"},{"id":5895,"precertRequired":false,"billingCode":"86200","codeType":"CPT"},{"id":5897,"precertRequired":false,"billingCode":"86225","codeType":"CPT"},{"id":5899,"precertRequired":false,"billingCode":"86235","codeType":"CPT"},{"id":5900,"precertRequired":false,"billingCode":"86255","codeType":"CPT"},{"id":5901,"precertRequired":false,"billingCode":"86256","codeType":"CPT"},{"id":5912,"precertRequired":false,"billingCode":"86316","codeType":"CPT"},{"id":5913,"precertRequired":false,"billingCode":"86317","codeType":"CPT"},{"id":5915,"precertRequired":false,"billingCode":"86320","codeType":"CPT"},{"id":5916,"precertRequired":false,"billingCode":"86325","codeType":"CPT"},{"id":5917,"precertRequired":false,"billingCode":"86327","codeType":"CPT"},{"id":5918,"precertRequired":false,"billingCode":"86329","codeType":"CPT"},{"id":5919,"precertRequired":false,"billingCode":"86331","codeType":"CPT"},{"id":5920,"precertRequired":false,"billingCode":"86332","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5922,"precertRequired":false,"billingCode":"86335","codeType":"CPT"},{"id":5924,"precertRequired":false,"billingCode":"86337","codeType":"CPT"},{"id":5925,"precertRequired":false,"billingCode":"86340","codeType":"CPT"},{"id":5926,"precertRequired":false,"billingCode":"86341","codeType":"CPT"},{"id":5927,"precertRequired":false,"billingCode":"86343","codeType":"CPT"},{"id":5928,"precertRequired":false,"billingCode":"86344","codeType":"CPT"},{"id":5929,"precertRequired":false,"billingCode":"86352","codeType":"CPT"},{"id":5931,"precertRequired":false,"billingCode":"86355","codeType":"CPT"},{"id":5932,"precertRequired":false,"billingCode":"86356","codeType":"CPT"},{"id":5933,"precertRequired":false,"billingCode":"86357","codeType":"CPT"},{"id":5934,"precertRequired":false,"billingCode":"86359","codeType":"CPT"},{"id":5935,"precertRequired":false,"billingCode":"86360","codeType":"CPT"},{"id":5936,"precertRequired":false,"billingCode":"86361","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":5944,"precertRequired":false,"billingCode":"86430","codeType":"CPT"},{"id":5945,"precertRequired":false,"billingCode":"86431","codeType":"CPT"},{"id":5947,"precertRequired":false,"billingCode":"86481","codeType":"CPT"},{"id":5956,"precertRequired":false,"billingCode":"86602","codeType":"CPT"},{"id":5957,"precertRequired":false,"billingCode":"86603","codeType":"CPT"},{"id":5958,"precertRequired":false,"billingCode":"86606","codeType":"CPT"},{"id":5959,"precertRequired":false,"billingCode":"86609","codeType":"CPT"},{"id":5961,"precertRequired":false,"billingCode":"86612","codeType":"CPT"},{"id":5964,"precertRequired":false,"billingCode":"86618","codeType":"CPT"},{"id":5971,"precertRequired":false,"billingCode":"86635","codeType":"CPT"},{"id":5972,"precertRequired":false,"billingCode":"86638","codeType":"CPT"},{"id":5973,"precertRequired":false,"billingCode":"86641","codeType":"CPT"},{"id":5974,"precertRequired":false,"billingCode":"86644","codeType":"CPT"},{"id":5975,"precertRequired":false,"billingCode":"86645","codeType":"CPT"},{"id":5976,"precertRequired":false,"billingCode":"86648","codeType":"CPT"},{"id":5990,"precertRequired":false,"billingCode":"86682","codeType":"CPT"},{"id":5991,"precertRequired":false,"billingCode":"86684","codeType":"CPT"},{"id":5992,"precertRequired":false,"billingCode":"86687","codeType":"CPT"},{"id":5993,"precertRequired":false,"billingCode":"86688","codeType":"CPT"},{"id":5999,"precertRequired":false,"billingCode":"86698","codeType":"CPT"},{"id":6003,"precertRequired":false,"billingCode":"86704","codeType":"CPT"},{"id":6004,"precertRequired":false,"billingCode":"86705","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6007,"precertRequired":false,"billingCode":"86708","codeType":"CPT"},{"id":6009,"precertRequired":false,"billingCode":"86710","codeType":"CPT"},{"id":6010,"precertRequired":false,"billingCode":"86711","codeType":"CPT"},{"id":6011,"precertRequired":false,"billingCode":"86713","codeType":"CPT"},{"id":6012,"precertRequired":false,"billingCode":"86717","codeType":"CPT"},{"id":6013,"precertRequired":false,"billingCode":"86720","codeType":"CPT"},{"id":6014,"precertRequired":false,"billingCode":"86723","codeType":"CPT"},{"id":6015,"precertRequired":false,"billingCode":"86727","codeType":"CPT"},{"id":6016,"precertRequired":false,"billingCode":"86732","codeType":"CPT"},{"id":6017,"precertRequired":false,"billingCode":"86735","codeType":"CPT"},{"id":6018,"precertRequired":false,"billingCode":"86738","codeType":"CPT"},{"id":6019,"precertRequired":false,"billingCode":"86741","codeType":"CPT"},{"id":6020,"precertRequired":false,"billingCode":"86744","codeType":"CPT"},{"id":6021,"precertRequired":false,"billingCode":"86747","codeType":"CPT"},{"id":6022,"precertRequired":false,"billingCode":"86750","codeType":"CPT"},{"id":6023,"precertRequired":false,"billingCode":"86753","codeType":"CPT"},{"id":6024,"precertRequired":false,"billingCode":"86756","codeType":"CPT"},{"id":6025,"precertRequired":false,"billingCode":"86757","codeType":"CPT"},{"id":6026,"precertRequired":false,"billingCode":"86759","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6028,"precertRequired":false,"billingCode":"86765","codeType":"CPT"},{"id":6030,"precertRequired":false,"billingCode":"86771","codeType":"CPT"},{"id":6032,"precertRequired":false,"billingCode":"86777","codeType":"CPT"},{"id":6033,"precertRequired":false,"billingCode":"86778","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6037,"precertRequired":false,"billingCode":"86788","codeType":"CPT"},{"id":6038,"precertRequired":false,"billingCode":"86789","codeType":"CPT"},{"id":6039,"precertRequired":false,"billingCode":"86790","codeType":"CPT"},{"id":6040,"precertRequired":false,"billingCode":"86793","codeType":"CPT"},{"id":6041,"precertRequired":false,"billingCode":"86794","codeType":"CPT"},{"id":6042,"precertRequired":false,"billingCode":"86800","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6044,"precertRequired":false,"billingCode":"86804","codeType":"CPT"},{"id":6071,"precertRequired":false,"billingCode":"86889","codeType":"CPT"},{"id":6099,"precertRequired":false,"billingCode":"86975","codeType":"CPT"},{"id":6100,"precertRequired":false,"billingCode":"86976","codeType":"CPT"},{"id":6101,"precertRequired":false,"billingCode":"86977","codeType":"CPT"},{"id":6102,"precertRequired":false,"billingCode":"86978","codeType":"CPT"},{"id":6106,"precertRequired":false,"billingCode":"87015","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6114,"precertRequired":false,"billingCode":"87076","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6127,"precertRequired":false,"billingCode":"87116","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6135,"precertRequired":false,"billingCode":"87153","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6153,"precertRequired":false,"billingCode":"87206","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6163,"precertRequired":false,"billingCode":"87255","codeType":"CPT"},{"id":6164,"precertRequired":false,"billingCode":"87260","codeType":"CPT"},{"id":6167,"precertRequired":false,"billingCode":"87269","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6173,"precertRequired":false,"billingCode":"87275","codeType":"CPT"},{"id":6174,"precertRequired":false,"billingCode":"87276","codeType":"CPT"},{"id":6175,"precertRequired":false,"billingCode":"87278","codeType":"CPT"},{"id":6176,"precertRequired":false,"billingCode":"87279","codeType":"CPT"},{"id":6177,"precertRequired":false,"billingCode":"87280","codeType":"CPT"},{"id":6178,"precertRequired":false,"billingCode":"87281","codeType":"CPT"},{"id":6179,"precertRequired":false,"billingCode":"87283","codeType":"CPT"},{"id":6180,"precertRequired":false,"billingCode":"87285","codeType":"CPT"},{"id":6181,"precertRequired":false,"billingCode":"87290","codeType":"CPT"},{"id":6182,"precertRequired":false,"billingCode":"87299","codeType":"CPT"},{"id":6183,"precertRequired":false,"billingCode":"87300","codeType":"CPT"},{"id":6184,"precertRequired":false,"billingCode":"87301","codeType":"CPT"},{"id":6185,"precertRequired":false,"billingCode":"87305","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6191,"precertRequired":false,"billingCode":"87332","codeType":"CPT"},{"id":6192,"precertRequired":false,"billingCode":"87335","codeType":"CPT"},{"id":6193,"precertRequired":false,"billingCode":"87336","codeType":"CPT"},{"id":6194,"precertRequired":false,"billingCode":"87337","codeType":"CPT"},{"id":6195,"precertRequired":false,"billingCode":"87338","codeType":"CPT"},{"id":6196,"precertRequired":false,"billingCode":"87339","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6198,"precertRequired":false,"billingCode":"87341","codeType":"CPT"},{"id":6199,"precertRequired":false,"billingCode":"87350","codeType":"CPT"},{"id":6200,"precertRequired":false,"billingCode":"87380","codeType":"CPT"},{"id":6201,"precertRequired":false,"billingCode":"87385","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6203,"precertRequired":false,"billingCode":"87390","codeType":"CPT"},{"id":6204,"precertRequired":false,"billingCode":"87391","codeType":"CPT"},{"id":6205,"precertRequired":false,"billingCode":"87400","codeType":"CPT"},{"id":6206,"precertRequired":false,"billingCode":"87420","codeType":"CPT"},{"id":6207,"precertRequired":false,"billingCode":"87425","codeType":"CPT"},{"id":6208,"precertRequired":false,"billingCode":"87427","codeType":"CPT"},{"id":6209,"precertRequired":false,"billingCode":"87430","codeType":"CPT"},{"id":6210,"precertRequired":false,"billingCode":"87449","codeType":"CPT"},{"id":6211,"precertRequired":false,"billingCode":"87450","codeType":"CPT"},{"id":6212,"precertRequired":false,"billingCode":"87451","codeType":"CPT"},{"id":6303,"precertRequired":false,"billingCode":"87804","codeType":"CPT"},{"id":6310,"precertRequired":false,"billingCode":"87880","codeType":"CPT"},{"id":6317,"precertRequired":false,"billingCode":"87905","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6440,"precertRequired":false,"billingCode":"88371","codeType":"CPT"},{"id":6441,"precertRequired":false,"billingCode":"88372","codeType":"CPT"},{"id":6443,"precertRequired":false,"billingCode":"88374","codeType":"CPT"},{"id":6504,"precertRequired":false,"billingCode":"89709","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":9791,"precertRequired":false,"billingCode":"99001","codeType":"CPT"},{"id":9857,"precertRequired":false,"billingCode":"86766","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1445,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4429,"precertRequired":false,"billingCode":"71010","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1446,"description":"Procedures/diagnostic studies relevant to the referred condition including but not limited to:  allergen skin testing, drug testing, chemical patch testing, methacholine challenge, PFT","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7185,"precertRequired":false,"billingCode":"96160","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1447,"description":"Standard immunotherapy and RUSH immunotherapy, including Nurse Visits","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7019,"precertRequired":false,"billingCode":"94664","codeType":"CPT"},{"id":7020,"precertRequired":false,"billingCode":"94667","codeType":"CPT"},{"id":7021,"precertRequired":false,"billingCode":"94668","codeType":"CPT"},{"id":7022,"precertRequired":false,"billingCode":"94669","codeType":"CPT"},{"id":7053,"precertRequired":false,"billingCode":"95115","codeType":"CPT"},{"id":7054,"precertRequired":false,"billingCode":"95117","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7069,"precertRequired":false,"billingCode":"95170","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7225,"precertRequired":false,"billingCode":"96900","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1448,"description":" Creation of serum for injections","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":8361,"precertRequired":false,"billingCode":"J0171","codeType":"HCPCS"},{"id":8396,"precertRequired":false,"billingCode":"J0878","codeType":"HCPCS"},{"id":8404,"precertRequired":true,"billingCode":"J0945","codeType":"HCPCS"},{"id":8406,"precertRequired":true,"billingCode":"J1020","codeType":"HCPCS"},{"id":8407,"precertRequired":true,"billingCode":"J1030","codeType":"HCPCS"},{"id":8408,"precertRequired":true,"billingCode":"J1040","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8431,"precertRequired":false,"billingCode":"J1559","codeType":"HCPCS"},{"id":8432,"precertRequired":true,"billingCode":"J1566","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8434,"precertRequired":true,"billingCode":"J1569","codeType":"HCPCS"},{"id":8451,"precertRequired":false,"billingCode":"J1815","codeType":"HCPCS"},{"id":8452,"precertRequired":false,"billingCode":"J1817","codeType":"HCPCS"},{"id":8453,"precertRequired":false,"billingCode":"J1885","codeType":"HCPCS"},{"id":8468,"precertRequired":false,"billingCode":"J2357","codeType":"HCPCS"},{"id":8480,"precertRequired":false,"billingCode":"J2650","codeType":"HCPCS"},{"id":8504,"precertRequired":true,"billingCode":"J3301","codeType":"HCPCS"},{"id":8513,"precertRequired":false,"billingCode":"J3410","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8552,"precertRequired":false,"billingCode":"J7509","codeType":"HCPCS"},{"id":8553,"precertRequired":false,"billingCode":"J7510","codeType":"HCPCS"},{"id":8554,"precertRequired":false,"billingCode":"J7512","codeType":"HCPCS"},{"id":8555,"precertRequired":false,"billingCode":"J7613","codeType":"HCPCS"},{"id":8557,"precertRequired":false,"billingCode":"J7644","codeType":"HCPCS"},{"id":9805,"precertRequired":false,"billingCode":"J0280","codeType":"HCPCS"},{"id":9808,"precertRequired":false,"billingCode":"J0295","codeType":"HCPCS"},{"id":9819,"precertRequired":false,"billingCode":"J1459","codeType":"HCPCS"},{"id":9821,"precertRequired":false,"billingCode":"J1556","codeType":"HCPCS"},{"id":9823,"precertRequired":false,"billingCode":"J1561","codeType":"HCPCS"},{"id":9826,"precertRequired":false,"billingCode":"J1575","codeType":"HCPCS"},{"id":9847,"precertRequired":false,"billingCode":"J7609","codeType":"HCPCS"},{"id":9848,"precertRequired":false,"billingCode":"J7610","codeType":"HCPCS"},{"id":9849,"precertRequired":false,"billingCode":"J7611","codeType":"HCPCS"},{"id":9850,"precertRequired":false,"billingCode":"J7620","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1449,"description":" Infusion therapy, in clinic, to include IV Fluids during infusion as relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1450,"description":"Follow up Visits for this Episode of Care Revelant to the Referred Condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1451,"description":"Follow Up Biopsy if Clinically Indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1452,"description":"Desensitization (Antibiotics and Chemotherapeutic Agents)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":6056,"precertRequired":false,"billingCode":"86828","codeType":"CPT"},{"id":6057,"precertRequired":false,"billingCode":"86829","codeType":"CPT"},{"id":6058,"precertRequired":false,"billingCode":"86830","codeType":"CPT"},{"id":6059,"precertRequired":false,"billingCode":"86831","codeType":"CPT"},{"id":6060,"precertRequired":false,"billingCode":"86832","codeType":"CPT"},{"id":6061,"precertRequired":false,"billingCode":"86833","codeType":"CPT"},{"id":6062,"precertRequired":false,"billingCode":"86834","codeType":"CPT"},{"id":6063,"precertRequired":false,"billingCode":"86835","codeType":"CPT"},{"id":7053,"precertRequired":false,"billingCode":"95115","codeType":"CPT"},{"id":7054,"precertRequired":false,"billingCode":"95117","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7069,"precertRequired":false,"billingCode":"95170","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":8468,"precertRequired":false,"billingCode":"J2357","codeType":"HCPCS"},{"id":8556,"precertRequired":false,"billingCode":"J7641","codeType":"HCPCS"},{"id":8775,"precertRequired":false,"billingCode":"Q0163","codeType":"HCPCS"},{"id":8783,"precertRequired":false,"billingCode":"Q0177","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1453,"description":"Inpatient Admission or Observation admission as related to referred condition on the consult. ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7322,"precertRequired":false,"billingCode":"99060","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]}]}},{"Seoc":{"id":301,"seocKey":8,"name":"Allergy-Immunology_PRCT","seocId":"MSC_ALLERGY-IMMUNOLOGY_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"03-12-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Labs/diagnostic studies relevant to the patient complaint/condition\r\n3. Pathology services relevant to the patient complaint/condition\r\n4. RAST testing\r\n5. Procedures to include allergen skin testing relevant to the patient complaint/condition\r\n6. Seven (7) follow-up visits for this episode of care\r\n7. Follow up biopsy if clinically indicated","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ALLERGY AND IMMUNOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207KA0200X"},{"hptc":"207RA0201X"}],"services":[{"id":1270,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1271,"description":"Labs/diagnostic studies relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":5870,"precertRequired":false,"billingCode":"86021","codeType":"CPT"},{"id":5871,"precertRequired":false,"billingCode":"86022","codeType":"CPT"},{"id":5872,"precertRequired":false,"billingCode":"86023","codeType":"CPT"},{"id":5873,"precertRequired":false,"billingCode":"86038","codeType":"CPT"},{"id":5874,"precertRequired":false,"billingCode":"86039","codeType":"CPT"},{"id":5875,"precertRequired":false,"billingCode":"86060","codeType":"CPT"},{"id":5878,"precertRequired":false,"billingCode":"86078","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5884,"precertRequired":false,"billingCode":"86148","codeType":"CPT"},{"id":5885,"precertRequired":false,"billingCode":"86152","codeType":"CPT"},{"id":5886,"precertRequired":false,"billingCode":"86153","codeType":"CPT"},{"id":5887,"precertRequired":false,"billingCode":"86155","codeType":"CPT"},{"id":5888,"precertRequired":false,"billingCode":"86156","codeType":"CPT"},{"id":5889,"precertRequired":false,"billingCode":"86157","codeType":"CPT"},{"id":5890,"precertRequired":false,"billingCode":"86160","codeType":"CPT"},{"id":5891,"precertRequired":false,"billingCode":"86161","codeType":"CPT"},{"id":5892,"precertRequired":false,"billingCode":"86162","codeType":"CPT"},{"id":5893,"precertRequired":false,"billingCode":"86171","codeType":"CPT"},{"id":5894,"precertRequired":false,"billingCode":"86185","codeType":"CPT"},{"id":5895,"precertRequired":false,"billingCode":"86200","codeType":"CPT"},{"id":5896,"precertRequired":false,"billingCode":"86215","codeType":"CPT"},{"id":5897,"precertRequired":false,"billingCode":"86225","codeType":"CPT"},{"id":5898,"precertRequired":false,"billingCode":"86226","codeType":"CPT"},{"id":5899,"precertRequired":false,"billingCode":"86235","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1272,"description":"Pathology services relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1273,"description":"RAST testing","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":5866,"precertRequired":false,"billingCode":"86001","codeType":"CPT"},{"id":5867,"precertRequired":false,"billingCode":"86003","codeType":"CPT"},{"id":5868,"precertRequired":false,"billingCode":"86005","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1274,"description":"Procedures to include allergen skin testing relevant to the patient complaint/condition ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6992,"precertRequired":false,"billingCode":"94011","codeType":"CPT"},{"id":6993,"precertRequired":false,"billingCode":"94012","codeType":"CPT"},{"id":6994,"precertRequired":false,"billingCode":"94013","codeType":"CPT"},{"id":6995,"precertRequired":false,"billingCode":"94014","codeType":"CPT"},{"id":6996,"precertRequired":false,"billingCode":"94015","codeType":"CPT"},{"id":6997,"precertRequired":false,"billingCode":"94016","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7004,"precertRequired":false,"billingCode":"94400","codeType":"CPT"},{"id":7005,"precertRequired":false,"billingCode":"94450","codeType":"CPT"},{"id":7006,"precertRequired":false,"billingCode":"94452","codeType":"CPT"},{"id":7007,"precertRequired":false,"billingCode":"94453","codeType":"CPT"},{"id":7008,"precertRequired":false,"billingCode":"94610","codeType":"CPT"},{"id":7011,"precertRequired":false,"billingCode":"94620","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7014,"precertRequired":false,"billingCode":"94642","codeType":"CPT"},{"id":7015,"precertRequired":false,"billingCode":"94644","codeType":"CPT"},{"id":7016,"precertRequired":false,"billingCode":"94645","codeType":"CPT"},{"id":7017,"precertRequired":false,"billingCode":"94660","codeType":"CPT"},{"id":7018,"precertRequired":false,"billingCode":"94662","codeType":"CPT"},{"id":7019,"precertRequired":false,"billingCode":"94664","codeType":"CPT"},{"id":7020,"precertRequired":false,"billingCode":"94667","codeType":"CPT"},{"id":7021,"precertRequired":false,"billingCode":"94668","codeType":"CPT"},{"id":7022,"precertRequired":false,"billingCode":"94669","codeType":"CPT"},{"id":7023,"precertRequired":false,"billingCode":"94680","codeType":"CPT"},{"id":7024,"precertRequired":false,"billingCode":"94681","codeType":"CPT"},{"id":7025,"precertRequired":false,"billingCode":"94690","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7033,"precertRequired":false,"billingCode":"94762","codeType":"CPT"},{"id":7034,"precertRequired":false,"billingCode":"94770","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7036,"precertRequired":false,"billingCode":"95010","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7038,"precertRequired":false,"billingCode":"95015","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7053,"precertRequired":false,"billingCode":"95115","codeType":"CPT"},{"id":7054,"precertRequired":false,"billingCode":"95117","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7069,"precertRequired":false,"billingCode":"95170","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":8555,"precertRequired":false,"billingCode":"J7613","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1275,"description":"Seven (7) follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":7,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":1276,"description":"Follow up biopsy if clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]}]}},{"Seoc":{"id":20,"seocKey":8,"name":"Allergy-Immunology_PRCT","seocId":"MSC_ALLERGY-IMMUNOLOGY_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Labs/diagnostic studies relevant to the patient complaint/condition\r\n3. Pathology services relevant to the patient complaint/condition\r\n4. RAST testing\r\n5. Procedures to include allergen skin testing relevant to the patient complaint/condition\r\n6. Seven (7) follow-up visits for this episode of care\r\n7. Follow up biopsy if clinically indicated","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ALLERGY AND IMMUNOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":640,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":641,"description":"Labs/diagnostic studies relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":5870,"precertRequired":false,"billingCode":"86021","codeType":"CPT"},{"id":5871,"precertRequired":false,"billingCode":"86022","codeType":"CPT"},{"id":5872,"precertRequired":false,"billingCode":"86023","codeType":"CPT"},{"id":5873,"precertRequired":false,"billingCode":"86038","codeType":"CPT"},{"id":5874,"precertRequired":false,"billingCode":"86039","codeType":"CPT"},{"id":5875,"precertRequired":false,"billingCode":"86060","codeType":"CPT"},{"id":5878,"precertRequired":false,"billingCode":"86078","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5884,"precertRequired":false,"billingCode":"86148","codeType":"CPT"},{"id":5885,"precertRequired":false,"billingCode":"86152","codeType":"CPT"},{"id":5886,"precertRequired":false,"billingCode":"86153","codeType":"CPT"},{"id":5887,"precertRequired":false,"billingCode":"86155","codeType":"CPT"},{"id":5888,"precertRequired":false,"billingCode":"86156","codeType":"CPT"},{"id":5889,"precertRequired":false,"billingCode":"86157","codeType":"CPT"},{"id":5890,"precertRequired":false,"billingCode":"86160","codeType":"CPT"},{"id":5891,"precertRequired":false,"billingCode":"86161","codeType":"CPT"},{"id":5892,"precertRequired":false,"billingCode":"86162","codeType":"CPT"},{"id":5893,"precertRequired":false,"billingCode":"86171","codeType":"CPT"},{"id":5894,"precertRequired":false,"billingCode":"86185","codeType":"CPT"},{"id":5895,"precertRequired":false,"billingCode":"86200","codeType":"CPT"},{"id":5896,"precertRequired":false,"billingCode":"86215","codeType":"CPT"},{"id":5897,"precertRequired":false,"billingCode":"86225","codeType":"CPT"},{"id":5898,"precertRequired":false,"billingCode":"86226","codeType":"CPT"},{"id":5899,"precertRequired":false,"billingCode":"86235","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":642,"description":"Pathology services relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":643,"description":"RAST testing","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":5866,"precertRequired":false,"billingCode":"86001","codeType":"CPT"},{"id":5867,"precertRequired":false,"billingCode":"86003","codeType":"CPT"},{"id":5868,"precertRequired":false,"billingCode":"86005","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":644,"description":"Procedures to include allergen skin testing relevant to the patient complaint/condition ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6992,"precertRequired":false,"billingCode":"94011","codeType":"CPT"},{"id":6993,"precertRequired":false,"billingCode":"94012","codeType":"CPT"},{"id":6994,"precertRequired":false,"billingCode":"94013","codeType":"CPT"},{"id":6995,"precertRequired":false,"billingCode":"94014","codeType":"CPT"},{"id":6996,"precertRequired":false,"billingCode":"94015","codeType":"CPT"},{"id":6997,"precertRequired":false,"billingCode":"94016","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7004,"precertRequired":false,"billingCode":"94400","codeType":"CPT"},{"id":7005,"precertRequired":false,"billingCode":"94450","codeType":"CPT"},{"id":7006,"precertRequired":false,"billingCode":"94452","codeType":"CPT"},{"id":7007,"precertRequired":false,"billingCode":"94453","codeType":"CPT"},{"id":7008,"precertRequired":false,"billingCode":"94610","codeType":"CPT"},{"id":7011,"precertRequired":false,"billingCode":"94620","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7014,"precertRequired":false,"billingCode":"94642","codeType":"CPT"},{"id":7015,"precertRequired":false,"billingCode":"94644","codeType":"CPT"},{"id":7016,"precertRequired":false,"billingCode":"94645","codeType":"CPT"},{"id":7017,"precertRequired":false,"billingCode":"94660","codeType":"CPT"},{"id":7018,"precertRequired":false,"billingCode":"94662","codeType":"CPT"},{"id":7019,"precertRequired":false,"billingCode":"94664","codeType":"CPT"},{"id":7020,"precertRequired":false,"billingCode":"94667","codeType":"CPT"},{"id":7021,"precertRequired":false,"billingCode":"94668","codeType":"CPT"},{"id":7022,"precertRequired":false,"billingCode":"94669","codeType":"CPT"},{"id":7023,"precertRequired":false,"billingCode":"94680","codeType":"CPT"},{"id":7024,"precertRequired":false,"billingCode":"94681","codeType":"CPT"},{"id":7025,"precertRequired":false,"billingCode":"94690","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7033,"precertRequired":false,"billingCode":"94762","codeType":"CPT"},{"id":7034,"precertRequired":false,"billingCode":"94770","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7036,"precertRequired":false,"billingCode":"95010","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7038,"precertRequired":false,"billingCode":"95015","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7053,"precertRequired":false,"billingCode":"95115","codeType":"CPT"},{"id":7054,"precertRequired":false,"billingCode":"95117","codeType":"CPT"},{"id":7055,"precertRequired":false,"billingCode":"95120","codeType":"CPT"},{"id":7056,"precertRequired":false,"billingCode":"95125","codeType":"CPT"},{"id":7057,"precertRequired":false,"billingCode":"95130","codeType":"CPT"},{"id":7058,"precertRequired":false,"billingCode":"95131","codeType":"CPT"},{"id":7059,"precertRequired":false,"billingCode":"95132","codeType":"CPT"},{"id":7060,"precertRequired":false,"billingCode":"95133","codeType":"CPT"},{"id":7061,"precertRequired":false,"billingCode":"95134","codeType":"CPT"},{"id":7062,"precertRequired":false,"billingCode":"95144","codeType":"CPT"},{"id":7063,"precertRequired":false,"billingCode":"95145","codeType":"CPT"},{"id":7064,"precertRequired":false,"billingCode":"95146","codeType":"CPT"},{"id":7065,"precertRequired":false,"billingCode":"95147","codeType":"CPT"},{"id":7066,"precertRequired":false,"billingCode":"95148","codeType":"CPT"},{"id":7067,"precertRequired":false,"billingCode":"95149","codeType":"CPT"},{"id":7068,"precertRequired":false,"billingCode":"95165","codeType":"CPT"},{"id":7069,"precertRequired":false,"billingCode":"95170","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":8555,"precertRequired":false,"billingCode":"J7613","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":645,"description":"Seven (7) follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":7,"codeRequired":"YES","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]},{"id":646,"description":"Follow up biopsy if clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"03-Allergy/immunology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"207KA0200X"},{"HPTC":"207KI0005X"},{"HPTC":"207K00000X"}]}]}},{"Seoc":{"id":187,"seocKey":9,"name":"Anti-Coag Lab","seocId":"LAB_ANTI-COAG LAB_1.1.2","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"04-19-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Lab services for monitoring of anticoagulation therapies","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the referred patient wil condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"LAB AND PATHOLOGY","serviceLine":"Lab & Pathology Services","hptcs":[{"hptc":"207ZP0101X"},{"hptc":"291U00000X"},{"hptc":"293D00000X"}],"services":[{"id":693,"description":"Lab services for monitoring of anticoagulation therapies","frequency":null,"frequencyType":"","visits":24,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5765,"precertRequired":false,"billingCode":"85002","codeType":"CPT"},{"id":5766,"precertRequired":false,"billingCode":"85004","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5768,"precertRequired":false,"billingCode":"85008","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5770,"precertRequired":false,"billingCode":"85013","codeType":"CPT"},{"id":5771,"precertRequired":false,"billingCode":"85014","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5775,"precertRequired":false,"billingCode":"85032","codeType":"CPT"},{"id":5776,"precertRequired":false,"billingCode":"85041","codeType":"CPT"},{"id":5777,"precertRequired":false,"billingCode":"85044","codeType":"CPT"},{"id":5778,"precertRequired":false,"billingCode":"85045","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5780,"precertRequired":false,"billingCode":"85048","codeType":"CPT"},{"id":5781,"precertRequired":false,"billingCode":"85049","codeType":"CPT"},{"id":5782,"precertRequired":false,"billingCode":"85055","codeType":"CPT"},{"id":5783,"precertRequired":false,"billingCode":"85060","codeType":"CPT"},{"id":5784,"precertRequired":false,"billingCode":"85097","codeType":"CPT"},{"id":5785,"precertRequired":false,"billingCode":"85130","codeType":"CPT"},{"id":5786,"precertRequired":false,"billingCode":"85170","codeType":"CPT"},{"id":5787,"precertRequired":false,"billingCode":"85175","codeType":"CPT"},{"id":5788,"precertRequired":false,"billingCode":"85210","codeType":"CPT"},{"id":5789,"precertRequired":false,"billingCode":"85220","codeType":"CPT"},{"id":5790,"precertRequired":false,"billingCode":"85230","codeType":"CPT"},{"id":5791,"precertRequired":false,"billingCode":"85240","codeType":"CPT"},{"id":5792,"precertRequired":false,"billingCode":"85244","codeType":"CPT"},{"id":5793,"precertRequired":false,"billingCode":"85245","codeType":"CPT"},{"id":5794,"precertRequired":false,"billingCode":"85246","codeType":"CPT"},{"id":5795,"precertRequired":false,"billingCode":"85247","codeType":"CPT"},{"id":5796,"precertRequired":false,"billingCode":"85250","codeType":"CPT"},{"id":5797,"precertRequired":false,"billingCode":"85260","codeType":"CPT"},{"id":5798,"precertRequired":false,"billingCode":"85270","codeType":"CPT"},{"id":5799,"precertRequired":false,"billingCode":"85280","codeType":"CPT"},{"id":5800,"precertRequired":false,"billingCode":"85290","codeType":"CPT"},{"id":5801,"precertRequired":false,"billingCode":"85291","codeType":"CPT"},{"id":5802,"precertRequired":false,"billingCode":"85292","codeType":"CPT"},{"id":5804,"precertRequired":false,"billingCode":"85300","codeType":"CPT"},{"id":5805,"precertRequired":false,"billingCode":"85301","codeType":"CPT"},{"id":5806,"precertRequired":false,"billingCode":"85302","codeType":"CPT"},{"id":5807,"precertRequired":false,"billingCode":"85303","codeType":"CPT"},{"id":5808,"precertRequired":false,"billingCode":"85305","codeType":"CPT"},{"id":5809,"precertRequired":false,"billingCode":"85306","codeType":"CPT"},{"id":5810,"precertRequired":false,"billingCode":"85307","codeType":"CPT"},{"id":5811,"precertRequired":false,"billingCode":"85335","codeType":"CPT"},{"id":5812,"precertRequired":false,"billingCode":"85337","codeType":"CPT"},{"id":5813,"precertRequired":false,"billingCode":"85345","codeType":"CPT"},{"id":5814,"precertRequired":false,"billingCode":"85347","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5816,"precertRequired":false,"billingCode":"85360","codeType":"CPT"},{"id":5817,"precertRequired":false,"billingCode":"85362","codeType":"CPT"},{"id":5818,"precertRequired":false,"billingCode":"85366","codeType":"CPT"},{"id":5819,"precertRequired":false,"billingCode":"85370","codeType":"CPT"},{"id":5820,"precertRequired":false,"billingCode":"85378","codeType":"CPT"},{"id":5821,"precertRequired":false,"billingCode":"85379","codeType":"CPT"},{"id":5828,"precertRequired":false,"billingCode":"85400","codeType":"CPT"},{"id":5829,"precertRequired":false,"billingCode":"85410","codeType":"CPT"},{"id":5830,"precertRequired":false,"billingCode":"85415","codeType":"CPT"},{"id":5831,"precertRequired":false,"billingCode":"85420","codeType":"CPT"},{"id":5832,"precertRequired":false,"billingCode":"85421","codeType":"CPT"},{"id":5833,"precertRequired":false,"billingCode":"85441","codeType":"CPT"},{"id":5834,"precertRequired":false,"billingCode":"85445","codeType":"CPT"},{"id":5835,"precertRequired":false,"billingCode":"85460","codeType":"CPT"},{"id":5836,"precertRequired":false,"billingCode":"85461","codeType":"CPT"},{"id":5837,"precertRequired":false,"billingCode":"85475","codeType":"CPT"},{"id":5838,"precertRequired":false,"billingCode":"85520","codeType":"CPT"},{"id":5839,"precertRequired":false,"billingCode":"85525","codeType":"CPT"},{"id":5840,"precertRequired":false,"billingCode":"85530","codeType":"CPT"},{"id":5841,"precertRequired":false,"billingCode":"85536","codeType":"CPT"},{"id":5842,"precertRequired":false,"billingCode":"85540","codeType":"CPT"},{"id":5843,"precertRequired":false,"billingCode":"85547","codeType":"CPT"},{"id":5844,"precertRequired":false,"billingCode":"85549","codeType":"CPT"},{"id":5845,"precertRequired":false,"billingCode":"85555","codeType":"CPT"},{"id":5846,"precertRequired":false,"billingCode":"85557","codeType":"CPT"},{"id":5847,"precertRequired":false,"billingCode":"85576","codeType":"CPT"},{"id":5848,"precertRequired":false,"billingCode":"85597","codeType":"CPT"},{"id":5849,"precertRequired":false,"billingCode":"85598","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5852,"precertRequired":false,"billingCode":"85612","codeType":"CPT"},{"id":5853,"precertRequired":false,"billingCode":"85613","codeType":"CPT"},{"id":5854,"precertRequired":false,"billingCode":"85635","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5857,"precertRequired":false,"billingCode":"85660","codeType":"CPT"},{"id":5858,"precertRequired":false,"billingCode":"85670","codeType":"CPT"},{"id":5859,"precertRequired":false,"billingCode":"85675","codeType":"CPT"},{"id":5860,"precertRequired":false,"billingCode":"85705","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5862,"precertRequired":false,"billingCode":"85732","codeType":"CPT"},{"id":5863,"precertRequired":false,"billingCode":"85810","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]}]}},{"Seoc":{"id":50,"seocKey":9,"name":"Anti-Coag Lab","seocId":"LAB_ANTI-COAG LAB_1.1.1","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-29-2018","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Lab services for monitoring of anticoagulation therapies","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the referred patient wil condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"LAB AND PATHOLOGY","serviceLine":"Lab & Pathology Services","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":18,"description":"Lab services for monitoring of anticoagulation therapies","frequency":null,"frequencyType":"","visits":24,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5765,"precertRequired":false,"billingCode":"85002","codeType":"CPT"},{"id":5766,"precertRequired":false,"billingCode":"85004","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5768,"precertRequired":false,"billingCode":"85008","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5770,"precertRequired":false,"billingCode":"85013","codeType":"CPT"},{"id":5771,"precertRequired":false,"billingCode":"85014","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5775,"precertRequired":false,"billingCode":"85032","codeType":"CPT"},{"id":5776,"precertRequired":false,"billingCode":"85041","codeType":"CPT"},{"id":5777,"precertRequired":false,"billingCode":"85044","codeType":"CPT"},{"id":5778,"precertRequired":false,"billingCode":"85045","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5780,"precertRequired":false,"billingCode":"85048","codeType":"CPT"},{"id":5781,"precertRequired":false,"billingCode":"85049","codeType":"CPT"},{"id":5782,"precertRequired":false,"billingCode":"85055","codeType":"CPT"},{"id":5783,"precertRequired":false,"billingCode":"85060","codeType":"CPT"},{"id":5784,"precertRequired":false,"billingCode":"85097","codeType":"CPT"},{"id":5785,"precertRequired":false,"billingCode":"85130","codeType":"CPT"},{"id":5786,"precertRequired":false,"billingCode":"85170","codeType":"CPT"},{"id":5787,"precertRequired":false,"billingCode":"85175","codeType":"CPT"},{"id":5788,"precertRequired":false,"billingCode":"85210","codeType":"CPT"},{"id":5789,"precertRequired":false,"billingCode":"85220","codeType":"CPT"},{"id":5790,"precertRequired":false,"billingCode":"85230","codeType":"CPT"},{"id":5791,"precertRequired":false,"billingCode":"85240","codeType":"CPT"},{"id":5792,"precertRequired":false,"billingCode":"85244","codeType":"CPT"},{"id":5793,"precertRequired":false,"billingCode":"85245","codeType":"CPT"},{"id":5794,"precertRequired":false,"billingCode":"85246","codeType":"CPT"},{"id":5795,"precertRequired":false,"billingCode":"85247","codeType":"CPT"},{"id":5796,"precertRequired":false,"billingCode":"85250","codeType":"CPT"},{"id":5797,"precertRequired":false,"billingCode":"85260","codeType":"CPT"},{"id":5798,"precertRequired":false,"billingCode":"85270","codeType":"CPT"},{"id":5799,"precertRequired":false,"billingCode":"85280","codeType":"CPT"},{"id":5800,"precertRequired":false,"billingCode":"85290","codeType":"CPT"},{"id":5801,"precertRequired":false,"billingCode":"85291","codeType":"CPT"},{"id":5802,"precertRequired":false,"billingCode":"85292","codeType":"CPT"},{"id":5804,"precertRequired":false,"billingCode":"85300","codeType":"CPT"},{"id":5805,"precertRequired":false,"billingCode":"85301","codeType":"CPT"},{"id":5806,"precertRequired":false,"billingCode":"85302","codeType":"CPT"},{"id":5807,"precertRequired":false,"billingCode":"85303","codeType":"CPT"},{"id":5808,"precertRequired":false,"billingCode":"85305","codeType":"CPT"},{"id":5809,"precertRequired":false,"billingCode":"85306","codeType":"CPT"},{"id":5810,"precertRequired":false,"billingCode":"85307","codeType":"CPT"},{"id":5811,"precertRequired":false,"billingCode":"85335","codeType":"CPT"},{"id":5812,"precertRequired":false,"billingCode":"85337","codeType":"CPT"},{"id":5813,"precertRequired":false,"billingCode":"85345","codeType":"CPT"},{"id":5814,"precertRequired":false,"billingCode":"85347","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5816,"precertRequired":false,"billingCode":"85360","codeType":"CPT"},{"id":5817,"precertRequired":false,"billingCode":"85362","codeType":"CPT"},{"id":5818,"precertRequired":false,"billingCode":"85366","codeType":"CPT"},{"id":5819,"precertRequired":false,"billingCode":"85370","codeType":"CPT"},{"id":5820,"precertRequired":false,"billingCode":"85378","codeType":"CPT"},{"id":5821,"precertRequired":false,"billingCode":"85379","codeType":"CPT"},{"id":5828,"precertRequired":false,"billingCode":"85400","codeType":"CPT"},{"id":5829,"precertRequired":false,"billingCode":"85410","codeType":"CPT"},{"id":5830,"precertRequired":false,"billingCode":"85415","codeType":"CPT"},{"id":5831,"precertRequired":false,"billingCode":"85420","codeType":"CPT"},{"id":5832,"precertRequired":false,"billingCode":"85421","codeType":"CPT"},{"id":5833,"precertRequired":false,"billingCode":"85441","codeType":"CPT"},{"id":5834,"precertRequired":false,"billingCode":"85445","codeType":"CPT"},{"id":5835,"precertRequired":false,"billingCode":"85460","codeType":"CPT"},{"id":5836,"precertRequired":false,"billingCode":"85461","codeType":"CPT"},{"id":5837,"precertRequired":false,"billingCode":"85475","codeType":"CPT"},{"id":5838,"precertRequired":false,"billingCode":"85520","codeType":"CPT"},{"id":5839,"precertRequired":false,"billingCode":"85525","codeType":"CPT"},{"id":5840,"precertRequired":false,"billingCode":"85530","codeType":"CPT"},{"id":5841,"precertRequired":false,"billingCode":"85536","codeType":"CPT"},{"id":5842,"precertRequired":false,"billingCode":"85540","codeType":"CPT"},{"id":5843,"precertRequired":false,"billingCode":"85547","codeType":"CPT"},{"id":5844,"precertRequired":false,"billingCode":"85549","codeType":"CPT"},{"id":5845,"precertRequired":false,"billingCode":"85555","codeType":"CPT"},{"id":5846,"precertRequired":false,"billingCode":"85557","codeType":"CPT"},{"id":5847,"precertRequired":false,"billingCode":"85576","codeType":"CPT"},{"id":5848,"precertRequired":false,"billingCode":"85597","codeType":"CPT"},{"id":5849,"precertRequired":false,"billingCode":"85598","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5852,"precertRequired":false,"billingCode":"85612","codeType":"CPT"},{"id":5853,"precertRequired":false,"billingCode":"85613","codeType":"CPT"},{"id":5854,"precertRequired":false,"billingCode":"85635","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5857,"precertRequired":false,"billingCode":"85660","codeType":"CPT"},{"id":5858,"precertRequired":false,"billingCode":"85670","codeType":"CPT"},{"id":5859,"precertRequired":false,"billingCode":"85675","codeType":"CPT"},{"id":5860,"precertRequired":false,"billingCode":"85705","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5862,"precertRequired":false,"billingCode":"85732","codeType":"CPT"},{"id":5863,"precertRequired":false,"billingCode":"85810","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]}]}},{"Seoc":{"id":188,"seocKey":10,"name":"ART-IVF Female_PRCT","seocId":"INF_ART-IVF FEMALE_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition. Services can only be provided through the Patient Centered Community Care (PC3) contract.","effectiveDate":"01-02-2019","endDate":"01-22-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for infertility\r\n2. Six (6) visits for diagnostic imaging relevant to the referred condition\r\n3. Twelve (12) visits for diagnostic studies, lab and pathology services relevant to the referred condition\r\n4. Procedures to include: ovarian stimulation medications (oral and/or injectable), oocyte harvesting, In-vitro insemination (IVF) including intra-cytoplasmic sperm injection (ICSI), embryo culture, fresh or frozen embryo transfer, cryopreservation techniques and genetic testing as indicated. Ovarian stimulation will require multiple labs and ultrasounds\r\n5. Maximum of six (6) attempts to achieve three (3) complete IVF cycles in a lifetime of the eligible service-connected Veteran. A cycle is defined as transfer of one (1) or more embryos.  Transfer of a frozen embryo would be considered a cycle.","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"IN-VITRO FERTILIZATION (IVF)/ ASSISTED REPRODUCTIVE TECH (ART)","serviceLine":"Infertility Care","hptcs":[{"hptc":"207VE0102X"}],"services":[{"id":694,"description":"Initial outpatient evaluation and treatment for infertility","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":695,"description":"Six (6) visits for diagnostic imaging relevant to the referred condition","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4737,"precertRequired":true,"billingCode":"76812","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":696,"description":" Twelve (12) visits for diagnostic studies, lab and pathology services relevant to the referred condition","frequency":null,"frequencyType":"","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":3706,"precertRequired":false,"billingCode":"58555","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5190,"precertRequired":true,"billingCode":"81224","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5567,"precertRequired":false,"billingCode":"83498","codeType":"CPT"},{"id":5573,"precertRequired":false,"billingCode":"83520","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5666,"precertRequired":false,"billingCode":"84146","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5763,"precertRequired":false,"billingCode":"84830","codeType":"CPT"},{"id":6368,"precertRequired":false,"billingCode":"88182","codeType":"CPT"},{"id":6383,"precertRequired":false,"billingCode":"88248","codeType":"CPT"},{"id":6385,"precertRequired":false,"billingCode":"88261","codeType":"CPT"},{"id":6386,"precertRequired":false,"billingCode":"88262","codeType":"CPT"},{"id":6387,"precertRequired":false,"billingCode":"88263","codeType":"CPT"},{"id":6393,"precertRequired":false,"billingCode":"88273","codeType":"CPT"},{"id":6396,"precertRequired":false,"billingCode":"88280","codeType":"CPT"},{"id":6397,"precertRequired":false,"billingCode":"88283","codeType":"CPT"},{"id":6398,"precertRequired":false,"billingCode":"88285","codeType":"CPT"},{"id":6466,"precertRequired":false,"billingCode":"89240","codeType":"CPT"},{"id":6467,"precertRequired":true,"billingCode":"89250","codeType":"CPT"},{"id":6468,"precertRequired":true,"billingCode":"89251","codeType":"CPT"},{"id":6469,"precertRequired":true,"billingCode":"89253","codeType":"CPT"},{"id":6470,"precertRequired":true,"billingCode":"89254","codeType":"CPT"},{"id":6471,"precertRequired":true,"billingCode":"89255","codeType":"CPT"},{"id":6473,"precertRequired":true,"billingCode":"89258","codeType":"CPT"},{"id":6478,"precertRequired":true,"billingCode":"89268","codeType":"CPT"},{"id":6479,"precertRequired":true,"billingCode":"89272","codeType":"CPT"},{"id":6480,"precertRequired":true,"billingCode":"89280","codeType":"CPT"},{"id":6481,"precertRequired":true,"billingCode":"89281","codeType":"CPT"},{"id":6482,"precertRequired":true,"billingCode":"89290","codeType":"CPT"},{"id":6483,"precertRequired":true,"billingCode":"89291","codeType":"CPT"},{"id":6491,"precertRequired":false,"billingCode":"89330","codeType":"CPT"},{"id":6495,"precertRequired":true,"billingCode":"89342","codeType":"CPT"},{"id":6496,"precertRequired":true,"billingCode":"89343","codeType":"CPT"},{"id":6497,"precertRequired":true,"billingCode":"89344","codeType":"CPT"},{"id":6498,"precertRequired":true,"billingCode":"89346","codeType":"CPT"},{"id":6499,"precertRequired":true,"billingCode":"89352","codeType":"CPT"},{"id":6501,"precertRequired":true,"billingCode":"89354","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":697,"description":"Procedures to include: ovarian stimulation medications (oral and/or injectable), oocyte harvesting, In-vitro insemination (IVF) including intra-cytoplasmic sperm injection (ICSI), embryo culture, fresh or frozen embryo transfer, cryopreservation techniques and genetic testing as indicated. Ovarian stimulation will require multiple labs and ultrasounds","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":95,"precertRequired":false,"billingCode":"00842","codeType":"CPT"},{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":222,"precertRequired":false,"billingCode":"10022","codeType":"CPT"},{"id":3658,"precertRequired":false,"billingCode":"58120","codeType":"CPT"},{"id":3659,"precertRequired":false,"billingCode":"58140","codeType":"CPT"},{"id":3660,"precertRequired":false,"billingCode":"58145","codeType":"CPT"},{"id":3661,"precertRequired":false,"billingCode":"58146","codeType":"CPT"},{"id":3683,"precertRequired":true,"billingCode":"58321","codeType":"CPT"},{"id":3684,"precertRequired":false,"billingCode":"58322","codeType":"CPT"},{"id":3685,"precertRequired":true,"billingCode":"58323","codeType":"CPT"},{"id":3686,"precertRequired":false,"billingCode":"58340","codeType":"CPT"},{"id":3687,"precertRequired":false,"billingCode":"58345","codeType":"CPT"},{"id":3688,"precertRequired":false,"billingCode":"58350","codeType":"CPT"},{"id":3694,"precertRequired":false,"billingCode":"58540","codeType":"CPT"},{"id":3699,"precertRequired":false,"billingCode":"58545","codeType":"CPT"},{"id":3700,"precertRequired":false,"billingCode":"58546","codeType":"CPT"},{"id":3707,"precertRequired":false,"billingCode":"58558","codeType":"CPT"},{"id":3708,"precertRequired":false,"billingCode":"58559","codeType":"CPT"},{"id":3709,"precertRequired":false,"billingCode":"58560","codeType":"CPT"},{"id":3710,"precertRequired":false,"billingCode":"58561","codeType":"CPT"},{"id":3727,"precertRequired":false,"billingCode":"58662","codeType":"CPT"},{"id":3728,"precertRequired":true,"billingCode":"58670","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3733,"precertRequired":false,"billingCode":"58679","codeType":"CPT"},{"id":3734,"precertRequired":false,"billingCode":"58700","codeType":"CPT"},{"id":3736,"precertRequired":false,"billingCode":"58740","codeType":"CPT"},{"id":3738,"precertRequired":false,"billingCode":"58752","codeType":"CPT"},{"id":3739,"precertRequired":false,"billingCode":"58760","codeType":"CPT"},{"id":3740,"precertRequired":false,"billingCode":"58770","codeType":"CPT"},{"id":3741,"precertRequired":false,"billingCode":"58800","codeType":"CPT"},{"id":3742,"precertRequired":false,"billingCode":"58805","codeType":"CPT"},{"id":3747,"precertRequired":false,"billingCode":"58920","codeType":"CPT"},{"id":3760,"precertRequired":false,"billingCode":"58970","codeType":"CPT"},{"id":3761,"precertRequired":false,"billingCode":"58974","codeType":"CPT"},{"id":3762,"precertRequired":false,"billingCode":"58976","codeType":"CPT"},{"id":3763,"precertRequired":false,"billingCode":"58999","codeType":"CPT"},{"id":3797,"precertRequired":false,"billingCode":"59425","codeType":"CPT"},{"id":3798,"precertRequired":false,"billingCode":"59426","codeType":"CPT"},{"id":3800,"precertRequired":false,"billingCode":"59510","codeType":"CPT"},{"id":3804,"precertRequired":false,"billingCode":"59610","codeType":"CPT"},{"id":3807,"precertRequired":false,"billingCode":"59618","codeType":"CPT"},{"id":3811,"precertRequired":false,"billingCode":"59820","codeType":"CPT"},{"id":3814,"precertRequired":false,"billingCode":"59840","codeType":"CPT"},{"id":4365,"precertRequired":false,"billingCode":"69990","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4740,"precertRequired":false,"billingCode":"76815","codeType":"CPT"},{"id":4741,"precertRequired":false,"billingCode":"76816","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4765,"precertRequired":false,"billingCode":"76941","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7325,"precertRequired":false,"billingCode":"99078","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":698,"description":"Maximum of six (6) attempts to achieve three (3) complete IVF cycles in a lifetime of the eligible service-connected Veteran. A cycle is defined as transfer of one (1) or more embryos.  Transfer of a frozen embryo would be considered a cycle.","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":8392,"precertRequired":false,"billingCode":"J0725","codeType":"HCPCS"},{"id":8508,"precertRequired":false,"billingCode":"J3355","codeType":"HCPCS"},{"id":8881,"precertRequired":false,"billingCode":"S0122","codeType":"HCPCS"},{"id":8882,"precertRequired":false,"billingCode":"S0126","codeType":"HCPCS"},{"id":8883,"precertRequired":false,"billingCode":"S0128","codeType":"HCPCS"},{"id":8908,"precertRequired":false,"billingCode":"S3600","codeType":"HCPCS"},{"id":8911,"precertRequired":false,"billingCode":"S3655","codeType":"HCPCS"},{"id":8913,"precertRequired":false,"billingCode":"S4011","codeType":"HCPCS"},{"id":8914,"precertRequired":false,"billingCode":"S4013","codeType":"HCPCS"},{"id":8915,"precertRequired":false,"billingCode":"S4014","codeType":"HCPCS"},{"id":8916,"precertRequired":true,"billingCode":"S4015","codeType":"HCPCS"},{"id":8917,"precertRequired":true,"billingCode":"S4016","codeType":"HCPCS"},{"id":8918,"precertRequired":false,"billingCode":"S4017","codeType":"HCPCS"},{"id":8919,"precertRequired":false,"billingCode":"S4018","codeType":"HCPCS"},{"id":8920,"precertRequired":false,"billingCode":"S4020","codeType":"HCPCS"},{"id":8921,"precertRequired":false,"billingCode":"S4021","codeType":"HCPCS"},{"id":8922,"precertRequired":false,"billingCode":"S4022","codeType":"HCPCS"},{"id":8923,"precertRequired":true,"billingCode":"S4023","codeType":"HCPCS"},{"id":8924,"precertRequired":true,"billingCode":"S4025","codeType":"HCPCS"},{"id":8925,"precertRequired":true,"billingCode":"S4026","codeType":"HCPCS"},{"id":8926,"precertRequired":false,"billingCode":"S4027","codeType":"HCPCS"},{"id":8930,"precertRequired":false,"billingCode":"S4035","codeType":"HCPCS"},{"id":8931,"precertRequired":false,"billingCode":"S4037","codeType":"HCPCS"},{"id":8932,"precertRequired":false,"billingCode":"S4042","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]}]}},{"Seoc":{"id":21,"seocKey":10,"name":"ART-IVF Female_PRCT","seocId":"INF_ART-IVF FEMALE_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition. Services can only be provided through the Patient Centered Community Care (PC3) contract.","effectiveDate":"11-01-2017","endDate":"01-02-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for infertility\r\n2. Six (6) visits for diagnostic imaging relevant to the referred condition\r\n3. Twelve (12) visits for diagnostic studies, lab and pathology services relevant to the referred condition\r\n4. Procedures to include: ovarian stimulation medications (oral and/or injectable), oocyte harvesting, In-vitro insemination (IVF) including intra-cytoplasmic sperm injection (ICSI), embryo culture, fresh or frozen embryo transfer, cryopreservation techniques and genetic testing as indicated. Ovarian stimulation will require multiple labs and ultrasounds\r\n5. Maximum of six (6) attempts to achieve three (3) complete IVF cycles in a lifetime of the eligible service-connected Veteran. A cycle is defined as transfer of one (1) or more embryos.  Transfer of a frozen embryo would be considered a cycle.","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"IN-VITRO FERTILIZATION (IVF)/ ASSISTED REPRODUCTIVE TECH (ART)","serviceLine":"Infertility Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":226,"description":"Initial outpatient evaluation and treatment for infertility","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":227,"description":"Six (6) visits for diagnostic imaging relevant to the referred condition","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4737,"precertRequired":true,"billingCode":"76812","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":228,"description":" Twelve (12) visits for diagnostic studies, lab and pathology services relevant to the referred condition","frequency":null,"frequencyType":"","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":3706,"precertRequired":false,"billingCode":"58555","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5190,"precertRequired":true,"billingCode":"81224","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5567,"precertRequired":false,"billingCode":"83498","codeType":"CPT"},{"id":5573,"precertRequired":false,"billingCode":"83520","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5666,"precertRequired":false,"billingCode":"84146","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5763,"precertRequired":false,"billingCode":"84830","codeType":"CPT"},{"id":6368,"precertRequired":false,"billingCode":"88182","codeType":"CPT"},{"id":6383,"precertRequired":false,"billingCode":"88248","codeType":"CPT"},{"id":6385,"precertRequired":false,"billingCode":"88261","codeType":"CPT"},{"id":6386,"precertRequired":false,"billingCode":"88262","codeType":"CPT"},{"id":6387,"precertRequired":false,"billingCode":"88263","codeType":"CPT"},{"id":6393,"precertRequired":false,"billingCode":"88273","codeType":"CPT"},{"id":6396,"precertRequired":false,"billingCode":"88280","codeType":"CPT"},{"id":6397,"precertRequired":false,"billingCode":"88283","codeType":"CPT"},{"id":6398,"precertRequired":false,"billingCode":"88285","codeType":"CPT"},{"id":6466,"precertRequired":false,"billingCode":"89240","codeType":"CPT"},{"id":6467,"precertRequired":true,"billingCode":"89250","codeType":"CPT"},{"id":6468,"precertRequired":true,"billingCode":"89251","codeType":"CPT"},{"id":6469,"precertRequired":true,"billingCode":"89253","codeType":"CPT"},{"id":6470,"precertRequired":true,"billingCode":"89254","codeType":"CPT"},{"id":6471,"precertRequired":true,"billingCode":"89255","codeType":"CPT"},{"id":6473,"precertRequired":true,"billingCode":"89258","codeType":"CPT"},{"id":6478,"precertRequired":true,"billingCode":"89268","codeType":"CPT"},{"id":6479,"precertRequired":true,"billingCode":"89272","codeType":"CPT"},{"id":6480,"precertRequired":true,"billingCode":"89280","codeType":"CPT"},{"id":6481,"precertRequired":true,"billingCode":"89281","codeType":"CPT"},{"id":6482,"precertRequired":true,"billingCode":"89290","codeType":"CPT"},{"id":6483,"precertRequired":true,"billingCode":"89291","codeType":"CPT"},{"id":6491,"precertRequired":false,"billingCode":"89330","codeType":"CPT"},{"id":6495,"precertRequired":true,"billingCode":"89342","codeType":"CPT"},{"id":6496,"precertRequired":true,"billingCode":"89343","codeType":"CPT"},{"id":6497,"precertRequired":true,"billingCode":"89344","codeType":"CPT"},{"id":6498,"precertRequired":true,"billingCode":"89346","codeType":"CPT"},{"id":6499,"precertRequired":true,"billingCode":"89352","codeType":"CPT"},{"id":6501,"precertRequired":true,"billingCode":"89354","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":229,"description":"Procedures to include: ovarian stimulation medications (oral and/or injectable), oocyte harvesting, In-vitro insemination (IVF) including intra-cytoplasmic sperm injection (ICSI), embryo culture, fresh or frozen embryo transfer, cryopreservation techniques and genetic testing as indicated. Ovarian stimulation will require multiple labs and ultrasounds","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":95,"precertRequired":false,"billingCode":"00842","codeType":"CPT"},{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":222,"precertRequired":false,"billingCode":"10022","codeType":"CPT"},{"id":3658,"precertRequired":false,"billingCode":"58120","codeType":"CPT"},{"id":3659,"precertRequired":false,"billingCode":"58140","codeType":"CPT"},{"id":3660,"precertRequired":false,"billingCode":"58145","codeType":"CPT"},{"id":3661,"precertRequired":false,"billingCode":"58146","codeType":"CPT"},{"id":3683,"precertRequired":true,"billingCode":"58321","codeType":"CPT"},{"id":3684,"precertRequired":false,"billingCode":"58322","codeType":"CPT"},{"id":3685,"precertRequired":true,"billingCode":"58323","codeType":"CPT"},{"id":3686,"precertRequired":false,"billingCode":"58340","codeType":"CPT"},{"id":3687,"precertRequired":false,"billingCode":"58345","codeType":"CPT"},{"id":3688,"precertRequired":false,"billingCode":"58350","codeType":"CPT"},{"id":3694,"precertRequired":false,"billingCode":"58540","codeType":"CPT"},{"id":3699,"precertRequired":false,"billingCode":"58545","codeType":"CPT"},{"id":3700,"precertRequired":false,"billingCode":"58546","codeType":"CPT"},{"id":3707,"precertRequired":false,"billingCode":"58558","codeType":"CPT"},{"id":3708,"precertRequired":false,"billingCode":"58559","codeType":"CPT"},{"id":3709,"precertRequired":false,"billingCode":"58560","codeType":"CPT"},{"id":3710,"precertRequired":false,"billingCode":"58561","codeType":"CPT"},{"id":3727,"precertRequired":false,"billingCode":"58662","codeType":"CPT"},{"id":3728,"precertRequired":true,"billingCode":"58670","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3733,"precertRequired":false,"billingCode":"58679","codeType":"CPT"},{"id":3734,"precertRequired":false,"billingCode":"58700","codeType":"CPT"},{"id":3736,"precertRequired":false,"billingCode":"58740","codeType":"CPT"},{"id":3738,"precertRequired":false,"billingCode":"58752","codeType":"CPT"},{"id":3739,"precertRequired":false,"billingCode":"58760","codeType":"CPT"},{"id":3740,"precertRequired":false,"billingCode":"58770","codeType":"CPT"},{"id":3741,"precertRequired":false,"billingCode":"58800","codeType":"CPT"},{"id":3742,"precertRequired":false,"billingCode":"58805","codeType":"CPT"},{"id":3747,"precertRequired":false,"billingCode":"58920","codeType":"CPT"},{"id":3760,"precertRequired":false,"billingCode":"58970","codeType":"CPT"},{"id":3761,"precertRequired":false,"billingCode":"58974","codeType":"CPT"},{"id":3762,"precertRequired":false,"billingCode":"58976","codeType":"CPT"},{"id":3763,"precertRequired":false,"billingCode":"58999","codeType":"CPT"},{"id":3797,"precertRequired":false,"billingCode":"59425","codeType":"CPT"},{"id":3798,"precertRequired":false,"billingCode":"59426","codeType":"CPT"},{"id":3800,"precertRequired":false,"billingCode":"59510","codeType":"CPT"},{"id":3804,"precertRequired":false,"billingCode":"59610","codeType":"CPT"},{"id":3807,"precertRequired":false,"billingCode":"59618","codeType":"CPT"},{"id":3811,"precertRequired":false,"billingCode":"59820","codeType":"CPT"},{"id":3814,"precertRequired":false,"billingCode":"59840","codeType":"CPT"},{"id":4365,"precertRequired":false,"billingCode":"69990","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4740,"precertRequired":false,"billingCode":"76815","codeType":"CPT"},{"id":4741,"precertRequired":false,"billingCode":"76816","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4765,"precertRequired":false,"billingCode":"76941","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7325,"precertRequired":false,"billingCode":"99078","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":230,"description":"Maximum of six (6) attempts to achieve three (3) complete IVF cycles in a lifetime of the eligible service-connected Veteran. A cycle is defined as transfer of one (1) or more embryos.  Transfer of a frozen embryo would be considered a cycle.","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":8392,"precertRequired":false,"billingCode":"J0725","codeType":"HCPCS"},{"id":8508,"precertRequired":false,"billingCode":"J3355","codeType":"HCPCS"},{"id":8881,"precertRequired":false,"billingCode":"S0122","codeType":"HCPCS"},{"id":8882,"precertRequired":false,"billingCode":"S0126","codeType":"HCPCS"},{"id":8883,"precertRequired":false,"billingCode":"S0128","codeType":"HCPCS"},{"id":8908,"precertRequired":false,"billingCode":"S3600","codeType":"HCPCS"},{"id":8911,"precertRequired":false,"billingCode":"S3655","codeType":"HCPCS"},{"id":8913,"precertRequired":false,"billingCode":"S4011","codeType":"HCPCS"},{"id":8914,"precertRequired":false,"billingCode":"S4013","codeType":"HCPCS"},{"id":8915,"precertRequired":false,"billingCode":"S4014","codeType":"HCPCS"},{"id":8916,"precertRequired":true,"billingCode":"S4015","codeType":"HCPCS"},{"id":8917,"precertRequired":true,"billingCode":"S4016","codeType":"HCPCS"},{"id":8918,"precertRequired":false,"billingCode":"S4017","codeType":"HCPCS"},{"id":8919,"precertRequired":false,"billingCode":"S4018","codeType":"HCPCS"},{"id":8920,"precertRequired":false,"billingCode":"S4020","codeType":"HCPCS"},{"id":8921,"precertRequired":false,"billingCode":"S4021","codeType":"HCPCS"},{"id":8922,"precertRequired":false,"billingCode":"S4022","codeType":"HCPCS"},{"id":8923,"precertRequired":true,"billingCode":"S4023","codeType":"HCPCS"},{"id":8924,"precertRequired":true,"billingCode":"S4025","codeType":"HCPCS"},{"id":8925,"precertRequired":true,"billingCode":"S4026","codeType":"HCPCS"},{"id":8926,"precertRequired":false,"billingCode":"S4027","codeType":"HCPCS"},{"id":8930,"precertRequired":false,"billingCode":"S4035","codeType":"HCPCS"},{"id":8931,"precertRequired":false,"billingCode":"S4037","codeType":"HCPCS"},{"id":8932,"precertRequired":false,"billingCode":"S4042","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]}]}},{"Seoc":{"id":539,"seocKey":11,"name":"Audiology DS Routine_PRCT","seocId":"AUD_AUDIOLOGY DS ROUTINE_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":null,"duration":240,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for a comprehensive diagnostic audiologic evaluation for the referred condition indicated on the consult\r\n2.  Hearing aid fitting\r\n3.  Follow-up visits for this episode of care","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"231H00000X"},{"hptc":"237600000X"}],"services":[{"id":3127,"description":"Initial outpatient evaluation and treatment for a comprehensive diagnostic audiologic evaluation for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":9126,"precertRequired":false,"billingCode":"V5010","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":3128,"description":"Hearing aid fitting","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9128,"precertRequired":false,"billingCode":"V5014","codeType":"HCPCS"},{"id":9129,"precertRequired":false,"billingCode":"V5020","codeType":"HCPCS"},{"id":9130,"precertRequired":false,"billingCode":"V5160","codeType":"HCPCS"},{"id":9133,"precertRequired":false,"billingCode":"V5275","codeType":"HCPCS"},{"id":11330,"precertRequired":false,"billingCode":"V5110","codeType":"HCPCS"},{"id":11331,"precertRequired":false,"billingCode":"V5241","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":3129,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":339,"seocKey":11,"name":"Audiology DS Routine_PRCT","seocId":"AUD_AUDIOLOGY DS ROUTINE_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"04-19-2019","endDate":"07-28-2019","duration":240,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for a comprehensive diagnostic audiologic evaluation for the referred condition indicated on the consult\r\n2.  Hearing aid fitting\r\n3.  Follow-up visits for this episode of care","maxAllowableVisits":null,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* If hearing aids are indicated they will be VA provided.  The community provider is required to send the hearing aid order form and a copy of the Veteran's audiogram to the VA Centralized Audiology Team.   Phone: 720-497-2330  FAX: 720-497-2316\r\n* Prior to authorization of cochlear implant surgery, cochlear implant candidacy documentation would be sent to the VA Centralized Audiology Team. Their phone number is (720) 497-2330 and their fax number is (720) 497-2316.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"231H00000X"},{"hptc":"237600000X"}],"services":[{"id":1766,"description":"Initial outpatient evaluation and treatment for a comprehensive diagnostic audiologic evaluation for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":9126,"precertRequired":false,"billingCode":"V5010","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":1767,"description":"Hearing aid fitting","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9128,"precertRequired":false,"billingCode":"V5014","codeType":"HCPCS"},{"id":9129,"precertRequired":false,"billingCode":"V5020","codeType":"HCPCS"},{"id":9130,"precertRequired":false,"billingCode":"V5160","codeType":"HCPCS"},{"id":9133,"precertRequired":false,"billingCode":"V5275","codeType":"HCPCS"},{"id":11330,"precertRequired":false,"billingCode":"V5110","codeType":"HCPCS"},{"id":11331,"precertRequired":false,"billingCode":"V5241","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":1768,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":192,"seocKey":11,"name":"Audiology DS Routine_PRCT","seocId":"AUD_AUDIOLOGY DS ROUTINE_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition. Prior to authorization of cochlear implant surgery, cochlear implant candidacy documentation is required to be sent to the VA Centralized Audiology Team (please refer to disclaimer below).","effectiveDate":"01-02-2019","endDate":"04-19-2019","duration":240,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the one (1) comprehensive diagnostic audiologic evaluation for the referred condition indicated on the consult\r\n2. One hearing aid fitting\r\n3. Three follow-up visits","maxAllowableVisits":999,"disclaimer":"** If hearing aids are indicated the community provider is required to send the hearing aid order form and a copy of the Veteran's audiogram to the referring VA for approval and ordering. Hearing aids will be mailed to the community provider by the VA.\r\n** Prior to authorization of cochlear implant surgery, cochlear implant candidacy documentation would be sent to the VA Centralized Audiology Team. Their phone number is (720) 497-2330 and their email is VACAT@va.gov.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"231H00000X"},{"hptc":"237600000X"}],"services":[{"id":729,"description":"Initial outpatient evaluation and treatment for the one (1) comprehensive diagnostic audiologic evaluation for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4356,"precertRequired":true,"billingCode":"69222","codeType":"CPT"},{"id":6712,"precertRequired":false,"billingCode":"92531","codeType":"CPT"},{"id":6713,"precertRequired":false,"billingCode":"92532","codeType":"CPT"},{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6715,"precertRequired":false,"billingCode":"92534","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6736,"precertRequired":false,"billingCode":"92562","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6749,"precertRequired":false,"billingCode":"92582","codeType":"CPT"},{"id":6750,"precertRequired":false,"billingCode":"92583","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6767,"precertRequired":false,"billingCode":"92606","codeType":"CPT"},{"id":6779,"precertRequired":true,"billingCode":"92618","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6785,"precertRequired":false,"billingCode":"92630","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"},{"id":6787,"precertRequired":false,"billingCode":"92640","codeType":"CPT"},{"id":6788,"precertRequired":false,"billingCode":"92700","codeType":"CPT"},{"id":7293,"precertRequired":false,"billingCode":"97762","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8700,"precertRequired":true,"billingCode":"L8616","codeType":"HCPCS"},{"id":8701,"precertRequired":true,"billingCode":"L8617","codeType":"HCPCS"},{"id":8702,"precertRequired":true,"billingCode":"L8618","codeType":"HCPCS"},{"id":8714,"precertRequired":true,"billingCode":"L8691","codeType":"HCPCS"},{"id":8715,"precertRequired":true,"billingCode":"L8692","codeType":"HCPCS"},{"id":8895,"precertRequired":false,"billingCode":"S0618","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":730,"description":"One hearing aid fitting","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6762,"precertRequired":false,"billingCode":"92596","codeType":"CPT"},{"id":9125,"precertRequired":false,"billingCode":"V5008","codeType":"HCPCS"},{"id":9126,"precertRequired":false,"billingCode":"V5010","codeType":"HCPCS"},{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9128,"precertRequired":false,"billingCode":"V5014","codeType":"HCPCS"},{"id":9129,"precertRequired":false,"billingCode":"V5020","codeType":"HCPCS"},{"id":9130,"precertRequired":false,"billingCode":"V5160","codeType":"HCPCS"},{"id":9131,"precertRequired":false,"billingCode":"V5264","codeType":"HCPCS"},{"id":9133,"precertRequired":false,"billingCode":"V5275","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":731,"description":"Three follow-up visits","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":127,"seocKey":11,"name":"Audiology DS Routine_PRCT","seocId":"AUD_AUDIOLOGY DS ROUTINE_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition. Prior to authorization of cochlear implant surgery, cochlear implant candidacy documentation is required to be sent to the VA Centralized Audiology Team (please refer to disclaimer below).","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":240,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the one (1) comprehensive diagnostic audiologic evaluation for the referred condition indicated on the consult\r\n2. One hearing aid fitting\r\n3. Three follow-up visits","maxAllowableVisits":999,"disclaimer":"** If hearing aids are indicated the community provider is required to send the hearing aid order form and a copy of the Veteran's audiogram to the referring VA for approval and ordering. Hearing aids will be mailed to the community provider by the VA.\r\n** Prior to authorization of cochlear implant surgery, cochlear implant candidacy documentation would be sent to the VA Centralized Audiology Team. Their phone number is (720) 497-2330 and their email is VACAT@va.gov.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":49,"description":"Initial outpatient evaluation and treatment for the one (1) comprehensive diagnostic audiologic evaluation for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4356,"precertRequired":true,"billingCode":"69222","codeType":"CPT"},{"id":6712,"precertRequired":false,"billingCode":"92531","codeType":"CPT"},{"id":6713,"precertRequired":false,"billingCode":"92532","codeType":"CPT"},{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6715,"precertRequired":false,"billingCode":"92534","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6736,"precertRequired":false,"billingCode":"92562","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6749,"precertRequired":false,"billingCode":"92582","codeType":"CPT"},{"id":6750,"precertRequired":false,"billingCode":"92583","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6767,"precertRequired":false,"billingCode":"92606","codeType":"CPT"},{"id":6779,"precertRequired":true,"billingCode":"92618","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6785,"precertRequired":false,"billingCode":"92630","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"},{"id":6787,"precertRequired":false,"billingCode":"92640","codeType":"CPT"},{"id":6788,"precertRequired":false,"billingCode":"92700","codeType":"CPT"},{"id":7293,"precertRequired":false,"billingCode":"97762","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8700,"precertRequired":true,"billingCode":"L8616","codeType":"HCPCS"},{"id":8701,"precertRequired":true,"billingCode":"L8617","codeType":"HCPCS"},{"id":8702,"precertRequired":true,"billingCode":"L8618","codeType":"HCPCS"},{"id":8714,"precertRequired":true,"billingCode":"L8691","codeType":"HCPCS"},{"id":8715,"precertRequired":true,"billingCode":"L8692","codeType":"HCPCS"},{"id":8895,"precertRequired":false,"billingCode":"S0618","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":50,"description":"One hearing aid fitting","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6762,"precertRequired":false,"billingCode":"92596","codeType":"CPT"},{"id":9125,"precertRequired":false,"billingCode":"V5008","codeType":"HCPCS"},{"id":9126,"precertRequired":false,"billingCode":"V5010","codeType":"HCPCS"},{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9128,"precertRequired":false,"billingCode":"V5014","codeType":"HCPCS"},{"id":9129,"precertRequired":false,"billingCode":"V5020","codeType":"HCPCS"},{"id":9130,"precertRequired":false,"billingCode":"V5160","codeType":"HCPCS"},{"id":9131,"precertRequired":false,"billingCode":"V5264","codeType":"HCPCS"},{"id":9133,"precertRequired":false,"billingCode":"V5275","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":51,"description":"Three follow-up visits","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":22,"seocKey":11,"name":"Audiology_PRCT","seocId":"AUD_AUDIOLOGY_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"12-07-2018","duration":240,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the one (1) comprehensive diagnostic audiologic evaluation for the referred condition indicated on the consult\r\n2. One hearing aid fitting\r\n3. One follow-up visit","maxAllowableVisits":999,"disclaimer":"*** If hearing aids are indicated the community provider is required to send the hearing aid order form and a copy of the Veteran's audiogram to the referring VA for approval and ordering. Hearing aids will be mailed to the community provider by the VA.\r\n**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1305,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":540,"seocKey":12,"name":"Audiology Cochlear Implant Annual Follow Up_PRCT","seocId":"AUD_AUDIOLOGY COCHLEAR IMPLANT ANNUAL FOLLOW UP_1.3.3_PRCT","versionNumber":"1.3.3","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"07-28-2019","endDate":null,"duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Follow-up for cochlear implant programming","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"231H00000X"}],"services":[{"id":3130,"description":"Follow-up for cochlear implant programming","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8692,"precertRequired":false,"billingCode":"L7510","codeType":"HCPCS"},{"id":8693,"precertRequired":false,"billingCode":"L7520","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":189,"seocKey":12,"name":"Audiology Cochlear Implant Annual Follow Up_PRCT","seocId":"AUD_AUDIOLOGY COCHLEAR IMPLANT ANNUAL FOLLOW UP_1.3.2_PRCT","versionNumber":"1.3.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Follow-up for cochlear implant programming","maxAllowableVisits":null,"disclaimer":"* Additional surgical or medical consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA *Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"231H00000X"}],"services":[{"id":699,"description":"Follow-up for cochlear implant programming","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8692,"precertRequired":false,"billingCode":"L7510","codeType":"HCPCS"},{"id":8693,"precertRequired":false,"billingCode":"L7520","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":125,"seocKey":12,"name":"Audiology Cochlear Implant Annual Follow Up_PRCT","seocId":"AUD_AUDIOLOGY COCHLEAR IMPLANT ANNUAL FOLLOW UP_1.3.1_PRCT","versionNumber":"1.3.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Follow-up for cochlear implant programming","maxAllowableVisits":999,"disclaimer":"* Additional surgical or medical consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA *Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":19,"description":"Follow-up for cochlear implant programming","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8692,"precertRequired":false,"billingCode":"L7510","codeType":"HCPCS"},{"id":8693,"precertRequired":false,"billingCode":"L7520","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":1891,"seocKey":13,"name":"Audiology Comprehensive_PRCT","seocId":"AUD_AUDIOLOGY COMPREHENSIVE_1.1.5_PRCT","versionNumber":"1.1.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.  Utilization of this SEOC requires previously documented audiologic evaluation/audiogram through the VA or community provider. This SEOC excludes cochlear implant procedures.","effectiveDate":"07-23-2020","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition indicated on the consult order\r\n2.    Device and/or programming follow up as clinically necessary\r\n3.    Diagnostic studies including but not limited to:  evoked potential testing, VNG, posturography, VHIT, VEMP, rotary chair after posturography relevant to the referred condition on the consult order\r\n4.    Canalith Repositioning - visit with 2 follow ups**\r\n5.    Surgical evaluation for osseointegrated hearing devices as clinically indicated for the referred condition on the consult order\r\n6.    Diagnostic imaging relevant to the evaluation for an osseointegrated hearing device\r\n7.    Labs and pathology relevant to the evaluation for an osseointegrated hearing device **\r\n8.    Anesthesia consultation related to the evaluation for an osseointegrated hearing device\r\n9.    Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR as related to the evaluation for an osseointegrated hearing device\r\n10.   Inpatient or observation admission for surgical procedure if indicated\r\n11.   Inpatient admission or observation status for complications related to the osseointegrated hearing device\r\n**Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n12.    Follow-up visits for this episode of care, to include up to three (3) clinically indicated\r\nvisits after the global period\r\n13.    Follow-up imaging as required by the surgeon after an osseointegrated hearing devices had been implanted\r\n14.    Follow-up studies as required by the surgeon after an osseointegrated hearing devices had been implanted\r\n15.    Audiology fitting of processor when osseointegration is complete as determined by surgeon\r\n16.    Follow up osseointegrated hearing testing after device fitting","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"231H00000X"}],"services":[{"id":6069,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6749,"precertRequired":false,"billingCode":"92582","codeType":"CPT"},{"id":6750,"precertRequired":false,"billingCode":"92583","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":6070,"description":"Device and/or programming follow up as clinically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":9128,"precertRequired":false,"billingCode":"V5014","codeType":"HCPCS"},{"id":9131,"precertRequired":false,"billingCode":"V5264","codeType":"HCPCS"},{"id":9133,"precertRequired":false,"billingCode":"V5275","codeType":"HCPCS"},{"id":13523,"precertRequired":false,"billingCode":"V5265","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":6071,"description":"Diagnostic studies including but not limited to:  evoked potential testing, VNG, posturography, VHIT, VEMP, rotary chair after posturography relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6708,"precertRequired":true,"billingCode":"92521","codeType":"CPT"},{"id":6709,"precertRequired":true,"billingCode":"92522","codeType":"CPT"},{"id":6710,"precertRequired":true,"billingCode":"92523","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6736,"precertRequired":false,"billingCode":"92562","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6762,"precertRequired":false,"billingCode":"92596","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6787,"precertRequired":false,"billingCode":"92640","codeType":"CPT"},{"id":6788,"precertRequired":false,"billingCode":"92700","codeType":"CPT"},{"id":8895,"precertRequired":false,"billingCode":"S0618","codeType":"HCPCS"},{"id":9125,"precertRequired":false,"billingCode":"V5008","codeType":"HCPCS"},{"id":9126,"precertRequired":false,"billingCode":"V5010","codeType":"HCPCS"},{"id":12114,"precertRequired":false,"billingCode":"0210T","codeType":"CPT"},{"id":12115,"precertRequired":false,"billingCode":"0211T","codeType":"CPT"},{"id":12116,"precertRequired":false,"billingCode":"0212T","codeType":"CPT"},{"id":13524,"precertRequired":false,"billingCode":"92559","codeType":"CPT"},{"id":13525,"precertRequired":false,"billingCode":"0208T","codeType":"CPT"},{"id":13526,"precertRequired":false,"billingCode":"0209T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":6072,"description":"Canalith Repositioning - visit with 2 follow ups**","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":6073,"description":"Surgical evaluation for osseointegrated hearing devices as clinically indicated for the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8168,"precertRequired":false,"billingCode":"G0268","codeType":"HCPCS"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"},{"id":13527,"precertRequired":false,"billingCode":"69710","codeType":"CPT"},{"id":13528,"precertRequired":false,"billingCode":"69711","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":6074,"description":"Diagnostic imaging relevant to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":6075,"description":"Labs and pathology relevant to the evaluation for an osseointegrated hearing device**","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":6076,"description":"Anesthesia consultation related to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":8331,"precertRequired":false,"billingCode":"G9654","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":6077,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR as related to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":6078,"description":"Inpatient or observation admission for surgical procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4360,"precertRequired":false,"billingCode":"69714","codeType":"CPT"},{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":8713,"precertRequired":false,"billingCode":"L8690","codeType":"HCPCS"},{"id":8714,"precertRequired":true,"billingCode":"L8691","codeType":"HCPCS"},{"id":8715,"precertRequired":true,"billingCode":"L8692","codeType":"HCPCS"},{"id":8716,"precertRequired":false,"billingCode":"L8693","codeType":"HCPCS"},{"id":8717,"precertRequired":false,"billingCode":"L8694","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":6079,"description":"Inpatient admission or observation status for complications related to the osseointegrated hearing device\r\n**Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":6080,"description":"Follow-up visits for this episode of care, to include up to three (3) clinically indicated\r\nvisits after the global period","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":6081,"description":"Follow-up imaging as required by the surgeon after an osseointegrated hearing devices had been implanted","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":6082,"description":"Follow-up studies as required by the surgeon after an osseointegrated hearing devices had been implanted","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6708,"precertRequired":true,"billingCode":"92521","codeType":"CPT"},{"id":6709,"precertRequired":true,"billingCode":"92522","codeType":"CPT"},{"id":6710,"precertRequired":true,"billingCode":"92523","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6736,"precertRequired":false,"billingCode":"92562","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6762,"precertRequired":false,"billingCode":"92596","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6787,"precertRequired":false,"billingCode":"92640","codeType":"CPT"},{"id":8895,"precertRequired":false,"billingCode":"S0618","codeType":"HCPCS"},{"id":9125,"precertRequired":false,"billingCode":"V5008","codeType":"HCPCS"},{"id":9126,"precertRequired":false,"billingCode":"V5010","codeType":"HCPCS"},{"id":12114,"precertRequired":false,"billingCode":"0210T","codeType":"CPT"},{"id":12115,"precertRequired":false,"billingCode":"0211T","codeType":"CPT"},{"id":12116,"precertRequired":false,"billingCode":"0212T","codeType":"CPT"},{"id":13524,"precertRequired":false,"billingCode":"92559","codeType":"CPT"},{"id":13525,"precertRequired":false,"billingCode":"0208T","codeType":"CPT"},{"id":13526,"precertRequired":false,"billingCode":"0209T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":6083,"description":"Audiology fitting of processor when osseointegration is complete as determined by surgeon","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9130,"precertRequired":false,"billingCode":"V5160","codeType":"HCPCS"},{"id":9134,"precertRequired":false,"billingCode":"V5336","codeType":"HCPCS"},{"id":11330,"precertRequired":false,"billingCode":"V5110","codeType":"HCPCS"},{"id":11331,"precertRequired":false,"billingCode":"V5241","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":6084,"description":"Follow up osseointegrated hearing testing after device fitting","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6785,"precertRequired":false,"billingCode":"92630","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"},{"id":9129,"precertRequired":false,"billingCode":"V5020","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":1839,"seocKey":13,"name":"Audiology Comprehensive_PRCT","seocId":"AUD_AUDIOLOGY COMPREHENSIVE_1.1.4_PRCT","versionNumber":"1.1.4","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order. Utilization of this SEOC requires previously documented audiologic evaluation/audiogram through the VA or community provider. This SEOC excludes cochlear implant procedures.","effectiveDate":"06-08-2020","endDate":"07-23-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition indicated on the consult order\r\n2.  Device and/or programming follow up as clinically necessary\r\n3.    Diagnostic studies including but not limited to:  evoked potential testing, VNG, posturography, VHIT, VEMP, rotary chair after posturography relevant to the referred condition on the consult order\r\n4.  Canalith Repositioning - visit with 2 follow ups**\r\n5.    Surgical evaluation for osseointegrated hearing devices as clinically indicated for the referred condition on the consult order\r\n6.    Diagnostic imaging relevant to the evaluation for an osseointegrated hearing device\r\n7.    Labs and pathology relevant to the evaluation for an osseointegrated hearing device **\r\n8.    Anesthesia consultation related to the evaluation for an osseointegrated hearing device\r\n9.  Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR as related to the evaluation for an osseointegrated hearing device\r\n10.   Inpatient or observation admission for surgical procedure if indicated\r\n11. Inpatient admission or observation status for complications related to the osseointegrated hearing device\r\n**Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n12.  Follow-up visits for this episode of care, to include up to three (3) clinically indicated\r\nvisits after the global period\r\n13.  Follow-up imaging as required by the surgeon after an osseointegrated hearing devices had been implanted\r\n14.  Follow-up studies as required by the surgeon after an osseointegrated hearing devices had been implanted\r\n15.  Audiology fitting of processor when osseointegration is complete as determined by surgeon\r\n16.  Follow up osseointegrated hearing testing after device fitting","maxAllowableVisits":null,"disclaimer":"*Please visit the VHA Storefront \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp \r\nfor 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","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"231H00000X"}],"services":[{"id":5843,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6749,"precertRequired":false,"billingCode":"92582","codeType":"CPT"},{"id":6750,"precertRequired":false,"billingCode":"92583","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":5844,"description":"Device and/or programming follow up as clinically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":9128,"precertRequired":false,"billingCode":"V5014","codeType":"HCPCS"},{"id":9131,"precertRequired":false,"billingCode":"V5264","codeType":"HCPCS"},{"id":9133,"precertRequired":false,"billingCode":"V5275","codeType":"HCPCS"},{"id":13523,"precertRequired":false,"billingCode":"V5265","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":5845,"description":"Diagnostic studies including but not limited to:  evoked potential testing, VNG, posturography, VHIT, VEMP, rotary chair after posturography relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6708,"precertRequired":true,"billingCode":"92521","codeType":"CPT"},{"id":6709,"precertRequired":true,"billingCode":"92522","codeType":"CPT"},{"id":6710,"precertRequired":true,"billingCode":"92523","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6736,"precertRequired":false,"billingCode":"92562","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6762,"precertRequired":false,"billingCode":"92596","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6787,"precertRequired":false,"billingCode":"92640","codeType":"CPT"},{"id":6788,"precertRequired":false,"billingCode":"92700","codeType":"CPT"},{"id":8895,"precertRequired":false,"billingCode":"S0618","codeType":"HCPCS"},{"id":9125,"precertRequired":false,"billingCode":"V5008","codeType":"HCPCS"},{"id":9126,"precertRequired":false,"billingCode":"V5010","codeType":"HCPCS"},{"id":12114,"precertRequired":false,"billingCode":"0210T","codeType":"CPT"},{"id":12115,"precertRequired":false,"billingCode":"0211T","codeType":"CPT"},{"id":12116,"precertRequired":false,"billingCode":"0212T","codeType":"CPT"},{"id":13524,"precertRequired":false,"billingCode":"92559","codeType":"CPT"},{"id":13525,"precertRequired":false,"billingCode":"0208T","codeType":"CPT"},{"id":13526,"precertRequired":false,"billingCode":"0209T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":5846,"description":"Canalith Repositioning - visit with 2 follow ups**","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":5847,"description":"Surgical evaluation for osseointegrated hearing devices as clinically indicated for the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8168,"precertRequired":false,"billingCode":"G0268","codeType":"HCPCS"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"},{"id":13527,"precertRequired":false,"billingCode":"69710","codeType":"CPT"},{"id":13528,"precertRequired":false,"billingCode":"69711","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5848,"description":"Diagnostic imaging relevant to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5849,"description":"Labs and pathology relevant to the evaluation for an osseointegrated hearing device**","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5850,"description":"Anesthesia consultation related to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":8331,"precertRequired":false,"billingCode":"G9654","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":5851,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR as related to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5852,"description":"Inpatient or observation admission for surgical procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4360,"precertRequired":false,"billingCode":"69714","codeType":"CPT"},{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":8713,"precertRequired":false,"billingCode":"L8690","codeType":"HCPCS"},{"id":8714,"precertRequired":true,"billingCode":"L8691","codeType":"HCPCS"},{"id":8715,"precertRequired":true,"billingCode":"L8692","codeType":"HCPCS"},{"id":8716,"precertRequired":false,"billingCode":"L8693","codeType":"HCPCS"},{"id":8717,"precertRequired":false,"billingCode":"L8694","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5853,"description":"Inpatient admission or observation status for complications related to the osseointegrated hearing device\r\n**Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5854,"description":"Follow-up visits for this episode of care, to include up to three (3) clinically indicated\r\nvisits after the global period","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5855,"description":"Follow-up imaging as required by the surgeon after an osseointegrated hearing devices had been implanted","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5856,"description":"Follow-up studies as required by the surgeon after an osseointegrated hearing devices had been implanted","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6708,"precertRequired":true,"billingCode":"92521","codeType":"CPT"},{"id":6709,"precertRequired":true,"billingCode":"92522","codeType":"CPT"},{"id":6710,"precertRequired":true,"billingCode":"92523","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6736,"precertRequired":false,"billingCode":"92562","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6762,"precertRequired":false,"billingCode":"92596","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6787,"precertRequired":false,"billingCode":"92640","codeType":"CPT"},{"id":8895,"precertRequired":false,"billingCode":"S0618","codeType":"HCPCS"},{"id":9125,"precertRequired":false,"billingCode":"V5008","codeType":"HCPCS"},{"id":9126,"precertRequired":false,"billingCode":"V5010","codeType":"HCPCS"},{"id":12114,"precertRequired":false,"billingCode":"0210T","codeType":"CPT"},{"id":12115,"precertRequired":false,"billingCode":"0211T","codeType":"CPT"},{"id":12116,"precertRequired":false,"billingCode":"0212T","codeType":"CPT"},{"id":13524,"precertRequired":false,"billingCode":"92559","codeType":"CPT"},{"id":13525,"precertRequired":false,"billingCode":"0208T","codeType":"CPT"},{"id":13526,"precertRequired":false,"billingCode":"0209T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5857,"description":"Audiology fitting of processor when osseointegration is complete as determined by surgeon","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9134,"precertRequired":false,"billingCode":"V5336","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":5858,"description":"Follow up osseointegrated hearing testing after device fitting","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6785,"precertRequired":false,"billingCode":"92630","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"},{"id":9129,"precertRequired":false,"billingCode":"V5020","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":487,"seocKey":13,"name":"Audiology Comprehensive_PRCT","seocId":"AUD_AUDIOLOGY COMPREHENSIVE_1.1.3_PRCT","versionNumber":"1.1.3","description":"This authorization covers services associated with all medical care listed below for the referred condition. Utilization of this SEOC requires previously documented audiologic evaluation/audiogram through the VA or community provider. This SEOC excludes cochlear implant procedures.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Device and/or programming follow up as clinically necessary\r\n3. Diagnostic studies including but not limited to:  evoked potential testing, VNG, posturography, VHIT, VEMP, rotary chair after posturography relevant to the referred condition on the consult\r\n4. Canalith Repositioning - visit with 2 follow ups**\r\n5. Surgical evaluation for osseointegrated hearing devices as clinically indicated for the referred condition on the consult\r\n6. Diagnostic imaging relevant to the evaluation for an osseointegrated hearing device\r\n7. Labs and pathology relevant to the evaluation for an osseointegrated hearing device **\r\n8. Anesthesia consultation related to the evaluation for an osseointegrated hearing device\r\n9. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR as related to the evaluation for an osseointegrated hearing device\r\n10. Inpatient or observation admission for surgical procedure if indicated\r\n11. Inpatient admission or observation status for complications related to the osseointegrated hearing device.  ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n12. Follow-up visits for this episode of care, to include up to three (3) clinically indicated\r\nvisits after the global period\r\n13. Follow-up imaging as required by the surgeon after an osseointegrated hearing devices had been implanted\r\n14. Follow-up studies as required by the surgeon after an osseointegrated hearing devices had been implanted\r\n15. Audiology fitting of processor when osseointegration is complete as determined by surgeon\r\n16. Follow up osseointegrated hearing testing after device fitting","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"231H00000X"}],"services":[{"id":2795,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":2796,"description":"Device and/or programming follow up as clinically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":2797,"description":"Diagnostic studies including but not limited to:  evoked potential testing, VNG, posturography, VHIT, VEMP, rotary chair after posturography relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6708,"precertRequired":true,"billingCode":"92521","codeType":"CPT"},{"id":6709,"precertRequired":true,"billingCode":"92522","codeType":"CPT"},{"id":6710,"precertRequired":true,"billingCode":"92523","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6788,"precertRequired":false,"billingCode":"92700","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":2798,"description":"Canalith Repositioning - visit with 2 follow ups**","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":2799,"description":"Surgical evaluation for osseointegrated hearing devices as clinically indicated for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2800,"description":"Diagnostic imaging relevant to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2801,"description":"Labs and pathology relevant to the evaluation for an osseointegrated hearing device **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":2802,"description":"Anesthesia consultation related to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":2803,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR as related to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5121,"precertRequired":false,"billingCode":"80410","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2804,"description":"Inpatient or observation admission for surgical procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4360,"precertRequired":false,"billingCode":"69714","codeType":"CPT"},{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":8713,"precertRequired":false,"billingCode":"L8690","codeType":"HCPCS"},{"id":8714,"precertRequired":true,"billingCode":"L8691","codeType":"HCPCS"},{"id":8715,"precertRequired":true,"billingCode":"L8692","codeType":"HCPCS"},{"id":8716,"precertRequired":false,"billingCode":"L8693","codeType":"HCPCS"},{"id":8717,"precertRequired":false,"billingCode":"L8694","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2805,"description":"Inpatient admission or observation status for complications related to the osseointegrated hearing device.  ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4360,"precertRequired":false,"billingCode":"69714","codeType":"CPT"},{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":8713,"precertRequired":false,"billingCode":"L8690","codeType":"HCPCS"},{"id":8714,"precertRequired":true,"billingCode":"L8691","codeType":"HCPCS"},{"id":8715,"precertRequired":true,"billingCode":"L8692","codeType":"HCPCS"},{"id":8716,"precertRequired":false,"billingCode":"L8693","codeType":"HCPCS"},{"id":8717,"precertRequired":false,"billingCode":"L8694","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2806,"description":"Follow-up visits for this episode of care, to include up to three (3) clinically indicated visits after the global period","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2807,"description":"Follow-up imaging as required by the surgeon after an osseointegrated hearing devices had been implanted","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2808,"description":"Follow-up studies as required by the surgeon after an osseointegrated hearing devices had been implanted","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6788,"precertRequired":false,"billingCode":"92700","codeType":"CPT"},{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9134,"precertRequired":false,"billingCode":"V5336","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2809,"description":"Audiology fitting of processor when osseointegration is complete as determined by surgeon","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9134,"precertRequired":false,"billingCode":"V5336","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":2810,"description":"Follow up osseointegrated hearing testing after device fitting","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6785,"precertRequired":false,"billingCode":"92630","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":191,"seocKey":13,"name":"Audiology Comprehensive_PRCT","seocId":"AUD_AUDIOLOGY COMPREHENSIVE_1.1.2_PRCT","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below for the referred condition. Utilization of this SEOC requires previously documented audiologic evaluation/audiogram through the VA or community provider. This SEOC excludes cochlear implant procedures.","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Device and/or programming follow up as clinically necessary\r\n3. Diagnostic studies including but not limited to:  evoked potential testing, VNG, posturography, VHIT, VEMP, rotary chair after posturography relevant to the referred condition on the consult\r\n4. Canalith Repositioning - visit with 2 follow ups**\r\n5. Surgical evaluation for osseointegrated hearing devices as clinically indicated for the referred condition on the consult\r\n6. Diagnostic imaging relevant to the evaluation for an osseointegrated hearing device\r\n7. Labs and pathology relevant to the evaluation for an osseointegrated hearing device **\r\n8. Anesthesia consultation related to the evaluation for an osseointegrated hearing device\r\n9. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR as related to the evaluation for an osseointegrated hearing device\r\n10. Inpatient or observation admission for surgical procedure if indicated\r\n11. Inpatient admission or observation status for complications related to the osseointegrated hearing device.  ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n12. Follow-up visits for this episode of care, to include up to three (3) clinically indicated\r\nvisits after the global period\r\n13. Follow-up imaging as required by the surgeon after an osseointegrated hearing devices had been implanted\r\n14. Follow-up studies as required by the surgeon after an osseointegrated hearing devices had been implanted\r\n15. Audiology fitting of processor when osseointegration is complete as determined by surgeon\r\n16. Follow up osseointegrated hearing testing after device fitting","maxAllowableVisits":null,"disclaimer":"* Additional surgical or medical consulations needed, relevant to the patient complaint/condition, require VA review and approval\r\n* DME, prosthetics and orthotics must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"231H00000X"}],"services":[{"id":713,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":714,"description":"Device and/or programming follow up as clinically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":715,"description":"Diagnostic studies including but not limited to:  evoked potential testing, VNG, posturography, VHIT, VEMP, rotary chair after posturography relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6788,"precertRequired":false,"billingCode":"92700","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":716,"description":"Canalith Repositioning - visit with 2 follow ups**","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":717,"description":"Surgical evaluation for osseointegrated hearing devices as clinically indicated for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":718,"description":"Diagnostic imaging relevant to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":719,"description":"Labs and pathology relevant to the evaluation for an osseointegrated hearing device **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":720,"description":"Anesthesia consultation related to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":721,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR as related to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5121,"precertRequired":false,"billingCode":"80410","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":722,"description":"Inpatient or observation admission for surgical procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4360,"precertRequired":false,"billingCode":"69714","codeType":"CPT"},{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":8713,"precertRequired":false,"billingCode":"L8690","codeType":"HCPCS"},{"id":8714,"precertRequired":true,"billingCode":"L8691","codeType":"HCPCS"},{"id":8715,"precertRequired":true,"billingCode":"L8692","codeType":"HCPCS"},{"id":8716,"precertRequired":false,"billingCode":"L8693","codeType":"HCPCS"},{"id":8717,"precertRequired":false,"billingCode":"L8694","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":723,"description":"Inpatient admission or observation status for complications related to the osseointegrated hearing device.  ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4360,"precertRequired":false,"billingCode":"69714","codeType":"CPT"},{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":8713,"precertRequired":false,"billingCode":"L8690","codeType":"HCPCS"},{"id":8714,"precertRequired":true,"billingCode":"L8691","codeType":"HCPCS"},{"id":8715,"precertRequired":true,"billingCode":"L8692","codeType":"HCPCS"},{"id":8716,"precertRequired":false,"billingCode":"L8693","codeType":"HCPCS"},{"id":8717,"precertRequired":false,"billingCode":"L8694","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":724,"description":"Follow-up visits for this episode of care, to include up to three (3) clinically indicated visits after the global period","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":725,"description":"Follow-up imaging as required by the surgeon after an osseointegrated hearing devices had been implanted","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":726,"description":"Follow-up studies as required by the surgeon after an osseointegrated hearing devices had been implanted","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6703,"precertRequired":false,"billingCode":"92506","codeType":"CPT"},{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6788,"precertRequired":false,"billingCode":"92700","codeType":"CPT"},{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9134,"precertRequired":false,"billingCode":"V5336","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":727,"description":"Audiology fitting of processor when osseointegration is complete as determined by surgeon","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6703,"precertRequired":false,"billingCode":"92506","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9134,"precertRequired":false,"billingCode":"V5336","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":728,"description":"Follow up osseointegrated hearing testing after device fitting","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6785,"precertRequired":false,"billingCode":"92630","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":126,"seocKey":13,"name":"Audiology Comprehensive_PRCT","seocId":"AUD_AUDIOLOGY COMPREHENSIVE_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below for the referred condition. Utilization of this SEOC requires previously documented audiologic evaluation/audiogram through the VA or community provider. This SEOC excludes cochlear implant procedures.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Device and/or programming follow up as clinically necessary\r\n3. Diagnostic studies including but not limited to:  evoked potential testing, VNG, posturography, VHIT, VEMP, rotary chair after posturography relevant to the referred condition on the consult\r\n4. Canalith Repositioning - visit with 2 follow ups**\r\n5. Surgical evaluation for osseointegrated hearing devices as clinically indicated for the referred condition on the consult\r\n6. Diagnostic imaging relevant to the evaluation for an osseointegrated hearing device\r\n7. Labs and pathology relevant to the evaluation for an osseointegrated hearing device **\r\n8. Anesthesia consultation related to the evaluation for an osseointegrated hearing device\r\n9. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR as related to the evaluation for an osseointegrated hearing device\r\n10. Inpatient or observation admission for surgical procedure if indicated\r\n11. Inpatient admission or observation status for complications related to the osseointegrated hearing device.  ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n12. Follow-up visits for this episode of care, to include up to three (3) clinically indicated\r\nvisits after the global period\r\n13. Follow-up imaging as required by the surgeon after an osseointegrated hearing devices had been implanted\r\n14. Follow-up studies as required by the surgeon after an osseointegrated hearing devices had been implanted\r\n15. Audiology fitting of processor when osseointegration is complete as determined by surgeon\r\n16. Follow up osseointegrated hearing testing after device fitting","maxAllowableVisits":999,"disclaimer":"* Additional surgical or medical consulations needed, relevant to the patient complaint/condition, require VA review and approval\r\n* DME, prosthetics and orthotics must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":33,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":34,"description":"Device and/or programming follow up as clinically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":35,"description":"Diagnostic studies including but not limited to:  evoked potential testing, VNG, posturography, VHIT, VEMP, rotary chair after posturography relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6788,"precertRequired":false,"billingCode":"92700","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":36,"description":"Canalith Repositioning - visit with 2 follow ups**","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":37,"description":"Surgical evaluation for osseointegrated hearing devices as clinically indicated for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":38,"description":"Diagnostic imaging relevant to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":39,"description":"Labs and pathology relevant to the evaluation for an osseointegrated hearing device **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":40,"description":"Anesthesia consultation related to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":41,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR as related to the evaluation for an osseointegrated hearing device","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5121,"precertRequired":false,"billingCode":"80410","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":42,"description":"Inpatient or observation admission for surgical procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4360,"precertRequired":false,"billingCode":"69714","codeType":"CPT"},{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":8713,"precertRequired":false,"billingCode":"L8690","codeType":"HCPCS"},{"id":8714,"precertRequired":true,"billingCode":"L8691","codeType":"HCPCS"},{"id":8715,"precertRequired":true,"billingCode":"L8692","codeType":"HCPCS"},{"id":8716,"precertRequired":false,"billingCode":"L8693","codeType":"HCPCS"},{"id":8717,"precertRequired":false,"billingCode":"L8694","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":43,"description":"Inpatient admission or observation status for complications related to the osseointegrated hearing device.  ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4360,"precertRequired":false,"billingCode":"69714","codeType":"CPT"},{"id":4361,"precertRequired":false,"billingCode":"69715","codeType":"CPT"},{"id":4362,"precertRequired":false,"billingCode":"69717","codeType":"CPT"},{"id":4363,"precertRequired":false,"billingCode":"69718","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":8713,"precertRequired":false,"billingCode":"L8690","codeType":"HCPCS"},{"id":8714,"precertRequired":true,"billingCode":"L8691","codeType":"HCPCS"},{"id":8715,"precertRequired":true,"billingCode":"L8692","codeType":"HCPCS"},{"id":8716,"precertRequired":false,"billingCode":"L8693","codeType":"HCPCS"},{"id":8717,"precertRequired":false,"billingCode":"L8694","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":44,"description":"Follow-up visits for this episode of care, to include up to three (3) clinically indicated visits after the global period","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":45,"description":"Follow-up imaging as required by the surgeon after an osseointegrated hearing devices had been implanted","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":46,"description":"Follow-up studies as required by the surgeon after an osseointegrated hearing devices had been implanted","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6703,"precertRequired":false,"billingCode":"92506","codeType":"CPT"},{"id":6714,"precertRequired":false,"billingCode":"92533","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6721,"precertRequired":false,"billingCode":"92544","codeType":"CPT"},{"id":6722,"precertRequired":false,"billingCode":"92545","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6724,"precertRequired":false,"billingCode":"92547","codeType":"CPT"},{"id":6725,"precertRequired":false,"billingCode":"92548","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6727,"precertRequired":false,"billingCode":"92551","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6733,"precertRequired":false,"billingCode":"92558","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6737,"precertRequired":false,"billingCode":"92563","codeType":"CPT"},{"id":6738,"precertRequired":false,"billingCode":"92564","codeType":"CPT"},{"id":6739,"precertRequired":false,"billingCode":"92565","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6744,"precertRequired":false,"billingCode":"92572","codeType":"CPT"},{"id":6745,"precertRequired":false,"billingCode":"92575","codeType":"CPT"},{"id":6746,"precertRequired":false,"billingCode":"92576","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6752,"precertRequired":false,"billingCode":"92585","codeType":"CPT"},{"id":6753,"precertRequired":false,"billingCode":"92586","codeType":"CPT"},{"id":6754,"precertRequired":false,"billingCode":"92587","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6780,"precertRequired":false,"billingCode":"92620","codeType":"CPT"},{"id":6781,"precertRequired":false,"billingCode":"92621","codeType":"CPT"},{"id":6782,"precertRequired":false,"billingCode":"92625","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6788,"precertRequired":false,"billingCode":"92700","codeType":"CPT"},{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9134,"precertRequired":false,"billingCode":"V5336","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":47,"description":"Audiology fitting of processor when osseointegration is complete as determined by surgeon","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6703,"precertRequired":false,"billingCode":"92506","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":9127,"precertRequired":false,"billingCode":"V5011","codeType":"HCPCS"},{"id":9134,"precertRequired":false,"billingCode":"V5336","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]},{"id":48,"description":"Follow up osseointegrated hearing testing after device fitting","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6756,"precertRequired":false,"billingCode":"92590","codeType":"CPT"},{"id":6757,"precertRequired":false,"billingCode":"92591","codeType":"CPT"},{"id":6758,"precertRequired":false,"billingCode":"92592","codeType":"CPT"},{"id":6759,"precertRequired":false,"billingCode":"92593","codeType":"CPT"},{"id":6760,"precertRequired":false,"billingCode":"92594","codeType":"CPT"},{"id":6761,"precertRequired":false,"billingCode":"92595","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6785,"precertRequired":false,"billingCode":"92630","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":1798,"seocKey":14,"name":"Blind Rehabilitation_PRCT","seocId":"PMR_BLIND REHABILITATION_1.1.4_PRCT","versionNumber":"1.1.4","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Provision of uncomplicated (requires one discipline to treat) or complicated (requires 2 or more disciplines to treat) blind rehabilitation therapy.\r\n2. Up to 18 visits for therapy.  Therapy initiation must include the development of a plan of care that is consistent with the evaluation and contains, at a minimum: \r\na.  Diagnosis linked to functional impairment and a detailed problem-based assessment\r\nb.  Treatment goals must be linked to objective measures of functional gain\r\nc.  Type, amount, duration, and frequency of services to meet outcome goals. \r\nd.  Only blind rehabilitation professionals (COMS, CVRT, CLVT, CATIS) may perform selected  therapy interventions as outlined by the ACVREP Scopes of Practice in accordance with clinical practice guidelines to improve function.\r\n3. A standardized outcomes questionnaire such as the NEI-VFQ25 must be completed at initial and discharge appointments.\r\n* Additional therapy justification must include a detailed plan linked to time limited attainment of objective functional outcomes with documented justification relating to standardized outcome questionnaire listed above.\r\n* Maintenance services to prevent exacerbations will be considered if exacerbations are caused by visual impairment becoming more acute.  If exacerbation is caused by some other disability, such as cognitive impairment or mobility impairment, it may not be treated by a blind rehabilitation professional.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"REHABILITATION MEDICINE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"152WL0500X"},{"hptc":"225XL0004X"}],"services":[{"id":5599,"description":"Provision of uncomplicated (requires one discipline to treat) or complicated (requires 2 or more disciplines to treat) blind rehabilitation therapy.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]},{"id":5600,"description":"Up to 18 visits for therapy.  Therapy initiation must include the development of a plan of care that is consistent with the evaluation and contains, at a minimum: \r\na.  Diagnosis linked to functional impairment and a detailed problem-based assessment.\r\nb.  Treatment goals must be linked to objective measures of functional gain.\r\nc.  Type, amount, duration, and frequency of services to meet outcome goals. \r\nd.  Only blind rehabilitation professionals (COMS, CVRT, CLVT, CATIS) may perform selected  therapy interventions as outlined by the ACVREP Scopes of Practice in accordance with clinical practice guidelines to improve function.","frequency":null,"frequencyType":"","visits":18,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7275,"precertRequired":false,"billingCode":"97533","codeType":"CPT"},{"id":7276,"precertRequired":false,"billingCode":"97535","codeType":"CPT"},{"id":7277,"precertRequired":false,"billingCode":"97537","codeType":"CPT"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8139,"precertRequired":false,"billingCode":"G0151","codeType":"HCPCS"},{"id":8140,"precertRequired":false,"billingCode":"G0152","codeType":"HCPCS"},{"id":8142,"precertRequired":true,"billingCode":"G0155","codeType":"HCPCS"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8144,"precertRequired":false,"billingCode":"G0157","codeType":"HCPCS"},{"id":8145,"precertRequired":false,"billingCode":"G0158","codeType":"HCPCS"},{"id":8146,"precertRequired":false,"billingCode":"G0159","codeType":"HCPCS"},{"id":8147,"precertRequired":false,"billingCode":"G0160","codeType":"HCPCS"},{"id":8148,"precertRequired":false,"billingCode":"G0161","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]},{"id":5601,"description":"A standardized outcomes questionnaire such as the NEI-VFQ25 must be completed at initial and discharge appointments.\r\n* Additional therapy justification must include a detailed plan linked to time limited attainment of objective functional outcomes with documented justification relating to standardized outcome questionnaire listed above.\r\n* Maintenance services to prevent exacerbations will be considered if exacerbations are caused by visual impairment becoming more acute.  If exacerbation is caused by some other disability, such as cognitive impairment or mobility impairment, it may not be treated by a blind rehabilitation professional.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]}]}},{"Seoc":{"id":541,"seocKey":14,"name":"Blind Rehabilitation_PRCT","seocId":"PMR_BLIND REHABILITATION_1.1.3_PRCT","versionNumber":"1.1.3","description":"This authorization covers services associated with all medical care listed below for the condition indicated on the consult.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Provision of uncomplicated (requires one discipline to treat) or complicated (requires 2 or more disciplines to treat) blind rehabilitation therapy\r\n2. Up to 18 visits for therapy.  Therapy initiation must include the development of a plan of care that is consistent with the evaluation and contains, at a minimum:   a.  Diagnosis linked to functional impairment and a detailed problem-based assessment b.  Treatment goals must be linked to objective measures of functional gain.  c.  Type, amount, duration, and frequency of services to meet outcome goals. d.  Only blind rehabilitation professionals (COMS, CVRT, CLVT, CATIS) may perform selected therapy interventions as outlined by the ACVREP Scopes of Practice in accordance with clinical practice guidelines to improve function\r\n3. A standardized outcomes questionnaire such as the NEI-VFQ25 must be completed at initial and discharge appointments.","maxAllowableVisits":null,"disclaimer":"* Additional therapy justification must include a detailed plan linked to time limited attainment of objective functional outcomes with documented justification relating to standardized outcome questionnaire listed above.\r\n* Maintenance services to prevent exacerbations will be considered if exacerbations are caused by visual impairment becoming more acute.  If exacerbation is caused by some other disability, such as cognitive im pairment or mobility impairment, it may not be treated by a blind rehabilitation professional.\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","QASP":"General Care","categoryOfCare":"REHABILITATION MEDICINE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"152WL0500X"},{"hptc":"225XL0004X"}],"services":[{"id":3131,"description":"Provision of uncomplicated (requires one discipline to treat) or complicated (requires 2 or more disciplines to treat) blind rehabilitation therapy.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]},{"id":3132,"description":"2. Up to 18 visits for therapy.  Therapy initiation must include the development of a plan of care that is consistent with the evaluation (see Procedural Overview no.2 for additional information)","frequency":null,"frequencyType":"","visits":18,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7275,"precertRequired":false,"billingCode":"97533","codeType":"CPT"},{"id":7276,"precertRequired":false,"billingCode":"97535","codeType":"CPT"},{"id":7277,"precertRequired":false,"billingCode":"97537","codeType":"CPT"},{"id":8071,"precertRequired":false,"billingCode":"E0100","codeType":"HCPCS"},{"id":8109,"precertRequired":true,"billingCode":"E2511","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8139,"precertRequired":false,"billingCode":"G0151","codeType":"HCPCS"},{"id":8140,"precertRequired":false,"billingCode":"G0152","codeType":"HCPCS"},{"id":8142,"precertRequired":true,"billingCode":"G0155","codeType":"HCPCS"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8144,"precertRequired":false,"billingCode":"G0157","codeType":"HCPCS"},{"id":8145,"precertRequired":false,"billingCode":"G0158","codeType":"HCPCS"},{"id":8146,"precertRequired":false,"billingCode":"G0159","codeType":"HCPCS"},{"id":8147,"precertRequired":false,"billingCode":"G0160","codeType":"HCPCS"},{"id":8148,"precertRequired":false,"billingCode":"G0161","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"},{"id":8276,"precertRequired":false,"billingCode":"G8978","codeType":"HCPCS"},{"id":8277,"precertRequired":false,"billingCode":"G8979","codeType":"HCPCS"},{"id":8278,"precertRequired":false,"billingCode":"G8980","codeType":"HCPCS"},{"id":8279,"precertRequired":false,"billingCode":"G8981","codeType":"HCPCS"},{"id":8280,"precertRequired":false,"billingCode":"G8982","codeType":"HCPCS"},{"id":8281,"precertRequired":false,"billingCode":"G8983","codeType":"HCPCS"},{"id":8282,"precertRequired":false,"billingCode":"G8984","codeType":"HCPCS"},{"id":8283,"precertRequired":false,"billingCode":"G8985","codeType":"HCPCS"},{"id":8284,"precertRequired":false,"billingCode":"G8986","codeType":"HCPCS"},{"id":8285,"precertRequired":false,"billingCode":"G8987","codeType":"HCPCS"},{"id":8286,"precertRequired":false,"billingCode":"G8988","codeType":"HCPCS"},{"id":8287,"precertRequired":false,"billingCode":"G8989","codeType":"HCPCS"},{"id":9085,"precertRequired":false,"billingCode":"V2600","codeType":"HCPCS"},{"id":9086,"precertRequired":false,"billingCode":"V2610","codeType":"HCPCS"},{"id":9087,"precertRequired":false,"billingCode":"V2615","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]},{"id":3133,"description":"A standardized outcomes questionnaire such as the NEI-VFQ25 must be completed at initial and discharge appointments.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]}]}},{"Seoc":{"id":193,"seocKey":14,"name":"Blind Rehabilitation PRCT_PRCT","seocId":"PMR_BLIND REHABILITATION PRCT_1.1.2_PRCT","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below for the condition indicated on the consult.","effectiveDate":"01-03-2019","endDate":"07-28-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Provision of uncomplicated (requires one discipline to treat) or complicated (requires 2 or more disciplines to treat) blind rehabilitation therapy\r\n2. Up to 18 visits for therapy.  Therapy initiation must include the development of a plan of care that is consistent with the evaluation and contains, at a minimum:   a.  Diagnosis linked to functional impairment and a detailed problem-based assessment b.  Treatment goals must be linked to objective measures of functional gain.  c.  Type, amount, duration, and frequency of services to meet outcome goals. d.  Only blind rehabilitation professionals (COMS, CVRT, CLVT, CATIS) may perform selected therapy interventions as outlined by the ACVREP Scopes of Practice in accordance with clinical practice guidelines to improve function\r\n3. A standardized outcomes questionnaire such as the NEI-VFQ25 must be completed at initial and discharge appointments.","maxAllowableVisits":null,"disclaimer":"* Requests for additional therapy/maintenance services must be submitted to VA for review and approval with supporting documentation\r\n* Additional therapy justification must include a detailed plan linked to time limited attainment of objective functional outcomes with documented justification relating to standardized outcome questionnaire listed above.\r\n* Maintenance services to prevent exacerbations will be considered if exacerbations are caused by visual impairment becoming more acute.  If exacerbation is caused by some other disability, such as cognitive im pairment or mobility impairment, it may not be treated by a blind rehabilitation professional.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"REHABILITATION MEDICINE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"152WL0500X"},{"hptc":"225XL0004X"}],"services":[{"id":732,"description":"Provision of uncomplicated (requires one discipline to treat) or complicated (requires 2 or more disciplines to treat) blind rehabilitation therapy.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]},{"id":733,"description":"2. Up to 18 visits for therapy.  Therapy initiation must include the development of a plan of care that is consistent with the evaluation (see Procedural Overview no.2 for additional information)","frequency":null,"frequencyType":"","visits":18,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7275,"precertRequired":false,"billingCode":"97533","codeType":"CPT"},{"id":7276,"precertRequired":false,"billingCode":"97535","codeType":"CPT"},{"id":7277,"precertRequired":false,"billingCode":"97537","codeType":"CPT"},{"id":8071,"precertRequired":false,"billingCode":"E0100","codeType":"HCPCS"},{"id":8109,"precertRequired":true,"billingCode":"E2511","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8139,"precertRequired":false,"billingCode":"G0151","codeType":"HCPCS"},{"id":8140,"precertRequired":false,"billingCode":"G0152","codeType":"HCPCS"},{"id":8142,"precertRequired":true,"billingCode":"G0155","codeType":"HCPCS"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8144,"precertRequired":false,"billingCode":"G0157","codeType":"HCPCS"},{"id":8145,"precertRequired":false,"billingCode":"G0158","codeType":"HCPCS"},{"id":8146,"precertRequired":false,"billingCode":"G0159","codeType":"HCPCS"},{"id":8147,"precertRequired":false,"billingCode":"G0160","codeType":"HCPCS"},{"id":8148,"precertRequired":false,"billingCode":"G0161","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"},{"id":8276,"precertRequired":false,"billingCode":"G8978","codeType":"HCPCS"},{"id":8277,"precertRequired":false,"billingCode":"G8979","codeType":"HCPCS"},{"id":8278,"precertRequired":false,"billingCode":"G8980","codeType":"HCPCS"},{"id":8279,"precertRequired":false,"billingCode":"G8981","codeType":"HCPCS"},{"id":8280,"precertRequired":false,"billingCode":"G8982","codeType":"HCPCS"},{"id":8281,"precertRequired":false,"billingCode":"G8983","codeType":"HCPCS"},{"id":8282,"precertRequired":false,"billingCode":"G8984","codeType":"HCPCS"},{"id":8283,"precertRequired":false,"billingCode":"G8985","codeType":"HCPCS"},{"id":8284,"precertRequired":false,"billingCode":"G8986","codeType":"HCPCS"},{"id":8285,"precertRequired":false,"billingCode":"G8987","codeType":"HCPCS"},{"id":8286,"precertRequired":false,"billingCode":"G8988","codeType":"HCPCS"},{"id":8287,"precertRequired":false,"billingCode":"G8989","codeType":"HCPCS"},{"id":9085,"precertRequired":false,"billingCode":"V2600","codeType":"HCPCS"},{"id":9086,"precertRequired":false,"billingCode":"V2610","codeType":"HCPCS"},{"id":9087,"precertRequired":false,"billingCode":"V2615","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]},{"id":734,"description":"A standardized outcomes questionnaire such as the NEI-VFQ25 must be completed at initial and discharge appointments.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]}]}},{"Seoc":{"id":128,"seocKey":14,"name":"Blind Rehabilitation PRCT_PRCT","seocId":"PMR_BLIND REHABILITATION PRCT_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below for the condition indicated on the consult.","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Provision of uncomplicated (requires one discipline to treat) or complicated (requires 2 or more disciplines to treat) blind rehabilitation therapy\r\n2. Up to 18 visits for therapy.  Therapy initiation must include the development of a plan of care that is consistent with the evaluation and contains, at a minimum:   a.  Diagnosis linked to functional impairment and a detailed problem-based assessment b.  Treatment goals must be linked to objective measures of functional gain.  c.  Type, amount, duration, and frequency of services to meet outcome goals. d.  Only blind rehabilitation professionals (COMS, CVRT, CLVT, CATIS) may perform selected therapy interventions as outlined by the ACVREP Scopes of Practice in accordance with clinical practice guidelines to improve function\r\n3. A standardized outcomes questionnaire such as the NEI-VFQ25 must be completed at initial and discharge appointments.","maxAllowableVisits":999,"disclaimer":"* Requests for additional therapy/maintenance services must be submitted to VA for review and approval with supporting documentation\r\n* Additional therapy justification must include a detailed plan linked to time limited attainment of objective functional outcomes with documented justification relating to standardized outcome questionnaire listed above.\r\n* Maintenance services to prevent exacerbations will be considered if exacerbations are caused by visual impairment becoming more acute.  If exacerbation is caused by some other disability, such as cognitive im pairment or mobility impairment, it may not be treated by a blind rehabilitation professional.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"REHABILITATION MEDICINE","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":52,"description":"Provision of uncomplicated (requires one discipline to treat) or complicated (requires 2 or more disciplines to treat) blind rehabilitation therapy.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]},{"id":53,"description":"2. Up to 18 visits for therapy.  Therapy initiation must include the development of a plan of care that is consistent with the evaluation (see Procedural Overview no.2 for additional information)","frequency":null,"frequencyType":"","visits":18,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7275,"precertRequired":false,"billingCode":"97533","codeType":"CPT"},{"id":7276,"precertRequired":false,"billingCode":"97535","codeType":"CPT"},{"id":7277,"precertRequired":false,"billingCode":"97537","codeType":"CPT"},{"id":8071,"precertRequired":false,"billingCode":"E0100","codeType":"HCPCS"},{"id":8109,"precertRequired":true,"billingCode":"E2511","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8139,"precertRequired":false,"billingCode":"G0151","codeType":"HCPCS"},{"id":8140,"precertRequired":false,"billingCode":"G0152","codeType":"HCPCS"},{"id":8142,"precertRequired":true,"billingCode":"G0155","codeType":"HCPCS"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8144,"precertRequired":false,"billingCode":"G0157","codeType":"HCPCS"},{"id":8145,"precertRequired":false,"billingCode":"G0158","codeType":"HCPCS"},{"id":8146,"precertRequired":false,"billingCode":"G0159","codeType":"HCPCS"},{"id":8147,"precertRequired":false,"billingCode":"G0160","codeType":"HCPCS"},{"id":8148,"precertRequired":false,"billingCode":"G0161","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"},{"id":8276,"precertRequired":false,"billingCode":"G8978","codeType":"HCPCS"},{"id":8277,"precertRequired":false,"billingCode":"G8979","codeType":"HCPCS"},{"id":8278,"precertRequired":false,"billingCode":"G8980","codeType":"HCPCS"},{"id":8279,"precertRequired":false,"billingCode":"G8981","codeType":"HCPCS"},{"id":8280,"precertRequired":false,"billingCode":"G8982","codeType":"HCPCS"},{"id":8281,"precertRequired":false,"billingCode":"G8983","codeType":"HCPCS"},{"id":8282,"precertRequired":false,"billingCode":"G8984","codeType":"HCPCS"},{"id":8283,"precertRequired":false,"billingCode":"G8985","codeType":"HCPCS"},{"id":8284,"precertRequired":false,"billingCode":"G8986","codeType":"HCPCS"},{"id":8285,"precertRequired":false,"billingCode":"G8987","codeType":"HCPCS"},{"id":8286,"precertRequired":false,"billingCode":"G8988","codeType":"HCPCS"},{"id":8287,"precertRequired":false,"billingCode":"G8989","codeType":"HCPCS"},{"id":9085,"precertRequired":false,"billingCode":"V2600","codeType":"HCPCS"},{"id":9086,"precertRequired":false,"billingCode":"V2610","codeType":"HCPCS"},{"id":9087,"precertRequired":false,"billingCode":"V2615","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]},{"id":54,"description":"A standardized outcomes questionnaire such as the NEI-VFQ25 must be completed at initial and discharge appointments.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"67-Occupational therapist "}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"225XR0403X"},{"HPTC":"225XE0001X"},{"HPTC":"225XL0004X"},{"HPTC":"225XH1200X"},{"HPTC":"225XH1300X"},{"HPTC":"225XG0600X"},{"HPTC":"225XP0019X"},{"HPTC":"225XE1200X"},{"HPTC":"225XF0002X"},{"HPTC":"225X00000X"},{"HPTC":"225XN1300X"},{"HPTC":"225XM0800X"},{"HPTC":"225XP0200X"}]}]}},{"Seoc":{"id":480,"seocKey":15,"name":"Blood Transfusion (Outpatient)","seocId":"MSC_BLOOD TRANSFUSION (OUTPATIENT)_1.0.3","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care for the referred condition on the consult","effectiveDate":"07-28-2019","endDate":null,"duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Eight visits for transfusion; blood or blood components\r\n3. Therapeutic apheresis (white blood cells, red blood cells, plasma, plasma pheresis, extracorporeal immunoadsorption and plasma reinfusion, extracorporeal selective adsorption or selective filtration and plasma reinfusion)\r\n4. Inpatient or observation admission for procedure complications \r\n\r\n** VA notification within 72 hours to local Community Care Office who initiated the referral is required for complications related to the initial referral.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RH0000X"},{"hptc":"207ZB0001X"},{"hptc":"261QM1300X"}],"services":[{"id":2726,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2727,"description":"Eight visits for transfusion; blood or blood components","frequency":null,"frequencyType":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2547,"precertRequired":false,"billingCode":"36455","codeType":"CPT"},{"id":6093,"precertRequired":false,"billingCode":"86950","codeType":"CPT"},{"id":8723,"precertRequired":false,"billingCode":"P9010","codeType":"HCPCS"},{"id":8724,"precertRequired":false,"billingCode":"P9011","codeType":"HCPCS"},{"id":8725,"precertRequired":false,"billingCode":"P9012","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8727,"precertRequired":false,"billingCode":"P9017","codeType":"HCPCS"},{"id":8728,"precertRequired":false,"billingCode":"P9019","codeType":"HCPCS"},{"id":8729,"precertRequired":false,"billingCode":"P9020","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8731,"precertRequired":false,"billingCode":"P9022","codeType":"HCPCS"},{"id":8732,"precertRequired":false,"billingCode":"P9023","codeType":"HCPCS"},{"id":8733,"precertRequired":false,"billingCode":"P9031","codeType":"HCPCS"},{"id":8734,"precertRequired":false,"billingCode":"P9032","codeType":"HCPCS"},{"id":8735,"precertRequired":false,"billingCode":"P9033","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8738,"precertRequired":false,"billingCode":"P9036","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8740,"precertRequired":false,"billingCode":"P9038","codeType":"HCPCS"},{"id":8741,"precertRequired":false,"billingCode":"P9039","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8743,"precertRequired":false,"billingCode":"P9041","codeType":"HCPCS"},{"id":8744,"precertRequired":false,"billingCode":"P9043","codeType":"HCPCS"},{"id":8745,"precertRequired":false,"billingCode":"P9044","codeType":"HCPCS"},{"id":8746,"precertRequired":false,"billingCode":"P9045","codeType":"HCPCS"},{"id":8747,"precertRequired":false,"billingCode":"P9046","codeType":"HCPCS"},{"id":8748,"precertRequired":false,"billingCode":"P9047","codeType":"HCPCS"},{"id":8749,"precertRequired":false,"billingCode":"P9048","codeType":"HCPCS"},{"id":8750,"precertRequired":false,"billingCode":"P9050","codeType":"HCPCS"},{"id":8751,"precertRequired":false,"billingCode":"P9051","codeType":"HCPCS"},{"id":8752,"precertRequired":false,"billingCode":"P9052","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8754,"precertRequired":false,"billingCode":"P9054","codeType":"HCPCS"},{"id":8755,"precertRequired":false,"billingCode":"P9055","codeType":"HCPCS"},{"id":8756,"precertRequired":false,"billingCode":"P9056","codeType":"HCPCS"},{"id":8757,"precertRequired":false,"billingCode":"P9057","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8759,"precertRequired":false,"billingCode":"P9059","codeType":"HCPCS"},{"id":8760,"precertRequired":false,"billingCode":"P9060","codeType":"HCPCS"},{"id":8761,"precertRequired":false,"billingCode":"P9070","codeType":"HCPCS"},{"id":8762,"precertRequired":false,"billingCode":"P9071","codeType":"HCPCS"},{"id":8763,"precertRequired":false,"billingCode":"P9073","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2728,"description":"Therapeutic apheresis (white blood cells, red blood cells, plasma, plasma pheresis, extracorporeal immunoadsorption and plasma reinfusion, extracorporeal selective adsorption or selective filtration and plasma reinfusion)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":2554,"precertRequired":false,"billingCode":"36511","codeType":"CPT"},{"id":2555,"precertRequired":false,"billingCode":"36512","codeType":"CPT"},{"id":2556,"precertRequired":false,"billingCode":"36513","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2559,"precertRequired":false,"billingCode":"36516","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":6065,"precertRequired":false,"billingCode":"86850","codeType":"CPT"},{"id":6067,"precertRequired":false,"billingCode":"86870","codeType":"CPT"},{"id":6068,"precertRequired":false,"billingCode":"86880","codeType":"CPT"},{"id":6069,"precertRequired":false,"billingCode":"86885","codeType":"CPT"},{"id":6070,"precertRequired":false,"billingCode":"86886","codeType":"CPT"},{"id":6072,"precertRequired":false,"billingCode":"86890","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6075,"precertRequired":false,"billingCode":"86901","codeType":"CPT"},{"id":6076,"precertRequired":false,"billingCode":"86902","codeType":"CPT"},{"id":6077,"precertRequired":false,"billingCode":"86904","codeType":"CPT"},{"id":6078,"precertRequired":false,"billingCode":"86905","codeType":"CPT"},{"id":6079,"precertRequired":false,"billingCode":"86906","codeType":"CPT"},{"id":6082,"precertRequired":false,"billingCode":"86920","codeType":"CPT"},{"id":6083,"precertRequired":false,"billingCode":"86921","codeType":"CPT"},{"id":6084,"precertRequired":false,"billingCode":"86922","codeType":"CPT"},{"id":6085,"precertRequired":false,"billingCode":"86923","codeType":"CPT"},{"id":6086,"precertRequired":false,"billingCode":"86927","codeType":"CPT"},{"id":6087,"precertRequired":false,"billingCode":"86930","codeType":"CPT"},{"id":6088,"precertRequired":false,"billingCode":"86931","codeType":"CPT"},{"id":6089,"precertRequired":false,"billingCode":"86932","codeType":"CPT"},{"id":6104,"precertRequired":false,"billingCode":"86999","codeType":"CPT"},{"id":8498,"precertRequired":false,"billingCode":"J2997","codeType":"HCPCS"},{"id":8510,"precertRequired":false,"billingCode":"J3364","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2729,"description":"Inpatient or observation admission for procedure complications ** VA notification within 72 hours to local Community Care Office who initiated the referral is required for complications related to the initial referral.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]}]}},{"Seoc":{"id":194,"seocKey":15,"name":"Blood Transfusion (Outpatient) PRCT","seocId":"MSC_BLOOD TRANSFUSION (OUTPATIENT) PRCT_1.0.2","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care for the referred condition on the consult","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Eight visits for transfusion; blood or blood components\r\n3. Therapeutic apheresis (white blood cells, red blood cells, plasma, plasma pheresis, extracorporeal immunoadsorption and plasma reinfusion, extracorporeal selective adsorption or selective filtration and plasma reinfusion)\r\n4. Inpatient or observation admission for procedure complications \r\n\r\n** VA notification within 72 hours to local Community Care Office who initiated the referral is required for complications related to the initial referral. ","maxAllowableVisits":null,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14 day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RH0000X"},{"hptc":"207ZB0001X"},{"hptc":"261QM1300X"}],"services":[{"id":735,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":736,"description":"Eight visits for transfusion; blood or blood components ","frequency":null,"frequencyType":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2547,"precertRequired":false,"billingCode":"36455","codeType":"CPT"},{"id":6093,"precertRequired":false,"billingCode":"86950","codeType":"CPT"},{"id":8723,"precertRequired":false,"billingCode":"P9010","codeType":"HCPCS"},{"id":8724,"precertRequired":false,"billingCode":"P9011","codeType":"HCPCS"},{"id":8725,"precertRequired":false,"billingCode":"P9012","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8727,"precertRequired":false,"billingCode":"P9017","codeType":"HCPCS"},{"id":8728,"precertRequired":false,"billingCode":"P9019","codeType":"HCPCS"},{"id":8729,"precertRequired":false,"billingCode":"P9020","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8731,"precertRequired":false,"billingCode":"P9022","codeType":"HCPCS"},{"id":8732,"precertRequired":false,"billingCode":"P9023","codeType":"HCPCS"},{"id":8733,"precertRequired":false,"billingCode":"P9031","codeType":"HCPCS"},{"id":8734,"precertRequired":false,"billingCode":"P9032","codeType":"HCPCS"},{"id":8735,"precertRequired":false,"billingCode":"P9033","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8738,"precertRequired":false,"billingCode":"P9036","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8740,"precertRequired":false,"billingCode":"P9038","codeType":"HCPCS"},{"id":8741,"precertRequired":false,"billingCode":"P9039","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8743,"precertRequired":false,"billingCode":"P9041","codeType":"HCPCS"},{"id":8744,"precertRequired":false,"billingCode":"P9043","codeType":"HCPCS"},{"id":8745,"precertRequired":false,"billingCode":"P9044","codeType":"HCPCS"},{"id":8746,"precertRequired":false,"billingCode":"P9045","codeType":"HCPCS"},{"id":8747,"precertRequired":false,"billingCode":"P9046","codeType":"HCPCS"},{"id":8748,"precertRequired":false,"billingCode":"P9047","codeType":"HCPCS"},{"id":8749,"precertRequired":false,"billingCode":"P9048","codeType":"HCPCS"},{"id":8750,"precertRequired":false,"billingCode":"P9050","codeType":"HCPCS"},{"id":8751,"precertRequired":false,"billingCode":"P9051","codeType":"HCPCS"},{"id":8752,"precertRequired":false,"billingCode":"P9052","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8754,"precertRequired":false,"billingCode":"P9054","codeType":"HCPCS"},{"id":8755,"precertRequired":false,"billingCode":"P9055","codeType":"HCPCS"},{"id":8756,"precertRequired":false,"billingCode":"P9056","codeType":"HCPCS"},{"id":8757,"precertRequired":false,"billingCode":"P9057","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8759,"precertRequired":false,"billingCode":"P9059","codeType":"HCPCS"},{"id":8760,"precertRequired":false,"billingCode":"P9060","codeType":"HCPCS"},{"id":8761,"precertRequired":false,"billingCode":"P9070","codeType":"HCPCS"},{"id":8762,"precertRequired":false,"billingCode":"P9071","codeType":"HCPCS"},{"id":8763,"precertRequired":false,"billingCode":"P9073","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":737,"description":"Therapeutic apheresis (white blood cells, red blood cells, plasma, plasma pheresis, extracorporeal immunoadsorption and plasma reinfusion, extracorporeal selective adsorption or selective filtration and plasma reinfusion)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":2554,"precertRequired":false,"billingCode":"36511","codeType":"CPT"},{"id":2555,"precertRequired":false,"billingCode":"36512","codeType":"CPT"},{"id":2556,"precertRequired":false,"billingCode":"36513","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2558,"precertRequired":false,"billingCode":"36515","codeType":"CPT"},{"id":2559,"precertRequired":false,"billingCode":"36516","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":6065,"precertRequired":false,"billingCode":"86850","codeType":"CPT"},{"id":6067,"precertRequired":false,"billingCode":"86870","codeType":"CPT"},{"id":6068,"precertRequired":false,"billingCode":"86880","codeType":"CPT"},{"id":6069,"precertRequired":false,"billingCode":"86885","codeType":"CPT"},{"id":6070,"precertRequired":false,"billingCode":"86886","codeType":"CPT"},{"id":6072,"precertRequired":false,"billingCode":"86890","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6075,"precertRequired":false,"billingCode":"86901","codeType":"CPT"},{"id":6076,"precertRequired":false,"billingCode":"86902","codeType":"CPT"},{"id":6077,"precertRequired":false,"billingCode":"86904","codeType":"CPT"},{"id":6078,"precertRequired":false,"billingCode":"86905","codeType":"CPT"},{"id":6079,"precertRequired":false,"billingCode":"86906","codeType":"CPT"},{"id":6082,"precertRequired":false,"billingCode":"86920","codeType":"CPT"},{"id":6083,"precertRequired":false,"billingCode":"86921","codeType":"CPT"},{"id":6084,"precertRequired":false,"billingCode":"86922","codeType":"CPT"},{"id":6085,"precertRequired":false,"billingCode":"86923","codeType":"CPT"},{"id":6086,"precertRequired":false,"billingCode":"86927","codeType":"CPT"},{"id":6087,"precertRequired":false,"billingCode":"86930","codeType":"CPT"},{"id":6088,"precertRequired":false,"billingCode":"86931","codeType":"CPT"},{"id":6089,"precertRequired":false,"billingCode":"86932","codeType":"CPT"},{"id":6104,"precertRequired":false,"billingCode":"86999","codeType":"CPT"},{"id":8498,"precertRequired":false,"billingCode":"J2997","codeType":"HCPCS"},{"id":8510,"precertRequired":false,"billingCode":"J3364","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":738,"description":"Inpatient or observation admission for procedure complications ** VA notification within 72 hours to local Community Care Office who initiated the referral is required for complications related to the initial referral. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]}]}},{"Seoc":{"id":129,"seocKey":15,"name":"Blood Transfusion (Outpatient) PRCT","seocId":"MSC_BLOOD TRANSFUSION (OUTPATIENT) PRCT_1.0.1","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care for the referred condition on the consult","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Eight visits for transfusion; blood or blood components\r\n3. Therapeutic apheresis (white blood cells, red blood cells, plasma, plasma pheresis, extracorporeal immunoadsorption and plasma reinfusion, extracorporeal selective adsorption or selective filtration and plasma reinfusion)\r\n4. Inpatient or observation admission for procedure complications \r\n\r\n** VA notification within 72 hours to local Community Care Office who initiated the referral is required for complications related to the initial referral. ","maxAllowableVisits":999,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14 day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":55,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":56,"description":"Eight visits for transfusion; blood or blood components ","frequency":null,"frequencyType":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2547,"precertRequired":false,"billingCode":"36455","codeType":"CPT"},{"id":6093,"precertRequired":false,"billingCode":"86950","codeType":"CPT"},{"id":8723,"precertRequired":false,"billingCode":"P9010","codeType":"HCPCS"},{"id":8724,"precertRequired":false,"billingCode":"P9011","codeType":"HCPCS"},{"id":8725,"precertRequired":false,"billingCode":"P9012","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8727,"precertRequired":false,"billingCode":"P9017","codeType":"HCPCS"},{"id":8728,"precertRequired":false,"billingCode":"P9019","codeType":"HCPCS"},{"id":8729,"precertRequired":false,"billingCode":"P9020","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8731,"precertRequired":false,"billingCode":"P9022","codeType":"HCPCS"},{"id":8732,"precertRequired":false,"billingCode":"P9023","codeType":"HCPCS"},{"id":8733,"precertRequired":false,"billingCode":"P9031","codeType":"HCPCS"},{"id":8734,"precertRequired":false,"billingCode":"P9032","codeType":"HCPCS"},{"id":8735,"precertRequired":false,"billingCode":"P9033","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8738,"precertRequired":false,"billingCode":"P9036","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8740,"precertRequired":false,"billingCode":"P9038","codeType":"HCPCS"},{"id":8741,"precertRequired":false,"billingCode":"P9039","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8743,"precertRequired":false,"billingCode":"P9041","codeType":"HCPCS"},{"id":8744,"precertRequired":false,"billingCode":"P9043","codeType":"HCPCS"},{"id":8745,"precertRequired":false,"billingCode":"P9044","codeType":"HCPCS"},{"id":8746,"precertRequired":false,"billingCode":"P9045","codeType":"HCPCS"},{"id":8747,"precertRequired":false,"billingCode":"P9046","codeType":"HCPCS"},{"id":8748,"precertRequired":false,"billingCode":"P9047","codeType":"HCPCS"},{"id":8749,"precertRequired":false,"billingCode":"P9048","codeType":"HCPCS"},{"id":8750,"precertRequired":false,"billingCode":"P9050","codeType":"HCPCS"},{"id":8751,"precertRequired":false,"billingCode":"P9051","codeType":"HCPCS"},{"id":8752,"precertRequired":false,"billingCode":"P9052","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8754,"precertRequired":false,"billingCode":"P9054","codeType":"HCPCS"},{"id":8755,"precertRequired":false,"billingCode":"P9055","codeType":"HCPCS"},{"id":8756,"precertRequired":false,"billingCode":"P9056","codeType":"HCPCS"},{"id":8757,"precertRequired":false,"billingCode":"P9057","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8759,"precertRequired":false,"billingCode":"P9059","codeType":"HCPCS"},{"id":8760,"precertRequired":false,"billingCode":"P9060","codeType":"HCPCS"},{"id":8761,"precertRequired":false,"billingCode":"P9070","codeType":"HCPCS"},{"id":8762,"precertRequired":false,"billingCode":"P9071","codeType":"HCPCS"},{"id":8763,"precertRequired":false,"billingCode":"P9073","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":57,"description":"Therapeutic apheresis (white blood cells, red blood cells, plasma, plasma pheresis, extracorporeal immunoadsorption and plasma reinfusion, extracorporeal selective adsorption or selective filtration and plasma reinfusion)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":2554,"precertRequired":false,"billingCode":"36511","codeType":"CPT"},{"id":2555,"precertRequired":false,"billingCode":"36512","codeType":"CPT"},{"id":2556,"precertRequired":false,"billingCode":"36513","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2558,"precertRequired":false,"billingCode":"36515","codeType":"CPT"},{"id":2559,"precertRequired":false,"billingCode":"36516","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":6065,"precertRequired":false,"billingCode":"86850","codeType":"CPT"},{"id":6067,"precertRequired":false,"billingCode":"86870","codeType":"CPT"},{"id":6068,"precertRequired":false,"billingCode":"86880","codeType":"CPT"},{"id":6069,"precertRequired":false,"billingCode":"86885","codeType":"CPT"},{"id":6070,"precertRequired":false,"billingCode":"86886","codeType":"CPT"},{"id":6072,"precertRequired":false,"billingCode":"86890","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6075,"precertRequired":false,"billingCode":"86901","codeType":"CPT"},{"id":6076,"precertRequired":false,"billingCode":"86902","codeType":"CPT"},{"id":6077,"precertRequired":false,"billingCode":"86904","codeType":"CPT"},{"id":6078,"precertRequired":false,"billingCode":"86905","codeType":"CPT"},{"id":6079,"precertRequired":false,"billingCode":"86906","codeType":"CPT"},{"id":6082,"precertRequired":false,"billingCode":"86920","codeType":"CPT"},{"id":6083,"precertRequired":false,"billingCode":"86921","codeType":"CPT"},{"id":6084,"precertRequired":false,"billingCode":"86922","codeType":"CPT"},{"id":6085,"precertRequired":false,"billingCode":"86923","codeType":"CPT"},{"id":6086,"precertRequired":false,"billingCode":"86927","codeType":"CPT"},{"id":6087,"precertRequired":false,"billingCode":"86930","codeType":"CPT"},{"id":6088,"precertRequired":false,"billingCode":"86931","codeType":"CPT"},{"id":6089,"precertRequired":false,"billingCode":"86932","codeType":"CPT"},{"id":6104,"precertRequired":false,"billingCode":"86999","codeType":"CPT"},{"id":8498,"precertRequired":false,"billingCode":"J2997","codeType":"HCPCS"},{"id":8510,"precertRequired":false,"billingCode":"J3364","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":58,"description":"Inpatient or observation admission for procedure complications ** VA notification within 72 hours to local Community Care Office who initiated the referral is required for complications related to the initial referral. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]}]}},{"Seoc":{"id":641,"seocKey":16,"name":"Bowel and Bladder Agency_PRCT","seocId":"NIC_BOWEL AND BLADDER AGENCY_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services provided by an agency, associated with all care listed below for the referred condition(s).","effectiveDate":"11-12-2019","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial evaluation for confirmation of treatment plan.\r\n2. Bowel and/or bladder services related to neurogenic bowel and bladder as necessary as indicated on the consult, including catheter irrigation, changing colostomy bags, changing external catheters, and bathing after completion of bowel & bladder care as needed as appropriate.\r\n Note: Duration and frequency of visits as indicated in  treatment plan established per consult.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"NIC BOWEL AND BLADDER","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251E00000X"}],"services":[{"id":3561,"description":"Initial evaluation for confirmation of treatment plan.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7413,"precertRequired":false,"billingCode":"99341","codeType":"CPT"},{"id":7414,"precertRequired":false,"billingCode":"99342","codeType":"CPT"},{"id":7415,"precertRequired":false,"billingCode":"99343","codeType":"CPT"},{"id":7416,"precertRequired":false,"billingCode":"99344","codeType":"CPT"},{"id":7417,"precertRequired":false,"billingCode":"99345","codeType":"CPT"},{"id":7418,"precertRequired":false,"billingCode":"99347","codeType":"CPT"},{"id":7419,"precertRequired":false,"billingCode":"99348","codeType":"CPT"},{"id":7420,"precertRequired":false,"billingCode":"99349","codeType":"CPT"},{"id":7421,"precertRequired":false,"billingCode":"99350","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":8981,"precertRequired":false,"billingCode":"S9122","codeType":"HCPCS"},{"id":8983,"precertRequired":false,"billingCode":"S9124","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":3564,"description":"Bowel and/or bladder services related to neurogenic bowel and bladder as necessary as indicated on the consult, including catheter irrigation, changing colostomy bags, changing external catheters, and bathing after completion of bowel & bladder care as needed as appropriate.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":3416,"precertRequired":false,"billingCode":"51700","codeType":"CPT"},{"id":3417,"precertRequired":false,"billingCode":"51701","codeType":"CPT"},{"id":3418,"precertRequired":false,"billingCode":"51702","codeType":"CPT"},{"id":3419,"precertRequired":false,"billingCode":"51703","codeType":"CPT"},{"id":7503,"precertRequired":false,"billingCode":"99505","codeType":"CPT"},{"id":7505,"precertRequired":true,"billingCode":"99507","codeType":"CPT"},{"id":7506,"precertRequired":false,"billingCode":"99509","codeType":"CPT"},{"id":7508,"precertRequired":false,"billingCode":"99511","codeType":"CPT"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"},{"id":8180,"precertRequired":false,"billingCode":"G0299","codeType":"HCPCS"},{"id":8181,"precertRequired":false,"billingCode":"G0300","codeType":"HCPCS"},{"id":8234,"precertRequired":false,"billingCode":"G0490","codeType":"HCPCS"},{"id":8238,"precertRequired":false,"billingCode":"G0495","codeType":"HCPCS"},{"id":8239,"precertRequired":false,"billingCode":"G0496","codeType":"HCPCS"},{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"},{"id":9047,"precertRequired":false,"billingCode":"T1019","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":542,"seocKey":16,"name":"Bowel and Bladder_PRCT","seocId":"NIC_BOWEL AND BLADDER_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all care listed below for the referred condition(s).","effectiveDate":"07-28-2019","endDate":"11-12-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial evaluation for confirmation of treatment plan.\r\n2. Bowel and/or bladder services related to neurogenic bowel and bladder as necessary as indicated on the consult, including catheter irrigation, changing colostomy bags, changing external catheters, and bathing after completion of bowel & bladder care as needed as appropriate.\r\n3. Bowel and/or bladder care  related to neurogenic bowel and bladder to be provided by a skilled licensed provider or an individual serving as a independent home health attendant trained and certified by VHA personnel (to include family members once trained and certified).\r\n Note: Duration and frequency of visits as indicated in  treatment plan established per consult.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"NIC BOWEL AND BLADDER","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251E00000X"}],"services":[{"id":3134,"description":"Initial evaluation for confirmation of treatment plan.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7413,"precertRequired":false,"billingCode":"99341","codeType":"CPT"},{"id":7414,"precertRequired":false,"billingCode":"99342","codeType":"CPT"},{"id":7415,"precertRequired":false,"billingCode":"99343","codeType":"CPT"},{"id":7416,"precertRequired":false,"billingCode":"99344","codeType":"CPT"},{"id":7417,"precertRequired":false,"billingCode":"99345","codeType":"CPT"},{"id":7418,"precertRequired":false,"billingCode":"99347","codeType":"CPT"},{"id":7419,"precertRequired":false,"billingCode":"99348","codeType":"CPT"},{"id":7420,"precertRequired":false,"billingCode":"99349","codeType":"CPT"},{"id":7421,"precertRequired":false,"billingCode":"99350","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":8981,"precertRequired":false,"billingCode":"S9122","codeType":"HCPCS"},{"id":8983,"precertRequired":false,"billingCode":"S9124","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":3135,"description":"Bowel and/or bladder services related to neurogenic bowel and bladder as necessary as indicated on the consult, including catheter irrigation, changing colostomy bags, changing external catheters, and bathing after completion of bowel & bladder care as needed as appropriate.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":3416,"precertRequired":false,"billingCode":"51700","codeType":"CPT"},{"id":3417,"precertRequired":false,"billingCode":"51701","codeType":"CPT"},{"id":3418,"precertRequired":false,"billingCode":"51702","codeType":"CPT"},{"id":3419,"precertRequired":false,"billingCode":"51703","codeType":"CPT"},{"id":3420,"precertRequired":false,"billingCode":"51705","codeType":"CPT"},{"id":3421,"precertRequired":false,"billingCode":"51710","codeType":"CPT"},{"id":7503,"precertRequired":false,"billingCode":"99505","codeType":"CPT"},{"id":7505,"precertRequired":true,"billingCode":"99507","codeType":"CPT"},{"id":7506,"precertRequired":false,"billingCode":"99509","codeType":"CPT"},{"id":7508,"precertRequired":false,"billingCode":"99511","codeType":"CPT"},{"id":8142,"precertRequired":true,"billingCode":"G0155","codeType":"HCPCS"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"},{"id":8180,"precertRequired":false,"billingCode":"G0299","codeType":"HCPCS"},{"id":8181,"precertRequired":false,"billingCode":"G0300","codeType":"HCPCS"},{"id":8234,"precertRequired":false,"billingCode":"G0490","codeType":"HCPCS"},{"id":8236,"precertRequired":false,"billingCode":"G0493","codeType":"HCPCS"},{"id":8237,"precertRequired":false,"billingCode":"G0494","codeType":"HCPCS"},{"id":8238,"precertRequired":false,"billingCode":"G0495","codeType":"HCPCS"},{"id":8239,"precertRequired":false,"billingCode":"G0496","codeType":"HCPCS"},{"id":8764,"precertRequired":false,"billingCode":"P9612","codeType":"HCPCS"},{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"},{"id":9047,"precertRequired":false,"billingCode":"T1019","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":3136,"description":"Bowel and/or bladder care  related to neurogenic bowel and bladder to be provided by a skilled licensed provider or an individual serving as a independent home health attendant trained and certified by VHA personnel (to include family members once trained and certified).\r\nNote: Duration and frequency of visits as indicated in  treatment plan established per consult.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"},{"id":8180,"precertRequired":false,"billingCode":"G0299","codeType":"HCPCS"},{"id":8181,"precertRequired":false,"billingCode":"G0300","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":409,"seocKey":16,"name":"Bowel and Bladder_PRCT","seocId":"NIC_BOWEL AND BLADDER_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all care listed below for the referred condition(s).","effectiveDate":"05-17-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial evaluation for confirmation of treatment plan.\r\n2. Bowel and/or bladder services related to neurogenic bowel and bladder as necessary as indicated on the consult, including catheter irrigation, changing colostomy bags, changing external catheters, and bathing after completion of bowel & bladder care as needed as appropriate.\r\n3. Bowel and/or bladder care  related to neurogenic bowel and bladder to be provided by a skilled licensed provider or an individual serving as a independent home health attendant trained and certified by VHA personnel (to include family members once trained and certified).\r\n Note: Duration and frequency of visits as indicated in  treatment plan established per consult.","maxAllowableVisits":null,"disclaimer":"* Changes in treatment plan during this EOC are to be communicated with VAMC and noted on initial consult and authorization re-issued to reflect changes.\r\n* Duration of a max approved 365 days with ongoing annual re-approval\r\n* Additional consultations needed relevant to the referred patient condition(s) require VA review and approval.\r\n* All routine medications/supplies will be provided by the VA.","QASP":"General Care","categoryOfCare":"NIC BOWEL AND BLADDER","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251E00000X"}],"services":[{"id":2168,"description":"Initial evaluation for confirmation of treatment plan.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7413,"precertRequired":false,"billingCode":"99341","codeType":"CPT"},{"id":7414,"precertRequired":false,"billingCode":"99342","codeType":"CPT"},{"id":7415,"precertRequired":false,"billingCode":"99343","codeType":"CPT"},{"id":7416,"precertRequired":false,"billingCode":"99344","codeType":"CPT"},{"id":7417,"precertRequired":false,"billingCode":"99345","codeType":"CPT"},{"id":7418,"precertRequired":false,"billingCode":"99347","codeType":"CPT"},{"id":7419,"precertRequired":false,"billingCode":"99348","codeType":"CPT"},{"id":7420,"precertRequired":false,"billingCode":"99349","codeType":"CPT"},{"id":7421,"precertRequired":false,"billingCode":"99350","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":8981,"precertRequired":false,"billingCode":"S9122","codeType":"HCPCS"},{"id":8983,"precertRequired":false,"billingCode":"S9124","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":2169,"description":"Bowel and/or bladder services related to neurogenic bowel and bladder as necessary as indicated on the consult, including catheter irrigation, changing colostomy bags, changing external catheters, and bathing after completion of bowel & bladder care as needed as appropriate.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":3416,"precertRequired":false,"billingCode":"51700","codeType":"CPT"},{"id":3417,"precertRequired":false,"billingCode":"51701","codeType":"CPT"},{"id":3418,"precertRequired":false,"billingCode":"51702","codeType":"CPT"},{"id":3419,"precertRequired":false,"billingCode":"51703","codeType":"CPT"},{"id":3420,"precertRequired":false,"billingCode":"51705","codeType":"CPT"},{"id":3421,"precertRequired":false,"billingCode":"51710","codeType":"CPT"},{"id":7503,"precertRequired":false,"billingCode":"99505","codeType":"CPT"},{"id":7505,"precertRequired":true,"billingCode":"99507","codeType":"CPT"},{"id":7506,"precertRequired":false,"billingCode":"99509","codeType":"CPT"},{"id":7508,"precertRequired":false,"billingCode":"99511","codeType":"CPT"},{"id":8142,"precertRequired":true,"billingCode":"G0155","codeType":"HCPCS"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"},{"id":8180,"precertRequired":false,"billingCode":"G0299","codeType":"HCPCS"},{"id":8181,"precertRequired":false,"billingCode":"G0300","codeType":"HCPCS"},{"id":8234,"precertRequired":false,"billingCode":"G0490","codeType":"HCPCS"},{"id":8236,"precertRequired":false,"billingCode":"G0493","codeType":"HCPCS"},{"id":8237,"precertRequired":false,"billingCode":"G0494","codeType":"HCPCS"},{"id":8238,"precertRequired":false,"billingCode":"G0495","codeType":"HCPCS"},{"id":8239,"precertRequired":false,"billingCode":"G0496","codeType":"HCPCS"},{"id":8764,"precertRequired":false,"billingCode":"P9612","codeType":"HCPCS"},{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"},{"id":9047,"precertRequired":false,"billingCode":"T1019","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":2170,"description":"Bowel and/or bladder care  related to neurogenic bowel and bladder to be provided by a skilled licensed provider or an individual serving as a independent home health attendant trained and certified by VHA personnel (to include family members once trained and certified).\r\nNote: Duration and frequency of visits as indicated in  treatment plan established per consult.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"},{"id":8180,"precertRequired":false,"billingCode":"G0299","codeType":"HCPCS"},{"id":8181,"precertRequired":false,"billingCode":"G0300","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":195,"seocKey":16,"name":"Bowel and Bladder_PRCT","seocId":"NIC_BOWEL AND BLADDER_1.0.2_PRCT","versionNumber":"1.0.2","description":"Duration and frequency of visits as indicated in  treatment plan established per consult.","effectiveDate":"01-02-2019","endDate":"05-17-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial evaluation for confirmation of treatment plan\r\n2. Bowel and/or bladder services related to neurogenic bowel and bladder as necessary as indicated on the consult, including catheter irrigation, changing colostomy bags, changing external catheters, and bathing after completion of bowel & bladder care as needed as appropriate\r\n3. Bowel and/or bladder care  related to neurogenic bowel and bladder to be provided by a skilled licensed provider or an individual serving as a independent home health attendant trained and certified by VHA personnel (to include family members once trained and certified)\r\n4. Duration and frequency of visits as indicated in  treatment plan established per consult","maxAllowableVisits":null,"disclaimer":"* Changes in treatment plan during this EOC are to be communicated with VAMC and noted on initial consult and authorization re-issued to reflect changes.\r\n* Duration of a max approved 365 days with ongoing annual re-approval\r\n* Additional consultations needed relevant to the referred patient condition(s) require VA review and approval.\r\n* All routine medications/supplies will be provided by the VA.","QASP":"General Care","categoryOfCare":"NIC BOWEL AND BLADDER","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251E00000X"}],"services":[{"id":739,"description":"Initial evaluation for confirmation of treatment plan.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":740,"description":"Bowel and/or bladder services related to neurogenic bowel and bladder as necessary as indicated on the consult, including catheter irrigation, changing colostomy bags, changing external catheters, and bathing after completion of bowel & bladder care as needed as appropriate.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":3223,"precertRequired":false,"billingCode":"46999","codeType":"CPT"},{"id":3412,"precertRequired":false,"billingCode":"50820","codeType":"CPT"},{"id":3416,"precertRequired":false,"billingCode":"51700","codeType":"CPT"},{"id":3417,"precertRequired":false,"billingCode":"51701","codeType":"CPT"},{"id":3418,"precertRequired":false,"billingCode":"51702","codeType":"CPT"},{"id":3419,"precertRequired":false,"billingCode":"51703","codeType":"CPT"},{"id":3420,"precertRequired":false,"billingCode":"51705","codeType":"CPT"},{"id":3421,"precertRequired":false,"billingCode":"51710","codeType":"CPT"},{"id":3934,"precertRequired":true,"billingCode":"64450","codeType":"CPT"},{"id":7715,"precertRequired":false,"billingCode":"A4332","codeType":"HCPCS"},{"id":7716,"precertRequired":false,"billingCode":"A4333","codeType":"HCPCS"},{"id":7717,"precertRequired":false,"billingCode":"A4334","codeType":"HCPCS"},{"id":7721,"precertRequired":false,"billingCode":"A4338","codeType":"HCPCS"},{"id":7722,"precertRequired":false,"billingCode":"A4340","codeType":"HCPCS"},{"id":7723,"precertRequired":false,"billingCode":"A4344","codeType":"HCPCS"},{"id":7724,"precertRequired":false,"billingCode":"A4346","codeType":"HCPCS"},{"id":7725,"precertRequired":false,"billingCode":"A4351","codeType":"HCPCS"},{"id":7726,"precertRequired":false,"billingCode":"A4352","codeType":"HCPCS"},{"id":7727,"precertRequired":false,"billingCode":"A4353","codeType":"HCPCS"},{"id":7729,"precertRequired":false,"billingCode":"A4355","codeType":"HCPCS"},{"id":7733,"precertRequired":false,"billingCode":"A4360","codeType":"HCPCS"},{"id":7734,"precertRequired":false,"billingCode":"A4361","codeType":"HCPCS"},{"id":7735,"precertRequired":false,"billingCode":"A4362","codeType":"HCPCS"},{"id":7736,"precertRequired":false,"billingCode":"A4363","codeType":"HCPCS"},{"id":7737,"precertRequired":false,"billingCode":"A4364","codeType":"HCPCS"},{"id":7738,"precertRequired":false,"billingCode":"A4366","codeType":"HCPCS"},{"id":7739,"precertRequired":false,"billingCode":"A4367","codeType":"HCPCS"},{"id":7740,"precertRequired":false,"billingCode":"A4368","codeType":"HCPCS"},{"id":7741,"precertRequired":false,"billingCode":"A4369","codeType":"HCPCS"},{"id":7742,"precertRequired":false,"billingCode":"A4371","codeType":"HCPCS"},{"id":7743,"precertRequired":false,"billingCode":"A4372","codeType":"HCPCS"},{"id":7744,"precertRequired":false,"billingCode":"A4373","codeType":"HCPCS"},{"id":7745,"precertRequired":false,"billingCode":"A4375","codeType":"HCPCS"},{"id":7746,"precertRequired":false,"billingCode":"A4376","codeType":"HCPCS"},{"id":7747,"precertRequired":false,"billingCode":"A4377","codeType":"HCPCS"},{"id":7748,"precertRequired":false,"billingCode":"A4378","codeType":"HCPCS"},{"id":7749,"precertRequired":false,"billingCode":"A4379","codeType":"HCPCS"},{"id":7750,"precertRequired":false,"billingCode":"A4380","codeType":"HCPCS"},{"id":7751,"precertRequired":false,"billingCode":"A4381","codeType":"HCPCS"},{"id":7752,"precertRequired":false,"billingCode":"A4382","codeType":"HCPCS"},{"id":7753,"precertRequired":false,"billingCode":"A4383","codeType":"HCPCS"},{"id":7754,"precertRequired":false,"billingCode":"A4384","codeType":"HCPCS"},{"id":7755,"precertRequired":false,"billingCode":"A4385","codeType":"HCPCS"},{"id":7756,"precertRequired":false,"billingCode":"A4387","codeType":"HCPCS"},{"id":7757,"precertRequired":false,"billingCode":"A4388","codeType":"HCPCS"},{"id":7758,"precertRequired":false,"billingCode":"A4389","codeType":"HCPCS"},{"id":7759,"precertRequired":false,"billingCode":"A4390","codeType":"HCPCS"},{"id":7760,"precertRequired":false,"billingCode":"A4391","codeType":"HCPCS"},{"id":7761,"precertRequired":false,"billingCode":"A4392","codeType":"HCPCS"},{"id":7762,"precertRequired":false,"billingCode":"A4393","codeType":"HCPCS"},{"id":7763,"precertRequired":false,"billingCode":"A4394","codeType":"HCPCS"},{"id":7764,"precertRequired":false,"billingCode":"A4395","codeType":"HCPCS"},{"id":7765,"precertRequired":false,"billingCode":"A4396","codeType":"HCPCS"},{"id":7766,"precertRequired":false,"billingCode":"A4397","codeType":"HCPCS"},{"id":7767,"precertRequired":false,"billingCode":"A4398","codeType":"HCPCS"},{"id":7768,"precertRequired":false,"billingCode":"A4399","codeType":"HCPCS"},{"id":7769,"precertRequired":false,"billingCode":"A4400","codeType":"HCPCS"},{"id":7831,"precertRequired":false,"billingCode":"A5112","codeType":"HCPCS"},{"id":8712,"precertRequired":false,"billingCode":"L8684","codeType":"HCPCS"},{"id":8764,"precertRequired":false,"billingCode":"P9612","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":741,"description":" Bowel and/or bladder care  related to neurogenic bowel and bladder to be provided by a skilled licensed provider or an individual serving as a independent home health attendant trained and certified by VHA personnel (to include family members once trained and certified).","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":6598,"precertRequired":false,"billingCode":"90901","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7247,"precertRequired":false,"billingCode":"97033","codeType":"CPT"},{"id":7276,"precertRequired":false,"billingCode":"97535","codeType":"CPT"},{"id":7278,"precertRequired":false,"billingCode":"97542","codeType":"CPT"},{"id":7503,"precertRequired":false,"billingCode":"99505","codeType":"CPT"},{"id":7505,"precertRequired":true,"billingCode":"99507","codeType":"CPT"},{"id":7506,"precertRequired":false,"billingCode":"99509","codeType":"CPT"},{"id":7508,"precertRequired":false,"billingCode":"99511","codeType":"CPT"},{"id":7510,"precertRequired":false,"billingCode":"99600","codeType":"CPT"},{"id":8139,"precertRequired":false,"billingCode":"G0151","codeType":"HCPCS"},{"id":8140,"precertRequired":false,"billingCode":"G0152","codeType":"HCPCS"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8144,"precertRequired":false,"billingCode":"G0157","codeType":"HCPCS"},{"id":8145,"precertRequired":false,"billingCode":"G0158","codeType":"HCPCS"},{"id":8146,"precertRequired":false,"billingCode":"G0159","codeType":"HCPCS"},{"id":8147,"precertRequired":false,"billingCode":"G0160","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"},{"id":8153,"precertRequired":false,"billingCode":"G0179","codeType":"HCPCS"},{"id":8154,"precertRequired":false,"billingCode":"G0180","codeType":"HCPCS"},{"id":8155,"precertRequired":false,"billingCode":"G0181","codeType":"HCPCS"},{"id":8180,"precertRequired":false,"billingCode":"G0299","codeType":"HCPCS"},{"id":8181,"precertRequired":false,"billingCode":"G0300","codeType":"HCPCS"},{"id":8234,"precertRequired":false,"billingCode":"G0490","codeType":"HCPCS"},{"id":8236,"precertRequired":false,"billingCode":"G0493","codeType":"HCPCS"},{"id":8237,"precertRequired":false,"billingCode":"G0494","codeType":"HCPCS"},{"id":8238,"precertRequired":false,"billingCode":"G0495","codeType":"HCPCS"},{"id":8239,"precertRequired":false,"billingCode":"G0496","codeType":"HCPCS"},{"id":8314,"precertRequired":false,"billingCode":"G9187","codeType":"HCPCS"},{"id":8326,"precertRequired":false,"billingCode":"G9490","codeType":"HCPCS"},{"id":8976,"precertRequired":false,"billingCode":"S9007","codeType":"HCPCS"},{"id":8981,"precertRequired":false,"billingCode":"S9122","codeType":"HCPCS"},{"id":8982,"precertRequired":false,"billingCode":"S9123","codeType":"HCPCS"},{"id":8983,"precertRequired":false,"billingCode":"S9124","codeType":"HCPCS"},{"id":8985,"precertRequired":false,"billingCode":"S9127","codeType":"HCPCS"},{"id":8987,"precertRequired":false,"billingCode":"S9129","codeType":"HCPCS"},{"id":8988,"precertRequired":false,"billingCode":"S9131","codeType":"HCPCS"},{"id":9047,"precertRequired":false,"billingCode":"T1019","codeType":"HCPCS"},{"id":9048,"precertRequired":false,"billingCode":"T1020","codeType":"HCPCS"},{"id":9050,"precertRequired":false,"billingCode":"T1022","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":742,"description":"Duration and frequency of visits as indicated in  treatment plan established per consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":104,"seocKey":16,"name":"Bowel and Bladder_PRCT","seocId":"NIC_BOWEL AND BLADDER_1.0.1_PRCT","versionNumber":"1.0.1","description":"Duration and frequency of visits as indicated in  treatment plan established per consult.","effectiveDate":"09-21-2018","endDate":"01-02-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial evaluation for confirmation of treatment plan\r\n2. Bowel and/or bladder services related to neurogenic bowel and bladder as necessary as indicated on the consult, including catheter irrigation, changing colostomy bags, changing external catheters, and bathing after completion of bowel & bladder care as needed as appropriate\r\n3. Bowel and/or bladder care  related to neurogenic bowel and bladder to be provided by a skilled licensed provider or an individual serving as a independent home health attendant trained and certified by VHA personnel (to include family members once trained and certified)\r\n4. Duration and frequency of visits as indicated in  treatment plan established per consult","maxAllowableVisits":999,"disclaimer":"* Changes in treatment plan during this EOC are to be communicated with VAMC and noted on initial consult and authorization re-issued to reflect changes.\r\n* Duration of a max approved 365 days with ongoing annual re-approval\r\n* Additional consultations needed relevant to the referred patient condition(s) require VA review and approval.\r\n* All routine medications/supplies will be provided by the VA.","QASP":"General Care","categoryOfCare":"NIC BOWEL AND BLADDER","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":365,"description":"Initial evaluation for confirmation of treatment plan.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":366,"description":"Bowel and/or bladder services related to neurogenic bowel and bladder as necessary as indicated on the consult, including catheter irrigation, changing colostomy bags, changing external catheters, and bathing after completion of bowel & bladder care as needed as appropriate.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":3223,"precertRequired":false,"billingCode":"46999","codeType":"CPT"},{"id":3412,"precertRequired":false,"billingCode":"50820","codeType":"CPT"},{"id":3416,"precertRequired":false,"billingCode":"51700","codeType":"CPT"},{"id":3417,"precertRequired":false,"billingCode":"51701","codeType":"CPT"},{"id":3418,"precertRequired":false,"billingCode":"51702","codeType":"CPT"},{"id":3419,"precertRequired":false,"billingCode":"51703","codeType":"CPT"},{"id":3420,"precertRequired":false,"billingCode":"51705","codeType":"CPT"},{"id":3421,"precertRequired":false,"billingCode":"51710","codeType":"CPT"},{"id":3934,"precertRequired":true,"billingCode":"64450","codeType":"CPT"},{"id":7715,"precertRequired":false,"billingCode":"A4332","codeType":"HCPCS"},{"id":7716,"precertRequired":false,"billingCode":"A4333","codeType":"HCPCS"},{"id":7717,"precertRequired":false,"billingCode":"A4334","codeType":"HCPCS"},{"id":7721,"precertRequired":false,"billingCode":"A4338","codeType":"HCPCS"},{"id":7722,"precertRequired":false,"billingCode":"A4340","codeType":"HCPCS"},{"id":7723,"precertRequired":false,"billingCode":"A4344","codeType":"HCPCS"},{"id":7724,"precertRequired":false,"billingCode":"A4346","codeType":"HCPCS"},{"id":7725,"precertRequired":false,"billingCode":"A4351","codeType":"HCPCS"},{"id":7726,"precertRequired":false,"billingCode":"A4352","codeType":"HCPCS"},{"id":7727,"precertRequired":false,"billingCode":"A4353","codeType":"HCPCS"},{"id":7729,"precertRequired":false,"billingCode":"A4355","codeType":"HCPCS"},{"id":7733,"precertRequired":false,"billingCode":"A4360","codeType":"HCPCS"},{"id":7734,"precertRequired":false,"billingCode":"A4361","codeType":"HCPCS"},{"id":7735,"precertRequired":false,"billingCode":"A4362","codeType":"HCPCS"},{"id":7736,"precertRequired":false,"billingCode":"A4363","codeType":"HCPCS"},{"id":7737,"precertRequired":false,"billingCode":"A4364","codeType":"HCPCS"},{"id":7738,"precertRequired":false,"billingCode":"A4366","codeType":"HCPCS"},{"id":7739,"precertRequired":false,"billingCode":"A4367","codeType":"HCPCS"},{"id":7740,"precertRequired":false,"billingCode":"A4368","codeType":"HCPCS"},{"id":7741,"precertRequired":false,"billingCode":"A4369","codeType":"HCPCS"},{"id":7742,"precertRequired":false,"billingCode":"A4371","codeType":"HCPCS"},{"id":7743,"precertRequired":false,"billingCode":"A4372","codeType":"HCPCS"},{"id":7744,"precertRequired":false,"billingCode":"A4373","codeType":"HCPCS"},{"id":7745,"precertRequired":false,"billingCode":"A4375","codeType":"HCPCS"},{"id":7746,"precertRequired":false,"billingCode":"A4376","codeType":"HCPCS"},{"id":7747,"precertRequired":false,"billingCode":"A4377","codeType":"HCPCS"},{"id":7748,"precertRequired":false,"billingCode":"A4378","codeType":"HCPCS"},{"id":7749,"precertRequired":false,"billingCode":"A4379","codeType":"HCPCS"},{"id":7750,"precertRequired":false,"billingCode":"A4380","codeType":"HCPCS"},{"id":7751,"precertRequired":false,"billingCode":"A4381","codeType":"HCPCS"},{"id":7752,"precertRequired":false,"billingCode":"A4382","codeType":"HCPCS"},{"id":7753,"precertRequired":false,"billingCode":"A4383","codeType":"HCPCS"},{"id":7754,"precertRequired":false,"billingCode":"A4384","codeType":"HCPCS"},{"id":7755,"precertRequired":false,"billingCode":"A4385","codeType":"HCPCS"},{"id":7756,"precertRequired":false,"billingCode":"A4387","codeType":"HCPCS"},{"id":7757,"precertRequired":false,"billingCode":"A4388","codeType":"HCPCS"},{"id":7758,"precertRequired":false,"billingCode":"A4389","codeType":"HCPCS"},{"id":7759,"precertRequired":false,"billingCode":"A4390","codeType":"HCPCS"},{"id":7760,"precertRequired":false,"billingCode":"A4391","codeType":"HCPCS"},{"id":7761,"precertRequired":false,"billingCode":"A4392","codeType":"HCPCS"},{"id":7762,"precertRequired":false,"billingCode":"A4393","codeType":"HCPCS"},{"id":7763,"precertRequired":false,"billingCode":"A4394","codeType":"HCPCS"},{"id":7764,"precertRequired":false,"billingCode":"A4395","codeType":"HCPCS"},{"id":7765,"precertRequired":false,"billingCode":"A4396","codeType":"HCPCS"},{"id":7766,"precertRequired":false,"billingCode":"A4397","codeType":"HCPCS"},{"id":7767,"precertRequired":false,"billingCode":"A4398","codeType":"HCPCS"},{"id":7768,"precertRequired":false,"billingCode":"A4399","codeType":"HCPCS"},{"id":7769,"precertRequired":false,"billingCode":"A4400","codeType":"HCPCS"},{"id":7831,"precertRequired":false,"billingCode":"A5112","codeType":"HCPCS"},{"id":8712,"precertRequired":false,"billingCode":"L8684","codeType":"HCPCS"},{"id":8764,"precertRequired":false,"billingCode":"P9612","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":367,"description":" Bowel and/or bladder care  related to neurogenic bowel and bladder to be provided by a skilled licensed provider or an individual serving as a independent home health attendant trained and certified by VHA personnel (to include family members once trained and certified).","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":6598,"precertRequired":false,"billingCode":"90901","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7247,"precertRequired":false,"billingCode":"97033","codeType":"CPT"},{"id":7276,"precertRequired":false,"billingCode":"97535","codeType":"CPT"},{"id":7278,"precertRequired":false,"billingCode":"97542","codeType":"CPT"},{"id":7503,"precertRequired":false,"billingCode":"99505","codeType":"CPT"},{"id":7505,"precertRequired":true,"billingCode":"99507","codeType":"CPT"},{"id":7506,"precertRequired":false,"billingCode":"99509","codeType":"CPT"},{"id":7508,"precertRequired":false,"billingCode":"99511","codeType":"CPT"},{"id":7510,"precertRequired":false,"billingCode":"99600","codeType":"CPT"},{"id":8139,"precertRequired":false,"billingCode":"G0151","codeType":"HCPCS"},{"id":8140,"precertRequired":false,"billingCode":"G0152","codeType":"HCPCS"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8144,"precertRequired":false,"billingCode":"G0157","codeType":"HCPCS"},{"id":8145,"precertRequired":false,"billingCode":"G0158","codeType":"HCPCS"},{"id":8146,"precertRequired":false,"billingCode":"G0159","codeType":"HCPCS"},{"id":8147,"precertRequired":false,"billingCode":"G0160","codeType":"HCPCS"},{"id":8149,"precertRequired":false,"billingCode":"G0162","codeType":"HCPCS"},{"id":8153,"precertRequired":false,"billingCode":"G0179","codeType":"HCPCS"},{"id":8154,"precertRequired":false,"billingCode":"G0180","codeType":"HCPCS"},{"id":8155,"precertRequired":false,"billingCode":"G0181","codeType":"HCPCS"},{"id":8180,"precertRequired":false,"billingCode":"G0299","codeType":"HCPCS"},{"id":8181,"precertRequired":false,"billingCode":"G0300","codeType":"HCPCS"},{"id":8234,"precertRequired":false,"billingCode":"G0490","codeType":"HCPCS"},{"id":8236,"precertRequired":false,"billingCode":"G0493","codeType":"HCPCS"},{"id":8237,"precertRequired":false,"billingCode":"G0494","codeType":"HCPCS"},{"id":8238,"precertRequired":false,"billingCode":"G0495","codeType":"HCPCS"},{"id":8239,"precertRequired":false,"billingCode":"G0496","codeType":"HCPCS"},{"id":8314,"precertRequired":false,"billingCode":"G9187","codeType":"HCPCS"},{"id":8326,"precertRequired":false,"billingCode":"G9490","codeType":"HCPCS"},{"id":8976,"precertRequired":false,"billingCode":"S9007","codeType":"HCPCS"},{"id":8981,"precertRequired":false,"billingCode":"S9122","codeType":"HCPCS"},{"id":8982,"precertRequired":false,"billingCode":"S9123","codeType":"HCPCS"},{"id":8983,"precertRequired":false,"billingCode":"S9124","codeType":"HCPCS"},{"id":8985,"precertRequired":false,"billingCode":"S9127","codeType":"HCPCS"},{"id":8987,"precertRequired":false,"billingCode":"S9129","codeType":"HCPCS"},{"id":8988,"precertRequired":false,"billingCode":"S9131","codeType":"HCPCS"},{"id":9047,"precertRequired":false,"billingCode":"T1019","codeType":"HCPCS"},{"id":9048,"precertRequired":false,"billingCode":"T1020","codeType":"HCPCS"},{"id":9050,"precertRequired":false,"billingCode":"T1022","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":368,"description":"Duration and frequency of visits as indicated in  treatment plan established per consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":1890,"seocKey":17,"name":"Cardiac Rehab","seocId":"PMR_CARDIAC REHAB_1.0.6","versionNumber":"1.0.6","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"07-23-2020","endDate":null,"duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for referred condition on the consult order\r\n2.    One visit for cardiac stress test if not already completed by VA\r\n3.    Cardiac rehabilitation, no more than 36 visits, 3 visits per week","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CARDIOLOGY REHAB","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"163WC3500X"},{"hptc":"207RC0000X"},{"hptc":"208100000X"},{"hptc":"2251C2600X"}],"services":[{"id":6066,"description":"Initial outpatient evaluation and treatment for referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]},{"id":6067,"description":"One visit for cardiac stress test if not already completed by VA","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":6068,"description":"Cardiac rehabilitation, no more than 36 visits, 3 visits per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":543,"seocKey":17,"name":"Cardiac Rehab","seocId":"PMR_CARDIAC REHAB_1.0.5","versionNumber":"1.0.5","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"07-28-2019","endDate":"07-23-2020","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for referred condition on the consult\r\n2. One visit for cardiac stress test if not already completed by VA\r\n3. Cardiac rehabilitation, no more than 3 visits per week","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CARDIOLOGY REHAB","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"163WC3500X"},{"hptc":"207RC0000X"},{"hptc":"208100000X"},{"hptc":"2251C2600X"}],"services":[{"id":3137,"description":"Initial outpatient evaluation and treatment for referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]},{"id":3138,"description":"One visit for cardiac stress test if not already completed by VA","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":3139,"description":"Cardiac rehabilitation, no more than 3 visits per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":8210,"precertRequired":false,"billingCode":"G0424","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":308,"seocKey":17,"name":"Cardiac Rehab","seocId":"PMR_CARDIAC REHAB_1.0.4","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"02-19-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for referred condition on the consult\r\n2. One visit for cardiac stress test if not already completed by VA\r\n3. Cardiac rehabilitation, no more than 3 visits per week","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.     \r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY REHAB","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"163WC3500X"},{"hptc":"207RC0000X"},{"hptc":"208100000X"},{"hptc":"2251C2600X"}],"services":[{"id":1358,"description":"Initial outpatient evaluation and treatment for referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]},{"id":1359,"description":"One visit for cardiac stress test if not already completed by VA","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":1360,"description":"Cardiac rehabilitation, no more than 3 visits per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":8210,"precertRequired":false,"billingCode":"G0424","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":196,"seocKey":17,"name":"Cardiac Rehab","seocId":"PMR_CARDIAC REHAB_1.0.3","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-03-2019","endDate":"02-19-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for referred condition on the consult\r\n2. One visit for cardiac stress test if not already completed by VA\r\n3. Cardiac rehabilitation, no more than 3 visits per week","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.     \r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY REHAB","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"163WC3500X"},{"hptc":"207RC0000X"},{"hptc":"208100000X"},{"hptc":"2251C2600X"}],"services":[{"id":743,"description":"Initial outpatient evaluation and treatment for referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"31-Intensive cardiac rehabilitation"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[]},{"id":744,"description":"One visit for cardiac stress test if not already completed by VA","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":745,"description":"Cardiac rehabilitation, no more than 3 visits per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"31-Intensive cardiac rehabilitation"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":8210,"precertRequired":false,"billingCode":"G0424","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"}],"serviceHptcs":[]}]}},{"Seoc":{"id":23,"seocKey":17,"name":"Cardiac Rehab","seocId":"PMR_CARDIAC REHAB_1.0.2","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"01-03-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for referred condition on the consult\r\n2. One visit for cardiac stress test if not already completed by VA\r\n3. Cardiac rehabilitation, no more than 3 visits per week","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.     \r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY REHAB","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":80,"description":"Initial outpatient evaluation and treatment for referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"31-Intensive cardiac rehabilitation"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[]},{"id":81,"description":"One visit for cardiac stress test if not already completed by VA","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":82,"description":"Cardiac rehabilitation, no more than 3 visits per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"31-Intensive cardiac rehabilitation"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":8210,"precertRequired":false,"billingCode":"G0424","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"}],"serviceHptcs":[]}]}},{"Seoc":{"id":24,"seocKey":17,"name":"Cardiac Rehab_PRCT","seocId":"PMR_CARDIAC REHAB_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"11-01-2017","endDate":"11-01-2017","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment patient complaint/condition on consult\r\n2. One visit for cardiac stress test if not already completed by VA\r\n3. Cardiac rehabilitation for a maximum of 21 visits no more than 3x per week","maxAllowableVisits":24,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14 day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY REHAB","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1306,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1767,"seocKey":18,"name":"Cardiology Cath - PCI_REV_PRCT","seocId":"MSC_CARDIOLOGY CATH - PCI_1.0.6_REV_PRCT","versionNumber":"1.0.6","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":180,"REV":true,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition on the consult order\r\n2.    Diagnostic imaging relevant to the referred condition on the consult order\r\n3.    Diagnostic studies relevant to the referred condition on the consult order\r\n4.    Labs and pathology relevant to the referred condition on the consult order **\r\n5.    One cardiac catheterization with PCI interventions and overnight observation if required\r\n6.    Anesthesia consultation related to the procedure\r\n7.    Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n8.    Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period\r\n***VA notification is required if emergent procedure is necessary.  Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n9.    Follow-up visits for this episode of care\r\n10.  Cardiac rehabilitation, up to 36 visits, no more than 3x per week **","maxAllowableVisits":null,"disclaimer":"*Please visit the VHA Storefront \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp \r\nfor 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","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0011X"}],"services":[{"id":5362,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5363,"description":"Diagnostic imaging relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":13463,"precertRequired":false,"billingCode":"G8961","codeType":"HCPCS"},{"id":13464,"precertRequired":false,"billingCode":"G8962","codeType":"HCPCS"},{"id":13465,"precertRequired":false,"billingCode":"G8963","codeType":"HCPCS"},{"id":13466,"precertRequired":false,"billingCode":"G8964","codeType":"HCPCS"},{"id":13467,"precertRequired":false,"billingCode":"G8965","codeType":"HCPCS"},{"id":13468,"precertRequired":false,"billingCode":"G8966","codeType":"HCPCS"},{"id":13529,"precertRequired":false,"billingCode":"77565","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5364,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":13530,"precertRequired":false,"billingCode":"G9321","codeType":"HCPCS"},{"id":13531,"precertRequired":false,"billingCode":"G9322","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5365,"description":"Labs and pathology relevant to the referred condition on the consult order **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5366,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6847,"precertRequired":false,"billingCode":"93279","codeType":"CPT"},{"id":6854,"precertRequired":false,"billingCode":"93286","codeType":"CPT"},{"id":6856,"precertRequired":false,"billingCode":"93288","codeType":"CPT"},{"id":6862,"precertRequired":false,"billingCode":"93294","codeType":"CPT"},{"id":6864,"precertRequired":false,"billingCode":"93296","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":6964,"precertRequired":false,"billingCode":"93799","codeType":"CPT"},{"id":7577,"precertRequired":false,"billingCode":"0483T","codeType":"CPT"},{"id":7578,"precertRequired":false,"billingCode":"0484T","codeType":"CPT"},{"id":7951,"precertRequired":false,"billingCode":"C1874","codeType":"HCPCS"},{"id":7952,"precertRequired":false,"billingCode":"C1875","codeType":"HCPCS"},{"id":7953,"precertRequired":false,"billingCode":"C1876","codeType":"HCPCS"},{"id":7954,"precertRequired":false,"billingCode":"C1877","codeType":"HCPCS"},{"id":8172,"precertRequired":false,"billingCode":"G0278","codeType":"HCPCS"},{"id":8764,"precertRequired":false,"billingCode":"P9612","codeType":"HCPCS"},{"id":11340,"precertRequired":false,"billingCode":"33274","codeType":"CPT"},{"id":11341,"precertRequired":false,"billingCode":"33275","codeType":"CPT"},{"id":11416,"precertRequired":false,"billingCode":"33289","codeType":"CPT"},{"id":13338,"precertRequired":true,"billingCode":"93451","codeType":"CPT"},{"id":13339,"precertRequired":true,"billingCode":"93452","codeType":"CPT"},{"id":13340,"precertRequired":true,"billingCode":"93453","codeType":"CPT"},{"id":13341,"precertRequired":true,"billingCode":"93530","codeType":"CPT"},{"id":13342,"precertRequired":true,"billingCode":"93531","codeType":"CPT"},{"id":13343,"precertRequired":true,"billingCode":"93532","codeType":"CPT"},{"id":13344,"precertRequired":true,"billingCode":"93533","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5367,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":65,"precertRequired":false,"billingCode":"00563","codeType":"CPT"},{"id":190,"precertRequired":false,"billingCode":"01770","codeType":"CPT"},{"id":193,"precertRequired":false,"billingCode":"01920","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":5368,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5369,"description":"Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period\r\n***VA notification is required if emergent procedure is necessary.  Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5370,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5371,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week **","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":508,"seocKey":18,"name":"Cardiology - Cath/PCI","seocId":"MSC_CARDIOLOGY - CATH/PCI_1.0.5","versionNumber":"1.0.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. labs and pathology relevant to the referred condition on the consult **\r\n5. One cardiac catheterization with PCI interventions and overnight observation if required\r\n6. Anesthesia consultation related to the procedure\r\n7. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n8. Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran\r\n9. Follow-up visits for this episode of care\r\n10. Cardiac rehabilitation, up to 36 visits, no more than 3x per week **","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0011X"}],"services":[{"id":2940,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2941,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2942,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2943,"description":"labs and pathology relevant to the referred condition on the consult **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":2944,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6847,"precertRequired":false,"billingCode":"93279","codeType":"CPT"},{"id":6854,"precertRequired":false,"billingCode":"93286","codeType":"CPT"},{"id":6856,"precertRequired":false,"billingCode":"93288","codeType":"CPT"},{"id":6862,"precertRequired":false,"billingCode":"93294","codeType":"CPT"},{"id":6864,"precertRequired":false,"billingCode":"93296","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6904,"precertRequired":false,"billingCode":"93531","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":7520,"precertRequired":false,"billingCode":"0205T","codeType":"CPT"},{"id":7577,"precertRequired":false,"billingCode":"0483T","codeType":"CPT"},{"id":7578,"precertRequired":false,"billingCode":"0484T","codeType":"CPT"},{"id":7951,"precertRequired":false,"billingCode":"C1874","codeType":"HCPCS"},{"id":7952,"precertRequired":false,"billingCode":"C1875","codeType":"HCPCS"},{"id":7953,"precertRequired":false,"billingCode":"C1876","codeType":"HCPCS"},{"id":7954,"precertRequired":false,"billingCode":"C1877","codeType":"HCPCS"},{"id":8172,"precertRequired":false,"billingCode":"G0278","codeType":"HCPCS"},{"id":8764,"precertRequired":false,"billingCode":"P9612","codeType":"HCPCS"},{"id":11340,"precertRequired":false,"billingCode":"33274","codeType":"CPT"},{"id":11341,"precertRequired":false,"billingCode":"33275","codeType":"CPT"},{"id":11416,"precertRequired":false,"billingCode":"33289","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2945,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":65,"precertRequired":false,"billingCode":"00563","codeType":"CPT"},{"id":190,"precertRequired":false,"billingCode":"01770","codeType":"CPT"},{"id":193,"precertRequired":false,"billingCode":"01920","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":2946,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":8196,"precertRequired":false,"billingCode":"G0403","codeType":"HCPCS"},{"id":8197,"precertRequired":false,"billingCode":"G0404","codeType":"HCPCS"},{"id":8198,"precertRequired":false,"billingCode":"G0405","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2947,"description":"Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2948,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2949,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week **","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":309,"seocKey":18,"name":"Cardiology - Cath/PCI","seocId":"MSC_CARDIOLOGY - CATH/PCI_1.0.4","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"02-19-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. labs and pathology relevant to the referred condition on the consult **\r\n5. One cardiac catheterization with PCI interventions and overnight observation if required\r\n6. Anesthesia consultation related to the procedure\r\n7. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n8. Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran\r\n9. Follow-up visits for this episode of care\r\n10. Cardiac rehabilitation, up to 36 visits, no more than 3x per week **","maxAllowableVisits":null,"disclaimer":"* If non-emergent bypass grafting is required an additional VA authorization must be acquired.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n** Visits for additional services are not included in the frequency total.  The number of visits authorized for ancillary services are noted within its service line description above.  \r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0011X"}],"services":[{"id":1361,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1362,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":8270,"precertRequired":false,"billingCode":"G8961","codeType":"HCPCS"},{"id":8271,"precertRequired":false,"billingCode":"G8962","codeType":"HCPCS"},{"id":8272,"precertRequired":false,"billingCode":"G8963","codeType":"HCPCS"},{"id":8273,"precertRequired":false,"billingCode":"G8964","codeType":"HCPCS"},{"id":8274,"precertRequired":false,"billingCode":"G8965","codeType":"HCPCS"},{"id":8275,"precertRequired":false,"billingCode":"G8966","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1363,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":8316,"precertRequired":false,"billingCode":"G9321","codeType":"HCPCS"},{"id":8317,"precertRequired":false,"billingCode":"G9322","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1364,"description":"labs and pathology relevant to the referred condition on the consult **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1365,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6904,"precertRequired":false,"billingCode":"93531","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":7520,"precertRequired":false,"billingCode":"0205T","codeType":"CPT"},{"id":7557,"precertRequired":false,"billingCode":"0387T","codeType":"CPT"},{"id":7558,"precertRequired":false,"billingCode":"0388T","codeType":"CPT"},{"id":7559,"precertRequired":false,"billingCode":"0389T","codeType":"CPT"},{"id":7560,"precertRequired":false,"billingCode":"0390T","codeType":"CPT"},{"id":7561,"precertRequired":false,"billingCode":"0391T","codeType":"CPT"},{"id":7577,"precertRequired":false,"billingCode":"0483T","codeType":"CPT"},{"id":7578,"precertRequired":false,"billingCode":"0484T","codeType":"CPT"},{"id":7951,"precertRequired":false,"billingCode":"C1874","codeType":"HCPCS"},{"id":7952,"precertRequired":false,"billingCode":"C1875","codeType":"HCPCS"},{"id":7953,"precertRequired":false,"billingCode":"C1876","codeType":"HCPCS"},{"id":7954,"precertRequired":false,"billingCode":"C1877","codeType":"HCPCS"},{"id":8000,"precertRequired":false,"billingCode":"C9741","codeType":"HCPCS"},{"id":8172,"precertRequired":false,"billingCode":"G0278","codeType":"HCPCS"},{"id":8764,"precertRequired":false,"billingCode":"P9612","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1366,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":65,"precertRequired":false,"billingCode":"00563","codeType":"CPT"},{"id":190,"precertRequired":false,"billingCode":"01770","codeType":"CPT"},{"id":193,"precertRequired":false,"billingCode":"01920","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1367,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":8196,"precertRequired":false,"billingCode":"G0403","codeType":"HCPCS"},{"id":8197,"precertRequired":false,"billingCode":"G0404","codeType":"HCPCS"},{"id":8198,"precertRequired":false,"billingCode":"G0405","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1368,"description":"Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1369,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1370,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week **","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":197,"seocKey":18,"name":"Cardiology - Cath/PCI","seocId":"MSC_CARDIOLOGY - CATH/PCI_1.0.3","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-02-2019","endDate":"02-19-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. labs and pathology relevant to the referred condition on the consult **\r\n5. One cardiac catheterization with PCI interventions and overnight observation if required\r\n6. Anesthesia consultation related to the procedure\r\n7. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n8. Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran\r\n9. Follow-up visits for this episode of care\r\n10. Cardiac rehabilitation, up to 36 visits, no more than 3x per week **","maxAllowableVisits":null,"disclaimer":"* If non-emergent bypass grafting is required an additional VA authorization must be acquired.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n** Visits for additional services are not included in the frequency total.  The number of visits authorized for ancillary services are noted within its service line description above.  \r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0011X"}],"services":[{"id":746,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":747,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":8270,"precertRequired":false,"billingCode":"G8961","codeType":"HCPCS"},{"id":8271,"precertRequired":false,"billingCode":"G8962","codeType":"HCPCS"},{"id":8272,"precertRequired":false,"billingCode":"G8963","codeType":"HCPCS"},{"id":8273,"precertRequired":false,"billingCode":"G8964","codeType":"HCPCS"},{"id":8274,"precertRequired":false,"billingCode":"G8965","codeType":"HCPCS"},{"id":8275,"precertRequired":false,"billingCode":"G8966","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":748,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":8316,"precertRequired":false,"billingCode":"G9321","codeType":"HCPCS"},{"id":8317,"precertRequired":false,"billingCode":"G9322","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":749,"description":"labs and pathology relevant to the referred condition on the consult **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":750,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6904,"precertRequired":false,"billingCode":"93531","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":7520,"precertRequired":false,"billingCode":"0205T","codeType":"CPT"},{"id":7557,"precertRequired":false,"billingCode":"0387T","codeType":"CPT"},{"id":7558,"precertRequired":false,"billingCode":"0388T","codeType":"CPT"},{"id":7559,"precertRequired":false,"billingCode":"0389T","codeType":"CPT"},{"id":7560,"precertRequired":false,"billingCode":"0390T","codeType":"CPT"},{"id":7561,"precertRequired":false,"billingCode":"0391T","codeType":"CPT"},{"id":7577,"precertRequired":false,"billingCode":"0483T","codeType":"CPT"},{"id":7578,"precertRequired":false,"billingCode":"0484T","codeType":"CPT"},{"id":7951,"precertRequired":false,"billingCode":"C1874","codeType":"HCPCS"},{"id":7952,"precertRequired":false,"billingCode":"C1875","codeType":"HCPCS"},{"id":7953,"precertRequired":false,"billingCode":"C1876","codeType":"HCPCS"},{"id":7954,"precertRequired":false,"billingCode":"C1877","codeType":"HCPCS"},{"id":8000,"precertRequired":false,"billingCode":"C9741","codeType":"HCPCS"},{"id":8172,"precertRequired":false,"billingCode":"G0278","codeType":"HCPCS"},{"id":8764,"precertRequired":false,"billingCode":"P9612","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":751,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":65,"precertRequired":false,"billingCode":"00563","codeType":"CPT"},{"id":190,"precertRequired":false,"billingCode":"01770","codeType":"CPT"},{"id":193,"precertRequired":false,"billingCode":"01920","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":752,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":8196,"precertRequired":false,"billingCode":"G0403","codeType":"HCPCS"},{"id":8197,"precertRequired":false,"billingCode":"G0404","codeType":"HCPCS"},{"id":8198,"precertRequired":false,"billingCode":"G0405","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":753,"description":"Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":754,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":755,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week **","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"31-Intensive cardiac rehabilitation"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"}],"serviceHptcs":[]}]}},{"Seoc":{"id":105,"seocKey":18,"name":"Cardiology - Cath/PCI","seocId":"MSC_CARDIOLOGY - CATH/PCI_1.0.2","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"09-21-2018","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. labs and pathology relevant to the referred condition on the consult **\r\n5. One cardiac catheterization with PCI interventions and overnight observation if required\r\n6. Anesthesia consultation related to the procedure\r\n7. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n8. Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran\r\n9. Follow-up visits for this episode of care\r\n10. Cardiac rehabilitation, up to 36 visits, no more than 3x per week **","maxAllowableVisits":999,"disclaimer":"* If non-emergent bypass grafting is required an additional VA authorization must be acquired.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n** Visits for additional services are not included in the frequency total.  The number of visits authorized for ancillary services are noted within its service line description above.  \r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":59,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":60,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":8270,"precertRequired":false,"billingCode":"G8961","codeType":"HCPCS"},{"id":8271,"precertRequired":false,"billingCode":"G8962","codeType":"HCPCS"},{"id":8272,"precertRequired":false,"billingCode":"G8963","codeType":"HCPCS"},{"id":8273,"precertRequired":false,"billingCode":"G8964","codeType":"HCPCS"},{"id":8274,"precertRequired":false,"billingCode":"G8965","codeType":"HCPCS"},{"id":8275,"precertRequired":false,"billingCode":"G8966","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":61,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":8316,"precertRequired":false,"billingCode":"G9321","codeType":"HCPCS"},{"id":8317,"precertRequired":false,"billingCode":"G9322","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":62,"description":"labs and pathology relevant to the referred condition on the consult **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":63,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6904,"precertRequired":false,"billingCode":"93531","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":7520,"precertRequired":false,"billingCode":"0205T","codeType":"CPT"},{"id":7557,"precertRequired":false,"billingCode":"0387T","codeType":"CPT"},{"id":7558,"precertRequired":false,"billingCode":"0388T","codeType":"CPT"},{"id":7559,"precertRequired":false,"billingCode":"0389T","codeType":"CPT"},{"id":7560,"precertRequired":false,"billingCode":"0390T","codeType":"CPT"},{"id":7561,"precertRequired":false,"billingCode":"0391T","codeType":"CPT"},{"id":7577,"precertRequired":false,"billingCode":"0483T","codeType":"CPT"},{"id":7578,"precertRequired":false,"billingCode":"0484T","codeType":"CPT"},{"id":7951,"precertRequired":false,"billingCode":"C1874","codeType":"HCPCS"},{"id":7952,"precertRequired":false,"billingCode":"C1875","codeType":"HCPCS"},{"id":7953,"precertRequired":false,"billingCode":"C1876","codeType":"HCPCS"},{"id":7954,"precertRequired":false,"billingCode":"C1877","codeType":"HCPCS"},{"id":8000,"precertRequired":false,"billingCode":"C9741","codeType":"HCPCS"},{"id":8172,"precertRequired":false,"billingCode":"G0278","codeType":"HCPCS"},{"id":8764,"precertRequired":false,"billingCode":"P9612","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":64,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":65,"precertRequired":false,"billingCode":"00563","codeType":"CPT"},{"id":190,"precertRequired":false,"billingCode":"01770","codeType":"CPT"},{"id":193,"precertRequired":false,"billingCode":"01920","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":65,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":8196,"precertRequired":false,"billingCode":"G0403","codeType":"HCPCS"},{"id":8197,"precertRequired":false,"billingCode":"G0404","codeType":"HCPCS"},{"id":8198,"precertRequired":false,"billingCode":"G0405","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":66,"description":"Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":67,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":68,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week **","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"31-Intensive cardiac rehabilitation"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"}],"serviceHptcs":[]}]}},{"Seoc":{"id":25,"seocKey":18,"name":"Cardiology - Cath/PCI_PRCT","seocId":"SSC_CARDIOLOGY - CATH/PCI_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below for the referred condition","effectiveDate":"11-01-2017","endDate":"09-21-2018","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Diagnostic imaging relevant to the referred condition\r\n3. Diagnostic studies and labs relevant to the referred condition\r\n4. One cardiac catheterization and PCI\r\n5. Anesthesia consultation related to the procedure\r\n6. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n7. Inpatient admission for surgical procedure (e.g. bypass grafting, valve replacements, dissection and/or cardiac aneurysm, AV fistula) if required \r\n8. Follow-up visits for this episode of care, as clinically required\r\n9. Cardiac rehabilitation, up to 36 visits, no more than 3x per week","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY CATH","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1307,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1768,"seocKey":21,"name":"Cardiology TAVR_REV_PRCT","seocId":"MSC_CARDIOLOGY TAVR_1.2.6_REV_PRCT","versionNumber":"1.2.6","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":180,"REV":true,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for TAVR workup\r\n2.    Diagnostic imaging relevant to the patient complaint/condition\r\n3.    Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient complaint/condition\r\n4.    One cardiac catheterization or PCI\r\n5.    Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider.\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n6.    Cardiology follow-up visits for this episode of care\r\n7.    Post-operative diagnostic imaging as clinically required\r\n8.    Post operative diagnostic studies as clinically required\r\n9.    Cardiac rehabilitation, up to 36 visits, no more than 3x per week","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0011X"}],"services":[{"id":5372,"description":"Initial outpatient evaluation and treatment for TAVR workup","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5373,"description":"Diagnostic imaging relevant to the patient compliant/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5374,"description":"Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5375,"description":"One cardiac catheterization or PCI","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":13338,"precertRequired":true,"billingCode":"93451","codeType":"CPT"},{"id":13339,"precertRequired":true,"billingCode":"93452","codeType":"CPT"},{"id":13340,"precertRequired":true,"billingCode":"93453","codeType":"CPT"},{"id":13341,"precertRequired":true,"billingCode":"93530","codeType":"CPT"},{"id":13343,"precertRequired":true,"billingCode":"93532","codeType":"CPT"},{"id":13344,"precertRequired":true,"billingCode":"93533","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5376,"description":"Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider.\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2180,"precertRequired":false,"billingCode":"33202","codeType":"CPT"},{"id":2181,"precertRequired":false,"billingCode":"33203","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2195,"precertRequired":false,"billingCode":"33221","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2211,"precertRequired":false,"billingCode":"33238","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2214,"precertRequired":false,"billingCode":"33243","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":9419,"precertRequired":true,"billingCode":"33285","codeType":"CPT"},{"id":9420,"precertRequired":true,"billingCode":"33286","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5377,"description":"Cardiology follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5378,"description":"Post-operative diagnostic imaging as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5379,"description":"Post operative diagnostic studies as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5380,"description":"Cardiac rehabilitation","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"},{"id":9033,"precertRequired":false,"billingCode":"S9475","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":479,"seocKey":21,"name":"Cardiology - TAVR_PRCT","seocId":"MSC_CARDIOLOGY - TAVR_1.2.5_PRCT","versionNumber":"1.2.5","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for TAVR workup\r\n2. Diagnostic imaging relevant to the patient compliant/condition\r\n3. Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient compliant/condition\r\n4. One cardiac catheterization or PCI\r\n5. Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider\r\n6. Cardiology follow-up visits for this episode of care\r\n7. Post-operative diagnostic imaging as clinically required\r\n8. Post operative diagnostic studies as clinically required\r\n9. Cardiac rehabilitation","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0011X"}],"services":[{"id":2717,"description":"Initial outpatient evaluation and treatment for TAVR workup","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2718,"description":"Diagnostic imaging relevant to the patient compliant/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2719,"description":"Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient compliant/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2720,"description":"One cardiac catheterization or PCI","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2721,"description":"Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2180,"precertRequired":false,"billingCode":"33202","codeType":"CPT"},{"id":2181,"precertRequired":false,"billingCode":"33203","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2195,"precertRequired":false,"billingCode":"33221","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2211,"precertRequired":false,"billingCode":"33238","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2214,"precertRequired":false,"billingCode":"33243","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":6948,"precertRequired":false,"billingCode":"93660","codeType":"CPT"},{"id":9419,"precertRequired":true,"billingCode":"33285","codeType":"CPT"},{"id":9420,"precertRequired":true,"billingCode":"33286","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2722,"description":"Cardiology follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2723,"description":"Post-operative diagnostic imaging as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2724,"description":"Post operative diagnostic studies as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2725,"description":"Cardiac rehabilitation","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"},{"id":9033,"precertRequired":false,"billingCode":"S9475","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":307,"seocKey":21,"name":"Cardiology - TAVR PRCT_PRCT","seocId":"MSC_CARDIOLOGY - TAVR PRCT_1.2.4_PRCT","versionNumber":"1.2.4","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"02-19-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for TAVR workup\r\n2. Diagnostic imaging relevant to the patient compliant/condition\r\n3. Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient compliant/condition\r\n4. One cardiac catheterization or PCI\r\n5. Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider\r\n6. Cardiology follow-up visits for this episode of care\r\n7. Post-operative diagnostic imaging as clinically required\r\n8. Post operative diagnostic studies as clinically required\r\n9. Cardiac rehabilitation","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics, and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0011X"}],"services":[{"id":1349,"description":"Initial outpatient evaluation and treatment for TAVR workup","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1350,"description":"Diagnostic imaging relevant to the patient compliant/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1351,"description":" Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient compliant/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1352,"description":"One cardiac catheterization or PCI","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1353,"description":"Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2180,"precertRequired":false,"billingCode":"33202","codeType":"CPT"},{"id":2181,"precertRequired":false,"billingCode":"33203","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2195,"precertRequired":false,"billingCode":"33221","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2211,"precertRequired":false,"billingCode":"33238","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2214,"precertRequired":false,"billingCode":"33243","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2233,"precertRequired":false,"billingCode":"33282","codeType":"CPT"},{"id":2234,"precertRequired":false,"billingCode":"33284","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":6948,"precertRequired":false,"billingCode":"93660","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1354,"description":"Cardiology follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1355,"description":"Post-operative diagnostic imaging as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1356,"description":"Post operative diagnostic studies as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1357,"description":"Cardiac rehabilitation","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"},{"id":9033,"precertRequired":false,"billingCode":"S9475","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":198,"seocKey":21,"name":"Cardiology - TAVR PRCT_PRCT","seocId":"MSC_CARDIOLOGY - TAVR PRCT_1.2.3_PRCT","versionNumber":"1.2.3","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"02-19-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for TAVR workup\r\n2. Diagnostic imaging relevant to the patient compliant/condition\r\n3. Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient compliant/condition\r\n4. One cardiac catheterization or PCI\r\n5. Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider\r\n6. Cardiology follow-up visits for this episode of care\r\n7. Post-operative diagnostic imaging as clinically required\r\n8. Post operative diagnostic studies as clinically required\r\n9. Cardiac rehabilitation","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics, and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0011X"}],"services":[{"id":756,"description":"Initial outpatient evaluation and treatment for TAVR workup","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":757,"description":"Diagnostic imaging relevant to the patient compliant/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":758,"description":" Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient compliant/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":759,"description":"One cardiac catheterization or PCI","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":760,"description":"Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2180,"precertRequired":false,"billingCode":"33202","codeType":"CPT"},{"id":2181,"precertRequired":false,"billingCode":"33203","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2195,"precertRequired":false,"billingCode":"33221","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2211,"precertRequired":false,"billingCode":"33238","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2214,"precertRequired":false,"billingCode":"33243","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2233,"precertRequired":false,"billingCode":"33282","codeType":"CPT"},{"id":2234,"precertRequired":false,"billingCode":"33284","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":6948,"precertRequired":false,"billingCode":"93660","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":761,"description":"Cardiology follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":762,"description":"Post-operative diagnostic imaging as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":763,"description":"Post operative diagnostic studies as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":764,"description":"Cardiac rehabilitation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"31-Intensive cardiac rehabilitation"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"},{"id":9033,"precertRequired":false,"billingCode":"S9475","codeType":"HCPCS"}],"serviceHptcs":[]}]}},{"Seoc":{"id":130,"seocKey":21,"name":"Cardiology - TAVR PRCT_PRCT","seocId":"MSC_CARDIOLOGY - TAVR PRCT_1.2.2_PRCT","versionNumber":"1.2.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for TAVR workup\r\n2. Diagnostic imaging relevant to the patient compliant/condition\r\n3. Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient compliant/condition\r\n4. One cardiac catheterization or PCI\r\n5. Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider\r\n6. Cardiology follow-up visits for this episode of care\r\n7. Post-operative diagnostic imaging as clinically required\r\n8. Post operative diagnostic studies as clinically required\r\n9. Cardiac rehabilitation","maxAllowableVisits":999,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics, and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":83,"description":"Initial outpatient evaluation and treatment for TAVR workup","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":84,"description":"Diagnostic imaging relevant to the patient compliant/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":85,"description":" Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient compliant/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":86,"description":"One cardiac catheterization or PCI","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":87,"description":"Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2180,"precertRequired":false,"billingCode":"33202","codeType":"CPT"},{"id":2181,"precertRequired":false,"billingCode":"33203","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2195,"precertRequired":false,"billingCode":"33221","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2211,"precertRequired":false,"billingCode":"33238","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2214,"precertRequired":false,"billingCode":"33243","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2233,"precertRequired":false,"billingCode":"33282","codeType":"CPT"},{"id":2234,"precertRequired":false,"billingCode":"33284","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":6948,"precertRequired":false,"billingCode":"93660","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":88,"description":"Cardiology follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":89,"description":"Post-operative diagnostic imaging as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":90,"description":"Post operative diagnostic studies as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7002,"precertRequired":false,"billingCode":"94250","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":91,"description":"Cardiac rehabilitation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"31-Intensive cardiac rehabilitation"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"},{"id":9033,"precertRequired":false,"billingCode":"S9475","codeType":"HCPCS"}],"serviceHptcs":[]}]}},{"Seoc":{"id":26,"seocKey":21,"name":"Cardiology - TAVR_PRCT","seocId":"MSC_CARDIOLOGY - TAVR_1.2.1_PRCT","versionNumber":"1.2.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.\r\n","effectiveDate":"11-01-2017","endDate":"12-07-2018","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for TAVR workup\r\n2. Diagnostic imaging relevant to the patient compliant/condition\r\n3. Diagnostic studies (Cardiac CTA, CTA for chest/abdomen/pelvis, ECHO, pulmonary function tests, EKG, walk test, fragility assessments) and labs relevant to the patient compliant/condition\r\n4. One cardiac catheterization or PCI\r\n5. Inpatient hospitalization to include: TAVR procedure, ECG, TTE or intraoperative TEE, ultrasound, electrophysiology consult, interventional cardiology therapeutic cardiac cath, pacemaker and/or ICD and/or loop implant, balloon aortic valvuloplasty, other interventions deemed necessary by authorized community provider\r\n6. Cardiology follow-up visits for this episode of care\r\n7. Post-operative diagnostic imaging as clinically required\r\n8. Post operative diagnostic studies as clinically required\r\n9. Cardiac rehabilitation for 36 visits\r\n10. Skilled home care services (physical therapy, visiting nursing service) for 20 visits within 3 months post-procedure","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1308,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1802,"seocKey":23,"name":"Cardiology Comprehensive_PRCT","seocId":"MSC_CARDIOLOGY COMPREHENSIVE_1.0.7_PRCT","versionNumber":"1.0.7","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition order \r\n2.    Diagnostic imaging relevant to the referred condition on the consult order\r\n3.    Diagnostic studies relevant to the referred condition on the consult order\r\n4.    Labs and pathology relevant to the referred condition on the consult order \r\n5.    One cardiac catheterization with PCI interventions and overnight observation if required\r\n6.    Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR, echo\r\n7.    Anesthesia consultation related to the procedure \r\n8.    Procedures performed by a cardiologist including but not limited to:  ablations, implantation of cardiac devices, etc.  Request for Service (RFS) is required for other non-emergent cardiac related services or specialties to include but not limited to electrophysiology, cardiothoracic surgery, etc.\r\n9.    Inpatient or observation admission for surgery/procedure and for emergent complications related to cardiac catheterization or other cardiac procedures performed under #8 to include emergent surgical intervention such as : cardiac bypass, TAVR, LAVD, angioplasty.\r\n**Note: Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n10.  Follow-up visits for this episode of care\r\n11.  Cardiac rehabilitation, up to 36 visits, no more than 3x per week","maxAllowableVisits":null,"disclaimer":"*Please visit the VHA Storefront \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp \r\nfor 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","QASP":"General Care","categoryOfCare":"CARDIOLOGY IMAGING","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RC0000X"},{"hptc":"207RC0001X"},{"hptc":"207RI0011X"}],"services":[{"id":5632,"description":"Initial outpatient evaluation and treatment for the referred condition order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":5633,"description":"Diagnostic imaging relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4522,"precertRequired":false,"billingCode":"73200","codeType":"CPT"},{"id":4523,"precertRequired":false,"billingCode":"73201","codeType":"CPT"},{"id":4524,"precertRequired":false,"billingCode":"73202","codeType":"CPT"},{"id":4525,"precertRequired":false,"billingCode":"73206","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4639,"precertRequired":false,"billingCode":"75600","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4645,"precertRequired":false,"billingCode":"75705","codeType":"CPT"},{"id":4646,"precertRequired":false,"billingCode":"75710","codeType":"CPT"},{"id":4647,"precertRequired":false,"billingCode":"75716","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4726,"precertRequired":false,"billingCode":"76706","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4933,"precertRequired":false,"billingCode":"78451","codeType":"CPT"},{"id":4934,"precertRequired":false,"billingCode":"78452","codeType":"CPT"},{"id":4935,"precertRequired":false,"billingCode":"78453","codeType":"CPT"},{"id":4936,"precertRequired":false,"billingCode":"78454","codeType":"CPT"},{"id":4940,"precertRequired":false,"billingCode":"78459","codeType":"CPT"},{"id":4941,"precertRequired":false,"billingCode":"78466","codeType":"CPT"},{"id":4942,"precertRequired":false,"billingCode":"78468","codeType":"CPT"},{"id":4943,"precertRequired":false,"billingCode":"78469","codeType":"CPT"},{"id":4944,"precertRequired":false,"billingCode":"78472","codeType":"CPT"},{"id":4945,"precertRequired":false,"billingCode":"78473","codeType":"CPT"},{"id":4946,"precertRequired":false,"billingCode":"78481","codeType":"CPT"},{"id":4947,"precertRequired":false,"billingCode":"78483","codeType":"CPT"},{"id":4948,"precertRequired":false,"billingCode":"78491","codeType":"CPT"},{"id":4949,"precertRequired":false,"billingCode":"78492","codeType":"CPT"},{"id":4950,"precertRequired":false,"billingCode":"78494","codeType":"CPT"},{"id":4951,"precertRequired":false,"billingCode":"78496","codeType":"CPT"},{"id":4955,"precertRequired":false,"billingCode":"78582","codeType":"CPT"},{"id":4993,"precertRequired":false,"billingCode":"78814","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":4995,"precertRequired":false,"billingCode":"78816","codeType":"CPT"},{"id":6868,"precertRequired":false,"billingCode":"93303","codeType":"CPT"},{"id":6869,"precertRequired":false,"billingCode":"93304","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6880,"precertRequired":false,"billingCode":"93320","codeType":"CPT"},{"id":6881,"precertRequired":false,"billingCode":"93321","codeType":"CPT"},{"id":6882,"precertRequired":false,"billingCode":"93325","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"},{"id":13321,"precertRequired":true,"billingCode":"70490","codeType":"CPT"},{"id":13322,"precertRequired":true,"billingCode":"70491","codeType":"CPT"},{"id":13323,"precertRequired":true,"billingCode":"70492","codeType":"CPT"},{"id":13324,"precertRequired":true,"billingCode":"70496","codeType":"CPT"},{"id":13325,"precertRequired":true,"billingCode":"70498","codeType":"CPT"},{"id":13326,"precertRequired":true,"billingCode":"70545","codeType":"CPT"},{"id":13327,"precertRequired":true,"billingCode":"70546","codeType":"CPT"},{"id":13328,"precertRequired":true,"billingCode":"70547","codeType":"CPT"},{"id":13329,"precertRequired":true,"billingCode":"70548","codeType":"CPT"},{"id":13460,"precertRequired":false,"billingCode":"93356","codeType":"CPT"},{"id":13656,"precertRequired":true,"billingCode":"71260","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5634,"description":"Diagnostic studies relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6828,"precertRequired":false,"billingCode":"93024","codeType":"CPT"},{"id":6829,"precertRequired":false,"billingCode":"93025","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":6834,"precertRequired":false,"billingCode":"93224","codeType":"CPT"},{"id":6835,"precertRequired":false,"billingCode":"93225","codeType":"CPT"},{"id":6836,"precertRequired":false,"billingCode":"93226","codeType":"CPT"},{"id":6837,"precertRequired":false,"billingCode":"93227","codeType":"CPT"},{"id":6838,"precertRequired":false,"billingCode":"93228","codeType":"CPT"},{"id":6839,"precertRequired":false,"billingCode":"93229","codeType":"CPT"},{"id":6840,"precertRequired":false,"billingCode":"93260","codeType":"CPT"},{"id":6841,"precertRequired":false,"billingCode":"93261","codeType":"CPT"},{"id":6842,"precertRequired":false,"billingCode":"93268","codeType":"CPT"},{"id":6843,"precertRequired":false,"billingCode":"93270","codeType":"CPT"},{"id":6844,"precertRequired":false,"billingCode":"93271","codeType":"CPT"},{"id":6845,"precertRequired":false,"billingCode":"93272","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6847,"precertRequired":false,"billingCode":"93279","codeType":"CPT"},{"id":6848,"precertRequired":false,"billingCode":"93280","codeType":"CPT"},{"id":6849,"precertRequired":false,"billingCode":"93281","codeType":"CPT"},{"id":6850,"precertRequired":false,"billingCode":"93282","codeType":"CPT"},{"id":6851,"precertRequired":false,"billingCode":"93283","codeType":"CPT"},{"id":6852,"precertRequired":false,"billingCode":"93284","codeType":"CPT"},{"id":6853,"precertRequired":false,"billingCode":"93285","codeType":"CPT"},{"id":6854,"precertRequired":false,"billingCode":"93286","codeType":"CPT"},{"id":6855,"precertRequired":false,"billingCode":"93287","codeType":"CPT"},{"id":6856,"precertRequired":false,"billingCode":"93288","codeType":"CPT"},{"id":6857,"precertRequired":false,"billingCode":"93289","codeType":"CPT"},{"id":6858,"precertRequired":false,"billingCode":"93290","codeType":"CPT"},{"id":6859,"precertRequired":false,"billingCode":"93291","codeType":"CPT"},{"id":6860,"precertRequired":false,"billingCode":"93292","codeType":"CPT"},{"id":6861,"precertRequired":false,"billingCode":"93293","codeType":"CPT"},{"id":6862,"precertRequired":false,"billingCode":"93294","codeType":"CPT"},{"id":6863,"precertRequired":false,"billingCode":"93295","codeType":"CPT"},{"id":6864,"precertRequired":false,"billingCode":"93296","codeType":"CPT"},{"id":6865,"precertRequired":false,"billingCode":"93297","codeType":"CPT"},{"id":6866,"precertRequired":false,"billingCode":"93298","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6922,"precertRequired":true,"billingCode":"93602","codeType":"CPT"},{"id":6923,"precertRequired":true,"billingCode":"93603","codeType":"CPT"},{"id":6924,"precertRequired":true,"billingCode":"93609","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6928,"precertRequired":true,"billingCode":"93615","codeType":"CPT"},{"id":6929,"precertRequired":true,"billingCode":"93616","codeType":"CPT"},{"id":6930,"precertRequired":true,"billingCode":"93618","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6948,"precertRequired":false,"billingCode":"93660","codeType":"CPT"},{"id":6949,"precertRequired":false,"billingCode":"93662","codeType":"CPT"},{"id":6956,"precertRequired":false,"billingCode":"93784","codeType":"CPT"},{"id":6957,"precertRequired":false,"billingCode":"93786","codeType":"CPT"},{"id":6958,"precertRequired":false,"billingCode":"93788","codeType":"CPT"},{"id":6959,"precertRequired":false,"billingCode":"93790","codeType":"CPT"},{"id":6965,"precertRequired":false,"billingCode":"93880","codeType":"CPT"},{"id":6966,"precertRequired":false,"billingCode":"93882","codeType":"CPT"},{"id":6972,"precertRequired":false,"billingCode":"93895","codeType":"CPT"},{"id":6973,"precertRequired":false,"billingCode":"93922","codeType":"CPT"},{"id":6974,"precertRequired":false,"billingCode":"93923","codeType":"CPT"},{"id":6975,"precertRequired":false,"billingCode":"93924","codeType":"CPT"},{"id":6976,"precertRequired":false,"billingCode":"93925","codeType":"CPT"},{"id":6977,"precertRequired":false,"billingCode":"93926","codeType":"CPT"},{"id":6978,"precertRequired":false,"billingCode":"93930","codeType":"CPT"},{"id":6979,"precertRequired":false,"billingCode":"93931","codeType":"CPT"},{"id":6980,"precertRequired":false,"billingCode":"93970","codeType":"CPT"},{"id":6981,"precertRequired":false,"billingCode":"93971","codeType":"CPT"},{"id":6982,"precertRequired":false,"billingCode":"93975","codeType":"CPT"},{"id":6983,"precertRequired":false,"billingCode":"93976","codeType":"CPT"},{"id":6984,"precertRequired":false,"billingCode":"93978","codeType":"CPT"},{"id":6985,"precertRequired":false,"billingCode":"93979","codeType":"CPT"},{"id":7010,"precertRequired":false,"billingCode":"94618","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7985,"precertRequired":false,"billingCode":"C8927","codeType":"HCPCS"},{"id":7986,"precertRequired":false,"billingCode":"C8928","codeType":"HCPCS"},{"id":7987,"precertRequired":false,"billingCode":"C8929","codeType":"HCPCS"},{"id":7988,"precertRequired":false,"billingCode":"C8930","codeType":"HCPCS"},{"id":9796,"precertRequired":false,"billingCode":"0296T","codeType":"CPT"},{"id":9797,"precertRequired":false,"billingCode":"0297T","codeType":"CPT"},{"id":13460,"precertRequired":false,"billingCode":"93356","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":5635,"description":"Labs and pathology relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5023,"precertRequired":false,"billingCode":"80162","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5329,"precertRequired":true,"billingCode":"81442","codeType":"CPT"},{"id":5409,"precertRequired":false,"billingCode":"82248","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5421,"precertRequired":false,"billingCode":"82330","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5469,"precertRequired":false,"billingCode":"82607","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5649,"precertRequired":false,"billingCode":"84100","codeType":"CPT"},{"id":5657,"precertRequired":false,"billingCode":"84132","codeType":"CPT"},{"id":5676,"precertRequired":false,"billingCode":"84165","codeType":"CPT"},{"id":5698,"precertRequired":false,"billingCode":"84295","codeType":"CPT"},{"id":5726,"precertRequired":false,"billingCode":"84450","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6114,"precertRequired":false,"billingCode":"87076","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6436,"precertRequired":false,"billingCode":"88366","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5636,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6803,"precertRequired":false,"billingCode":"92953","codeType":"CPT"},{"id":6804,"precertRequired":false,"billingCode":"92960","codeType":"CPT"},{"id":6805,"precertRequired":false,"billingCode":"92961","codeType":"CPT"},{"id":6806,"precertRequired":false,"billingCode":"92970","codeType":"CPT"},{"id":6807,"precertRequired":false,"billingCode":"92971","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6814,"precertRequired":false,"billingCode":"92986","codeType":"CPT"},{"id":6815,"precertRequired":false,"billingCode":"92987","codeType":"CPT"},{"id":6816,"precertRequired":false,"billingCode":"92990","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6819,"precertRequired":false,"billingCode":"92997","codeType":"CPT"},{"id":6820,"precertRequired":false,"billingCode":"92998","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6902,"precertRequired":false,"billingCode":"93505","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":13338,"precertRequired":true,"billingCode":"93451","codeType":"CPT"},{"id":13339,"precertRequired":true,"billingCode":"93452","codeType":"CPT"},{"id":13340,"precertRequired":true,"billingCode":"93453","codeType":"CPT"},{"id":13341,"precertRequired":true,"billingCode":"93530","codeType":"CPT"},{"id":13342,"precertRequired":true,"billingCode":"93531","codeType":"CPT"},{"id":13343,"precertRequired":true,"billingCode":"93532","codeType":"CPT"},{"id":13344,"precertRequired":true,"billingCode":"93533","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5637,"description":"Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR, echo","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":5638,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":40,"precertRequired":false,"billingCode":"00410","codeType":"CPT"},{"id":53,"precertRequired":false,"billingCode":"00534","codeType":"CPT"},{"id":54,"precertRequired":false,"billingCode":"00537","codeType":"CPT"},{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":65,"precertRequired":false,"billingCode":"00563","codeType":"CPT"},{"id":66,"precertRequired":false,"billingCode":"00566","codeType":"CPT"},{"id":67,"precertRequired":false,"billingCode":"00567","codeType":"CPT"},{"id":193,"precertRequired":false,"billingCode":"01920","codeType":"CPT"},{"id":196,"precertRequired":false,"billingCode":"01925","codeType":"CPT"},{"id":197,"precertRequired":false,"billingCode":"01926","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":11845,"precertRequired":false,"billingCode":"00530","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":5639,"description":"Procedures performed by a cardiologist including but not limited to:  ablations, implantation of cardiac devices, etc.  Request for Service (RFS) is required for other non-emergent cardiac related services or specialties to include but not limited to electrophysiology, cardiothoracic surgery, etc.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2088,"precertRequired":true,"billingCode":"32160","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2195,"precertRequired":false,"billingCode":"33221","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2198,"precertRequired":true,"billingCode":"33224","codeType":"CPT"},{"id":2199,"precertRequired":true,"billingCode":"33225","codeType":"CPT"},{"id":2200,"precertRequired":false,"billingCode":"33226","codeType":"CPT"},{"id":2201,"precertRequired":false,"billingCode":"33227","codeType":"CPT"},{"id":2202,"precertRequired":false,"billingCode":"33228","codeType":"CPT"},{"id":2203,"precertRequired":false,"billingCode":"33229","codeType":"CPT"},{"id":2204,"precertRequired":false,"billingCode":"33230","codeType":"CPT"},{"id":2205,"precertRequired":false,"billingCode":"33231","codeType":"CPT"},{"id":2206,"precertRequired":false,"billingCode":"33233","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2214,"precertRequired":false,"billingCode":"33243","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2235,"precertRequired":false,"billingCode":"33300","codeType":"CPT"},{"id":2236,"precertRequired":false,"billingCode":"33305","codeType":"CPT"},{"id":2237,"precertRequired":false,"billingCode":"33310","codeType":"CPT"},{"id":2238,"precertRequired":false,"billingCode":"33315","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2253,"precertRequired":false,"billingCode":"33390","codeType":"CPT"},{"id":2254,"precertRequired":false,"billingCode":"33391","codeType":"CPT"},{"id":2255,"precertRequired":false,"billingCode":"33404","codeType":"CPT"},{"id":2256,"precertRequired":true,"billingCode":"33405","codeType":"CPT"},{"id":2257,"precertRequired":true,"billingCode":"33406","codeType":"CPT"},{"id":2258,"precertRequired":true,"billingCode":"33410","codeType":"CPT"},{"id":2259,"precertRequired":true,"billingCode":"33411","codeType":"CPT"},{"id":2260,"precertRequired":true,"billingCode":"33412","codeType":"CPT"},{"id":2261,"precertRequired":false,"billingCode":"33413","codeType":"CPT"},{"id":2262,"precertRequired":true,"billingCode":"33414","codeType":"CPT"},{"id":2263,"precertRequired":false,"billingCode":"33415","codeType":"CPT"},{"id":2264,"precertRequired":false,"billingCode":"33416","codeType":"CPT"},{"id":2265,"precertRequired":false,"billingCode":"33417","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2268,"precertRequired":false,"billingCode":"33420","codeType":"CPT"},{"id":2269,"precertRequired":false,"billingCode":"33422","codeType":"CPT"},{"id":2270,"precertRequired":false,"billingCode":"33425","codeType":"CPT"},{"id":2271,"precertRequired":false,"billingCode":"33426","codeType":"CPT"},{"id":2272,"precertRequired":false,"billingCode":"33427","codeType":"CPT"},{"id":2273,"precertRequired":false,"billingCode":"33430","codeType":"CPT"},{"id":2274,"precertRequired":false,"billingCode":"33460","codeType":"CPT"},{"id":2275,"precertRequired":false,"billingCode":"33463","codeType":"CPT"},{"id":2276,"precertRequired":false,"billingCode":"33464","codeType":"CPT"},{"id":2277,"precertRequired":true,"billingCode":"33465","codeType":"CPT"},{"id":2278,"precertRequired":false,"billingCode":"33468","codeType":"CPT"},{"id":2279,"precertRequired":false,"billingCode":"33470","codeType":"CPT"},{"id":2280,"precertRequired":false,"billingCode":"33471","codeType":"CPT"},{"id":2281,"precertRequired":false,"billingCode":"33474","codeType":"CPT"},{"id":2282,"precertRequired":false,"billingCode":"33475","codeType":"CPT"},{"id":2283,"precertRequired":false,"billingCode":"33476","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2285,"precertRequired":false,"billingCode":"33478","codeType":"CPT"},{"id":2286,"precertRequired":false,"billingCode":"33496","codeType":"CPT"},{"id":2293,"precertRequired":false,"billingCode":"33508","codeType":"CPT"},{"id":2294,"precertRequired":false,"billingCode":"33510","codeType":"CPT"},{"id":2295,"precertRequired":false,"billingCode":"33511","codeType":"CPT"},{"id":2296,"precertRequired":false,"billingCode":"33512","codeType":"CPT"},{"id":2297,"precertRequired":false,"billingCode":"33513","codeType":"CPT"},{"id":2298,"precertRequired":false,"billingCode":"33514","codeType":"CPT"},{"id":2299,"precertRequired":false,"billingCode":"33516","codeType":"CPT"},{"id":2300,"precertRequired":false,"billingCode":"33517","codeType":"CPT"},{"id":2301,"precertRequired":false,"billingCode":"33518","codeType":"CPT"},{"id":2302,"precertRequired":false,"billingCode":"33519","codeType":"CPT"},{"id":2303,"precertRequired":false,"billingCode":"33521","codeType":"CPT"},{"id":2304,"precertRequired":false,"billingCode":"33522","codeType":"CPT"},{"id":2305,"precertRequired":false,"billingCode":"33523","codeType":"CPT"},{"id":2306,"precertRequired":false,"billingCode":"33530","codeType":"CPT"},{"id":2307,"precertRequired":false,"billingCode":"33533","codeType":"CPT"},{"id":2308,"precertRequired":false,"billingCode":"33534","codeType":"CPT"},{"id":2309,"precertRequired":false,"billingCode":"33535","codeType":"CPT"},{"id":2310,"precertRequired":false,"billingCode":"33536","codeType":"CPT"},{"id":2311,"precertRequired":false,"billingCode":"33542","codeType":"CPT"},{"id":2312,"precertRequired":false,"billingCode":"33545","codeType":"CPT"},{"id":2313,"precertRequired":false,"billingCode":"33548","codeType":"CPT"},{"id":2314,"precertRequired":false,"billingCode":"33572","codeType":"CPT"},{"id":2341,"precertRequired":false,"billingCode":"33735","codeType":"CPT"},{"id":2342,"precertRequired":false,"billingCode":"33736","codeType":"CPT"},{"id":2343,"precertRequired":false,"billingCode":"33737","codeType":"CPT"},{"id":2344,"precertRequired":false,"billingCode":"33750","codeType":"CPT"},{"id":2345,"precertRequired":false,"billingCode":"33755","codeType":"CPT"},{"id":2346,"precertRequired":false,"billingCode":"33762","codeType":"CPT"},{"id":2347,"precertRequired":false,"billingCode":"33764","codeType":"CPT"},{"id":2348,"precertRequired":false,"billingCode":"33766","codeType":"CPT"},{"id":2349,"precertRequired":false,"billingCode":"33767","codeType":"CPT"},{"id":2350,"precertRequired":false,"billingCode":"33768","codeType":"CPT"},{"id":2379,"precertRequired":false,"billingCode":"33863","codeType":"CPT"},{"id":2380,"precertRequired":false,"billingCode":"33864","codeType":"CPT"},{"id":2382,"precertRequired":false,"billingCode":"33875","codeType":"CPT"},{"id":2383,"precertRequired":false,"billingCode":"33877","codeType":"CPT"},{"id":2402,"precertRequired":true,"billingCode":"33967","codeType":"CPT"},{"id":2403,"precertRequired":false,"billingCode":"33968","codeType":"CPT"},{"id":2404,"precertRequired":false,"billingCode":"33970","codeType":"CPT"},{"id":2405,"precertRequired":false,"billingCode":"33971","codeType":"CPT"},{"id":2406,"precertRequired":false,"billingCode":"33973","codeType":"CPT"},{"id":2407,"precertRequired":false,"billingCode":"33974","codeType":"CPT"},{"id":2408,"precertRequired":false,"billingCode":"33975","codeType":"CPT"},{"id":2409,"precertRequired":false,"billingCode":"33976","codeType":"CPT"},{"id":2410,"precertRequired":false,"billingCode":"33977","codeType":"CPT"},{"id":2411,"precertRequired":false,"billingCode":"33978","codeType":"CPT"},{"id":2412,"precertRequired":false,"billingCode":"33979","codeType":"CPT"},{"id":2413,"precertRequired":false,"billingCode":"33980","codeType":"CPT"},{"id":2414,"precertRequired":false,"billingCode":"33981","codeType":"CPT"},{"id":2415,"precertRequired":false,"billingCode":"33982","codeType":"CPT"},{"id":2416,"precertRequired":false,"billingCode":"33983","codeType":"CPT"},{"id":2417,"precertRequired":false,"billingCode":"33990","codeType":"CPT"},{"id":2418,"precertRequired":false,"billingCode":"33991","codeType":"CPT"},{"id":2419,"precertRequired":false,"billingCode":"33992","codeType":"CPT"},{"id":2420,"precertRequired":false,"billingCode":"33993","codeType":"CPT"},{"id":2422,"precertRequired":false,"billingCode":"34701","codeType":"CPT"},{"id":2423,"precertRequired":false,"billingCode":"34702","codeType":"CPT"},{"id":2424,"precertRequired":false,"billingCode":"34703","codeType":"CPT"},{"id":2425,"precertRequired":false,"billingCode":"34704","codeType":"CPT"},{"id":2426,"precertRequired":false,"billingCode":"34705","codeType":"CPT"},{"id":2427,"precertRequired":false,"billingCode":"34706","codeType":"CPT"},{"id":2428,"precertRequired":false,"billingCode":"34707","codeType":"CPT"},{"id":2429,"precertRequired":false,"billingCode":"34708","codeType":"CPT"},{"id":2430,"precertRequired":false,"billingCode":"34709","codeType":"CPT"},{"id":2431,"precertRequired":false,"billingCode":"34712","codeType":"CPT"},{"id":2433,"precertRequired":false,"billingCode":"35180","codeType":"CPT"},{"id":2434,"precertRequired":false,"billingCode":"35182","codeType":"CPT"},{"id":2435,"precertRequired":false,"billingCode":"35184","codeType":"CPT"},{"id":2436,"precertRequired":false,"billingCode":"35188","codeType":"CPT"},{"id":2437,"precertRequired":false,"billingCode":"35189","codeType":"CPT"},{"id":2438,"precertRequired":false,"billingCode":"35190","codeType":"CPT"},{"id":2445,"precertRequired":false,"billingCode":"35500","codeType":"CPT"},{"id":2446,"precertRequired":false,"billingCode":"35501","codeType":"CPT"},{"id":2447,"precertRequired":false,"billingCode":"35506","codeType":"CPT"},{"id":2448,"precertRequired":false,"billingCode":"35508","codeType":"CPT"},{"id":2449,"precertRequired":false,"billingCode":"35509","codeType":"CPT"},{"id":2450,"precertRequired":false,"billingCode":"35510","codeType":"CPT"},{"id":2451,"precertRequired":false,"billingCode":"35511","codeType":"CPT"},{"id":2452,"precertRequired":false,"billingCode":"35512","codeType":"CPT"},{"id":2453,"precertRequired":false,"billingCode":"35515","codeType":"CPT"},{"id":2454,"precertRequired":false,"billingCode":"35516","codeType":"CPT"},{"id":2455,"precertRequired":false,"billingCode":"35518","codeType":"CPT"},{"id":2456,"precertRequired":false,"billingCode":"35521","codeType":"CPT"},{"id":2457,"precertRequired":false,"billingCode":"35522","codeType":"CPT"},{"id":2458,"precertRequired":false,"billingCode":"35523","codeType":"CPT"},{"id":2459,"precertRequired":false,"billingCode":"35525","codeType":"CPT"},{"id":2460,"precertRequired":false,"billingCode":"35526","codeType":"CPT"},{"id":2461,"precertRequired":false,"billingCode":"35531","codeType":"CPT"},{"id":2462,"precertRequired":false,"billingCode":"35533","codeType":"CPT"},{"id":2463,"precertRequired":false,"billingCode":"35535","codeType":"CPT"},{"id":2464,"precertRequired":false,"billingCode":"35536","codeType":"CPT"},{"id":2465,"precertRequired":false,"billingCode":"35537","codeType":"CPT"},{"id":2466,"precertRequired":false,"billingCode":"35538","codeType":"CPT"},{"id":2467,"precertRequired":false,"billingCode":"35539","codeType":"CPT"},{"id":2468,"precertRequired":false,"billingCode":"35540","codeType":"CPT"},{"id":2469,"precertRequired":false,"billingCode":"35556","codeType":"CPT"},{"id":2470,"precertRequired":false,"billingCode":"35558","codeType":"CPT"},{"id":2471,"precertRequired":false,"billingCode":"35560","codeType":"CPT"},{"id":2472,"precertRequired":false,"billingCode":"35563","codeType":"CPT"},{"id":2473,"precertRequired":false,"billingCode":"35565","codeType":"CPT"},{"id":2474,"precertRequired":false,"billingCode":"35566","codeType":"CPT"},{"id":2475,"precertRequired":false,"billingCode":"35570","codeType":"CPT"},{"id":2476,"precertRequired":false,"billingCode":"35571","codeType":"CPT"},{"id":2477,"precertRequired":false,"billingCode":"35572","codeType":"CPT"},{"id":2478,"precertRequired":false,"billingCode":"35583","codeType":"CPT"},{"id":2479,"precertRequired":false,"billingCode":"35585","codeType":"CPT"},{"id":2480,"precertRequired":false,"billingCode":"35587","codeType":"CPT"},{"id":2481,"precertRequired":false,"billingCode":"35600","codeType":"CPT"},{"id":2482,"precertRequired":false,"billingCode":"35601","codeType":"CPT"},{"id":2483,"precertRequired":false,"billingCode":"35606","codeType":"CPT"},{"id":2484,"precertRequired":false,"billingCode":"35612","codeType":"CPT"},{"id":2485,"precertRequired":false,"billingCode":"35616","codeType":"CPT"},{"id":2486,"precertRequired":false,"billingCode":"35621","codeType":"CPT"},{"id":2487,"precertRequired":false,"billingCode":"35623","codeType":"CPT"},{"id":2488,"precertRequired":false,"billingCode":"35626","codeType":"CPT"},{"id":2489,"precertRequired":false,"billingCode":"35631","codeType":"CPT"},{"id":2490,"precertRequired":false,"billingCode":"35632","codeType":"CPT"},{"id":2491,"precertRequired":false,"billingCode":"35633","codeType":"CPT"},{"id":2492,"precertRequired":false,"billingCode":"35634","codeType":"CPT"},{"id":2493,"precertRequired":false,"billingCode":"35636","codeType":"CPT"},{"id":2494,"precertRequired":false,"billingCode":"35637","codeType":"CPT"},{"id":2495,"precertRequired":false,"billingCode":"35638","codeType":"CPT"},{"id":2496,"precertRequired":false,"billingCode":"35642","codeType":"CPT"},{"id":2497,"precertRequired":false,"billingCode":"35645","codeType":"CPT"},{"id":2498,"precertRequired":false,"billingCode":"35646","codeType":"CPT"},{"id":2499,"precertRequired":false,"billingCode":"35647","codeType":"CPT"},{"id":2500,"precertRequired":false,"billingCode":"35650","codeType":"CPT"},{"id":2501,"precertRequired":true,"billingCode":"35654","codeType":"CPT"},{"id":2502,"precertRequired":true,"billingCode":"35656","codeType":"CPT"},{"id":2503,"precertRequired":false,"billingCode":"35661","codeType":"CPT"},{"id":2504,"precertRequired":false,"billingCode":"35663","codeType":"CPT"},{"id":2505,"precertRequired":false,"billingCode":"35665","codeType":"CPT"},{"id":2506,"precertRequired":false,"billingCode":"35666","codeType":"CPT"},{"id":2507,"precertRequired":false,"billingCode":"35671","codeType":"CPT"},{"id":2508,"precertRequired":false,"billingCode":"35905","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2510,"precertRequired":false,"billingCode":"36002","codeType":"CPT"},{"id":2511,"precertRequired":false,"billingCode":"36005","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":2513,"precertRequired":false,"billingCode":"36011","codeType":"CPT"},{"id":2514,"precertRequired":false,"billingCode":"36012","codeType":"CPT"},{"id":2515,"precertRequired":false,"billingCode":"36100","codeType":"CPT"},{"id":2517,"precertRequired":false,"billingCode":"36140","codeType":"CPT"},{"id":2518,"precertRequired":false,"billingCode":"36160","codeType":"CPT"},{"id":2519,"precertRequired":false,"billingCode":"36200","codeType":"CPT"},{"id":2520,"precertRequired":false,"billingCode":"36215","codeType":"CPT"},{"id":2521,"precertRequired":false,"billingCode":"36216","codeType":"CPT"},{"id":2522,"precertRequired":false,"billingCode":"36217","codeType":"CPT"},{"id":2523,"precertRequired":false,"billingCode":"36218","codeType":"CPT"},{"id":2524,"precertRequired":false,"billingCode":"36221","codeType":"CPT"},{"id":2525,"precertRequired":false,"billingCode":"36222","codeType":"CPT"},{"id":2526,"precertRequired":false,"billingCode":"36223","codeType":"CPT"},{"id":2527,"precertRequired":false,"billingCode":"36224","codeType":"CPT"},{"id":2528,"precertRequired":false,"billingCode":"36225","codeType":"CPT"},{"id":2529,"precertRequired":false,"billingCode":"36226","codeType":"CPT"},{"id":2530,"precertRequired":false,"billingCode":"36227","codeType":"CPT"},{"id":2531,"precertRequired":false,"billingCode":"36228","codeType":"CPT"},{"id":2532,"precertRequired":false,"billingCode":"36245","codeType":"CPT"},{"id":2533,"precertRequired":false,"billingCode":"36246","codeType":"CPT"},{"id":2534,"precertRequired":false,"billingCode":"36247","codeType":"CPT"},{"id":2535,"precertRequired":false,"billingCode":"36248","codeType":"CPT"},{"id":2536,"precertRequired":false,"billingCode":"36251","codeType":"CPT"},{"id":2537,"precertRequired":false,"billingCode":"36252","codeType":"CPT"},{"id":2538,"precertRequired":false,"billingCode":"36253","codeType":"CPT"},{"id":2539,"precertRequired":false,"billingCode":"36254","codeType":"CPT"},{"id":2552,"precertRequired":false,"billingCode":"36481","codeType":"CPT"},{"id":2622,"precertRequired":false,"billingCode":"37182","codeType":"CPT"},{"id":2623,"precertRequired":false,"billingCode":"37183","codeType":"CPT"},{"id":2624,"precertRequired":false,"billingCode":"37184","codeType":"CPT"},{"id":2625,"precertRequired":false,"billingCode":"37185","codeType":"CPT"},{"id":2626,"precertRequired":false,"billingCode":"37186","codeType":"CPT"},{"id":2627,"precertRequired":false,"billingCode":"37187","codeType":"CPT"},{"id":2628,"precertRequired":false,"billingCode":"37188","codeType":"CPT"},{"id":2629,"precertRequired":false,"billingCode":"37191","codeType":"CPT"},{"id":2630,"precertRequired":false,"billingCode":"37192","codeType":"CPT"},{"id":2631,"precertRequired":false,"billingCode":"37193","codeType":"CPT"},{"id":2632,"precertRequired":false,"billingCode":"37197","codeType":"CPT"},{"id":2634,"precertRequired":false,"billingCode":"37211","codeType":"CPT"},{"id":2635,"precertRequired":false,"billingCode":"37212","codeType":"CPT"},{"id":2636,"precertRequired":false,"billingCode":"37213","codeType":"CPT"},{"id":2637,"precertRequired":false,"billingCode":"37214","codeType":"CPT"},{"id":2638,"precertRequired":false,"billingCode":"37215","codeType":"CPT"},{"id":2639,"precertRequired":false,"billingCode":"37216","codeType":"CPT"},{"id":2642,"precertRequired":false,"billingCode":"37220","codeType":"CPT"},{"id":2643,"precertRequired":false,"billingCode":"37221","codeType":"CPT"},{"id":2644,"precertRequired":false,"billingCode":"37222","codeType":"CPT"},{"id":2645,"precertRequired":false,"billingCode":"37223","codeType":"CPT"},{"id":2646,"precertRequired":false,"billingCode":"37224","codeType":"CPT"},{"id":2647,"precertRequired":false,"billingCode":"37225","codeType":"CPT"},{"id":2648,"precertRequired":false,"billingCode":"37226","codeType":"CPT"},{"id":2649,"precertRequired":false,"billingCode":"37227","codeType":"CPT"},{"id":2650,"precertRequired":false,"billingCode":"37228","codeType":"CPT"},{"id":2651,"precertRequired":false,"billingCode":"37229","codeType":"CPT"},{"id":2652,"precertRequired":false,"billingCode":"37230","codeType":"CPT"},{"id":2653,"precertRequired":false,"billingCode":"37231","codeType":"CPT"},{"id":2654,"precertRequired":false,"billingCode":"37232","codeType":"CPT"},{"id":2655,"precertRequired":false,"billingCode":"37233","codeType":"CPT"},{"id":2656,"precertRequired":false,"billingCode":"37234","codeType":"CPT"},{"id":2657,"precertRequired":false,"billingCode":"37235","codeType":"CPT"},{"id":2658,"precertRequired":false,"billingCode":"37236","codeType":"CPT"},{"id":2659,"precertRequired":false,"billingCode":"37237","codeType":"CPT"},{"id":2660,"precertRequired":false,"billingCode":"37238","codeType":"CPT"},{"id":2661,"precertRequired":false,"billingCode":"37239","codeType":"CPT"},{"id":2666,"precertRequired":false,"billingCode":"37246","codeType":"CPT"},{"id":2667,"precertRequired":false,"billingCode":"37247","codeType":"CPT"},{"id":2668,"precertRequired":false,"billingCode":"37248","codeType":"CPT"},{"id":2669,"precertRequired":false,"billingCode":"37249","codeType":"CPT"},{"id":2670,"precertRequired":false,"billingCode":"37252","codeType":"CPT"},{"id":2671,"precertRequired":false,"billingCode":"37253","codeType":"CPT"},{"id":2842,"precertRequired":false,"billingCode":"43320","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4685,"precertRequired":false,"billingCode":"75956","codeType":"CPT"},{"id":4686,"precertRequired":false,"billingCode":"75957","codeType":"CPT"},{"id":4687,"precertRequired":false,"billingCode":"75958","codeType":"CPT"},{"id":4688,"precertRequired":false,"billingCode":"75959","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4930,"precertRequired":false,"billingCode":"78414","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":6918,"precertRequired":false,"billingCode":"93581","codeType":"CPT"},{"id":6919,"precertRequired":false,"billingCode":"93582","codeType":"CPT"},{"id":6920,"precertRequired":false,"billingCode":"93583","codeType":"CPT"},{"id":6942,"precertRequired":false,"billingCode":"93650","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6945,"precertRequired":false,"billingCode":"93655","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":6951,"precertRequired":false,"billingCode":"93701","codeType":"CPT"},{"id":6952,"precertRequired":false,"billingCode":"93724","codeType":"CPT"},{"id":6953,"precertRequired":false,"billingCode":"93740","codeType":"CPT"},{"id":6954,"precertRequired":false,"billingCode":"93745","codeType":"CPT"},{"id":6955,"precertRequired":false,"billingCode":"93770","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7562,"precertRequired":false,"billingCode":"0408T","codeType":"CPT"},{"id":7563,"precertRequired":false,"billingCode":"0409T","codeType":"CPT"},{"id":7564,"precertRequired":false,"billingCode":"0410T","codeType":"CPT"},{"id":7565,"precertRequired":false,"billingCode":"0411T","codeType":"CPT"},{"id":7566,"precertRequired":false,"billingCode":"0412T","codeType":"CPT"},{"id":7567,"precertRequired":false,"billingCode":"0413T","codeType":"CPT"},{"id":7568,"precertRequired":false,"billingCode":"0414T","codeType":"CPT"},{"id":7569,"precertRequired":false,"billingCode":"0415T","codeType":"CPT"},{"id":7570,"precertRequired":false,"billingCode":"0416T","codeType":"CPT"},{"id":7571,"precertRequired":false,"billingCode":"0417T","codeType":"CPT"},{"id":7572,"precertRequired":false,"billingCode":"0418T","codeType":"CPT"},{"id":7574,"precertRequired":false,"billingCode":"0439T","codeType":"CPT"},{"id":8169,"precertRequired":false,"billingCode":"G0269","codeType":"HCPCS"},{"id":9419,"precertRequired":true,"billingCode":"33285","codeType":"CPT"},{"id":9420,"precertRequired":true,"billingCode":"33286","codeType":"CPT"},{"id":9776,"precertRequired":true,"billingCode":"93591","codeType":"CPT"},{"id":9777,"precertRequired":true,"billingCode":"93592","codeType":"CPT"},{"id":9778,"precertRequired":false,"billingCode":"93750","codeType":"CPT"},{"id":11416,"precertRequired":false,"billingCode":"33289","codeType":"CPT"},{"id":11640,"precertRequired":false,"billingCode":"35820","codeType":"CPT"},{"id":11669,"precertRequired":false,"billingCode":"34710","codeType":"CPT"},{"id":11670,"precertRequired":false,"billingCode":"34711","codeType":"CPT"},{"id":11671,"precertRequired":false,"billingCode":"34713","codeType":"CPT"},{"id":11672,"precertRequired":false,"billingCode":"34714","codeType":"CPT"},{"id":11673,"precertRequired":false,"billingCode":"34715","codeType":"CPT"},{"id":11674,"precertRequired":false,"billingCode":"34716","codeType":"CPT"},{"id":11675,"precertRequired":false,"billingCode":"34808","codeType":"CPT"},{"id":11676,"precertRequired":false,"billingCode":"34812","codeType":"CPT"},{"id":11677,"precertRequired":false,"billingCode":"34813","codeType":"CPT"},{"id":11678,"precertRequired":false,"billingCode":"34820","codeType":"CPT"},{"id":11679,"precertRequired":false,"billingCode":"34830","codeType":"CPT"},{"id":11680,"precertRequired":false,"billingCode":"34831","codeType":"CPT"},{"id":11681,"precertRequired":false,"billingCode":"34832","codeType":"CPT"},{"id":11682,"precertRequired":false,"billingCode":"34833","codeType":"CPT"},{"id":11683,"precertRequired":false,"billingCode":"34834","codeType":"CPT"},{"id":11729,"precertRequired":false,"billingCode":"35301","codeType":"CPT"},{"id":11746,"precertRequired":false,"billingCode":"35681","codeType":"CPT"},{"id":11747,"precertRequired":false,"billingCode":"35682","codeType":"CPT"},{"id":11748,"precertRequired":false,"billingCode":"35683","codeType":"CPT"},{"id":11749,"precertRequired":false,"billingCode":"35685","codeType":"CPT"},{"id":11750,"precertRequired":false,"billingCode":"35686","codeType":"CPT"},{"id":11751,"precertRequired":false,"billingCode":"35691","codeType":"CPT"},{"id":11752,"precertRequired":false,"billingCode":"35693","codeType":"CPT"},{"id":11753,"precertRequired":false,"billingCode":"35694","codeType":"CPT"},{"id":11754,"precertRequired":false,"billingCode":"35695","codeType":"CPT"},{"id":11755,"precertRequired":false,"billingCode":"35697","codeType":"CPT"},{"id":11756,"precertRequired":false,"billingCode":"35700","codeType":"CPT"},{"id":11757,"precertRequired":false,"billingCode":"35701","codeType":"CPT"},{"id":11761,"precertRequired":false,"billingCode":"35800","codeType":"CPT"},{"id":11762,"precertRequired":false,"billingCode":"35840","codeType":"CPT"},{"id":11763,"precertRequired":false,"billingCode":"35860","codeType":"CPT"},{"id":11764,"precertRequired":false,"billingCode":"35870","codeType":"CPT"},{"id":11765,"precertRequired":false,"billingCode":"35875","codeType":"CPT"},{"id":11766,"precertRequired":false,"billingCode":"35876","codeType":"CPT"},{"id":11767,"precertRequired":false,"billingCode":"35879","codeType":"CPT"},{"id":11768,"precertRequired":false,"billingCode":"35881","codeType":"CPT"},{"id":11769,"precertRequired":false,"billingCode":"35883","codeType":"CPT"},{"id":11770,"precertRequired":false,"billingCode":"35884","codeType":"CPT"},{"id":11771,"precertRequired":false,"billingCode":"35901","codeType":"CPT"},{"id":11772,"precertRequired":false,"billingCode":"35903","codeType":"CPT"},{"id":11773,"precertRequired":false,"billingCode":"35907","codeType":"CPT"},{"id":11774,"precertRequired":false,"billingCode":"36013","codeType":"CPT"},{"id":11775,"precertRequired":false,"billingCode":"36014","codeType":"CPT"},{"id":11776,"precertRequired":false,"billingCode":"36015","codeType":"CPT"},{"id":11788,"precertRequired":false,"billingCode":"37500","codeType":"CPT"},{"id":11841,"precertRequired":false,"billingCode":"C9600","codeType":"HCPCS"},{"id":11842,"precertRequired":false,"billingCode":"C9602","codeType":"HCPCS"},{"id":11843,"precertRequired":false,"billingCode":"C9604","codeType":"HCPCS"},{"id":11844,"precertRequired":false,"billingCode":"C9607","codeType":"HCPCS"},{"id":11846,"precertRequired":false,"billingCode":"33340","codeType":"CPT"},{"id":13029,"precertRequired":false,"billingCode":"33866","codeType":"CPT"},{"id":13030,"precertRequired":false,"billingCode":"37140","codeType":"CPT"},{"id":13031,"precertRequired":false,"billingCode":"37145","codeType":"CPT"},{"id":13032,"precertRequired":false,"billingCode":"37160","codeType":"CPT"},{"id":13033,"precertRequired":false,"billingCode":"37180","codeType":"CPT"},{"id":13034,"precertRequired":false,"billingCode":"37181","codeType":"CPT"},{"id":13035,"precertRequired":false,"billingCode":"93590","codeType":"CPT"},{"id":13037,"precertRequired":false,"billingCode":"C9601","codeType":"HCPCS"},{"id":13038,"precertRequired":false,"billingCode":"C9603","codeType":"HCPCS"},{"id":13039,"precertRequired":false,"billingCode":"C9605","codeType":"HCPCS"},{"id":13040,"precertRequired":false,"billingCode":"C9606","codeType":"HCPCS"},{"id":13041,"precertRequired":false,"billingCode":"C9608","codeType":"HCPCS"},{"id":13335,"precertRequired":true,"billingCode":"76000","codeType":"CPT"},{"id":13402,"precertRequired":false,"billingCode":"33871","codeType":"CPT"},{"id":13405,"precertRequired":false,"billingCode":"33858","codeType":"CPT"},{"id":13406,"precertRequired":false,"billingCode":"33859","codeType":"CPT"},{"id":13407,"precertRequired":false,"billingCode":"33016","codeType":"CPT"},{"id":13408,"precertRequired":false,"billingCode":"33017","codeType":"CPT"},{"id":13409,"precertRequired":false,"billingCode":"33018","codeType":"CPT"},{"id":13410,"precertRequired":false,"billingCode":"33019","codeType":"CPT"},{"id":13476,"precertRequired":false,"billingCode":"G2066","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":5640,"description":"Inpatient or observation admission for surgery/procedure and for emergent complications related to cardiac catheterization or other cardiac procedures performed under #8 to include emergent surgical intervention such as : cardiac bypass, TAVR, LAVD, angioplasty.\r\n**Note: Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":5641,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":5642,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6950,"precertRequired":false,"billingCode":"93668","codeType":"CPT"},{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":1699,"seocKey":23,"name":"Cardiology Comprehensive_PRCT","seocId":"MSC_CARDIOLOGY COMPREHENSIVE_1.0.6_PRCT","versionNumber":"1.0.6","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"01-24-2020","endDate":"06-08-2020","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. Labs and pathology relevant to the referred condition on the consult **\r\n5. One cardiac catheterization with PCI interventions and overnight observation if required\r\n6. Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n7. Anesthesia consultation related to the procedure\r\n8. Procedures performed by a cardiologist including but not limited to:  ablations, implantation of cardiac devices, etc.  Request for Service (RFS) is required for other non-emergent cardiac related services or specialties to include but not limited to electrophysiology, cardiothoracic surgery, etc.\r\n9. Inpatient or observation admission for surgery/procedure and for emergent complications related to cardiac catheterization or other cardiac procedures performed under #8 to include emergent surgical intervention such as : cardiac bypass, TAVR, LAVD, angioplasty.\r\n***Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n10. Follow-up visits for this episode of care\r\n11. Cardiac rehabilitation, up to 36 visits, no more than 3x per week","maxAllowableVisits":null,"disclaimer":"*Please visit the VHA Storefront \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp \r\nfor 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","QASP":"General Care","categoryOfCare":"CARDIOLOGY IMAGING","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RC0000X"},{"hptc":"207RC0001X"},{"hptc":"207RI0011X"}],"services":[{"id":4802,"description":"Initial outpatient evaluation and treatment for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":4803,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4522,"precertRequired":false,"billingCode":"73200","codeType":"CPT"},{"id":4523,"precertRequired":false,"billingCode":"73201","codeType":"CPT"},{"id":4524,"precertRequired":false,"billingCode":"73202","codeType":"CPT"},{"id":4525,"precertRequired":false,"billingCode":"73206","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4630,"precertRequired":false,"billingCode":"75557","codeType":"CPT"},{"id":4631,"precertRequired":false,"billingCode":"75559","codeType":"CPT"},{"id":4632,"precertRequired":false,"billingCode":"75561","codeType":"CPT"},{"id":4633,"precertRequired":false,"billingCode":"75563","codeType":"CPT"},{"id":4634,"precertRequired":false,"billingCode":"75565","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4639,"precertRequired":false,"billingCode":"75600","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4645,"precertRequired":false,"billingCode":"75705","codeType":"CPT"},{"id":4646,"precertRequired":false,"billingCode":"75710","codeType":"CPT"},{"id":4647,"precertRequired":false,"billingCode":"75716","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4726,"precertRequired":false,"billingCode":"76706","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4933,"precertRequired":false,"billingCode":"78451","codeType":"CPT"},{"id":4934,"precertRequired":false,"billingCode":"78452","codeType":"CPT"},{"id":4935,"precertRequired":false,"billingCode":"78453","codeType":"CPT"},{"id":4936,"precertRequired":false,"billingCode":"78454","codeType":"CPT"},{"id":4940,"precertRequired":false,"billingCode":"78459","codeType":"CPT"},{"id":4941,"precertRequired":false,"billingCode":"78466","codeType":"CPT"},{"id":4942,"precertRequired":false,"billingCode":"78468","codeType":"CPT"},{"id":4943,"precertRequired":false,"billingCode":"78469","codeType":"CPT"},{"id":4944,"precertRequired":false,"billingCode":"78472","codeType":"CPT"},{"id":4945,"precertRequired":false,"billingCode":"78473","codeType":"CPT"},{"id":4946,"precertRequired":false,"billingCode":"78481","codeType":"CPT"},{"id":4947,"precertRequired":false,"billingCode":"78483","codeType":"CPT"},{"id":4948,"precertRequired":false,"billingCode":"78491","codeType":"CPT"},{"id":4949,"precertRequired":false,"billingCode":"78492","codeType":"CPT"},{"id":4950,"precertRequired":false,"billingCode":"78494","codeType":"CPT"},{"id":4951,"precertRequired":false,"billingCode":"78496","codeType":"CPT"},{"id":4955,"precertRequired":false,"billingCode":"78582","codeType":"CPT"},{"id":4993,"precertRequired":false,"billingCode":"78814","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":4995,"precertRequired":false,"billingCode":"78816","codeType":"CPT"},{"id":6868,"precertRequired":false,"billingCode":"93303","codeType":"CPT"},{"id":6869,"precertRequired":false,"billingCode":"93304","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6880,"precertRequired":false,"billingCode":"93320","codeType":"CPT"},{"id":6881,"precertRequired":false,"billingCode":"93321","codeType":"CPT"},{"id":6882,"precertRequired":false,"billingCode":"93325","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"},{"id":13321,"precertRequired":true,"billingCode":"70490","codeType":"CPT"},{"id":13322,"precertRequired":true,"billingCode":"70491","codeType":"CPT"},{"id":13323,"precertRequired":true,"billingCode":"70492","codeType":"CPT"},{"id":13324,"precertRequired":true,"billingCode":"70496","codeType":"CPT"},{"id":13325,"precertRequired":true,"billingCode":"70498","codeType":"CPT"},{"id":13326,"precertRequired":true,"billingCode":"70545","codeType":"CPT"},{"id":13327,"precertRequired":true,"billingCode":"70546","codeType":"CPT"},{"id":13328,"precertRequired":true,"billingCode":"70547","codeType":"CPT"},{"id":13329,"precertRequired":true,"billingCode":"70548","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":4804,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6828,"precertRequired":false,"billingCode":"93024","codeType":"CPT"},{"id":6829,"precertRequired":false,"billingCode":"93025","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":6834,"precertRequired":false,"billingCode":"93224","codeType":"CPT"},{"id":6835,"precertRequired":false,"billingCode":"93225","codeType":"CPT"},{"id":6836,"precertRequired":false,"billingCode":"93226","codeType":"CPT"},{"id":6837,"precertRequired":false,"billingCode":"93227","codeType":"CPT"},{"id":6838,"precertRequired":false,"billingCode":"93228","codeType":"CPT"},{"id":6839,"precertRequired":false,"billingCode":"93229","codeType":"CPT"},{"id":6840,"precertRequired":false,"billingCode":"93260","codeType":"CPT"},{"id":6841,"precertRequired":false,"billingCode":"93261","codeType":"CPT"},{"id":6842,"precertRequired":false,"billingCode":"93268","codeType":"CPT"},{"id":6843,"precertRequired":false,"billingCode":"93270","codeType":"CPT"},{"id":6844,"precertRequired":false,"billingCode":"93271","codeType":"CPT"},{"id":6845,"precertRequired":false,"billingCode":"93272","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6847,"precertRequired":false,"billingCode":"93279","codeType":"CPT"},{"id":6848,"precertRequired":false,"billingCode":"93280","codeType":"CPT"},{"id":6849,"precertRequired":false,"billingCode":"93281","codeType":"CPT"},{"id":6850,"precertRequired":false,"billingCode":"93282","codeType":"CPT"},{"id":6851,"precertRequired":false,"billingCode":"93283","codeType":"CPT"},{"id":6852,"precertRequired":false,"billingCode":"93284","codeType":"CPT"},{"id":6853,"precertRequired":false,"billingCode":"93285","codeType":"CPT"},{"id":6854,"precertRequired":false,"billingCode":"93286","codeType":"CPT"},{"id":6855,"precertRequired":false,"billingCode":"93287","codeType":"CPT"},{"id":6856,"precertRequired":false,"billingCode":"93288","codeType":"CPT"},{"id":6857,"precertRequired":false,"billingCode":"93289","codeType":"CPT"},{"id":6858,"precertRequired":false,"billingCode":"93290","codeType":"CPT"},{"id":6859,"precertRequired":false,"billingCode":"93291","codeType":"CPT"},{"id":6860,"precertRequired":false,"billingCode":"93292","codeType":"CPT"},{"id":6861,"precertRequired":false,"billingCode":"93293","codeType":"CPT"},{"id":6862,"precertRequired":false,"billingCode":"93294","codeType":"CPT"},{"id":6863,"precertRequired":false,"billingCode":"93295","codeType":"CPT"},{"id":6864,"precertRequired":false,"billingCode":"93296","codeType":"CPT"},{"id":6865,"precertRequired":false,"billingCode":"93297","codeType":"CPT"},{"id":6866,"precertRequired":false,"billingCode":"93298","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6922,"precertRequired":true,"billingCode":"93602","codeType":"CPT"},{"id":6923,"precertRequired":true,"billingCode":"93603","codeType":"CPT"},{"id":6924,"precertRequired":true,"billingCode":"93609","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6928,"precertRequired":true,"billingCode":"93615","codeType":"CPT"},{"id":6929,"precertRequired":true,"billingCode":"93616","codeType":"CPT"},{"id":6930,"precertRequired":true,"billingCode":"93618","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6948,"precertRequired":false,"billingCode":"93660","codeType":"CPT"},{"id":6949,"precertRequired":false,"billingCode":"93662","codeType":"CPT"},{"id":6956,"precertRequired":false,"billingCode":"93784","codeType":"CPT"},{"id":6957,"precertRequired":false,"billingCode":"93786","codeType":"CPT"},{"id":6958,"precertRequired":false,"billingCode":"93788","codeType":"CPT"},{"id":6959,"precertRequired":false,"billingCode":"93790","codeType":"CPT"},{"id":6965,"precertRequired":false,"billingCode":"93880","codeType":"CPT"},{"id":6966,"precertRequired":false,"billingCode":"93882","codeType":"CPT"},{"id":6972,"precertRequired":false,"billingCode":"93895","codeType":"CPT"},{"id":6973,"precertRequired":false,"billingCode":"93922","codeType":"CPT"},{"id":6974,"precertRequired":false,"billingCode":"93923","codeType":"CPT"},{"id":6975,"precertRequired":false,"billingCode":"93924","codeType":"CPT"},{"id":6976,"precertRequired":false,"billingCode":"93925","codeType":"CPT"},{"id":6977,"precertRequired":false,"billingCode":"93926","codeType":"CPT"},{"id":6978,"precertRequired":false,"billingCode":"93930","codeType":"CPT"},{"id":6979,"precertRequired":false,"billingCode":"93931","codeType":"CPT"},{"id":6980,"precertRequired":false,"billingCode":"93970","codeType":"CPT"},{"id":6981,"precertRequired":false,"billingCode":"93971","codeType":"CPT"},{"id":6982,"precertRequired":false,"billingCode":"93975","codeType":"CPT"},{"id":6983,"precertRequired":false,"billingCode":"93976","codeType":"CPT"},{"id":6984,"precertRequired":false,"billingCode":"93978","codeType":"CPT"},{"id":6985,"precertRequired":false,"billingCode":"93979","codeType":"CPT"},{"id":7012,"precertRequired":false,"billingCode":"94621","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7985,"precertRequired":false,"billingCode":"C8927","codeType":"HCPCS"},{"id":7986,"precertRequired":false,"billingCode":"C8928","codeType":"HCPCS"},{"id":7987,"precertRequired":false,"billingCode":"C8929","codeType":"HCPCS"},{"id":7988,"precertRequired":false,"billingCode":"C8930","codeType":"HCPCS"},{"id":9796,"precertRequired":false,"billingCode":"0296T","codeType":"CPT"},{"id":9797,"precertRequired":false,"billingCode":"0297T","codeType":"CPT"},{"id":9798,"precertRequired":false,"billingCode":"0298T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":4805,"description":"Labs and pathology relevant to the referred condition on the consult **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5023,"precertRequired":false,"billingCode":"80162","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5329,"precertRequired":true,"billingCode":"81442","codeType":"CPT"},{"id":5409,"precertRequired":false,"billingCode":"82248","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5421,"precertRequired":false,"billingCode":"82330","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5469,"precertRequired":false,"billingCode":"82607","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5649,"precertRequired":false,"billingCode":"84100","codeType":"CPT"},{"id":5657,"precertRequired":false,"billingCode":"84132","codeType":"CPT"},{"id":5676,"precertRequired":false,"billingCode":"84165","codeType":"CPT"},{"id":5698,"precertRequired":false,"billingCode":"84295","codeType":"CPT"},{"id":5726,"precertRequired":false,"billingCode":"84450","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6114,"precertRequired":false,"billingCode":"87076","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6436,"precertRequired":false,"billingCode":"88366","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":4806,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6803,"precertRequired":false,"billingCode":"92953","codeType":"CPT"},{"id":6804,"precertRequired":false,"billingCode":"92960","codeType":"CPT"},{"id":6805,"precertRequired":false,"billingCode":"92961","codeType":"CPT"},{"id":6806,"precertRequired":false,"billingCode":"92970","codeType":"CPT"},{"id":6807,"precertRequired":false,"billingCode":"92971","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6814,"precertRequired":false,"billingCode":"92986","codeType":"CPT"},{"id":6815,"precertRequired":false,"billingCode":"92987","codeType":"CPT"},{"id":6816,"precertRequired":false,"billingCode":"92990","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6819,"precertRequired":false,"billingCode":"92997","codeType":"CPT"},{"id":6820,"precertRequired":false,"billingCode":"92998","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6902,"precertRequired":false,"billingCode":"93505","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":13338,"precertRequired":true,"billingCode":"93451","codeType":"CPT"},{"id":13339,"precertRequired":true,"billingCode":"93452","codeType":"CPT"},{"id":13340,"precertRequired":true,"billingCode":"93453","codeType":"CPT"},{"id":13341,"precertRequired":true,"billingCode":"93530","codeType":"CPT"},{"id":13342,"precertRequired":true,"billingCode":"93531","codeType":"CPT"},{"id":13343,"precertRequired":true,"billingCode":"93532","codeType":"CPT"},{"id":13344,"precertRequired":true,"billingCode":"93533","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":4807,"description":"Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":4808,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":40,"precertRequired":false,"billingCode":"00410","codeType":"CPT"},{"id":53,"precertRequired":false,"billingCode":"00534","codeType":"CPT"},{"id":54,"precertRequired":false,"billingCode":"00537","codeType":"CPT"},{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":65,"precertRequired":false,"billingCode":"00563","codeType":"CPT"},{"id":66,"precertRequired":false,"billingCode":"00566","codeType":"CPT"},{"id":67,"precertRequired":false,"billingCode":"00567","codeType":"CPT"},{"id":193,"precertRequired":false,"billingCode":"01920","codeType":"CPT"},{"id":196,"precertRequired":false,"billingCode":"01925","codeType":"CPT"},{"id":197,"precertRequired":false,"billingCode":"01926","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":11845,"precertRequired":false,"billingCode":"00530","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":4809,"description":"Procedures performed by a cardiologist including but not limited to:  ablations, implantation of cardiac devices, etc.  Request for Service (RFS) is required for other non-emergent cardiac related services or specialties to include but not limted to electrophysiology, cardiothoracic surgery, etc.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2088,"precertRequired":true,"billingCode":"32160","codeType":"CPT"},{"id":2171,"precertRequired":true,"billingCode":"33011","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2195,"precertRequired":false,"billingCode":"33221","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2198,"precertRequired":true,"billingCode":"33224","codeType":"CPT"},{"id":2199,"precertRequired":true,"billingCode":"33225","codeType":"CPT"},{"id":2200,"precertRequired":false,"billingCode":"33226","codeType":"CPT"},{"id":2201,"precertRequired":false,"billingCode":"33227","codeType":"CPT"},{"id":2202,"precertRequired":false,"billingCode":"33228","codeType":"CPT"},{"id":2203,"precertRequired":false,"billingCode":"33229","codeType":"CPT"},{"id":2204,"precertRequired":false,"billingCode":"33230","codeType":"CPT"},{"id":2205,"precertRequired":false,"billingCode":"33231","codeType":"CPT"},{"id":2206,"precertRequired":false,"billingCode":"33233","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2214,"precertRequired":false,"billingCode":"33243","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2235,"precertRequired":false,"billingCode":"33300","codeType":"CPT"},{"id":2236,"precertRequired":false,"billingCode":"33305","codeType":"CPT"},{"id":2237,"precertRequired":false,"billingCode":"33310","codeType":"CPT"},{"id":2238,"precertRequired":false,"billingCode":"33315","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2253,"precertRequired":false,"billingCode":"33390","codeType":"CPT"},{"id":2254,"precertRequired":false,"billingCode":"33391","codeType":"CPT"},{"id":2255,"precertRequired":false,"billingCode":"33404","codeType":"CPT"},{"id":2256,"precertRequired":true,"billingCode":"33405","codeType":"CPT"},{"id":2257,"precertRequired":true,"billingCode":"33406","codeType":"CPT"},{"id":2258,"precertRequired":true,"billingCode":"33410","codeType":"CPT"},{"id":2259,"precertRequired":true,"billingCode":"33411","codeType":"CPT"},{"id":2260,"precertRequired":true,"billingCode":"33412","codeType":"CPT"},{"id":2261,"precertRequired":false,"billingCode":"33413","codeType":"CPT"},{"id":2262,"precertRequired":true,"billingCode":"33414","codeType":"CPT"},{"id":2263,"precertRequired":false,"billingCode":"33415","codeType":"CPT"},{"id":2264,"precertRequired":false,"billingCode":"33416","codeType":"CPT"},{"id":2265,"precertRequired":false,"billingCode":"33417","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2268,"precertRequired":false,"billingCode":"33420","codeType":"CPT"},{"id":2269,"precertRequired":false,"billingCode":"33422","codeType":"CPT"},{"id":2270,"precertRequired":false,"billingCode":"33425","codeType":"CPT"},{"id":2271,"precertRequired":false,"billingCode":"33426","codeType":"CPT"},{"id":2272,"precertRequired":false,"billingCode":"33427","codeType":"CPT"},{"id":2273,"precertRequired":false,"billingCode":"33430","codeType":"CPT"},{"id":2274,"precertRequired":false,"billingCode":"33460","codeType":"CPT"},{"id":2275,"precertRequired":false,"billingCode":"33463","codeType":"CPT"},{"id":2276,"precertRequired":false,"billingCode":"33464","codeType":"CPT"},{"id":2277,"precertRequired":true,"billingCode":"33465","codeType":"CPT"},{"id":2278,"precertRequired":false,"billingCode":"33468","codeType":"CPT"},{"id":2279,"precertRequired":false,"billingCode":"33470","codeType":"CPT"},{"id":2280,"precertRequired":false,"billingCode":"33471","codeType":"CPT"},{"id":2281,"precertRequired":false,"billingCode":"33474","codeType":"CPT"},{"id":2282,"precertRequired":false,"billingCode":"33475","codeType":"CPT"},{"id":2283,"precertRequired":false,"billingCode":"33476","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2285,"precertRequired":false,"billingCode":"33478","codeType":"CPT"},{"id":2286,"precertRequired":false,"billingCode":"33496","codeType":"CPT"},{"id":2293,"precertRequired":false,"billingCode":"33508","codeType":"CPT"},{"id":2294,"precertRequired":false,"billingCode":"33510","codeType":"CPT"},{"id":2295,"precertRequired":false,"billingCode":"33511","codeType":"CPT"},{"id":2296,"precertRequired":false,"billingCode":"33512","codeType":"CPT"},{"id":2297,"precertRequired":false,"billingCode":"33513","codeType":"CPT"},{"id":2298,"precertRequired":false,"billingCode":"33514","codeType":"CPT"},{"id":2299,"precertRequired":false,"billingCode":"33516","codeType":"CPT"},{"id":2300,"precertRequired":false,"billingCode":"33517","codeType":"CPT"},{"id":2301,"precertRequired":false,"billingCode":"33518","codeType":"CPT"},{"id":2302,"precertRequired":false,"billingCode":"33519","codeType":"CPT"},{"id":2303,"precertRequired":false,"billingCode":"33521","codeType":"CPT"},{"id":2304,"precertRequired":false,"billingCode":"33522","codeType":"CPT"},{"id":2305,"precertRequired":false,"billingCode":"33523","codeType":"CPT"},{"id":2306,"precertRequired":false,"billingCode":"33530","codeType":"CPT"},{"id":2307,"precertRequired":false,"billingCode":"33533","codeType":"CPT"},{"id":2308,"precertRequired":false,"billingCode":"33534","codeType":"CPT"},{"id":2309,"precertRequired":false,"billingCode":"33535","codeType":"CPT"},{"id":2310,"precertRequired":false,"billingCode":"33536","codeType":"CPT"},{"id":2311,"precertRequired":false,"billingCode":"33542","codeType":"CPT"},{"id":2312,"precertRequired":false,"billingCode":"33545","codeType":"CPT"},{"id":2313,"precertRequired":false,"billingCode":"33548","codeType":"CPT"},{"id":2314,"precertRequired":false,"billingCode":"33572","codeType":"CPT"},{"id":2341,"precertRequired":false,"billingCode":"33735","codeType":"CPT"},{"id":2342,"precertRequired":false,"billingCode":"33736","codeType":"CPT"},{"id":2343,"precertRequired":false,"billingCode":"33737","codeType":"CPT"},{"id":2344,"precertRequired":false,"billingCode":"33750","codeType":"CPT"},{"id":2345,"precertRequired":false,"billingCode":"33755","codeType":"CPT"},{"id":2346,"precertRequired":false,"billingCode":"33762","codeType":"CPT"},{"id":2347,"precertRequired":false,"billingCode":"33764","codeType":"CPT"},{"id":2348,"precertRequired":false,"billingCode":"33766","codeType":"CPT"},{"id":2349,"precertRequired":false,"billingCode":"33767","codeType":"CPT"},{"id":2350,"precertRequired":false,"billingCode":"33768","codeType":"CPT"},{"id":2379,"precertRequired":false,"billingCode":"33863","codeType":"CPT"},{"id":2380,"precertRequired":false,"billingCode":"33864","codeType":"CPT"},{"id":2382,"precertRequired":false,"billingCode":"33875","codeType":"CPT"},{"id":2383,"precertRequired":false,"billingCode":"33877","codeType":"CPT"},{"id":2402,"precertRequired":true,"billingCode":"33967","codeType":"CPT"},{"id":2403,"precertRequired":false,"billingCode":"33968","codeType":"CPT"},{"id":2404,"precertRequired":false,"billingCode":"33970","codeType":"CPT"},{"id":2405,"precertRequired":false,"billingCode":"33971","codeType":"CPT"},{"id":2406,"precertRequired":false,"billingCode":"33973","codeType":"CPT"},{"id":2407,"precertRequired":false,"billingCode":"33974","codeType":"CPT"},{"id":2408,"precertRequired":false,"billingCode":"33975","codeType":"CPT"},{"id":2409,"precertRequired":false,"billingCode":"33976","codeType":"CPT"},{"id":2410,"precertRequired":false,"billingCode":"33977","codeType":"CPT"},{"id":2411,"precertRequired":false,"billingCode":"33978","codeType":"CPT"},{"id":2412,"precertRequired":false,"billingCode":"33979","codeType":"CPT"},{"id":2413,"precertRequired":false,"billingCode":"33980","codeType":"CPT"},{"id":2414,"precertRequired":false,"billingCode":"33981","codeType":"CPT"},{"id":2415,"precertRequired":false,"billingCode":"33982","codeType":"CPT"},{"id":2416,"precertRequired":false,"billingCode":"33983","codeType":"CPT"},{"id":2417,"precertRequired":false,"billingCode":"33990","codeType":"CPT"},{"id":2418,"precertRequired":false,"billingCode":"33991","codeType":"CPT"},{"id":2419,"precertRequired":false,"billingCode":"33992","codeType":"CPT"},{"id":2420,"precertRequired":false,"billingCode":"33993","codeType":"CPT"},{"id":2422,"precertRequired":false,"billingCode":"34701","codeType":"CPT"},{"id":2423,"precertRequired":false,"billingCode":"34702","codeType":"CPT"},{"id":2424,"precertRequired":false,"billingCode":"34703","codeType":"CPT"},{"id":2425,"precertRequired":false,"billingCode":"34704","codeType":"CPT"},{"id":2426,"precertRequired":false,"billingCode":"34705","codeType":"CPT"},{"id":2427,"precertRequired":false,"billingCode":"34706","codeType":"CPT"},{"id":2428,"precertRequired":false,"billingCode":"34707","codeType":"CPT"},{"id":2429,"precertRequired":false,"billingCode":"34708","codeType":"CPT"},{"id":2430,"precertRequired":false,"billingCode":"34709","codeType":"CPT"},{"id":2431,"precertRequired":false,"billingCode":"34712","codeType":"CPT"},{"id":2433,"precertRequired":false,"billingCode":"35180","codeType":"CPT"},{"id":2434,"precertRequired":false,"billingCode":"35182","codeType":"CPT"},{"id":2435,"precertRequired":false,"billingCode":"35184","codeType":"CPT"},{"id":2436,"precertRequired":false,"billingCode":"35188","codeType":"CPT"},{"id":2437,"precertRequired":false,"billingCode":"35189","codeType":"CPT"},{"id":2438,"precertRequired":false,"billingCode":"35190","codeType":"CPT"},{"id":2445,"precertRequired":false,"billingCode":"35500","codeType":"CPT"},{"id":2446,"precertRequired":false,"billingCode":"35501","codeType":"CPT"},{"id":2447,"precertRequired":false,"billingCode":"35506","codeType":"CPT"},{"id":2448,"precertRequired":false,"billingCode":"35508","codeType":"CPT"},{"id":2449,"precertRequired":false,"billingCode":"35509","codeType":"CPT"},{"id":2450,"precertRequired":false,"billingCode":"35510","codeType":"CPT"},{"id":2451,"precertRequired":false,"billingCode":"35511","codeType":"CPT"},{"id":2452,"precertRequired":false,"billingCode":"35512","codeType":"CPT"},{"id":2453,"precertRequired":false,"billingCode":"35515","codeType":"CPT"},{"id":2454,"precertRequired":false,"billingCode":"35516","codeType":"CPT"},{"id":2455,"precertRequired":false,"billingCode":"35518","codeType":"CPT"},{"id":2456,"precertRequired":false,"billingCode":"35521","codeType":"CPT"},{"id":2457,"precertRequired":false,"billingCode":"35522","codeType":"CPT"},{"id":2458,"precertRequired":false,"billingCode":"35523","codeType":"CPT"},{"id":2459,"precertRequired":false,"billingCode":"35525","codeType":"CPT"},{"id":2460,"precertRequired":false,"billingCode":"35526","codeType":"CPT"},{"id":2461,"precertRequired":false,"billingCode":"35531","codeType":"CPT"},{"id":2462,"precertRequired":false,"billingCode":"35533","codeType":"CPT"},{"id":2463,"precertRequired":false,"billingCode":"35535","codeType":"CPT"},{"id":2464,"precertRequired":false,"billingCode":"35536","codeType":"CPT"},{"id":2465,"precertRequired":false,"billingCode":"35537","codeType":"CPT"},{"id":2466,"precertRequired":false,"billingCode":"35538","codeType":"CPT"},{"id":2467,"precertRequired":false,"billingCode":"35539","codeType":"CPT"},{"id":2468,"precertRequired":false,"billingCode":"35540","codeType":"CPT"},{"id":2469,"precertRequired":false,"billingCode":"35556","codeType":"CPT"},{"id":2470,"precertRequired":false,"billingCode":"35558","codeType":"CPT"},{"id":2471,"precertRequired":false,"billingCode":"35560","codeType":"CPT"},{"id":2472,"precertRequired":false,"billingCode":"35563","codeType":"CPT"},{"id":2473,"precertRequired":false,"billingCode":"35565","codeType":"CPT"},{"id":2474,"precertRequired":false,"billingCode":"35566","codeType":"CPT"},{"id":2475,"precertRequired":false,"billingCode":"35570","codeType":"CPT"},{"id":2476,"precertRequired":false,"billingCode":"35571","codeType":"CPT"},{"id":2477,"precertRequired":false,"billingCode":"35572","codeType":"CPT"},{"id":2478,"precertRequired":false,"billingCode":"35583","codeType":"CPT"},{"id":2479,"precertRequired":false,"billingCode":"35585","codeType":"CPT"},{"id":2480,"precertRequired":false,"billingCode":"35587","codeType":"CPT"},{"id":2481,"precertRequired":false,"billingCode":"35600","codeType":"CPT"},{"id":2482,"precertRequired":false,"billingCode":"35601","codeType":"CPT"},{"id":2483,"precertRequired":false,"billingCode":"35606","codeType":"CPT"},{"id":2484,"precertRequired":false,"billingCode":"35612","codeType":"CPT"},{"id":2485,"precertRequired":false,"billingCode":"35616","codeType":"CPT"},{"id":2486,"precertRequired":false,"billingCode":"35621","codeType":"CPT"},{"id":2487,"precertRequired":false,"billingCode":"35623","codeType":"CPT"},{"id":2488,"precertRequired":false,"billingCode":"35626","codeType":"CPT"},{"id":2489,"precertRequired":false,"billingCode":"35631","codeType":"CPT"},{"id":2490,"precertRequired":false,"billingCode":"35632","codeType":"CPT"},{"id":2491,"precertRequired":false,"billingCode":"35633","codeType":"CPT"},{"id":2492,"precertRequired":false,"billingCode":"35634","codeType":"CPT"},{"id":2493,"precertRequired":false,"billingCode":"35636","codeType":"CPT"},{"id":2494,"precertRequired":false,"billingCode":"35637","codeType":"CPT"},{"id":2495,"precertRequired":false,"billingCode":"35638","codeType":"CPT"},{"id":2496,"precertRequired":false,"billingCode":"35642","codeType":"CPT"},{"id":2497,"precertRequired":false,"billingCode":"35645","codeType":"CPT"},{"id":2498,"precertRequired":false,"billingCode":"35646","codeType":"CPT"},{"id":2499,"precertRequired":false,"billingCode":"35647","codeType":"CPT"},{"id":2500,"precertRequired":false,"billingCode":"35650","codeType":"CPT"},{"id":2501,"precertRequired":true,"billingCode":"35654","codeType":"CPT"},{"id":2502,"precertRequired":true,"billingCode":"35656","codeType":"CPT"},{"id":2503,"precertRequired":false,"billingCode":"35661","codeType":"CPT"},{"id":2504,"precertRequired":false,"billingCode":"35663","codeType":"CPT"},{"id":2505,"precertRequired":false,"billingCode":"35665","codeType":"CPT"},{"id":2506,"precertRequired":false,"billingCode":"35666","codeType":"CPT"},{"id":2507,"precertRequired":false,"billingCode":"35671","codeType":"CPT"},{"id":2508,"precertRequired":false,"billingCode":"35905","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2510,"precertRequired":false,"billingCode":"36002","codeType":"CPT"},{"id":2511,"precertRequired":false,"billingCode":"36005","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":2513,"precertRequired":false,"billingCode":"36011","codeType":"CPT"},{"id":2514,"precertRequired":false,"billingCode":"36012","codeType":"CPT"},{"id":2515,"precertRequired":false,"billingCode":"36100","codeType":"CPT"},{"id":2517,"precertRequired":false,"billingCode":"36140","codeType":"CPT"},{"id":2518,"precertRequired":false,"billingCode":"36160","codeType":"CPT"},{"id":2519,"precertRequired":false,"billingCode":"36200","codeType":"CPT"},{"id":2520,"precertRequired":false,"billingCode":"36215","codeType":"CPT"},{"id":2521,"precertRequired":false,"billingCode":"36216","codeType":"CPT"},{"id":2522,"precertRequired":false,"billingCode":"36217","codeType":"CPT"},{"id":2523,"precertRequired":false,"billingCode":"36218","codeType":"CPT"},{"id":2524,"precertRequired":false,"billingCode":"36221","codeType":"CPT"},{"id":2525,"precertRequired":false,"billingCode":"36222","codeType":"CPT"},{"id":2526,"precertRequired":false,"billingCode":"36223","codeType":"CPT"},{"id":2527,"precertRequired":false,"billingCode":"36224","codeType":"CPT"},{"id":2528,"precertRequired":false,"billingCode":"36225","codeType":"CPT"},{"id":2529,"precertRequired":false,"billingCode":"36226","codeType":"CPT"},{"id":2530,"precertRequired":false,"billingCode":"36227","codeType":"CPT"},{"id":2531,"precertRequired":false,"billingCode":"36228","codeType":"CPT"},{"id":2532,"precertRequired":false,"billingCode":"36245","codeType":"CPT"},{"id":2533,"precertRequired":false,"billingCode":"36246","codeType":"CPT"},{"id":2534,"precertRequired":false,"billingCode":"36247","codeType":"CPT"},{"id":2535,"precertRequired":false,"billingCode":"36248","codeType":"CPT"},{"id":2536,"precertRequired":false,"billingCode":"36251","codeType":"CPT"},{"id":2537,"precertRequired":false,"billingCode":"36252","codeType":"CPT"},{"id":2538,"precertRequired":false,"billingCode":"36253","codeType":"CPT"},{"id":2539,"precertRequired":false,"billingCode":"36254","codeType":"CPT"},{"id":2552,"precertRequired":false,"billingCode":"36481","codeType":"CPT"},{"id":2622,"precertRequired":false,"billingCode":"37182","codeType":"CPT"},{"id":2623,"precertRequired":false,"billingCode":"37183","codeType":"CPT"},{"id":2624,"precertRequired":false,"billingCode":"37184","codeType":"CPT"},{"id":2625,"precertRequired":false,"billingCode":"37185","codeType":"CPT"},{"id":2626,"precertRequired":false,"billingCode":"37186","codeType":"CPT"},{"id":2627,"precertRequired":false,"billingCode":"37187","codeType":"CPT"},{"id":2628,"precertRequired":false,"billingCode":"37188","codeType":"CPT"},{"id":2629,"precertRequired":false,"billingCode":"37191","codeType":"CPT"},{"id":2630,"precertRequired":false,"billingCode":"37192","codeType":"CPT"},{"id":2631,"precertRequired":false,"billingCode":"37193","codeType":"CPT"},{"id":2632,"precertRequired":false,"billingCode":"37197","codeType":"CPT"},{"id":2634,"precertRequired":false,"billingCode":"37211","codeType":"CPT"},{"id":2635,"precertRequired":false,"billingCode":"37212","codeType":"CPT"},{"id":2636,"precertRequired":false,"billingCode":"37213","codeType":"CPT"},{"id":2637,"precertRequired":false,"billingCode":"37214","codeType":"CPT"},{"id":2638,"precertRequired":false,"billingCode":"37215","codeType":"CPT"},{"id":2639,"precertRequired":false,"billingCode":"37216","codeType":"CPT"},{"id":2642,"precertRequired":false,"billingCode":"37220","codeType":"CPT"},{"id":2643,"precertRequired":false,"billingCode":"37221","codeType":"CPT"},{"id":2644,"precertRequired":false,"billingCode":"37222","codeType":"CPT"},{"id":2645,"precertRequired":false,"billingCode":"37223","codeType":"CPT"},{"id":2646,"precertRequired":false,"billingCode":"37224","codeType":"CPT"},{"id":2647,"precertRequired":false,"billingCode":"37225","codeType":"CPT"},{"id":2648,"precertRequired":false,"billingCode":"37226","codeType":"CPT"},{"id":2649,"precertRequired":false,"billingCode":"37227","codeType":"CPT"},{"id":2650,"precertRequired":false,"billingCode":"37228","codeType":"CPT"},{"id":2651,"precertRequired":false,"billingCode":"37229","codeType":"CPT"},{"id":2652,"precertRequired":false,"billingCode":"37230","codeType":"CPT"},{"id":2653,"precertRequired":false,"billingCode":"37231","codeType":"CPT"},{"id":2654,"precertRequired":false,"billingCode":"37232","codeType":"CPT"},{"id":2655,"precertRequired":false,"billingCode":"37233","codeType":"CPT"},{"id":2656,"precertRequired":false,"billingCode":"37234","codeType":"CPT"},{"id":2657,"precertRequired":false,"billingCode":"37235","codeType":"CPT"},{"id":2658,"precertRequired":false,"billingCode":"37236","codeType":"CPT"},{"id":2659,"precertRequired":false,"billingCode":"37237","codeType":"CPT"},{"id":2660,"precertRequired":false,"billingCode":"37238","codeType":"CPT"},{"id":2661,"precertRequired":false,"billingCode":"37239","codeType":"CPT"},{"id":2666,"precertRequired":false,"billingCode":"37246","codeType":"CPT"},{"id":2667,"precertRequired":false,"billingCode":"37247","codeType":"CPT"},{"id":2668,"precertRequired":false,"billingCode":"37248","codeType":"CPT"},{"id":2669,"precertRequired":false,"billingCode":"37249","codeType":"CPT"},{"id":2670,"precertRequired":false,"billingCode":"37252","codeType":"CPT"},{"id":2671,"precertRequired":false,"billingCode":"37253","codeType":"CPT"},{"id":2842,"precertRequired":false,"billingCode":"43320","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4685,"precertRequired":false,"billingCode":"75956","codeType":"CPT"},{"id":4686,"precertRequired":false,"billingCode":"75957","codeType":"CPT"},{"id":4687,"precertRequired":false,"billingCode":"75958","codeType":"CPT"},{"id":4688,"precertRequired":false,"billingCode":"75959","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4930,"precertRequired":false,"billingCode":"78414","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":6918,"precertRequired":false,"billingCode":"93581","codeType":"CPT"},{"id":6919,"precertRequired":false,"billingCode":"93582","codeType":"CPT"},{"id":6920,"precertRequired":false,"billingCode":"93583","codeType":"CPT"},{"id":6942,"precertRequired":false,"billingCode":"93650","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6945,"precertRequired":false,"billingCode":"93655","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":6951,"precertRequired":false,"billingCode":"93701","codeType":"CPT"},{"id":6952,"precertRequired":false,"billingCode":"93724","codeType":"CPT"},{"id":6953,"precertRequired":false,"billingCode":"93740","codeType":"CPT"},{"id":6954,"precertRequired":false,"billingCode":"93745","codeType":"CPT"},{"id":6955,"precertRequired":false,"billingCode":"93770","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7562,"precertRequired":false,"billingCode":"0408T","codeType":"CPT"},{"id":7563,"precertRequired":false,"billingCode":"0409T","codeType":"CPT"},{"id":7564,"precertRequired":false,"billingCode":"0410T","codeType":"CPT"},{"id":7565,"precertRequired":false,"billingCode":"0411T","codeType":"CPT"},{"id":7566,"precertRequired":false,"billingCode":"0412T","codeType":"CPT"},{"id":7567,"precertRequired":false,"billingCode":"0413T","codeType":"CPT"},{"id":7568,"precertRequired":false,"billingCode":"0414T","codeType":"CPT"},{"id":7569,"precertRequired":false,"billingCode":"0415T","codeType":"CPT"},{"id":7570,"precertRequired":false,"billingCode":"0416T","codeType":"CPT"},{"id":7571,"precertRequired":false,"billingCode":"0417T","codeType":"CPT"},{"id":7572,"precertRequired":false,"billingCode":"0418T","codeType":"CPT"},{"id":7574,"precertRequired":false,"billingCode":"0439T","codeType":"CPT"},{"id":8169,"precertRequired":false,"billingCode":"G0269","codeType":"HCPCS"},{"id":9419,"precertRequired":true,"billingCode":"33285","codeType":"CPT"},{"id":9420,"precertRequired":true,"billingCode":"33286","codeType":"CPT"},{"id":9776,"precertRequired":true,"billingCode":"93591","codeType":"CPT"},{"id":9777,"precertRequired":true,"billingCode":"93592","codeType":"CPT"},{"id":9778,"precertRequired":false,"billingCode":"93750","codeType":"CPT"},{"id":11416,"precertRequired":false,"billingCode":"33289","codeType":"CPT"},{"id":11640,"precertRequired":false,"billingCode":"35820","codeType":"CPT"},{"id":11669,"precertRequired":false,"billingCode":"34710","codeType":"CPT"},{"id":11670,"precertRequired":false,"billingCode":"34711","codeType":"CPT"},{"id":11671,"precertRequired":false,"billingCode":"34713","codeType":"CPT"},{"id":11672,"precertRequired":false,"billingCode":"34714","codeType":"CPT"},{"id":11673,"precertRequired":false,"billingCode":"34715","codeType":"CPT"},{"id":11674,"precertRequired":false,"billingCode":"34716","codeType":"CPT"},{"id":11675,"precertRequired":false,"billingCode":"34808","codeType":"CPT"},{"id":11676,"precertRequired":false,"billingCode":"34812","codeType":"CPT"},{"id":11677,"precertRequired":false,"billingCode":"34813","codeType":"CPT"},{"id":11678,"precertRequired":false,"billingCode":"34820","codeType":"CPT"},{"id":11679,"precertRequired":false,"billingCode":"34830","codeType":"CPT"},{"id":11680,"precertRequired":false,"billingCode":"34831","codeType":"CPT"},{"id":11681,"precertRequired":false,"billingCode":"34832","codeType":"CPT"},{"id":11682,"precertRequired":false,"billingCode":"34833","codeType":"CPT"},{"id":11683,"precertRequired":false,"billingCode":"34834","codeType":"CPT"},{"id":11729,"precertRequired":false,"billingCode":"35301","codeType":"CPT"},{"id":11746,"precertRequired":false,"billingCode":"35681","codeType":"CPT"},{"id":11747,"precertRequired":false,"billingCode":"35682","codeType":"CPT"},{"id":11748,"precertRequired":false,"billingCode":"35683","codeType":"CPT"},{"id":11749,"precertRequired":false,"billingCode":"35685","codeType":"CPT"},{"id":11750,"precertRequired":false,"billingCode":"35686","codeType":"CPT"},{"id":11751,"precertRequired":false,"billingCode":"35691","codeType":"CPT"},{"id":11752,"precertRequired":false,"billingCode":"35693","codeType":"CPT"},{"id":11753,"precertRequired":false,"billingCode":"35694","codeType":"CPT"},{"id":11754,"precertRequired":false,"billingCode":"35695","codeType":"CPT"},{"id":11755,"precertRequired":false,"billingCode":"35697","codeType":"CPT"},{"id":11756,"precertRequired":false,"billingCode":"35700","codeType":"CPT"},{"id":11757,"precertRequired":false,"billingCode":"35701","codeType":"CPT"},{"id":11761,"precertRequired":false,"billingCode":"35800","codeType":"CPT"},{"id":11762,"precertRequired":false,"billingCode":"35840","codeType":"CPT"},{"id":11763,"precertRequired":false,"billingCode":"35860","codeType":"CPT"},{"id":11764,"precertRequired":false,"billingCode":"35870","codeType":"CPT"},{"id":11765,"precertRequired":false,"billingCode":"35875","codeType":"CPT"},{"id":11766,"precertRequired":false,"billingCode":"35876","codeType":"CPT"},{"id":11767,"precertRequired":false,"billingCode":"35879","codeType":"CPT"},{"id":11768,"precertRequired":false,"billingCode":"35881","codeType":"CPT"},{"id":11769,"precertRequired":false,"billingCode":"35883","codeType":"CPT"},{"id":11770,"precertRequired":false,"billingCode":"35884","codeType":"CPT"},{"id":11771,"precertRequired":false,"billingCode":"35901","codeType":"CPT"},{"id":11772,"precertRequired":false,"billingCode":"35903","codeType":"CPT"},{"id":11773,"precertRequired":false,"billingCode":"35907","codeType":"CPT"},{"id":11774,"precertRequired":false,"billingCode":"36013","codeType":"CPT"},{"id":11775,"precertRequired":false,"billingCode":"36014","codeType":"CPT"},{"id":11776,"precertRequired":false,"billingCode":"36015","codeType":"CPT"},{"id":11788,"precertRequired":false,"billingCode":"37500","codeType":"CPT"},{"id":11841,"precertRequired":false,"billingCode":"C9600","codeType":"HCPCS"},{"id":11842,"precertRequired":false,"billingCode":"C9602","codeType":"HCPCS"},{"id":11843,"precertRequired":false,"billingCode":"C9604","codeType":"HCPCS"},{"id":11844,"precertRequired":false,"billingCode":"C9607","codeType":"HCPCS"},{"id":11846,"precertRequired":false,"billingCode":"33340","codeType":"CPT"},{"id":13029,"precertRequired":false,"billingCode":"33866","codeType":"CPT"},{"id":13030,"precertRequired":false,"billingCode":"37140","codeType":"CPT"},{"id":13031,"precertRequired":false,"billingCode":"37145","codeType":"CPT"},{"id":13032,"precertRequired":false,"billingCode":"37160","codeType":"CPT"},{"id":13033,"precertRequired":false,"billingCode":"37180","codeType":"CPT"},{"id":13034,"precertRequired":false,"billingCode":"37181","codeType":"CPT"},{"id":13035,"precertRequired":false,"billingCode":"93590","codeType":"CPT"},{"id":13037,"precertRequired":false,"billingCode":"C9601","codeType":"HCPCS"},{"id":13038,"precertRequired":false,"billingCode":"C9603","codeType":"HCPCS"},{"id":13039,"precertRequired":false,"billingCode":"C9605","codeType":"HCPCS"},{"id":13040,"precertRequired":false,"billingCode":"C9606","codeType":"HCPCS"},{"id":13041,"precertRequired":false,"billingCode":"C9608","codeType":"HCPCS"},{"id":13335,"precertRequired":true,"billingCode":"76000","codeType":"CPT"},{"id":13402,"precertRequired":false,"billingCode":"33871","codeType":"CPT"},{"id":13403,"precertRequired":false,"billingCode":"34717","codeType":"CPT"},{"id":13404,"precertRequired":false,"billingCode":"34718","codeType":"CPT"},{"id":13405,"precertRequired":false,"billingCode":"33858","codeType":"CPT"},{"id":13406,"precertRequired":false,"billingCode":"33859","codeType":"CPT"},{"id":13407,"precertRequired":false,"billingCode":"33016","codeType":"CPT"},{"id":13408,"precertRequired":false,"billingCode":"33017","codeType":"CPT"},{"id":13409,"precertRequired":false,"billingCode":"33018","codeType":"CPT"},{"id":13410,"precertRequired":false,"billingCode":"33019","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":4810,"description":"Inpatient or observation admission for surgery/procedure and for emergent complications related to cardiac catheterization or other cardiac procedures performed under #8 to include emergent surgical intervention such as : cardiac bypass, TAVR, LAVD, angioplasty.\r\n**Note: Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":4811,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":4812,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6950,"precertRequired":false,"billingCode":"93668","codeType":"CPT"},{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":9031,"precertRequired":false,"billingCode":"S9472","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":478,"seocKey":23,"name":"Cardiology Comprehensive_PRCT","seocId":"MSC_CARDIOLOGY COMPREHENSIVE_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"07-28-2019","endDate":"01-24-2020","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. Labs and pathology relevant to the referred condition on the consult **\r\n5. One cardiac catheterization with PCI interventions and overnight observation if required\r\n6. Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n7. Anesthesia consultation related to the procedure\r\n8. Procedures to include A-fib ablations, implantation of cardiac devices and emergent or urgent surgical interventions such as: cardiac bypass, TAVR, LVAD, angioplasty\r\n9. Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran\r\n10. Follow-up visits for this episode of care\r\n11. Cardiac rehabilitation, up to 36 visits, no more than 3x per week","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CARDIOLOGY IMAGING","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RC0000X"},{"hptc":"207RC0001X"},{"hptc":"207RI0011X"}],"services":[{"id":2706,"description":"Initial outpatient evaluation and treatment for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":2707,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4645,"precertRequired":false,"billingCode":"75705","codeType":"CPT"},{"id":4646,"precertRequired":false,"billingCode":"75710","codeType":"CPT"},{"id":4647,"precertRequired":false,"billingCode":"75716","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4686,"precertRequired":false,"billingCode":"75957","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2708,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6965,"precertRequired":false,"billingCode":"93880","codeType":"CPT"},{"id":6972,"precertRequired":false,"billingCode":"93895","codeType":"CPT"},{"id":6976,"precertRequired":false,"billingCode":"93925","codeType":"CPT"},{"id":6977,"precertRequired":false,"billingCode":"93926","codeType":"CPT"},{"id":6980,"precertRequired":false,"billingCode":"93970","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":2709,"description":"Labs and pathology relevant to the referred condition on the consult **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":2710,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6902,"precertRequired":false,"billingCode":"93505","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6904,"precertRequired":false,"billingCode":"93531","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2711,"description":"Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":2712,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":66,"precertRequired":false,"billingCode":"00566","codeType":"CPT"},{"id":67,"precertRequired":false,"billingCode":"00567","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":2713,"description":"Procedures to include A-fib ablations, implantation of cardiac devices and emergent or urgent surgical interventions such as: cardiac bypass, TAVR, LVAD, angioplasty.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":750,"precertRequired":true,"billingCode":"21811","codeType":"CPT"},{"id":2170,"precertRequired":true,"billingCode":"33010","codeType":"CPT"},{"id":2171,"precertRequired":true,"billingCode":"33011","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2198,"precertRequired":true,"billingCode":"33224","codeType":"CPT"},{"id":2199,"precertRequired":true,"billingCode":"33225","codeType":"CPT"},{"id":2200,"precertRequired":false,"billingCode":"33226","codeType":"CPT"},{"id":2201,"precertRequired":false,"billingCode":"33227","codeType":"CPT"},{"id":2202,"precertRequired":false,"billingCode":"33228","codeType":"CPT"},{"id":2203,"precertRequired":false,"billingCode":"33229","codeType":"CPT"},{"id":2204,"precertRequired":false,"billingCode":"33230","codeType":"CPT"},{"id":2205,"precertRequired":false,"billingCode":"33231","codeType":"CPT"},{"id":2206,"precertRequired":false,"billingCode":"33233","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2253,"precertRequired":false,"billingCode":"33390","codeType":"CPT"},{"id":2254,"precertRequired":false,"billingCode":"33391","codeType":"CPT"},{"id":2255,"precertRequired":false,"billingCode":"33404","codeType":"CPT"},{"id":2256,"precertRequired":true,"billingCode":"33405","codeType":"CPT"},{"id":2257,"precertRequired":true,"billingCode":"33406","codeType":"CPT"},{"id":2258,"precertRequired":true,"billingCode":"33410","codeType":"CPT"},{"id":2259,"precertRequired":true,"billingCode":"33411","codeType":"CPT"},{"id":2260,"precertRequired":true,"billingCode":"33412","codeType":"CPT"},{"id":2261,"precertRequired":false,"billingCode":"33413","codeType":"CPT"},{"id":2262,"precertRequired":true,"billingCode":"33414","codeType":"CPT"},{"id":2263,"precertRequired":false,"billingCode":"33415","codeType":"CPT"},{"id":2264,"precertRequired":false,"billingCode":"33416","codeType":"CPT"},{"id":2265,"precertRequired":false,"billingCode":"33417","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2268,"precertRequired":false,"billingCode":"33420","codeType":"CPT"},{"id":2269,"precertRequired":false,"billingCode":"33422","codeType":"CPT"},{"id":2270,"precertRequired":false,"billingCode":"33425","codeType":"CPT"},{"id":2271,"precertRequired":false,"billingCode":"33426","codeType":"CPT"},{"id":2272,"precertRequired":false,"billingCode":"33427","codeType":"CPT"},{"id":2273,"precertRequired":false,"billingCode":"33430","codeType":"CPT"},{"id":2274,"precertRequired":false,"billingCode":"33460","codeType":"CPT"},{"id":2275,"precertRequired":false,"billingCode":"33463","codeType":"CPT"},{"id":2276,"precertRequired":false,"billingCode":"33464","codeType":"CPT"},{"id":2277,"precertRequired":true,"billingCode":"33465","codeType":"CPT"},{"id":2278,"precertRequired":false,"billingCode":"33468","codeType":"CPT"},{"id":2279,"precertRequired":false,"billingCode":"33470","codeType":"CPT"},{"id":2280,"precertRequired":false,"billingCode":"33471","codeType":"CPT"},{"id":2281,"precertRequired":false,"billingCode":"33474","codeType":"CPT"},{"id":2282,"precertRequired":false,"billingCode":"33475","codeType":"CPT"},{"id":2283,"precertRequired":false,"billingCode":"33476","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2285,"precertRequired":false,"billingCode":"33478","codeType":"CPT"},{"id":2286,"precertRequired":false,"billingCode":"33496","codeType":"CPT"},{"id":2294,"precertRequired":false,"billingCode":"33510","codeType":"CPT"},{"id":2295,"precertRequired":false,"billingCode":"33511","codeType":"CPT"},{"id":2296,"precertRequired":false,"billingCode":"33512","codeType":"CPT"},{"id":2297,"precertRequired":false,"billingCode":"33513","codeType":"CPT"},{"id":2298,"precertRequired":false,"billingCode":"33514","codeType":"CPT"},{"id":2299,"precertRequired":false,"billingCode":"33516","codeType":"CPT"},{"id":2300,"precertRequired":false,"billingCode":"33517","codeType":"CPT"},{"id":2301,"precertRequired":false,"billingCode":"33518","codeType":"CPT"},{"id":2302,"precertRequired":false,"billingCode":"33519","codeType":"CPT"},{"id":2303,"precertRequired":false,"billingCode":"33521","codeType":"CPT"},{"id":2304,"precertRequired":false,"billingCode":"33522","codeType":"CPT"},{"id":2305,"precertRequired":false,"billingCode":"33523","codeType":"CPT"},{"id":2306,"precertRequired":false,"billingCode":"33530","codeType":"CPT"},{"id":2307,"precertRequired":false,"billingCode":"33533","codeType":"CPT"},{"id":2308,"precertRequired":false,"billingCode":"33534","codeType":"CPT"},{"id":2309,"precertRequired":false,"billingCode":"33535","codeType":"CPT"},{"id":2310,"precertRequired":false,"billingCode":"33536","codeType":"CPT"},{"id":2311,"precertRequired":false,"billingCode":"33542","codeType":"CPT"},{"id":2312,"precertRequired":false,"billingCode":"33545","codeType":"CPT"},{"id":2313,"precertRequired":false,"billingCode":"33548","codeType":"CPT"},{"id":2314,"precertRequired":false,"billingCode":"33572","codeType":"CPT"},{"id":2341,"precertRequired":false,"billingCode":"33735","codeType":"CPT"},{"id":2342,"precertRequired":false,"billingCode":"33736","codeType":"CPT"},{"id":2343,"precertRequired":false,"billingCode":"33737","codeType":"CPT"},{"id":2344,"precertRequired":false,"billingCode":"33750","codeType":"CPT"},{"id":2345,"precertRequired":false,"billingCode":"33755","codeType":"CPT"},{"id":2346,"precertRequired":false,"billingCode":"33762","codeType":"CPT"},{"id":2347,"precertRequired":false,"billingCode":"33764","codeType":"CPT"},{"id":2348,"precertRequired":false,"billingCode":"33766","codeType":"CPT"},{"id":2349,"precertRequired":false,"billingCode":"33767","codeType":"CPT"},{"id":2350,"precertRequired":false,"billingCode":"33768","codeType":"CPT"},{"id":2378,"precertRequired":false,"billingCode":"33860","codeType":"CPT"},{"id":2379,"precertRequired":false,"billingCode":"33863","codeType":"CPT"},{"id":2380,"precertRequired":false,"billingCode":"33864","codeType":"CPT"},{"id":2381,"precertRequired":true,"billingCode":"33870","codeType":"CPT"},{"id":2382,"precertRequired":false,"billingCode":"33875","codeType":"CPT"},{"id":2383,"precertRequired":false,"billingCode":"33877","codeType":"CPT"},{"id":2402,"precertRequired":true,"billingCode":"33967","codeType":"CPT"},{"id":2422,"precertRequired":false,"billingCode":"34701","codeType":"CPT"},{"id":2423,"precertRequired":false,"billingCode":"34702","codeType":"CPT"},{"id":2424,"precertRequired":false,"billingCode":"34703","codeType":"CPT"},{"id":2425,"precertRequired":false,"billingCode":"34704","codeType":"CPT"},{"id":2426,"precertRequired":false,"billingCode":"34705","codeType":"CPT"},{"id":2427,"precertRequired":false,"billingCode":"34706","codeType":"CPT"},{"id":2428,"precertRequired":false,"billingCode":"34707","codeType":"CPT"},{"id":2429,"precertRequired":false,"billingCode":"34708","codeType":"CPT"},{"id":2430,"precertRequired":false,"billingCode":"34709","codeType":"CPT"},{"id":2433,"precertRequired":false,"billingCode":"35180","codeType":"CPT"},{"id":2434,"precertRequired":false,"billingCode":"35182","codeType":"CPT"},{"id":2435,"precertRequired":false,"billingCode":"35184","codeType":"CPT"},{"id":2436,"precertRequired":false,"billingCode":"35188","codeType":"CPT"},{"id":2437,"precertRequired":false,"billingCode":"35189","codeType":"CPT"},{"id":2438,"precertRequired":false,"billingCode":"35190","codeType":"CPT"},{"id":2445,"precertRequired":false,"billingCode":"35500","codeType":"CPT"},{"id":2446,"precertRequired":false,"billingCode":"35501","codeType":"CPT"},{"id":2447,"precertRequired":false,"billingCode":"35506","codeType":"CPT"},{"id":2448,"precertRequired":false,"billingCode":"35508","codeType":"CPT"},{"id":2449,"precertRequired":false,"billingCode":"35509","codeType":"CPT"},{"id":2450,"precertRequired":false,"billingCode":"35510","codeType":"CPT"},{"id":2451,"precertRequired":false,"billingCode":"35511","codeType":"CPT"},{"id":2452,"precertRequired":false,"billingCode":"35512","codeType":"CPT"},{"id":2453,"precertRequired":false,"billingCode":"35515","codeType":"CPT"},{"id":2454,"precertRequired":false,"billingCode":"35516","codeType":"CPT"},{"id":2455,"precertRequired":false,"billingCode":"35518","codeType":"CPT"},{"id":2456,"precertRequired":false,"billingCode":"35521","codeType":"CPT"},{"id":2457,"precertRequired":false,"billingCode":"35522","codeType":"CPT"},{"id":2458,"precertRequired":false,"billingCode":"35523","codeType":"CPT"},{"id":2459,"precertRequired":false,"billingCode":"35525","codeType":"CPT"},{"id":2461,"precertRequired":false,"billingCode":"35531","codeType":"CPT"},{"id":2462,"precertRequired":false,"billingCode":"35533","codeType":"CPT"},{"id":2463,"precertRequired":false,"billingCode":"35535","codeType":"CPT"},{"id":2464,"precertRequired":false,"billingCode":"35536","codeType":"CPT"},{"id":2465,"precertRequired":false,"billingCode":"35537","codeType":"CPT"},{"id":2466,"precertRequired":false,"billingCode":"35538","codeType":"CPT"},{"id":2467,"precertRequired":false,"billingCode":"35539","codeType":"CPT"},{"id":2468,"precertRequired":false,"billingCode":"35540","codeType":"CPT"},{"id":2469,"precertRequired":false,"billingCode":"35556","codeType":"CPT"},{"id":2470,"precertRequired":false,"billingCode":"35558","codeType":"CPT"},{"id":2471,"precertRequired":false,"billingCode":"35560","codeType":"CPT"},{"id":2472,"precertRequired":false,"billingCode":"35563","codeType":"CPT"},{"id":2473,"precertRequired":false,"billingCode":"35565","codeType":"CPT"},{"id":2474,"precertRequired":false,"billingCode":"35566","codeType":"CPT"},{"id":2475,"precertRequired":false,"billingCode":"35570","codeType":"CPT"},{"id":2476,"precertRequired":false,"billingCode":"35571","codeType":"CPT"},{"id":2477,"precertRequired":false,"billingCode":"35572","codeType":"CPT"},{"id":2478,"precertRequired":false,"billingCode":"35583","codeType":"CPT"},{"id":2479,"precertRequired":false,"billingCode":"35585","codeType":"CPT"},{"id":2480,"precertRequired":false,"billingCode":"35587","codeType":"CPT"},{"id":2481,"precertRequired":false,"billingCode":"35600","codeType":"CPT"},{"id":2482,"precertRequired":false,"billingCode":"35601","codeType":"CPT"},{"id":2483,"precertRequired":false,"billingCode":"35606","codeType":"CPT"},{"id":2484,"precertRequired":false,"billingCode":"35612","codeType":"CPT"},{"id":2485,"precertRequired":false,"billingCode":"35616","codeType":"CPT"},{"id":2486,"precertRequired":false,"billingCode":"35621","codeType":"CPT"},{"id":2487,"precertRequired":false,"billingCode":"35623","codeType":"CPT"},{"id":2488,"precertRequired":false,"billingCode":"35626","codeType":"CPT"},{"id":2489,"precertRequired":false,"billingCode":"35631","codeType":"CPT"},{"id":2490,"precertRequired":false,"billingCode":"35632","codeType":"CPT"},{"id":2491,"precertRequired":false,"billingCode":"35633","codeType":"CPT"},{"id":2492,"precertRequired":false,"billingCode":"35634","codeType":"CPT"},{"id":2493,"precertRequired":false,"billingCode":"35636","codeType":"CPT"},{"id":2494,"precertRequired":false,"billingCode":"35637","codeType":"CPT"},{"id":2495,"precertRequired":false,"billingCode":"35638","codeType":"CPT"},{"id":2496,"precertRequired":false,"billingCode":"35642","codeType":"CPT"},{"id":2497,"precertRequired":false,"billingCode":"35645","codeType":"CPT"},{"id":2498,"precertRequired":false,"billingCode":"35646","codeType":"CPT"},{"id":2499,"precertRequired":false,"billingCode":"35647","codeType":"CPT"},{"id":2500,"precertRequired":false,"billingCode":"35650","codeType":"CPT"},{"id":2501,"precertRequired":true,"billingCode":"35654","codeType":"CPT"},{"id":2502,"precertRequired":true,"billingCode":"35656","codeType":"CPT"},{"id":2503,"precertRequired":false,"billingCode":"35661","codeType":"CPT"},{"id":2504,"precertRequired":false,"billingCode":"35663","codeType":"CPT"},{"id":2505,"precertRequired":false,"billingCode":"35665","codeType":"CPT"},{"id":2506,"precertRequired":false,"billingCode":"35666","codeType":"CPT"},{"id":2507,"precertRequired":false,"billingCode":"35671","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2510,"precertRequired":false,"billingCode":"36002","codeType":"CPT"},{"id":2511,"precertRequired":false,"billingCode":"36005","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":2513,"precertRequired":false,"billingCode":"36011","codeType":"CPT"},{"id":2514,"precertRequired":false,"billingCode":"36012","codeType":"CPT"},{"id":2515,"precertRequired":false,"billingCode":"36100","codeType":"CPT"},{"id":2517,"precertRequired":false,"billingCode":"36140","codeType":"CPT"},{"id":2519,"precertRequired":false,"billingCode":"36200","codeType":"CPT"},{"id":2520,"precertRequired":false,"billingCode":"36215","codeType":"CPT"},{"id":2521,"precertRequired":false,"billingCode":"36216","codeType":"CPT"},{"id":2522,"precertRequired":false,"billingCode":"36217","codeType":"CPT"},{"id":2523,"precertRequired":false,"billingCode":"36218","codeType":"CPT"},{"id":2524,"precertRequired":false,"billingCode":"36221","codeType":"CPT"},{"id":2525,"precertRequired":false,"billingCode":"36222","codeType":"CPT"},{"id":2526,"precertRequired":false,"billingCode":"36223","codeType":"CPT"},{"id":2527,"precertRequired":false,"billingCode":"36224","codeType":"CPT"},{"id":2528,"precertRequired":false,"billingCode":"36225","codeType":"CPT"},{"id":2529,"precertRequired":false,"billingCode":"36226","codeType":"CPT"},{"id":2530,"precertRequired":false,"billingCode":"36227","codeType":"CPT"},{"id":2531,"precertRequired":false,"billingCode":"36228","codeType":"CPT"},{"id":2532,"precertRequired":false,"billingCode":"36245","codeType":"CPT"},{"id":2533,"precertRequired":false,"billingCode":"36246","codeType":"CPT"},{"id":2534,"precertRequired":false,"billingCode":"36247","codeType":"CPT"},{"id":2535,"precertRequired":false,"billingCode":"36248","codeType":"CPT"},{"id":2536,"precertRequired":false,"billingCode":"36251","codeType":"CPT"},{"id":2537,"precertRequired":false,"billingCode":"36252","codeType":"CPT"},{"id":2538,"precertRequired":false,"billingCode":"36253","codeType":"CPT"},{"id":2539,"precertRequired":false,"billingCode":"36254","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":2552,"precertRequired":false,"billingCode":"36481","codeType":"CPT"},{"id":2613,"precertRequired":true,"billingCode":"36901","codeType":"CPT"},{"id":2614,"precertRequired":true,"billingCode":"36902","codeType":"CPT"},{"id":2615,"precertRequired":true,"billingCode":"36903","codeType":"CPT"},{"id":2624,"precertRequired":false,"billingCode":"37184","codeType":"CPT"},{"id":2625,"precertRequired":false,"billingCode":"37185","codeType":"CPT"},{"id":2626,"precertRequired":false,"billingCode":"37186","codeType":"CPT"},{"id":2627,"precertRequired":false,"billingCode":"37187","codeType":"CPT"},{"id":2628,"precertRequired":false,"billingCode":"37188","codeType":"CPT"},{"id":2629,"precertRequired":false,"billingCode":"37191","codeType":"CPT"},{"id":2630,"precertRequired":false,"billingCode":"37192","codeType":"CPT"},{"id":2631,"precertRequired":false,"billingCode":"37193","codeType":"CPT"},{"id":2632,"precertRequired":false,"billingCode":"37197","codeType":"CPT"},{"id":2634,"precertRequired":false,"billingCode":"37211","codeType":"CPT"},{"id":2635,"precertRequired":false,"billingCode":"37212","codeType":"CPT"},{"id":2636,"precertRequired":false,"billingCode":"37213","codeType":"CPT"},{"id":2637,"precertRequired":false,"billingCode":"37214","codeType":"CPT"},{"id":2638,"precertRequired":false,"billingCode":"37215","codeType":"CPT"},{"id":2639,"precertRequired":false,"billingCode":"37216","codeType":"CPT"},{"id":2642,"precertRequired":false,"billingCode":"37220","codeType":"CPT"},{"id":2643,"precertRequired":false,"billingCode":"37221","codeType":"CPT"},{"id":2644,"precertRequired":false,"billingCode":"37222","codeType":"CPT"},{"id":2645,"precertRequired":false,"billingCode":"37223","codeType":"CPT"},{"id":2646,"precertRequired":false,"billingCode":"37224","codeType":"CPT"},{"id":2647,"precertRequired":false,"billingCode":"37225","codeType":"CPT"},{"id":2648,"precertRequired":false,"billingCode":"37226","codeType":"CPT"},{"id":2649,"precertRequired":false,"billingCode":"37227","codeType":"CPT"},{"id":2650,"precertRequired":false,"billingCode":"37228","codeType":"CPT"},{"id":2651,"precertRequired":false,"billingCode":"37229","codeType":"CPT"},{"id":2652,"precertRequired":false,"billingCode":"37230","codeType":"CPT"},{"id":2653,"precertRequired":false,"billingCode":"37231","codeType":"CPT"},{"id":2654,"precertRequired":false,"billingCode":"37232","codeType":"CPT"},{"id":2655,"precertRequired":false,"billingCode":"37233","codeType":"CPT"},{"id":2656,"precertRequired":false,"billingCode":"37234","codeType":"CPT"},{"id":2657,"precertRequired":false,"billingCode":"37235","codeType":"CPT"},{"id":2658,"precertRequired":false,"billingCode":"37236","codeType":"CPT"},{"id":2659,"precertRequired":false,"billingCode":"37237","codeType":"CPT"},{"id":2660,"precertRequired":false,"billingCode":"37238","codeType":"CPT"},{"id":2661,"precertRequired":false,"billingCode":"37239","codeType":"CPT"},{"id":2666,"precertRequired":false,"billingCode":"37246","codeType":"CPT"},{"id":2667,"precertRequired":false,"billingCode":"37247","codeType":"CPT"},{"id":2668,"precertRequired":false,"billingCode":"37248","codeType":"CPT"},{"id":2669,"precertRequired":false,"billingCode":"37249","codeType":"CPT"},{"id":2670,"precertRequired":false,"billingCode":"37252","codeType":"CPT"},{"id":2671,"precertRequired":false,"billingCode":"37253","codeType":"CPT"},{"id":2672,"precertRequired":false,"billingCode":"37619","codeType":"CPT"},{"id":2673,"precertRequired":false,"billingCode":"37718","codeType":"CPT"},{"id":4685,"precertRequired":false,"billingCode":"75956","codeType":"CPT"},{"id":4687,"precertRequired":false,"billingCode":"75958","codeType":"CPT"},{"id":4688,"precertRequired":false,"billingCode":"75959","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4761,"precertRequired":false,"billingCode":"76930","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4933,"precertRequired":false,"billingCode":"78451","codeType":"CPT"},{"id":4934,"precertRequired":false,"billingCode":"78452","codeType":"CPT"},{"id":4935,"precertRequired":false,"billingCode":"78453","codeType":"CPT"},{"id":4940,"precertRequired":false,"billingCode":"78459","codeType":"CPT"},{"id":4941,"precertRequired":false,"billingCode":"78466","codeType":"CPT"},{"id":4943,"precertRequired":false,"billingCode":"78469","codeType":"CPT"},{"id":4944,"precertRequired":false,"billingCode":"78472","codeType":"CPT"},{"id":4945,"precertRequired":false,"billingCode":"78473","codeType":"CPT"},{"id":4946,"precertRequired":false,"billingCode":"78481","codeType":"CPT"},{"id":4947,"precertRequired":false,"billingCode":"78483","codeType":"CPT"},{"id":4948,"precertRequired":false,"billingCode":"78491","codeType":"CPT"},{"id":4949,"precertRequired":false,"billingCode":"78492","codeType":"CPT"},{"id":4951,"precertRequired":false,"billingCode":"78496","codeType":"CPT"},{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6803,"precertRequired":false,"billingCode":"92953","codeType":"CPT"},{"id":6804,"precertRequired":false,"billingCode":"92960","codeType":"CPT"},{"id":6805,"precertRequired":false,"billingCode":"92961","codeType":"CPT"},{"id":6806,"precertRequired":false,"billingCode":"92970","codeType":"CPT"},{"id":6807,"precertRequired":false,"billingCode":"92971","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6814,"precertRequired":false,"billingCode":"92986","codeType":"CPT"},{"id":6815,"precertRequired":false,"billingCode":"92987","codeType":"CPT"},{"id":6816,"precertRequired":false,"billingCode":"92990","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6819,"precertRequired":false,"billingCode":"92997","codeType":"CPT"},{"id":6820,"precertRequired":false,"billingCode":"92998","codeType":"CPT"},{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6828,"precertRequired":false,"billingCode":"93024","codeType":"CPT"},{"id":6829,"precertRequired":false,"billingCode":"93025","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":6834,"precertRequired":false,"billingCode":"93224","codeType":"CPT"},{"id":6835,"precertRequired":false,"billingCode":"93225","codeType":"CPT"},{"id":6836,"precertRequired":false,"billingCode":"93226","codeType":"CPT"},{"id":6837,"precertRequired":false,"billingCode":"93227","codeType":"CPT"},{"id":6838,"precertRequired":false,"billingCode":"93228","codeType":"CPT"},{"id":6839,"precertRequired":false,"billingCode":"93229","codeType":"CPT"},{"id":6840,"precertRequired":false,"billingCode":"93260","codeType":"CPT"},{"id":6841,"precertRequired":false,"billingCode":"93261","codeType":"CPT"},{"id":6842,"precertRequired":false,"billingCode":"93268","codeType":"CPT"},{"id":6843,"precertRequired":false,"billingCode":"93270","codeType":"CPT"},{"id":6844,"precertRequired":false,"billingCode":"93271","codeType":"CPT"},{"id":6845,"precertRequired":false,"billingCode":"93272","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6847,"precertRequired":false,"billingCode":"93279","codeType":"CPT"},{"id":6848,"precertRequired":false,"billingCode":"93280","codeType":"CPT"},{"id":6849,"precertRequired":false,"billingCode":"93281","codeType":"CPT"},{"id":6850,"precertRequired":false,"billingCode":"93282","codeType":"CPT"},{"id":6851,"precertRequired":false,"billingCode":"93283","codeType":"CPT"},{"id":6852,"precertRequired":false,"billingCode":"93284","codeType":"CPT"},{"id":6853,"precertRequired":false,"billingCode":"93285","codeType":"CPT"},{"id":6854,"precertRequired":false,"billingCode":"93286","codeType":"CPT"},{"id":6855,"precertRequired":false,"billingCode":"93287","codeType":"CPT"},{"id":6856,"precertRequired":false,"billingCode":"93288","codeType":"CPT"},{"id":6857,"precertRequired":false,"billingCode":"93289","codeType":"CPT"},{"id":6858,"precertRequired":false,"billingCode":"93290","codeType":"CPT"},{"id":6859,"precertRequired":false,"billingCode":"93291","codeType":"CPT"},{"id":6860,"precertRequired":false,"billingCode":"93292","codeType":"CPT"},{"id":6861,"precertRequired":false,"billingCode":"93293","codeType":"CPT"},{"id":6862,"precertRequired":false,"billingCode":"93294","codeType":"CPT"},{"id":6863,"precertRequired":false,"billingCode":"93295","codeType":"CPT"},{"id":6864,"precertRequired":false,"billingCode":"93296","codeType":"CPT"},{"id":6865,"precertRequired":false,"billingCode":"93297","codeType":"CPT"},{"id":6866,"precertRequired":false,"billingCode":"93298","codeType":"CPT"},{"id":6867,"precertRequired":false,"billingCode":"93299","codeType":"CPT"},{"id":6868,"precertRequired":false,"billingCode":"93303","codeType":"CPT"},{"id":6869,"precertRequired":false,"billingCode":"93304","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6880,"precertRequired":false,"billingCode":"93320","codeType":"CPT"},{"id":6881,"precertRequired":false,"billingCode":"93321","codeType":"CPT"},{"id":6882,"precertRequired":false,"billingCode":"93325","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":6918,"precertRequired":false,"billingCode":"93581","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6922,"precertRequired":true,"billingCode":"93602","codeType":"CPT"},{"id":6923,"precertRequired":true,"billingCode":"93603","codeType":"CPT"},{"id":6924,"precertRequired":true,"billingCode":"93609","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6928,"precertRequired":true,"billingCode":"93615","codeType":"CPT"},{"id":6929,"precertRequired":true,"billingCode":"93616","codeType":"CPT"},{"id":6930,"precertRequired":true,"billingCode":"93618","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6942,"precertRequired":false,"billingCode":"93650","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6945,"precertRequired":false,"billingCode":"93655","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":6948,"precertRequired":false,"billingCode":"93660","codeType":"CPT"},{"id":6949,"precertRequired":false,"billingCode":"93662","codeType":"CPT"},{"id":6950,"precertRequired":false,"billingCode":"93668","codeType":"CPT"},{"id":6951,"precertRequired":false,"billingCode":"93701","codeType":"CPT"},{"id":6952,"precertRequired":false,"billingCode":"93724","codeType":"CPT"},{"id":6953,"precertRequired":false,"billingCode":"93740","codeType":"CPT"},{"id":6954,"precertRequired":false,"billingCode":"93745","codeType":"CPT"},{"id":6955,"precertRequired":false,"billingCode":"93770","codeType":"CPT"},{"id":6956,"precertRequired":false,"billingCode":"93784","codeType":"CPT"},{"id":6957,"precertRequired":false,"billingCode":"93786","codeType":"CPT"},{"id":6958,"precertRequired":false,"billingCode":"93788","codeType":"CPT"},{"id":6959,"precertRequired":false,"billingCode":"93790","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7945,"precertRequired":false,"billingCode":"C1760","codeType":"HCPCS"},{"id":7951,"precertRequired":false,"billingCode":"C1874","codeType":"HCPCS"},{"id":7952,"precertRequired":false,"billingCode":"C1875","codeType":"HCPCS"},{"id":7953,"precertRequired":false,"billingCode":"C1876","codeType":"HCPCS"},{"id":7954,"precertRequired":false,"billingCode":"C1877","codeType":"HCPCS"},{"id":7986,"precertRequired":false,"billingCode":"C8928","codeType":"HCPCS"},{"id":7988,"precertRequired":false,"billingCode":"C8930","codeType":"HCPCS"},{"id":8169,"precertRequired":false,"billingCode":"G0269","codeType":"HCPCS"},{"id":8218,"precertRequired":false,"billingCode":"G0446","codeType":"HCPCS"},{"id":8477,"precertRequired":false,"billingCode":"J2502","codeType":"HCPCS"},{"id":8532,"precertRequired":false,"billingCode":"J7188","codeType":"HCPCS"},{"id":8533,"precertRequired":false,"billingCode":"J7205","codeType":"HCPCS"},{"id":9419,"precertRequired":true,"billingCode":"33285","codeType":"CPT"},{"id":9420,"precertRequired":true,"billingCode":"33286","codeType":"CPT"},{"id":11669,"precertRequired":false,"billingCode":"34710","codeType":"CPT"},{"id":11670,"precertRequired":false,"billingCode":"34711","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":2714,"description":"Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":2715,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":2716,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":8210,"precertRequired":false,"billingCode":"G0424","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":310,"seocKey":23,"name":"Cardiology Comprehensive_PRCT","seocId":"MSC_CARDIOLOGY COMPREHENSIVE_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"02-19-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. Labs and pathology relevant to the referred condition on the consult **\r\n5. One cardiac catheterization with PCI interventions and overnight observation if required\r\n6. Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n7. Anesthesia consultation related to the procedure\r\n8. Procedures to include A-fib ablations, implantation of cardiac devices and emergent or urgent surgical interventions such as: cardiac bypass, TAVR, LVAD, angioplasty\r\n9. Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran\r\n10. Follow-up visits for this episode of care\r\n11. Cardiac rehabilitation, up to 36 visits, no more than 3x per week","maxAllowableVisits":null,"disclaimer":"* If non-emergent bypass grafting is required an additional VA authorization must be acquired.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n** Visits for additional services are not included in the frequency total.\r\nThe number of visits authorized for ancillary services are noted within its service line description above.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY IMAGING","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RC0000X"},{"hptc":"207RC0001X"},{"hptc":"207RI0011X"}],"services":[{"id":1371,"description":"Initial outpatient evaluation and treatment for the referred condition ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":1372,"description":"Diagnostic imaging relevant to the referred condition on the consult ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4644,"precertRequired":false,"billingCode":"75658","codeType":"CPT"},{"id":4645,"precertRequired":false,"billingCode":"75705","codeType":"CPT"},{"id":4646,"precertRequired":false,"billingCode":"75710","codeType":"CPT"},{"id":4647,"precertRequired":false,"billingCode":"75716","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4686,"precertRequired":false,"billingCode":"75957","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1373,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6965,"precertRequired":false,"billingCode":"93880","codeType":"CPT"},{"id":6972,"precertRequired":false,"billingCode":"93895","codeType":"CPT"},{"id":6976,"precertRequired":false,"billingCode":"93925","codeType":"CPT"},{"id":6977,"precertRequired":false,"billingCode":"93926","codeType":"CPT"},{"id":6980,"precertRequired":false,"billingCode":"93970","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":1374,"description":"Labs and pathology relevant to the referred condition on the consult **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5591,"precertRequired":false,"billingCode":"83658","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1375,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6902,"precertRequired":false,"billingCode":"93505","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6904,"precertRequired":false,"billingCode":"93531","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1376,"description":"Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5591,"precertRequired":false,"billingCode":"83658","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":1377,"description":" Anesthesia consultation related to the procedure ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":66,"precertRequired":false,"billingCode":"00566","codeType":"CPT"},{"id":67,"precertRequired":false,"billingCode":"00567","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1378,"description":"Procedures to include A-fib ablations, implantation of cardiac devices and emergent or urgent surgical interventions such as: cardiac bypass, TAVR, LVAD, angioplasty. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2170,"precertRequired":true,"billingCode":"33010","codeType":"CPT"},{"id":2171,"precertRequired":true,"billingCode":"33011","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2198,"precertRequired":true,"billingCode":"33224","codeType":"CPT"},{"id":2199,"precertRequired":true,"billingCode":"33225","codeType":"CPT"},{"id":2200,"precertRequired":false,"billingCode":"33226","codeType":"CPT"},{"id":2201,"precertRequired":false,"billingCode":"33227","codeType":"CPT"},{"id":2202,"precertRequired":false,"billingCode":"33228","codeType":"CPT"},{"id":2203,"precertRequired":false,"billingCode":"33229","codeType":"CPT"},{"id":2204,"precertRequired":false,"billingCode":"33230","codeType":"CPT"},{"id":2205,"precertRequired":false,"billingCode":"33231","codeType":"CPT"},{"id":2206,"precertRequired":false,"billingCode":"33233","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2233,"precertRequired":false,"billingCode":"33282","codeType":"CPT"},{"id":2234,"precertRequired":false,"billingCode":"33284","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2253,"precertRequired":false,"billingCode":"33390","codeType":"CPT"},{"id":2254,"precertRequired":false,"billingCode":"33391","codeType":"CPT"},{"id":2255,"precertRequired":false,"billingCode":"33404","codeType":"CPT"},{"id":2256,"precertRequired":true,"billingCode":"33405","codeType":"CPT"},{"id":2257,"precertRequired":true,"billingCode":"33406","codeType":"CPT"},{"id":2258,"precertRequired":true,"billingCode":"33410","codeType":"CPT"},{"id":2259,"precertRequired":true,"billingCode":"33411","codeType":"CPT"},{"id":2260,"precertRequired":true,"billingCode":"33412","codeType":"CPT"},{"id":2261,"precertRequired":false,"billingCode":"33413","codeType":"CPT"},{"id":2262,"precertRequired":true,"billingCode":"33414","codeType":"CPT"},{"id":2263,"precertRequired":false,"billingCode":"33415","codeType":"CPT"},{"id":2264,"precertRequired":false,"billingCode":"33416","codeType":"CPT"},{"id":2265,"precertRequired":false,"billingCode":"33417","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2268,"precertRequired":false,"billingCode":"33420","codeType":"CPT"},{"id":2269,"precertRequired":false,"billingCode":"33422","codeType":"CPT"},{"id":2270,"precertRequired":false,"billingCode":"33425","codeType":"CPT"},{"id":2271,"precertRequired":false,"billingCode":"33426","codeType":"CPT"},{"id":2272,"precertRequired":false,"billingCode":"33427","codeType":"CPT"},{"id":2273,"precertRequired":false,"billingCode":"33430","codeType":"CPT"},{"id":2274,"precertRequired":false,"billingCode":"33460","codeType":"CPT"},{"id":2275,"precertRequired":false,"billingCode":"33463","codeType":"CPT"},{"id":2276,"precertRequired":false,"billingCode":"33464","codeType":"CPT"},{"id":2277,"precertRequired":true,"billingCode":"33465","codeType":"CPT"},{"id":2278,"precertRequired":false,"billingCode":"33468","codeType":"CPT"},{"id":2279,"precertRequired":false,"billingCode":"33470","codeType":"CPT"},{"id":2280,"precertRequired":false,"billingCode":"33471","codeType":"CPT"},{"id":2281,"precertRequired":false,"billingCode":"33474","codeType":"CPT"},{"id":2282,"precertRequired":false,"billingCode":"33475","codeType":"CPT"},{"id":2283,"precertRequired":false,"billingCode":"33476","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2285,"precertRequired":false,"billingCode":"33478","codeType":"CPT"},{"id":2286,"precertRequired":false,"billingCode":"33496","codeType":"CPT"},{"id":2294,"precertRequired":false,"billingCode":"33510","codeType":"CPT"},{"id":2295,"precertRequired":false,"billingCode":"33511","codeType":"CPT"},{"id":2296,"precertRequired":false,"billingCode":"33512","codeType":"CPT"},{"id":2297,"precertRequired":false,"billingCode":"33513","codeType":"CPT"},{"id":2298,"precertRequired":false,"billingCode":"33514","codeType":"CPT"},{"id":2299,"precertRequired":false,"billingCode":"33516","codeType":"CPT"},{"id":2300,"precertRequired":false,"billingCode":"33517","codeType":"CPT"},{"id":2301,"precertRequired":false,"billingCode":"33518","codeType":"CPT"},{"id":2302,"precertRequired":false,"billingCode":"33519","codeType":"CPT"},{"id":2303,"precertRequired":false,"billingCode":"33521","codeType":"CPT"},{"id":2304,"precertRequired":false,"billingCode":"33522","codeType":"CPT"},{"id":2305,"precertRequired":false,"billingCode":"33523","codeType":"CPT"},{"id":2306,"precertRequired":false,"billingCode":"33530","codeType":"CPT"},{"id":2307,"precertRequired":false,"billingCode":"33533","codeType":"CPT"},{"id":2308,"precertRequired":false,"billingCode":"33534","codeType":"CPT"},{"id":2309,"precertRequired":false,"billingCode":"33535","codeType":"CPT"},{"id":2310,"precertRequired":false,"billingCode":"33536","codeType":"CPT"},{"id":2311,"precertRequired":false,"billingCode":"33542","codeType":"CPT"},{"id":2312,"precertRequired":false,"billingCode":"33545","codeType":"CPT"},{"id":2313,"precertRequired":false,"billingCode":"33548","codeType":"CPT"},{"id":2314,"precertRequired":false,"billingCode":"33572","codeType":"CPT"},{"id":2341,"precertRequired":false,"billingCode":"33735","codeType":"CPT"},{"id":2342,"precertRequired":false,"billingCode":"33736","codeType":"CPT"},{"id":2343,"precertRequired":false,"billingCode":"33737","codeType":"CPT"},{"id":2344,"precertRequired":false,"billingCode":"33750","codeType":"CPT"},{"id":2345,"precertRequired":false,"billingCode":"33755","codeType":"CPT"},{"id":2346,"precertRequired":false,"billingCode":"33762","codeType":"CPT"},{"id":2347,"precertRequired":false,"billingCode":"33764","codeType":"CPT"},{"id":2348,"precertRequired":false,"billingCode":"33766","codeType":"CPT"},{"id":2349,"precertRequired":false,"billingCode":"33767","codeType":"CPT"},{"id":2350,"precertRequired":false,"billingCode":"33768","codeType":"CPT"},{"id":2378,"precertRequired":false,"billingCode":"33860","codeType":"CPT"},{"id":2379,"precertRequired":false,"billingCode":"33863","codeType":"CPT"},{"id":2380,"precertRequired":false,"billingCode":"33864","codeType":"CPT"},{"id":2381,"precertRequired":true,"billingCode":"33870","codeType":"CPT"},{"id":2382,"precertRequired":false,"billingCode":"33875","codeType":"CPT"},{"id":2383,"precertRequired":false,"billingCode":"33877","codeType":"CPT"},{"id":2402,"precertRequired":true,"billingCode":"33967","codeType":"CPT"},{"id":2422,"precertRequired":false,"billingCode":"34701","codeType":"CPT"},{"id":2423,"precertRequired":false,"billingCode":"34702","codeType":"CPT"},{"id":2424,"precertRequired":false,"billingCode":"34703","codeType":"CPT"},{"id":2425,"precertRequired":false,"billingCode":"34704","codeType":"CPT"},{"id":2426,"precertRequired":false,"billingCode":"34705","codeType":"CPT"},{"id":2427,"precertRequired":false,"billingCode":"34706","codeType":"CPT"},{"id":2428,"precertRequired":false,"billingCode":"34707","codeType":"CPT"},{"id":2429,"precertRequired":false,"billingCode":"34708","codeType":"CPT"},{"id":2430,"precertRequired":false,"billingCode":"34709","codeType":"CPT"},{"id":2432,"precertRequired":false,"billingCode":"34800","codeType":"CPT"},{"id":2433,"precertRequired":false,"billingCode":"35180","codeType":"CPT"},{"id":2434,"precertRequired":false,"billingCode":"35182","codeType":"CPT"},{"id":2435,"precertRequired":false,"billingCode":"35184","codeType":"CPT"},{"id":2436,"precertRequired":false,"billingCode":"35188","codeType":"CPT"},{"id":2437,"precertRequired":false,"billingCode":"35189","codeType":"CPT"},{"id":2438,"precertRequired":false,"billingCode":"35190","codeType":"CPT"},{"id":2445,"precertRequired":false,"billingCode":"35500","codeType":"CPT"},{"id":2446,"precertRequired":false,"billingCode":"35501","codeType":"CPT"},{"id":2447,"precertRequired":false,"billingCode":"35506","codeType":"CPT"},{"id":2448,"precertRequired":false,"billingCode":"35508","codeType":"CPT"},{"id":2449,"precertRequired":false,"billingCode":"35509","codeType":"CPT"},{"id":2450,"precertRequired":false,"billingCode":"35510","codeType":"CPT"},{"id":2451,"precertRequired":false,"billingCode":"35511","codeType":"CPT"},{"id":2452,"precertRequired":false,"billingCode":"35512","codeType":"CPT"},{"id":2453,"precertRequired":false,"billingCode":"35515","codeType":"CPT"},{"id":2454,"precertRequired":false,"billingCode":"35516","codeType":"CPT"},{"id":2455,"precertRequired":false,"billingCode":"35518","codeType":"CPT"},{"id":2456,"precertRequired":false,"billingCode":"35521","codeType":"CPT"},{"id":2457,"precertRequired":false,"billingCode":"35522","codeType":"CPT"},{"id":2458,"precertRequired":false,"billingCode":"35523","codeType":"CPT"},{"id":2459,"precertRequired":false,"billingCode":"35525","codeType":"CPT"},{"id":2461,"precertRequired":false,"billingCode":"35531","codeType":"CPT"},{"id":2462,"precertRequired":false,"billingCode":"35533","codeType":"CPT"},{"id":2463,"precertRequired":false,"billingCode":"35535","codeType":"CPT"},{"id":2464,"precertRequired":false,"billingCode":"35536","codeType":"CPT"},{"id":2465,"precertRequired":false,"billingCode":"35537","codeType":"CPT"},{"id":2466,"precertRequired":false,"billingCode":"35538","codeType":"CPT"},{"id":2467,"precertRequired":false,"billingCode":"35539","codeType":"CPT"},{"id":2468,"precertRequired":false,"billingCode":"35540","codeType":"CPT"},{"id":2469,"precertRequired":false,"billingCode":"35556","codeType":"CPT"},{"id":2470,"precertRequired":false,"billingCode":"35558","codeType":"CPT"},{"id":2471,"precertRequired":false,"billingCode":"35560","codeType":"CPT"},{"id":2472,"precertRequired":false,"billingCode":"35563","codeType":"CPT"},{"id":2473,"precertRequired":false,"billingCode":"35565","codeType":"CPT"},{"id":2474,"precertRequired":false,"billingCode":"35566","codeType":"CPT"},{"id":2475,"precertRequired":false,"billingCode":"35570","codeType":"CPT"},{"id":2476,"precertRequired":false,"billingCode":"35571","codeType":"CPT"},{"id":2477,"precertRequired":false,"billingCode":"35572","codeType":"CPT"},{"id":2478,"precertRequired":false,"billingCode":"35583","codeType":"CPT"},{"id":2479,"precertRequired":false,"billingCode":"35585","codeType":"CPT"},{"id":2480,"precertRequired":false,"billingCode":"35587","codeType":"CPT"},{"id":2481,"precertRequired":false,"billingCode":"35600","codeType":"CPT"},{"id":2482,"precertRequired":false,"billingCode":"35601","codeType":"CPT"},{"id":2483,"precertRequired":false,"billingCode":"35606","codeType":"CPT"},{"id":2484,"precertRequired":false,"billingCode":"35612","codeType":"CPT"},{"id":2485,"precertRequired":false,"billingCode":"35616","codeType":"CPT"},{"id":2486,"precertRequired":false,"billingCode":"35621","codeType":"CPT"},{"id":2487,"precertRequired":false,"billingCode":"35623","codeType":"CPT"},{"id":2488,"precertRequired":false,"billingCode":"35626","codeType":"CPT"},{"id":2489,"precertRequired":false,"billingCode":"35631","codeType":"CPT"},{"id":2490,"precertRequired":false,"billingCode":"35632","codeType":"CPT"},{"id":2491,"precertRequired":false,"billingCode":"35633","codeType":"CPT"},{"id":2492,"precertRequired":false,"billingCode":"35634","codeType":"CPT"},{"id":2493,"precertRequired":false,"billingCode":"35636","codeType":"CPT"},{"id":2494,"precertRequired":false,"billingCode":"35637","codeType":"CPT"},{"id":2495,"precertRequired":false,"billingCode":"35638","codeType":"CPT"},{"id":2496,"precertRequired":false,"billingCode":"35642","codeType":"CPT"},{"id":2497,"precertRequired":false,"billingCode":"35645","codeType":"CPT"},{"id":2498,"precertRequired":false,"billingCode":"35646","codeType":"CPT"},{"id":2499,"precertRequired":false,"billingCode":"35647","codeType":"CPT"},{"id":2500,"precertRequired":false,"billingCode":"35650","codeType":"CPT"},{"id":2501,"precertRequired":true,"billingCode":"35654","codeType":"CPT"},{"id":2502,"precertRequired":true,"billingCode":"35656","codeType":"CPT"},{"id":2503,"precertRequired":false,"billingCode":"35661","codeType":"CPT"},{"id":2504,"precertRequired":false,"billingCode":"35663","codeType":"CPT"},{"id":2505,"precertRequired":false,"billingCode":"35665","codeType":"CPT"},{"id":2506,"precertRequired":false,"billingCode":"35666","codeType":"CPT"},{"id":2507,"precertRequired":false,"billingCode":"35671","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2510,"precertRequired":false,"billingCode":"36002","codeType":"CPT"},{"id":2511,"precertRequired":false,"billingCode":"36005","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":2513,"precertRequired":false,"billingCode":"36011","codeType":"CPT"},{"id":2514,"precertRequired":false,"billingCode":"36012","codeType":"CPT"},{"id":2515,"precertRequired":false,"billingCode":"36100","codeType":"CPT"},{"id":2516,"precertRequired":false,"billingCode":"36120","codeType":"CPT"},{"id":2517,"precertRequired":false,"billingCode":"36140","codeType":"CPT"},{"id":2519,"precertRequired":false,"billingCode":"36200","codeType":"CPT"},{"id":2520,"precertRequired":false,"billingCode":"36215","codeType":"CPT"},{"id":2521,"precertRequired":false,"billingCode":"36216","codeType":"CPT"},{"id":2522,"precertRequired":false,"billingCode":"36217","codeType":"CPT"},{"id":2523,"precertRequired":false,"billingCode":"36218","codeType":"CPT"},{"id":2524,"precertRequired":false,"billingCode":"36221","codeType":"CPT"},{"id":2525,"precertRequired":false,"billingCode":"36222","codeType":"CPT"},{"id":2526,"precertRequired":false,"billingCode":"36223","codeType":"CPT"},{"id":2527,"precertRequired":false,"billingCode":"36224","codeType":"CPT"},{"id":2528,"precertRequired":false,"billingCode":"36225","codeType":"CPT"},{"id":2529,"precertRequired":false,"billingCode":"36226","codeType":"CPT"},{"id":2530,"precertRequired":false,"billingCode":"36227","codeType":"CPT"},{"id":2531,"precertRequired":false,"billingCode":"36228","codeType":"CPT"},{"id":2532,"precertRequired":false,"billingCode":"36245","codeType":"CPT"},{"id":2533,"precertRequired":false,"billingCode":"36246","codeType":"CPT"},{"id":2534,"precertRequired":false,"billingCode":"36247","codeType":"CPT"},{"id":2535,"precertRequired":false,"billingCode":"36248","codeType":"CPT"},{"id":2536,"precertRequired":false,"billingCode":"36251","codeType":"CPT"},{"id":2537,"precertRequired":false,"billingCode":"36252","codeType":"CPT"},{"id":2538,"precertRequired":false,"billingCode":"36253","codeType":"CPT"},{"id":2539,"precertRequired":false,"billingCode":"36254","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":2552,"precertRequired":false,"billingCode":"36481","codeType":"CPT"},{"id":2613,"precertRequired":true,"billingCode":"36901","codeType":"CPT"},{"id":2614,"precertRequired":true,"billingCode":"36902","codeType":"CPT"},{"id":2615,"precertRequired":true,"billingCode":"36903","codeType":"CPT"},{"id":2624,"precertRequired":false,"billingCode":"37184","codeType":"CPT"},{"id":2625,"precertRequired":false,"billingCode":"37185","codeType":"CPT"},{"id":2626,"precertRequired":false,"billingCode":"37186","codeType":"CPT"},{"id":2627,"precertRequired":false,"billingCode":"37187","codeType":"CPT"},{"id":2628,"precertRequired":false,"billingCode":"37188","codeType":"CPT"},{"id":2629,"precertRequired":false,"billingCode":"37191","codeType":"CPT"},{"id":2630,"precertRequired":false,"billingCode":"37192","codeType":"CPT"},{"id":2631,"precertRequired":false,"billingCode":"37193","codeType":"CPT"},{"id":2632,"precertRequired":false,"billingCode":"37197","codeType":"CPT"},{"id":2634,"precertRequired":false,"billingCode":"37211","codeType":"CPT"},{"id":2635,"precertRequired":false,"billingCode":"37212","codeType":"CPT"},{"id":2636,"precertRequired":false,"billingCode":"37213","codeType":"CPT"},{"id":2637,"precertRequired":false,"billingCode":"37214","codeType":"CPT"},{"id":2638,"precertRequired":false,"billingCode":"37215","codeType":"CPT"},{"id":2639,"precertRequired":false,"billingCode":"37216","codeType":"CPT"},{"id":2642,"precertRequired":false,"billingCode":"37220","codeType":"CPT"},{"id":2643,"precertRequired":false,"billingCode":"37221","codeType":"CPT"},{"id":2644,"precertRequired":false,"billingCode":"37222","codeType":"CPT"},{"id":2645,"precertRequired":false,"billingCode":"37223","codeType":"CPT"},{"id":2646,"precertRequired":false,"billingCode":"37224","codeType":"CPT"},{"id":2647,"precertRequired":false,"billingCode":"37225","codeType":"CPT"},{"id":2648,"precertRequired":false,"billingCode":"37226","codeType":"CPT"},{"id":2649,"precertRequired":false,"billingCode":"37227","codeType":"CPT"},{"id":2650,"precertRequired":false,"billingCode":"37228","codeType":"CPT"},{"id":2651,"precertRequired":false,"billingCode":"37229","codeType":"CPT"},{"id":2652,"precertRequired":false,"billingCode":"37230","codeType":"CPT"},{"id":2653,"precertRequired":false,"billingCode":"37231","codeType":"CPT"},{"id":2654,"precertRequired":false,"billingCode":"37232","codeType":"CPT"},{"id":2655,"precertRequired":false,"billingCode":"37233","codeType":"CPT"},{"id":2656,"precertRequired":false,"billingCode":"37234","codeType":"CPT"},{"id":2657,"precertRequired":false,"billingCode":"37235","codeType":"CPT"},{"id":2658,"precertRequired":false,"billingCode":"37236","codeType":"CPT"},{"id":2659,"precertRequired":false,"billingCode":"37237","codeType":"CPT"},{"id":2660,"precertRequired":false,"billingCode":"37238","codeType":"CPT"},{"id":2661,"precertRequired":false,"billingCode":"37239","codeType":"CPT"},{"id":2666,"precertRequired":false,"billingCode":"37246","codeType":"CPT"},{"id":2667,"precertRequired":false,"billingCode":"37247","codeType":"CPT"},{"id":2668,"precertRequired":false,"billingCode":"37248","codeType":"CPT"},{"id":2669,"precertRequired":false,"billingCode":"37249","codeType":"CPT"},{"id":2670,"precertRequired":false,"billingCode":"37252","codeType":"CPT"},{"id":2671,"precertRequired":false,"billingCode":"37253","codeType":"CPT"},{"id":2672,"precertRequired":false,"billingCode":"37619","codeType":"CPT"},{"id":2673,"precertRequired":false,"billingCode":"37718","codeType":"CPT"},{"id":4684,"precertRequired":false,"billingCode":"75952","codeType":"CPT"},{"id":4685,"precertRequired":false,"billingCode":"75956","codeType":"CPT"},{"id":4687,"precertRequired":false,"billingCode":"75958","codeType":"CPT"},{"id":4688,"precertRequired":false,"billingCode":"75959","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4761,"precertRequired":false,"billingCode":"76930","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4933,"precertRequired":false,"billingCode":"78451","codeType":"CPT"},{"id":4934,"precertRequired":false,"billingCode":"78452","codeType":"CPT"},{"id":4935,"precertRequired":false,"billingCode":"78453","codeType":"CPT"},{"id":4940,"precertRequired":false,"billingCode":"78459","codeType":"CPT"},{"id":4941,"precertRequired":false,"billingCode":"78466","codeType":"CPT"},{"id":4943,"precertRequired":false,"billingCode":"78469","codeType":"CPT"},{"id":4944,"precertRequired":false,"billingCode":"78472","codeType":"CPT"},{"id":4945,"precertRequired":false,"billingCode":"78473","codeType":"CPT"},{"id":4946,"precertRequired":false,"billingCode":"78481","codeType":"CPT"},{"id":4947,"precertRequired":false,"billingCode":"78483","codeType":"CPT"},{"id":4948,"precertRequired":false,"billingCode":"78491","codeType":"CPT"},{"id":4949,"precertRequired":false,"billingCode":"78492","codeType":"CPT"},{"id":4951,"precertRequired":false,"billingCode":"78496","codeType":"CPT"},{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6803,"precertRequired":false,"billingCode":"92953","codeType":"CPT"},{"id":6804,"precertRequired":false,"billingCode":"92960","codeType":"CPT"},{"id":6805,"precertRequired":false,"billingCode":"92961","codeType":"CPT"},{"id":6806,"precertRequired":false,"billingCode":"92970","codeType":"CPT"},{"id":6807,"precertRequired":false,"billingCode":"92971","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6814,"precertRequired":false,"billingCode":"92986","codeType":"CPT"},{"id":6815,"precertRequired":false,"billingCode":"92987","codeType":"CPT"},{"id":6816,"precertRequired":false,"billingCode":"92990","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6819,"precertRequired":false,"billingCode":"92997","codeType":"CPT"},{"id":6820,"precertRequired":false,"billingCode":"92998","codeType":"CPT"},{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6828,"precertRequired":false,"billingCode":"93024","codeType":"CPT"},{"id":6829,"precertRequired":false,"billingCode":"93025","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":6834,"precertRequired":false,"billingCode":"93224","codeType":"CPT"},{"id":6835,"precertRequired":false,"billingCode":"93225","codeType":"CPT"},{"id":6836,"precertRequired":false,"billingCode":"93226","codeType":"CPT"},{"id":6837,"precertRequired":false,"billingCode":"93227","codeType":"CPT"},{"id":6838,"precertRequired":false,"billingCode":"93228","codeType":"CPT"},{"id":6839,"precertRequired":false,"billingCode":"93229","codeType":"CPT"},{"id":6840,"precertRequired":false,"billingCode":"93260","codeType":"CPT"},{"id":6841,"precertRequired":false,"billingCode":"93261","codeType":"CPT"},{"id":6842,"precertRequired":false,"billingCode":"93268","codeType":"CPT"},{"id":6843,"precertRequired":false,"billingCode":"93270","codeType":"CPT"},{"id":6844,"precertRequired":false,"billingCode":"93271","codeType":"CPT"},{"id":6845,"precertRequired":false,"billingCode":"93272","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6847,"precertRequired":false,"billingCode":"93279","codeType":"CPT"},{"id":6848,"precertRequired":false,"billingCode":"93280","codeType":"CPT"},{"id":6849,"precertRequired":false,"billingCode":"93281","codeType":"CPT"},{"id":6850,"precertRequired":false,"billingCode":"93282","codeType":"CPT"},{"id":6851,"precertRequired":false,"billingCode":"93283","codeType":"CPT"},{"id":6852,"precertRequired":false,"billingCode":"93284","codeType":"CPT"},{"id":6853,"precertRequired":false,"billingCode":"93285","codeType":"CPT"},{"id":6854,"precertRequired":false,"billingCode":"93286","codeType":"CPT"},{"id":6855,"precertRequired":false,"billingCode":"93287","codeType":"CPT"},{"id":6856,"precertRequired":false,"billingCode":"93288","codeType":"CPT"},{"id":6857,"precertRequired":false,"billingCode":"93289","codeType":"CPT"},{"id":6858,"precertRequired":false,"billingCode":"93290","codeType":"CPT"},{"id":6859,"precertRequired":false,"billingCode":"93291","codeType":"CPT"},{"id":6860,"precertRequired":false,"billingCode":"93292","codeType":"CPT"},{"id":6861,"precertRequired":false,"billingCode":"93293","codeType":"CPT"},{"id":6862,"precertRequired":false,"billingCode":"93294","codeType":"CPT"},{"id":6863,"precertRequired":false,"billingCode":"93295","codeType":"CPT"},{"id":6864,"precertRequired":false,"billingCode":"93296","codeType":"CPT"},{"id":6865,"precertRequired":false,"billingCode":"93297","codeType":"CPT"},{"id":6866,"precertRequired":false,"billingCode":"93298","codeType":"CPT"},{"id":6867,"precertRequired":false,"billingCode":"93299","codeType":"CPT"},{"id":6868,"precertRequired":false,"billingCode":"93303","codeType":"CPT"},{"id":6869,"precertRequired":false,"billingCode":"93304","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6880,"precertRequired":false,"billingCode":"93320","codeType":"CPT"},{"id":6881,"precertRequired":false,"billingCode":"93321","codeType":"CPT"},{"id":6882,"precertRequired":false,"billingCode":"93325","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":6918,"precertRequired":false,"billingCode":"93581","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6922,"precertRequired":true,"billingCode":"93602","codeType":"CPT"},{"id":6923,"precertRequired":true,"billingCode":"93603","codeType":"CPT"},{"id":6924,"precertRequired":true,"billingCode":"93609","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6928,"precertRequired":true,"billingCode":"93615","codeType":"CPT"},{"id":6929,"precertRequired":true,"billingCode":"93616","codeType":"CPT"},{"id":6930,"precertRequired":true,"billingCode":"93618","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6942,"precertRequired":false,"billingCode":"93650","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6945,"precertRequired":false,"billingCode":"93655","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":6948,"precertRequired":false,"billingCode":"93660","codeType":"CPT"},{"id":6949,"precertRequired":false,"billingCode":"93662","codeType":"CPT"},{"id":6950,"precertRequired":false,"billingCode":"93668","codeType":"CPT"},{"id":6951,"precertRequired":false,"billingCode":"93701","codeType":"CPT"},{"id":6952,"precertRequired":false,"billingCode":"93724","codeType":"CPT"},{"id":6953,"precertRequired":false,"billingCode":"93740","codeType":"CPT"},{"id":6954,"precertRequired":false,"billingCode":"93745","codeType":"CPT"},{"id":6955,"precertRequired":false,"billingCode":"93770","codeType":"CPT"},{"id":6956,"precertRequired":false,"billingCode":"93784","codeType":"CPT"},{"id":6957,"precertRequired":false,"billingCode":"93786","codeType":"CPT"},{"id":6958,"precertRequired":false,"billingCode":"93788","codeType":"CPT"},{"id":6959,"precertRequired":false,"billingCode":"93790","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7945,"precertRequired":false,"billingCode":"C1760","codeType":"HCPCS"},{"id":7951,"precertRequired":false,"billingCode":"C1874","codeType":"HCPCS"},{"id":7952,"precertRequired":false,"billingCode":"C1875","codeType":"HCPCS"},{"id":7953,"precertRequired":false,"billingCode":"C1876","codeType":"HCPCS"},{"id":7954,"precertRequired":false,"billingCode":"C1877","codeType":"HCPCS"},{"id":7986,"precertRequired":false,"billingCode":"C8928","codeType":"HCPCS"},{"id":7988,"precertRequired":false,"billingCode":"C8930","codeType":"HCPCS"},{"id":8169,"precertRequired":false,"billingCode":"G0269","codeType":"HCPCS"},{"id":8218,"precertRequired":false,"billingCode":"G0446","codeType":"HCPCS"},{"id":8477,"precertRequired":false,"billingCode":"J2502","codeType":"HCPCS"},{"id":8532,"precertRequired":false,"billingCode":"J7188","codeType":"HCPCS"},{"id":8533,"precertRequired":false,"billingCode":"J7205","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":1379,"description":"Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":1380,"description":" Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":1381,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":8210,"precertRequired":false,"billingCode":"G0424","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":199,"seocKey":23,"name":"Cardiology Comprehensive_PRCT","seocId":"MSC_CARDIOLOGY COMPREHENSIVE_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"01-02-2019","endDate":"02-19-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. Labs and pathology relevant to the referred condition on the consult **\r\n5. One cardiac catheterization with PCI interventions and overnight observation if required\r\n6. Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n7. Anesthesia consultation related to the procedure\r\n8. Procedures to include A-fib ablations, implantation of cardiac devices and emergent or urgent surgical interventions such as: cardiac bypass, TAVR, LVAD, angioplasty\r\n9. Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran\r\n10. Follow-up visits for this episode of care\r\n11. Cardiac rehabilitation, up to 36 visits, no more than 3x per week","maxAllowableVisits":null,"disclaimer":"* If non-emergent bypass grafting is required an additional VA authorization must be acquired.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n** Visits for additional services are not included in the frequency total.\r\nThe number of visits authorized for ancillary services are noted within its service line description above.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY IMAGING","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RC0000X"},{"hptc":"207RC0001X"},{"hptc":"207RI0011X"}],"services":[{"id":765,"description":"Initial outpatient evaluation and treatment for the referred condition ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":766,"description":"Diagnostic imaging relevant to the referred condition on the consult ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4644,"precertRequired":false,"billingCode":"75658","codeType":"CPT"},{"id":4645,"precertRequired":false,"billingCode":"75705","codeType":"CPT"},{"id":4646,"precertRequired":false,"billingCode":"75710","codeType":"CPT"},{"id":4647,"precertRequired":false,"billingCode":"75716","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4686,"precertRequired":false,"billingCode":"75957","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":767,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6965,"precertRequired":false,"billingCode":"93880","codeType":"CPT"},{"id":6972,"precertRequired":false,"billingCode":"93895","codeType":"CPT"},{"id":6976,"precertRequired":false,"billingCode":"93925","codeType":"CPT"},{"id":6977,"precertRequired":false,"billingCode":"93926","codeType":"CPT"},{"id":6980,"precertRequired":false,"billingCode":"93970","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":768,"description":"Labs and pathology relevant to the referred condition on the consult **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5591,"precertRequired":false,"billingCode":"83658","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":769,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6902,"precertRequired":false,"billingCode":"93505","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6904,"precertRequired":false,"billingCode":"93531","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":770,"description":"Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5591,"precertRequired":false,"billingCode":"83658","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":771,"description":" Anesthesia consultation related to the procedure ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":66,"precertRequired":false,"billingCode":"00566","codeType":"CPT"},{"id":67,"precertRequired":false,"billingCode":"00567","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":772,"description":"Procedures to include A-fib ablations, implantation of cardiac devices and emergent or urgent surgical interventions such as: cardiac bypass, TAVR, LVAD, angioplasty. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2170,"precertRequired":true,"billingCode":"33010","codeType":"CPT"},{"id":2171,"precertRequired":true,"billingCode":"33011","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2198,"precertRequired":true,"billingCode":"33224","codeType":"CPT"},{"id":2199,"precertRequired":true,"billingCode":"33225","codeType":"CPT"},{"id":2200,"precertRequired":false,"billingCode":"33226","codeType":"CPT"},{"id":2201,"precertRequired":false,"billingCode":"33227","codeType":"CPT"},{"id":2202,"precertRequired":false,"billingCode":"33228","codeType":"CPT"},{"id":2203,"precertRequired":false,"billingCode":"33229","codeType":"CPT"},{"id":2204,"precertRequired":false,"billingCode":"33230","codeType":"CPT"},{"id":2205,"precertRequired":false,"billingCode":"33231","codeType":"CPT"},{"id":2206,"precertRequired":false,"billingCode":"33233","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2233,"precertRequired":false,"billingCode":"33282","codeType":"CPT"},{"id":2234,"precertRequired":false,"billingCode":"33284","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2253,"precertRequired":false,"billingCode":"33390","codeType":"CPT"},{"id":2254,"precertRequired":false,"billingCode":"33391","codeType":"CPT"},{"id":2255,"precertRequired":false,"billingCode":"33404","codeType":"CPT"},{"id":2256,"precertRequired":true,"billingCode":"33405","codeType":"CPT"},{"id":2257,"precertRequired":true,"billingCode":"33406","codeType":"CPT"},{"id":2258,"precertRequired":true,"billingCode":"33410","codeType":"CPT"},{"id":2259,"precertRequired":true,"billingCode":"33411","codeType":"CPT"},{"id":2260,"precertRequired":true,"billingCode":"33412","codeType":"CPT"},{"id":2261,"precertRequired":false,"billingCode":"33413","codeType":"CPT"},{"id":2262,"precertRequired":true,"billingCode":"33414","codeType":"CPT"},{"id":2263,"precertRequired":false,"billingCode":"33415","codeType":"CPT"},{"id":2264,"precertRequired":false,"billingCode":"33416","codeType":"CPT"},{"id":2265,"precertRequired":false,"billingCode":"33417","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2268,"precertRequired":false,"billingCode":"33420","codeType":"CPT"},{"id":2269,"precertRequired":false,"billingCode":"33422","codeType":"CPT"},{"id":2270,"precertRequired":false,"billingCode":"33425","codeType":"CPT"},{"id":2271,"precertRequired":false,"billingCode":"33426","codeType":"CPT"},{"id":2272,"precertRequired":false,"billingCode":"33427","codeType":"CPT"},{"id":2273,"precertRequired":false,"billingCode":"33430","codeType":"CPT"},{"id":2274,"precertRequired":false,"billingCode":"33460","codeType":"CPT"},{"id":2275,"precertRequired":false,"billingCode":"33463","codeType":"CPT"},{"id":2276,"precertRequired":false,"billingCode":"33464","codeType":"CPT"},{"id":2277,"precertRequired":true,"billingCode":"33465","codeType":"CPT"},{"id":2278,"precertRequired":false,"billingCode":"33468","codeType":"CPT"},{"id":2279,"precertRequired":false,"billingCode":"33470","codeType":"CPT"},{"id":2280,"precertRequired":false,"billingCode":"33471","codeType":"CPT"},{"id":2281,"precertRequired":false,"billingCode":"33474","codeType":"CPT"},{"id":2282,"precertRequired":false,"billingCode":"33475","codeType":"CPT"},{"id":2283,"precertRequired":false,"billingCode":"33476","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2285,"precertRequired":false,"billingCode":"33478","codeType":"CPT"},{"id":2286,"precertRequired":false,"billingCode":"33496","codeType":"CPT"},{"id":2294,"precertRequired":false,"billingCode":"33510","codeType":"CPT"},{"id":2295,"precertRequired":false,"billingCode":"33511","codeType":"CPT"},{"id":2296,"precertRequired":false,"billingCode":"33512","codeType":"CPT"},{"id":2297,"precertRequired":false,"billingCode":"33513","codeType":"CPT"},{"id":2298,"precertRequired":false,"billingCode":"33514","codeType":"CPT"},{"id":2299,"precertRequired":false,"billingCode":"33516","codeType":"CPT"},{"id":2300,"precertRequired":false,"billingCode":"33517","codeType":"CPT"},{"id":2301,"precertRequired":false,"billingCode":"33518","codeType":"CPT"},{"id":2302,"precertRequired":false,"billingCode":"33519","codeType":"CPT"},{"id":2303,"precertRequired":false,"billingCode":"33521","codeType":"CPT"},{"id":2304,"precertRequired":false,"billingCode":"33522","codeType":"CPT"},{"id":2305,"precertRequired":false,"billingCode":"33523","codeType":"CPT"},{"id":2306,"precertRequired":false,"billingCode":"33530","codeType":"CPT"},{"id":2307,"precertRequired":false,"billingCode":"33533","codeType":"CPT"},{"id":2308,"precertRequired":false,"billingCode":"33534","codeType":"CPT"},{"id":2309,"precertRequired":false,"billingCode":"33535","codeType":"CPT"},{"id":2310,"precertRequired":false,"billingCode":"33536","codeType":"CPT"},{"id":2311,"precertRequired":false,"billingCode":"33542","codeType":"CPT"},{"id":2312,"precertRequired":false,"billingCode":"33545","codeType":"CPT"},{"id":2313,"precertRequired":false,"billingCode":"33548","codeType":"CPT"},{"id":2314,"precertRequired":false,"billingCode":"33572","codeType":"CPT"},{"id":2341,"precertRequired":false,"billingCode":"33735","codeType":"CPT"},{"id":2342,"precertRequired":false,"billingCode":"33736","codeType":"CPT"},{"id":2343,"precertRequired":false,"billingCode":"33737","codeType":"CPT"},{"id":2344,"precertRequired":false,"billingCode":"33750","codeType":"CPT"},{"id":2345,"precertRequired":false,"billingCode":"33755","codeType":"CPT"},{"id":2346,"precertRequired":false,"billingCode":"33762","codeType":"CPT"},{"id":2347,"precertRequired":false,"billingCode":"33764","codeType":"CPT"},{"id":2348,"precertRequired":false,"billingCode":"33766","codeType":"CPT"},{"id":2349,"precertRequired":false,"billingCode":"33767","codeType":"CPT"},{"id":2350,"precertRequired":false,"billingCode":"33768","codeType":"CPT"},{"id":2378,"precertRequired":false,"billingCode":"33860","codeType":"CPT"},{"id":2379,"precertRequired":false,"billingCode":"33863","codeType":"CPT"},{"id":2380,"precertRequired":false,"billingCode":"33864","codeType":"CPT"},{"id":2381,"precertRequired":true,"billingCode":"33870","codeType":"CPT"},{"id":2382,"precertRequired":false,"billingCode":"33875","codeType":"CPT"},{"id":2383,"precertRequired":false,"billingCode":"33877","codeType":"CPT"},{"id":2402,"precertRequired":true,"billingCode":"33967","codeType":"CPT"},{"id":2422,"precertRequired":false,"billingCode":"34701","codeType":"CPT"},{"id":2423,"precertRequired":false,"billingCode":"34702","codeType":"CPT"},{"id":2424,"precertRequired":false,"billingCode":"34703","codeType":"CPT"},{"id":2425,"precertRequired":false,"billingCode":"34704","codeType":"CPT"},{"id":2426,"precertRequired":false,"billingCode":"34705","codeType":"CPT"},{"id":2427,"precertRequired":false,"billingCode":"34706","codeType":"CPT"},{"id":2428,"precertRequired":false,"billingCode":"34707","codeType":"CPT"},{"id":2429,"precertRequired":false,"billingCode":"34708","codeType":"CPT"},{"id":2430,"precertRequired":false,"billingCode":"34709","codeType":"CPT"},{"id":2432,"precertRequired":false,"billingCode":"34800","codeType":"CPT"},{"id":2433,"precertRequired":false,"billingCode":"35180","codeType":"CPT"},{"id":2434,"precertRequired":false,"billingCode":"35182","codeType":"CPT"},{"id":2435,"precertRequired":false,"billingCode":"35184","codeType":"CPT"},{"id":2436,"precertRequired":false,"billingCode":"35188","codeType":"CPT"},{"id":2437,"precertRequired":false,"billingCode":"35189","codeType":"CPT"},{"id":2438,"precertRequired":false,"billingCode":"35190","codeType":"CPT"},{"id":2445,"precertRequired":false,"billingCode":"35500","codeType":"CPT"},{"id":2446,"precertRequired":false,"billingCode":"35501","codeType":"CPT"},{"id":2447,"precertRequired":false,"billingCode":"35506","codeType":"CPT"},{"id":2448,"precertRequired":false,"billingCode":"35508","codeType":"CPT"},{"id":2449,"precertRequired":false,"billingCode":"35509","codeType":"CPT"},{"id":2450,"precertRequired":false,"billingCode":"35510","codeType":"CPT"},{"id":2451,"precertRequired":false,"billingCode":"35511","codeType":"CPT"},{"id":2452,"precertRequired":false,"billingCode":"35512","codeType":"CPT"},{"id":2453,"precertRequired":false,"billingCode":"35515","codeType":"CPT"},{"id":2454,"precertRequired":false,"billingCode":"35516","codeType":"CPT"},{"id":2455,"precertRequired":false,"billingCode":"35518","codeType":"CPT"},{"id":2456,"precertRequired":false,"billingCode":"35521","codeType":"CPT"},{"id":2457,"precertRequired":false,"billingCode":"35522","codeType":"CPT"},{"id":2458,"precertRequired":false,"billingCode":"35523","codeType":"CPT"},{"id":2459,"precertRequired":false,"billingCode":"35525","codeType":"CPT"},{"id":2461,"precertRequired":false,"billingCode":"35531","codeType":"CPT"},{"id":2462,"precertRequired":false,"billingCode":"35533","codeType":"CPT"},{"id":2463,"precertRequired":false,"billingCode":"35535","codeType":"CPT"},{"id":2464,"precertRequired":false,"billingCode":"35536","codeType":"CPT"},{"id":2465,"precertRequired":false,"billingCode":"35537","codeType":"CPT"},{"id":2466,"precertRequired":false,"billingCode":"35538","codeType":"CPT"},{"id":2467,"precertRequired":false,"billingCode":"35539","codeType":"CPT"},{"id":2468,"precertRequired":false,"billingCode":"35540","codeType":"CPT"},{"id":2469,"precertRequired":false,"billingCode":"35556","codeType":"CPT"},{"id":2470,"precertRequired":false,"billingCode":"35558","codeType":"CPT"},{"id":2471,"precertRequired":false,"billingCode":"35560","codeType":"CPT"},{"id":2472,"precertRequired":false,"billingCode":"35563","codeType":"CPT"},{"id":2473,"precertRequired":false,"billingCode":"35565","codeType":"CPT"},{"id":2474,"precertRequired":false,"billingCode":"35566","codeType":"CPT"},{"id":2475,"precertRequired":false,"billingCode":"35570","codeType":"CPT"},{"id":2476,"precertRequired":false,"billingCode":"35571","codeType":"CPT"},{"id":2477,"precertRequired":false,"billingCode":"35572","codeType":"CPT"},{"id":2478,"precertRequired":false,"billingCode":"35583","codeType":"CPT"},{"id":2479,"precertRequired":false,"billingCode":"35585","codeType":"CPT"},{"id":2480,"precertRequired":false,"billingCode":"35587","codeType":"CPT"},{"id":2481,"precertRequired":false,"billingCode":"35600","codeType":"CPT"},{"id":2482,"precertRequired":false,"billingCode":"35601","codeType":"CPT"},{"id":2483,"precertRequired":false,"billingCode":"35606","codeType":"CPT"},{"id":2484,"precertRequired":false,"billingCode":"35612","codeType":"CPT"},{"id":2485,"precertRequired":false,"billingCode":"35616","codeType":"CPT"},{"id":2486,"precertRequired":false,"billingCode":"35621","codeType":"CPT"},{"id":2487,"precertRequired":false,"billingCode":"35623","codeType":"CPT"},{"id":2488,"precertRequired":false,"billingCode":"35626","codeType":"CPT"},{"id":2489,"precertRequired":false,"billingCode":"35631","codeType":"CPT"},{"id":2490,"precertRequired":false,"billingCode":"35632","codeType":"CPT"},{"id":2491,"precertRequired":false,"billingCode":"35633","codeType":"CPT"},{"id":2492,"precertRequired":false,"billingCode":"35634","codeType":"CPT"},{"id":2493,"precertRequired":false,"billingCode":"35636","codeType":"CPT"},{"id":2494,"precertRequired":false,"billingCode":"35637","codeType":"CPT"},{"id":2495,"precertRequired":false,"billingCode":"35638","codeType":"CPT"},{"id":2496,"precertRequired":false,"billingCode":"35642","codeType":"CPT"},{"id":2497,"precertRequired":false,"billingCode":"35645","codeType":"CPT"},{"id":2498,"precertRequired":false,"billingCode":"35646","codeType":"CPT"},{"id":2499,"precertRequired":false,"billingCode":"35647","codeType":"CPT"},{"id":2500,"precertRequired":false,"billingCode":"35650","codeType":"CPT"},{"id":2501,"precertRequired":true,"billingCode":"35654","codeType":"CPT"},{"id":2502,"precertRequired":true,"billingCode":"35656","codeType":"CPT"},{"id":2503,"precertRequired":false,"billingCode":"35661","codeType":"CPT"},{"id":2504,"precertRequired":false,"billingCode":"35663","codeType":"CPT"},{"id":2505,"precertRequired":false,"billingCode":"35665","codeType":"CPT"},{"id":2506,"precertRequired":false,"billingCode":"35666","codeType":"CPT"},{"id":2507,"precertRequired":false,"billingCode":"35671","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2510,"precertRequired":false,"billingCode":"36002","codeType":"CPT"},{"id":2511,"precertRequired":false,"billingCode":"36005","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":2513,"precertRequired":false,"billingCode":"36011","codeType":"CPT"},{"id":2514,"precertRequired":false,"billingCode":"36012","codeType":"CPT"},{"id":2515,"precertRequired":false,"billingCode":"36100","codeType":"CPT"},{"id":2516,"precertRequired":false,"billingCode":"36120","codeType":"CPT"},{"id":2517,"precertRequired":false,"billingCode":"36140","codeType":"CPT"},{"id":2519,"precertRequired":false,"billingCode":"36200","codeType":"CPT"},{"id":2520,"precertRequired":false,"billingCode":"36215","codeType":"CPT"},{"id":2521,"precertRequired":false,"billingCode":"36216","codeType":"CPT"},{"id":2522,"precertRequired":false,"billingCode":"36217","codeType":"CPT"},{"id":2523,"precertRequired":false,"billingCode":"36218","codeType":"CPT"},{"id":2524,"precertRequired":false,"billingCode":"36221","codeType":"CPT"},{"id":2525,"precertRequired":false,"billingCode":"36222","codeType":"CPT"},{"id":2526,"precertRequired":false,"billingCode":"36223","codeType":"CPT"},{"id":2527,"precertRequired":false,"billingCode":"36224","codeType":"CPT"},{"id":2528,"precertRequired":false,"billingCode":"36225","codeType":"CPT"},{"id":2529,"precertRequired":false,"billingCode":"36226","codeType":"CPT"},{"id":2530,"precertRequired":false,"billingCode":"36227","codeType":"CPT"},{"id":2531,"precertRequired":false,"billingCode":"36228","codeType":"CPT"},{"id":2532,"precertRequired":false,"billingCode":"36245","codeType":"CPT"},{"id":2533,"precertRequired":false,"billingCode":"36246","codeType":"CPT"},{"id":2534,"precertRequired":false,"billingCode":"36247","codeType":"CPT"},{"id":2535,"precertRequired":false,"billingCode":"36248","codeType":"CPT"},{"id":2536,"precertRequired":false,"billingCode":"36251","codeType":"CPT"},{"id":2537,"precertRequired":false,"billingCode":"36252","codeType":"CPT"},{"id":2538,"precertRequired":false,"billingCode":"36253","codeType":"CPT"},{"id":2539,"precertRequired":false,"billingCode":"36254","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":2552,"precertRequired":false,"billingCode":"36481","codeType":"CPT"},{"id":2613,"precertRequired":true,"billingCode":"36901","codeType":"CPT"},{"id":2614,"precertRequired":true,"billingCode":"36902","codeType":"CPT"},{"id":2615,"precertRequired":true,"billingCode":"36903","codeType":"CPT"},{"id":2624,"precertRequired":false,"billingCode":"37184","codeType":"CPT"},{"id":2625,"precertRequired":false,"billingCode":"37185","codeType":"CPT"},{"id":2626,"precertRequired":false,"billingCode":"37186","codeType":"CPT"},{"id":2627,"precertRequired":false,"billingCode":"37187","codeType":"CPT"},{"id":2628,"precertRequired":false,"billingCode":"37188","codeType":"CPT"},{"id":2629,"precertRequired":false,"billingCode":"37191","codeType":"CPT"},{"id":2630,"precertRequired":false,"billingCode":"37192","codeType":"CPT"},{"id":2631,"precertRequired":false,"billingCode":"37193","codeType":"CPT"},{"id":2632,"precertRequired":false,"billingCode":"37197","codeType":"CPT"},{"id":2634,"precertRequired":false,"billingCode":"37211","codeType":"CPT"},{"id":2635,"precertRequired":false,"billingCode":"37212","codeType":"CPT"},{"id":2636,"precertRequired":false,"billingCode":"37213","codeType":"CPT"},{"id":2637,"precertRequired":false,"billingCode":"37214","codeType":"CPT"},{"id":2638,"precertRequired":false,"billingCode":"37215","codeType":"CPT"},{"id":2639,"precertRequired":false,"billingCode":"37216","codeType":"CPT"},{"id":2642,"precertRequired":false,"billingCode":"37220","codeType":"CPT"},{"id":2643,"precertRequired":false,"billingCode":"37221","codeType":"CPT"},{"id":2644,"precertRequired":false,"billingCode":"37222","codeType":"CPT"},{"id":2645,"precertRequired":false,"billingCode":"37223","codeType":"CPT"},{"id":2646,"precertRequired":false,"billingCode":"37224","codeType":"CPT"},{"id":2647,"precertRequired":false,"billingCode":"37225","codeType":"CPT"},{"id":2648,"precertRequired":false,"billingCode":"37226","codeType":"CPT"},{"id":2649,"precertRequired":false,"billingCode":"37227","codeType":"CPT"},{"id":2650,"precertRequired":false,"billingCode":"37228","codeType":"CPT"},{"id":2651,"precertRequired":false,"billingCode":"37229","codeType":"CPT"},{"id":2652,"precertRequired":false,"billingCode":"37230","codeType":"CPT"},{"id":2653,"precertRequired":false,"billingCode":"37231","codeType":"CPT"},{"id":2654,"precertRequired":false,"billingCode":"37232","codeType":"CPT"},{"id":2655,"precertRequired":false,"billingCode":"37233","codeType":"CPT"},{"id":2656,"precertRequired":false,"billingCode":"37234","codeType":"CPT"},{"id":2657,"precertRequired":false,"billingCode":"37235","codeType":"CPT"},{"id":2658,"precertRequired":false,"billingCode":"37236","codeType":"CPT"},{"id":2659,"precertRequired":false,"billingCode":"37237","codeType":"CPT"},{"id":2660,"precertRequired":false,"billingCode":"37238","codeType":"CPT"},{"id":2661,"precertRequired":false,"billingCode":"37239","codeType":"CPT"},{"id":2666,"precertRequired":false,"billingCode":"37246","codeType":"CPT"},{"id":2667,"precertRequired":false,"billingCode":"37247","codeType":"CPT"},{"id":2668,"precertRequired":false,"billingCode":"37248","codeType":"CPT"},{"id":2669,"precertRequired":false,"billingCode":"37249","codeType":"CPT"},{"id":2670,"precertRequired":false,"billingCode":"37252","codeType":"CPT"},{"id":2671,"precertRequired":false,"billingCode":"37253","codeType":"CPT"},{"id":2672,"precertRequired":false,"billingCode":"37619","codeType":"CPT"},{"id":2673,"precertRequired":false,"billingCode":"37718","codeType":"CPT"},{"id":4684,"precertRequired":false,"billingCode":"75952","codeType":"CPT"},{"id":4685,"precertRequired":false,"billingCode":"75956","codeType":"CPT"},{"id":4687,"precertRequired":false,"billingCode":"75958","codeType":"CPT"},{"id":4688,"precertRequired":false,"billingCode":"75959","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4761,"precertRequired":false,"billingCode":"76930","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4933,"precertRequired":false,"billingCode":"78451","codeType":"CPT"},{"id":4934,"precertRequired":false,"billingCode":"78452","codeType":"CPT"},{"id":4935,"precertRequired":false,"billingCode":"78453","codeType":"CPT"},{"id":4940,"precertRequired":false,"billingCode":"78459","codeType":"CPT"},{"id":4941,"precertRequired":false,"billingCode":"78466","codeType":"CPT"},{"id":4943,"precertRequired":false,"billingCode":"78469","codeType":"CPT"},{"id":4944,"precertRequired":false,"billingCode":"78472","codeType":"CPT"},{"id":4945,"precertRequired":false,"billingCode":"78473","codeType":"CPT"},{"id":4946,"precertRequired":false,"billingCode":"78481","codeType":"CPT"},{"id":4947,"precertRequired":false,"billingCode":"78483","codeType":"CPT"},{"id":4948,"precertRequired":false,"billingCode":"78491","codeType":"CPT"},{"id":4949,"precertRequired":false,"billingCode":"78492","codeType":"CPT"},{"id":4951,"precertRequired":false,"billingCode":"78496","codeType":"CPT"},{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6803,"precertRequired":false,"billingCode":"92953","codeType":"CPT"},{"id":6804,"precertRequired":false,"billingCode":"92960","codeType":"CPT"},{"id":6805,"precertRequired":false,"billingCode":"92961","codeType":"CPT"},{"id":6806,"precertRequired":false,"billingCode":"92970","codeType":"CPT"},{"id":6807,"precertRequired":false,"billingCode":"92971","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6814,"precertRequired":false,"billingCode":"92986","codeType":"CPT"},{"id":6815,"precertRequired":false,"billingCode":"92987","codeType":"CPT"},{"id":6816,"precertRequired":false,"billingCode":"92990","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6819,"precertRequired":false,"billingCode":"92997","codeType":"CPT"},{"id":6820,"precertRequired":false,"billingCode":"92998","codeType":"CPT"},{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6828,"precertRequired":false,"billingCode":"93024","codeType":"CPT"},{"id":6829,"precertRequired":false,"billingCode":"93025","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":6834,"precertRequired":false,"billingCode":"93224","codeType":"CPT"},{"id":6835,"precertRequired":false,"billingCode":"93225","codeType":"CPT"},{"id":6836,"precertRequired":false,"billingCode":"93226","codeType":"CPT"},{"id":6837,"precertRequired":false,"billingCode":"93227","codeType":"CPT"},{"id":6838,"precertRequired":false,"billingCode":"93228","codeType":"CPT"},{"id":6839,"precertRequired":false,"billingCode":"93229","codeType":"CPT"},{"id":6840,"precertRequired":false,"billingCode":"93260","codeType":"CPT"},{"id":6841,"precertRequired":false,"billingCode":"93261","codeType":"CPT"},{"id":6842,"precertRequired":false,"billingCode":"93268","codeType":"CPT"},{"id":6843,"precertRequired":false,"billingCode":"93270","codeType":"CPT"},{"id":6844,"precertRequired":false,"billingCode":"93271","codeType":"CPT"},{"id":6845,"precertRequired":false,"billingCode":"93272","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6847,"precertRequired":false,"billingCode":"93279","codeType":"CPT"},{"id":6848,"precertRequired":false,"billingCode":"93280","codeType":"CPT"},{"id":6849,"precertRequired":false,"billingCode":"93281","codeType":"CPT"},{"id":6850,"precertRequired":false,"billingCode":"93282","codeType":"CPT"},{"id":6851,"precertRequired":false,"billingCode":"93283","codeType":"CPT"},{"id":6852,"precertRequired":false,"billingCode":"93284","codeType":"CPT"},{"id":6853,"precertRequired":false,"billingCode":"93285","codeType":"CPT"},{"id":6854,"precertRequired":false,"billingCode":"93286","codeType":"CPT"},{"id":6855,"precertRequired":false,"billingCode":"93287","codeType":"CPT"},{"id":6856,"precertRequired":false,"billingCode":"93288","codeType":"CPT"},{"id":6857,"precertRequired":false,"billingCode":"93289","codeType":"CPT"},{"id":6858,"precertRequired":false,"billingCode":"93290","codeType":"CPT"},{"id":6859,"precertRequired":false,"billingCode":"93291","codeType":"CPT"},{"id":6860,"precertRequired":false,"billingCode":"93292","codeType":"CPT"},{"id":6861,"precertRequired":false,"billingCode":"93293","codeType":"CPT"},{"id":6862,"precertRequired":false,"billingCode":"93294","codeType":"CPT"},{"id":6863,"precertRequired":false,"billingCode":"93295","codeType":"CPT"},{"id":6864,"precertRequired":false,"billingCode":"93296","codeType":"CPT"},{"id":6865,"precertRequired":false,"billingCode":"93297","codeType":"CPT"},{"id":6866,"precertRequired":false,"billingCode":"93298","codeType":"CPT"},{"id":6867,"precertRequired":false,"billingCode":"93299","codeType":"CPT"},{"id":6868,"precertRequired":false,"billingCode":"93303","codeType":"CPT"},{"id":6869,"precertRequired":false,"billingCode":"93304","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6880,"precertRequired":false,"billingCode":"93320","codeType":"CPT"},{"id":6881,"precertRequired":false,"billingCode":"93321","codeType":"CPT"},{"id":6882,"precertRequired":false,"billingCode":"93325","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":6918,"precertRequired":false,"billingCode":"93581","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6922,"precertRequired":true,"billingCode":"93602","codeType":"CPT"},{"id":6923,"precertRequired":true,"billingCode":"93603","codeType":"CPT"},{"id":6924,"precertRequired":true,"billingCode":"93609","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6928,"precertRequired":true,"billingCode":"93615","codeType":"CPT"},{"id":6929,"precertRequired":true,"billingCode":"93616","codeType":"CPT"},{"id":6930,"precertRequired":true,"billingCode":"93618","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6942,"precertRequired":false,"billingCode":"93650","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6945,"precertRequired":false,"billingCode":"93655","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":6948,"precertRequired":false,"billingCode":"93660","codeType":"CPT"},{"id":6949,"precertRequired":false,"billingCode":"93662","codeType":"CPT"},{"id":6950,"precertRequired":false,"billingCode":"93668","codeType":"CPT"},{"id":6951,"precertRequired":false,"billingCode":"93701","codeType":"CPT"},{"id":6952,"precertRequired":false,"billingCode":"93724","codeType":"CPT"},{"id":6953,"precertRequired":false,"billingCode":"93740","codeType":"CPT"},{"id":6954,"precertRequired":false,"billingCode":"93745","codeType":"CPT"},{"id":6955,"precertRequired":false,"billingCode":"93770","codeType":"CPT"},{"id":6956,"precertRequired":false,"billingCode":"93784","codeType":"CPT"},{"id":6957,"precertRequired":false,"billingCode":"93786","codeType":"CPT"},{"id":6958,"precertRequired":false,"billingCode":"93788","codeType":"CPT"},{"id":6959,"precertRequired":false,"billingCode":"93790","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7945,"precertRequired":false,"billingCode":"C1760","codeType":"HCPCS"},{"id":7951,"precertRequired":false,"billingCode":"C1874","codeType":"HCPCS"},{"id":7952,"precertRequired":false,"billingCode":"C1875","codeType":"HCPCS"},{"id":7953,"precertRequired":false,"billingCode":"C1876","codeType":"HCPCS"},{"id":7954,"precertRequired":false,"billingCode":"C1877","codeType":"HCPCS"},{"id":7986,"precertRequired":false,"billingCode":"C8928","codeType":"HCPCS"},{"id":7988,"precertRequired":false,"billingCode":"C8930","codeType":"HCPCS"},{"id":8169,"precertRequired":false,"billingCode":"G0269","codeType":"HCPCS"},{"id":8218,"precertRequired":false,"billingCode":"G0446","codeType":"HCPCS"},{"id":8477,"precertRequired":false,"billingCode":"J2502","codeType":"HCPCS"},{"id":8532,"precertRequired":false,"billingCode":"J7188","codeType":"HCPCS"},{"id":8533,"precertRequired":false,"billingCode":"J7205","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":773,"description":"Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":774,"description":" Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":775,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"31-Intensive cardiac rehabilitation"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":8210,"precertRequired":false,"billingCode":"G0424","codeType":"HCPCS"}],"serviceHptcs":[]}]}},{"Seoc":{"id":106,"seocKey":23,"name":"Cardiology Comprehensive_PRCT","seocId":"MSC_CARDIOLOGY COMPREHENSIVE_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"09-21-2018","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. Labs and pathology relevant to the referred condition on the consult **\r\n5. One cardiac catheterization with PCI interventions and overnight observation if required\r\n6. Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n7. Anesthesia consultation related to the procedure\r\n8. Procedures to include A-fib ablations, implantation of cardiac devices and emergent or urgent surgical interventions such as: cardiac bypass, TAVR, LVAD, angioplasty\r\n9. Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran\r\n10. Follow-up visits for this episode of care\r\n11. Cardiac rehabilitation, up to 36 visits, no more than 3x per week","maxAllowableVisits":999,"disclaimer":"* If non-emergent bypass grafting is required an additional VA authorization must be acquired.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n** Visits for additional services are not included in the frequency total.\r\nThe number of visits authorized for ancillary services are noted within its service line description above.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY IMAGING","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":69,"description":"Initial outpatient evaluation and treatment for the referred condition ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":70,"description":"Diagnostic imaging relevant to the referred condition on the consult ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4644,"precertRequired":false,"billingCode":"75658","codeType":"CPT"},{"id":4645,"precertRequired":false,"billingCode":"75705","codeType":"CPT"},{"id":4646,"precertRequired":false,"billingCode":"75710","codeType":"CPT"},{"id":4647,"precertRequired":false,"billingCode":"75716","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4686,"precertRequired":false,"billingCode":"75957","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":71,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6909,"precertRequired":false,"billingCode":"93563","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6911,"precertRequired":false,"billingCode":"93565","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6965,"precertRequired":false,"billingCode":"93880","codeType":"CPT"},{"id":6972,"precertRequired":false,"billingCode":"93895","codeType":"CPT"},{"id":6976,"precertRequired":false,"billingCode":"93925","codeType":"CPT"},{"id":6977,"precertRequired":false,"billingCode":"93926","codeType":"CPT"},{"id":6980,"precertRequired":false,"billingCode":"93970","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":72,"description":"Labs and pathology relevant to the referred condition on the consult **","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5591,"precertRequired":false,"billingCode":"83658","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":73,"description":"One cardiac catheterization with PCI interventions and overnight observation if required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6800,"precertRequired":false,"billingCode":"92943","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6901,"precertRequired":false,"billingCode":"93503","codeType":"CPT"},{"id":6902,"precertRequired":false,"billingCode":"93505","codeType":"CPT"},{"id":6903,"precertRequired":false,"billingCode":"93530","codeType":"CPT"},{"id":6904,"precertRequired":false,"billingCode":"93531","codeType":"CPT"},{"id":6905,"precertRequired":false,"billingCode":"93532","codeType":"CPT"},{"id":6906,"precertRequired":false,"billingCode":"93533","codeType":"CPT"},{"id":6907,"precertRequired":false,"billingCode":"93561","codeType":"CPT"},{"id":6908,"precertRequired":false,"billingCode":"93562","codeType":"CPT"},{"id":6910,"precertRequired":false,"billingCode":"93564","codeType":"CPT"},{"id":6912,"precertRequired":false,"billingCode":"93566","codeType":"CPT"},{"id":6913,"precertRequired":false,"billingCode":"93567","codeType":"CPT"},{"id":6914,"precertRequired":false,"billingCode":"93568","codeType":"CPT"},{"id":6915,"precertRequired":false,"billingCode":"93571","codeType":"CPT"},{"id":6916,"precertRequired":false,"billingCode":"93572","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":74,"description":"Pre-procedure medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5591,"precertRequired":false,"billingCode":"83658","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":75,"description":" Anesthesia consultation related to the procedure ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":62,"precertRequired":false,"billingCode":"00560","codeType":"CPT"},{"id":64,"precertRequired":false,"billingCode":"00562","codeType":"CPT"},{"id":66,"precertRequired":false,"billingCode":"00566","codeType":"CPT"},{"id":67,"precertRequired":false,"billingCode":"00567","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":76,"description":"Procedures to include A-fib ablations, implantation of cardiac devices and emergent or urgent surgical interventions such as: cardiac bypass, TAVR, LVAD, angioplasty. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C3-Interventional cardiology"}],"billingCodes":[{"id":2170,"precertRequired":true,"billingCode":"33010","codeType":"CPT"},{"id":2171,"precertRequired":true,"billingCode":"33011","codeType":"CPT"},{"id":2182,"precertRequired":false,"billingCode":"33206","codeType":"CPT"},{"id":2183,"precertRequired":false,"billingCode":"33207","codeType":"CPT"},{"id":2184,"precertRequired":false,"billingCode":"33208","codeType":"CPT"},{"id":2185,"precertRequired":false,"billingCode":"33210","codeType":"CPT"},{"id":2186,"precertRequired":false,"billingCode":"33211","codeType":"CPT"},{"id":2187,"precertRequired":false,"billingCode":"33212","codeType":"CPT"},{"id":2188,"precertRequired":false,"billingCode":"33213","codeType":"CPT"},{"id":2189,"precertRequired":false,"billingCode":"33214","codeType":"CPT"},{"id":2190,"precertRequired":false,"billingCode":"33215","codeType":"CPT"},{"id":2191,"precertRequired":true,"billingCode":"33216","codeType":"CPT"},{"id":2192,"precertRequired":true,"billingCode":"33217","codeType":"CPT"},{"id":2193,"precertRequired":false,"billingCode":"33218","codeType":"CPT"},{"id":2194,"precertRequired":false,"billingCode":"33220","codeType":"CPT"},{"id":2196,"precertRequired":false,"billingCode":"33222","codeType":"CPT"},{"id":2197,"precertRequired":false,"billingCode":"33223","codeType":"CPT"},{"id":2198,"precertRequired":true,"billingCode":"33224","codeType":"CPT"},{"id":2199,"precertRequired":true,"billingCode":"33225","codeType":"CPT"},{"id":2200,"precertRequired":false,"billingCode":"33226","codeType":"CPT"},{"id":2201,"precertRequired":false,"billingCode":"33227","codeType":"CPT"},{"id":2202,"precertRequired":false,"billingCode":"33228","codeType":"CPT"},{"id":2203,"precertRequired":false,"billingCode":"33229","codeType":"CPT"},{"id":2204,"precertRequired":false,"billingCode":"33230","codeType":"CPT"},{"id":2205,"precertRequired":false,"billingCode":"33231","codeType":"CPT"},{"id":2206,"precertRequired":false,"billingCode":"33233","codeType":"CPT"},{"id":2207,"precertRequired":false,"billingCode":"33234","codeType":"CPT"},{"id":2208,"precertRequired":false,"billingCode":"33235","codeType":"CPT"},{"id":2209,"precertRequired":false,"billingCode":"33236","codeType":"CPT"},{"id":2210,"precertRequired":false,"billingCode":"33237","codeType":"CPT"},{"id":2212,"precertRequired":false,"billingCode":"33240","codeType":"CPT"},{"id":2213,"precertRequired":false,"billingCode":"33241","codeType":"CPT"},{"id":2215,"precertRequired":false,"billingCode":"33244","codeType":"CPT"},{"id":2216,"precertRequired":false,"billingCode":"33249","codeType":"CPT"},{"id":2226,"precertRequired":false,"billingCode":"33262","codeType":"CPT"},{"id":2227,"precertRequired":false,"billingCode":"33263","codeType":"CPT"},{"id":2228,"precertRequired":false,"billingCode":"33264","codeType":"CPT"},{"id":2229,"precertRequired":false,"billingCode":"33270","codeType":"CPT"},{"id":2230,"precertRequired":false,"billingCode":"33271","codeType":"CPT"},{"id":2231,"precertRequired":false,"billingCode":"33272","codeType":"CPT"},{"id":2232,"precertRequired":false,"billingCode":"33273","codeType":"CPT"},{"id":2233,"precertRequired":false,"billingCode":"33282","codeType":"CPT"},{"id":2234,"precertRequired":false,"billingCode":"33284","codeType":"CPT"},{"id":2244,"precertRequired":false,"billingCode":"33361","codeType":"CPT"},{"id":2245,"precertRequired":false,"billingCode":"33362","codeType":"CPT"},{"id":2246,"precertRequired":false,"billingCode":"33363","codeType":"CPT"},{"id":2247,"precertRequired":false,"billingCode":"33364","codeType":"CPT"},{"id":2248,"precertRequired":false,"billingCode":"33365","codeType":"CPT"},{"id":2249,"precertRequired":false,"billingCode":"33366","codeType":"CPT"},{"id":2250,"precertRequired":false,"billingCode":"33367","codeType":"CPT"},{"id":2251,"precertRequired":false,"billingCode":"33368","codeType":"CPT"},{"id":2252,"precertRequired":false,"billingCode":"33369","codeType":"CPT"},{"id":2253,"precertRequired":false,"billingCode":"33390","codeType":"CPT"},{"id":2254,"precertRequired":false,"billingCode":"33391","codeType":"CPT"},{"id":2255,"precertRequired":false,"billingCode":"33404","codeType":"CPT"},{"id":2256,"precertRequired":true,"billingCode":"33405","codeType":"CPT"},{"id":2257,"precertRequired":true,"billingCode":"33406","codeType":"CPT"},{"id":2258,"precertRequired":true,"billingCode":"33410","codeType":"CPT"},{"id":2259,"precertRequired":true,"billingCode":"33411","codeType":"CPT"},{"id":2260,"precertRequired":true,"billingCode":"33412","codeType":"CPT"},{"id":2261,"precertRequired":false,"billingCode":"33413","codeType":"CPT"},{"id":2262,"precertRequired":true,"billingCode":"33414","codeType":"CPT"},{"id":2263,"precertRequired":false,"billingCode":"33415","codeType":"CPT"},{"id":2264,"precertRequired":false,"billingCode":"33416","codeType":"CPT"},{"id":2265,"precertRequired":false,"billingCode":"33417","codeType":"CPT"},{"id":2266,"precertRequired":false,"billingCode":"33418","codeType":"CPT"},{"id":2267,"precertRequired":false,"billingCode":"33419","codeType":"CPT"},{"id":2268,"precertRequired":false,"billingCode":"33420","codeType":"CPT"},{"id":2269,"precertRequired":false,"billingCode":"33422","codeType":"CPT"},{"id":2270,"precertRequired":false,"billingCode":"33425","codeType":"CPT"},{"id":2271,"precertRequired":false,"billingCode":"33426","codeType":"CPT"},{"id":2272,"precertRequired":false,"billingCode":"33427","codeType":"CPT"},{"id":2273,"precertRequired":false,"billingCode":"33430","codeType":"CPT"},{"id":2274,"precertRequired":false,"billingCode":"33460","codeType":"CPT"},{"id":2275,"precertRequired":false,"billingCode":"33463","codeType":"CPT"},{"id":2276,"precertRequired":false,"billingCode":"33464","codeType":"CPT"},{"id":2277,"precertRequired":true,"billingCode":"33465","codeType":"CPT"},{"id":2278,"precertRequired":false,"billingCode":"33468","codeType":"CPT"},{"id":2279,"precertRequired":false,"billingCode":"33470","codeType":"CPT"},{"id":2280,"precertRequired":false,"billingCode":"33471","codeType":"CPT"},{"id":2281,"precertRequired":false,"billingCode":"33474","codeType":"CPT"},{"id":2282,"precertRequired":false,"billingCode":"33475","codeType":"CPT"},{"id":2283,"precertRequired":false,"billingCode":"33476","codeType":"CPT"},{"id":2284,"precertRequired":false,"billingCode":"33477","codeType":"CPT"},{"id":2285,"precertRequired":false,"billingCode":"33478","codeType":"CPT"},{"id":2286,"precertRequired":false,"billingCode":"33496","codeType":"CPT"},{"id":2294,"precertRequired":false,"billingCode":"33510","codeType":"CPT"},{"id":2295,"precertRequired":false,"billingCode":"33511","codeType":"CPT"},{"id":2296,"precertRequired":false,"billingCode":"33512","codeType":"CPT"},{"id":2297,"precertRequired":false,"billingCode":"33513","codeType":"CPT"},{"id":2298,"precertRequired":false,"billingCode":"33514","codeType":"CPT"},{"id":2299,"precertRequired":false,"billingCode":"33516","codeType":"CPT"},{"id":2300,"precertRequired":false,"billingCode":"33517","codeType":"CPT"},{"id":2301,"precertRequired":false,"billingCode":"33518","codeType":"CPT"},{"id":2302,"precertRequired":false,"billingCode":"33519","codeType":"CPT"},{"id":2303,"precertRequired":false,"billingCode":"33521","codeType":"CPT"},{"id":2304,"precertRequired":false,"billingCode":"33522","codeType":"CPT"},{"id":2305,"precertRequired":false,"billingCode":"33523","codeType":"CPT"},{"id":2306,"precertRequired":false,"billingCode":"33530","codeType":"CPT"},{"id":2307,"precertRequired":false,"billingCode":"33533","codeType":"CPT"},{"id":2308,"precertRequired":false,"billingCode":"33534","codeType":"CPT"},{"id":2309,"precertRequired":false,"billingCode":"33535","codeType":"CPT"},{"id":2310,"precertRequired":false,"billingCode":"33536","codeType":"CPT"},{"id":2311,"precertRequired":false,"billingCode":"33542","codeType":"CPT"},{"id":2312,"precertRequired":false,"billingCode":"33545","codeType":"CPT"},{"id":2313,"precertRequired":false,"billingCode":"33548","codeType":"CPT"},{"id":2314,"precertRequired":false,"billingCode":"33572","codeType":"CPT"},{"id":2341,"precertRequired":false,"billingCode":"33735","codeType":"CPT"},{"id":2342,"precertRequired":false,"billingCode":"33736","codeType":"CPT"},{"id":2343,"precertRequired":false,"billingCode":"33737","codeType":"CPT"},{"id":2344,"precertRequired":false,"billingCode":"33750","codeType":"CPT"},{"id":2345,"precertRequired":false,"billingCode":"33755","codeType":"CPT"},{"id":2346,"precertRequired":false,"billingCode":"33762","codeType":"CPT"},{"id":2347,"precertRequired":false,"billingCode":"33764","codeType":"CPT"},{"id":2348,"precertRequired":false,"billingCode":"33766","codeType":"CPT"},{"id":2349,"precertRequired":false,"billingCode":"33767","codeType":"CPT"},{"id":2350,"precertRequired":false,"billingCode":"33768","codeType":"CPT"},{"id":2378,"precertRequired":false,"billingCode":"33860","codeType":"CPT"},{"id":2379,"precertRequired":false,"billingCode":"33863","codeType":"CPT"},{"id":2380,"precertRequired":false,"billingCode":"33864","codeType":"CPT"},{"id":2381,"precertRequired":true,"billingCode":"33870","codeType":"CPT"},{"id":2382,"precertRequired":false,"billingCode":"33875","codeType":"CPT"},{"id":2383,"precertRequired":false,"billingCode":"33877","codeType":"CPT"},{"id":2402,"precertRequired":true,"billingCode":"33967","codeType":"CPT"},{"id":2422,"precertRequired":false,"billingCode":"34701","codeType":"CPT"},{"id":2423,"precertRequired":false,"billingCode":"34702","codeType":"CPT"},{"id":2424,"precertRequired":false,"billingCode":"34703","codeType":"CPT"},{"id":2425,"precertRequired":false,"billingCode":"34704","codeType":"CPT"},{"id":2426,"precertRequired":false,"billingCode":"34705","codeType":"CPT"},{"id":2427,"precertRequired":false,"billingCode":"34706","codeType":"CPT"},{"id":2428,"precertRequired":false,"billingCode":"34707","codeType":"CPT"},{"id":2429,"precertRequired":false,"billingCode":"34708","codeType":"CPT"},{"id":2430,"precertRequired":false,"billingCode":"34709","codeType":"CPT"},{"id":2432,"precertRequired":false,"billingCode":"34800","codeType":"CPT"},{"id":2433,"precertRequired":false,"billingCode":"35180","codeType":"CPT"},{"id":2434,"precertRequired":false,"billingCode":"35182","codeType":"CPT"},{"id":2435,"precertRequired":false,"billingCode":"35184","codeType":"CPT"},{"id":2436,"precertRequired":false,"billingCode":"35188","codeType":"CPT"},{"id":2437,"precertRequired":false,"billingCode":"35189","codeType":"CPT"},{"id":2438,"precertRequired":false,"billingCode":"35190","codeType":"CPT"},{"id":2445,"precertRequired":false,"billingCode":"35500","codeType":"CPT"},{"id":2446,"precertRequired":false,"billingCode":"35501","codeType":"CPT"},{"id":2447,"precertRequired":false,"billingCode":"35506","codeType":"CPT"},{"id":2448,"precertRequired":false,"billingCode":"35508","codeType":"CPT"},{"id":2449,"precertRequired":false,"billingCode":"35509","codeType":"CPT"},{"id":2450,"precertRequired":false,"billingCode":"35510","codeType":"CPT"},{"id":2451,"precertRequired":false,"billingCode":"35511","codeType":"CPT"},{"id":2452,"precertRequired":false,"billingCode":"35512","codeType":"CPT"},{"id":2453,"precertRequired":false,"billingCode":"35515","codeType":"CPT"},{"id":2454,"precertRequired":false,"billingCode":"35516","codeType":"CPT"},{"id":2455,"precertRequired":false,"billingCode":"35518","codeType":"CPT"},{"id":2456,"precertRequired":false,"billingCode":"35521","codeType":"CPT"},{"id":2457,"precertRequired":false,"billingCode":"35522","codeType":"CPT"},{"id":2458,"precertRequired":false,"billingCode":"35523","codeType":"CPT"},{"id":2459,"precertRequired":false,"billingCode":"35525","codeType":"CPT"},{"id":2461,"precertRequired":false,"billingCode":"35531","codeType":"CPT"},{"id":2462,"precertRequired":false,"billingCode":"35533","codeType":"CPT"},{"id":2463,"precertRequired":false,"billingCode":"35535","codeType":"CPT"},{"id":2464,"precertRequired":false,"billingCode":"35536","codeType":"CPT"},{"id":2465,"precertRequired":false,"billingCode":"35537","codeType":"CPT"},{"id":2466,"precertRequired":false,"billingCode":"35538","codeType":"CPT"},{"id":2467,"precertRequired":false,"billingCode":"35539","codeType":"CPT"},{"id":2468,"precertRequired":false,"billingCode":"35540","codeType":"CPT"},{"id":2469,"precertRequired":false,"billingCode":"35556","codeType":"CPT"},{"id":2470,"precertRequired":false,"billingCode":"35558","codeType":"CPT"},{"id":2471,"precertRequired":false,"billingCode":"35560","codeType":"CPT"},{"id":2472,"precertRequired":false,"billingCode":"35563","codeType":"CPT"},{"id":2473,"precertRequired":false,"billingCode":"35565","codeType":"CPT"},{"id":2474,"precertRequired":false,"billingCode":"35566","codeType":"CPT"},{"id":2475,"precertRequired":false,"billingCode":"35570","codeType":"CPT"},{"id":2476,"precertRequired":false,"billingCode":"35571","codeType":"CPT"},{"id":2477,"precertRequired":false,"billingCode":"35572","codeType":"CPT"},{"id":2478,"precertRequired":false,"billingCode":"35583","codeType":"CPT"},{"id":2479,"precertRequired":false,"billingCode":"35585","codeType":"CPT"},{"id":2480,"precertRequired":false,"billingCode":"35587","codeType":"CPT"},{"id":2481,"precertRequired":false,"billingCode":"35600","codeType":"CPT"},{"id":2482,"precertRequired":false,"billingCode":"35601","codeType":"CPT"},{"id":2483,"precertRequired":false,"billingCode":"35606","codeType":"CPT"},{"id":2484,"precertRequired":false,"billingCode":"35612","codeType":"CPT"},{"id":2485,"precertRequired":false,"billingCode":"35616","codeType":"CPT"},{"id":2486,"precertRequired":false,"billingCode":"35621","codeType":"CPT"},{"id":2487,"precertRequired":false,"billingCode":"35623","codeType":"CPT"},{"id":2488,"precertRequired":false,"billingCode":"35626","codeType":"CPT"},{"id":2489,"precertRequired":false,"billingCode":"35631","codeType":"CPT"},{"id":2490,"precertRequired":false,"billingCode":"35632","codeType":"CPT"},{"id":2491,"precertRequired":false,"billingCode":"35633","codeType":"CPT"},{"id":2492,"precertRequired":false,"billingCode":"35634","codeType":"CPT"},{"id":2493,"precertRequired":false,"billingCode":"35636","codeType":"CPT"},{"id":2494,"precertRequired":false,"billingCode":"35637","codeType":"CPT"},{"id":2495,"precertRequired":false,"billingCode":"35638","codeType":"CPT"},{"id":2496,"precertRequired":false,"billingCode":"35642","codeType":"CPT"},{"id":2497,"precertRequired":false,"billingCode":"35645","codeType":"CPT"},{"id":2498,"precertRequired":false,"billingCode":"35646","codeType":"CPT"},{"id":2499,"precertRequired":false,"billingCode":"35647","codeType":"CPT"},{"id":2500,"precertRequired":false,"billingCode":"35650","codeType":"CPT"},{"id":2501,"precertRequired":true,"billingCode":"35654","codeType":"CPT"},{"id":2502,"precertRequired":true,"billingCode":"35656","codeType":"CPT"},{"id":2503,"precertRequired":false,"billingCode":"35661","codeType":"CPT"},{"id":2504,"precertRequired":false,"billingCode":"35663","codeType":"CPT"},{"id":2505,"precertRequired":false,"billingCode":"35665","codeType":"CPT"},{"id":2506,"precertRequired":false,"billingCode":"35666","codeType":"CPT"},{"id":2507,"precertRequired":false,"billingCode":"35671","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2510,"precertRequired":false,"billingCode":"36002","codeType":"CPT"},{"id":2511,"precertRequired":false,"billingCode":"36005","codeType":"CPT"},{"id":2512,"precertRequired":false,"billingCode":"36010","codeType":"CPT"},{"id":2513,"precertRequired":false,"billingCode":"36011","codeType":"CPT"},{"id":2514,"precertRequired":false,"billingCode":"36012","codeType":"CPT"},{"id":2515,"precertRequired":false,"billingCode":"36100","codeType":"CPT"},{"id":2516,"precertRequired":false,"billingCode":"36120","codeType":"CPT"},{"id":2517,"precertRequired":false,"billingCode":"36140","codeType":"CPT"},{"id":2519,"precertRequired":false,"billingCode":"36200","codeType":"CPT"},{"id":2520,"precertRequired":false,"billingCode":"36215","codeType":"CPT"},{"id":2521,"precertRequired":false,"billingCode":"36216","codeType":"CPT"},{"id":2522,"precertRequired":false,"billingCode":"36217","codeType":"CPT"},{"id":2523,"precertRequired":false,"billingCode":"36218","codeType":"CPT"},{"id":2524,"precertRequired":false,"billingCode":"36221","codeType":"CPT"},{"id":2525,"precertRequired":false,"billingCode":"36222","codeType":"CPT"},{"id":2526,"precertRequired":false,"billingCode":"36223","codeType":"CPT"},{"id":2527,"precertRequired":false,"billingCode":"36224","codeType":"CPT"},{"id":2528,"precertRequired":false,"billingCode":"36225","codeType":"CPT"},{"id":2529,"precertRequired":false,"billingCode":"36226","codeType":"CPT"},{"id":2530,"precertRequired":false,"billingCode":"36227","codeType":"CPT"},{"id":2531,"precertRequired":false,"billingCode":"36228","codeType":"CPT"},{"id":2532,"precertRequired":false,"billingCode":"36245","codeType":"CPT"},{"id":2533,"precertRequired":false,"billingCode":"36246","codeType":"CPT"},{"id":2534,"precertRequired":false,"billingCode":"36247","codeType":"CPT"},{"id":2535,"precertRequired":false,"billingCode":"36248","codeType":"CPT"},{"id":2536,"precertRequired":false,"billingCode":"36251","codeType":"CPT"},{"id":2537,"precertRequired":false,"billingCode":"36252","codeType":"CPT"},{"id":2538,"precertRequired":false,"billingCode":"36253","codeType":"CPT"},{"id":2539,"precertRequired":false,"billingCode":"36254","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":2552,"precertRequired":false,"billingCode":"36481","codeType":"CPT"},{"id":2613,"precertRequired":true,"billingCode":"36901","codeType":"CPT"},{"id":2614,"precertRequired":true,"billingCode":"36902","codeType":"CPT"},{"id":2615,"precertRequired":true,"billingCode":"36903","codeType":"CPT"},{"id":2624,"precertRequired":false,"billingCode":"37184","codeType":"CPT"},{"id":2625,"precertRequired":false,"billingCode":"37185","codeType":"CPT"},{"id":2626,"precertRequired":false,"billingCode":"37186","codeType":"CPT"},{"id":2627,"precertRequired":false,"billingCode":"37187","codeType":"CPT"},{"id":2628,"precertRequired":false,"billingCode":"37188","codeType":"CPT"},{"id":2629,"precertRequired":false,"billingCode":"37191","codeType":"CPT"},{"id":2630,"precertRequired":false,"billingCode":"37192","codeType":"CPT"},{"id":2631,"precertRequired":false,"billingCode":"37193","codeType":"CPT"},{"id":2632,"precertRequired":false,"billingCode":"37197","codeType":"CPT"},{"id":2634,"precertRequired":false,"billingCode":"37211","codeType":"CPT"},{"id":2635,"precertRequired":false,"billingCode":"37212","codeType":"CPT"},{"id":2636,"precertRequired":false,"billingCode":"37213","codeType":"CPT"},{"id":2637,"precertRequired":false,"billingCode":"37214","codeType":"CPT"},{"id":2638,"precertRequired":false,"billingCode":"37215","codeType":"CPT"},{"id":2639,"precertRequired":false,"billingCode":"37216","codeType":"CPT"},{"id":2642,"precertRequired":false,"billingCode":"37220","codeType":"CPT"},{"id":2643,"precertRequired":false,"billingCode":"37221","codeType":"CPT"},{"id":2644,"precertRequired":false,"billingCode":"37222","codeType":"CPT"},{"id":2645,"precertRequired":false,"billingCode":"37223","codeType":"CPT"},{"id":2646,"precertRequired":false,"billingCode":"37224","codeType":"CPT"},{"id":2647,"precertRequired":false,"billingCode":"37225","codeType":"CPT"},{"id":2648,"precertRequired":false,"billingCode":"37226","codeType":"CPT"},{"id":2649,"precertRequired":false,"billingCode":"37227","codeType":"CPT"},{"id":2650,"precertRequired":false,"billingCode":"37228","codeType":"CPT"},{"id":2651,"precertRequired":false,"billingCode":"37229","codeType":"CPT"},{"id":2652,"precertRequired":false,"billingCode":"37230","codeType":"CPT"},{"id":2653,"precertRequired":false,"billingCode":"37231","codeType":"CPT"},{"id":2654,"precertRequired":false,"billingCode":"37232","codeType":"CPT"},{"id":2655,"precertRequired":false,"billingCode":"37233","codeType":"CPT"},{"id":2656,"precertRequired":false,"billingCode":"37234","codeType":"CPT"},{"id":2657,"precertRequired":false,"billingCode":"37235","codeType":"CPT"},{"id":2658,"precertRequired":false,"billingCode":"37236","codeType":"CPT"},{"id":2659,"precertRequired":false,"billingCode":"37237","codeType":"CPT"},{"id":2660,"precertRequired":false,"billingCode":"37238","codeType":"CPT"},{"id":2661,"precertRequired":false,"billingCode":"37239","codeType":"CPT"},{"id":2666,"precertRequired":false,"billingCode":"37246","codeType":"CPT"},{"id":2667,"precertRequired":false,"billingCode":"37247","codeType":"CPT"},{"id":2668,"precertRequired":false,"billingCode":"37248","codeType":"CPT"},{"id":2669,"precertRequired":false,"billingCode":"37249","codeType":"CPT"},{"id":2670,"precertRequired":false,"billingCode":"37252","codeType":"CPT"},{"id":2671,"precertRequired":false,"billingCode":"37253","codeType":"CPT"},{"id":2672,"precertRequired":false,"billingCode":"37619","codeType":"CPT"},{"id":2673,"precertRequired":false,"billingCode":"37718","codeType":"CPT"},{"id":4684,"precertRequired":false,"billingCode":"75952","codeType":"CPT"},{"id":4685,"precertRequired":false,"billingCode":"75956","codeType":"CPT"},{"id":4687,"precertRequired":false,"billingCode":"75958","codeType":"CPT"},{"id":4688,"precertRequired":false,"billingCode":"75959","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4761,"precertRequired":false,"billingCode":"76930","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4933,"precertRequired":false,"billingCode":"78451","codeType":"CPT"},{"id":4934,"precertRequired":false,"billingCode":"78452","codeType":"CPT"},{"id":4935,"precertRequired":false,"billingCode":"78453","codeType":"CPT"},{"id":4940,"precertRequired":false,"billingCode":"78459","codeType":"CPT"},{"id":4941,"precertRequired":false,"billingCode":"78466","codeType":"CPT"},{"id":4943,"precertRequired":false,"billingCode":"78469","codeType":"CPT"},{"id":4944,"precertRequired":false,"billingCode":"78472","codeType":"CPT"},{"id":4945,"precertRequired":false,"billingCode":"78473","codeType":"CPT"},{"id":4946,"precertRequired":false,"billingCode":"78481","codeType":"CPT"},{"id":4947,"precertRequired":false,"billingCode":"78483","codeType":"CPT"},{"id":4948,"precertRequired":false,"billingCode":"78491","codeType":"CPT"},{"id":4949,"precertRequired":false,"billingCode":"78492","codeType":"CPT"},{"id":4951,"precertRequired":false,"billingCode":"78496","codeType":"CPT"},{"id":6789,"precertRequired":false,"billingCode":"92920","codeType":"CPT"},{"id":6790,"precertRequired":false,"billingCode":"92921","codeType":"CPT"},{"id":6791,"precertRequired":false,"billingCode":"92924","codeType":"CPT"},{"id":6792,"precertRequired":false,"billingCode":"92925","codeType":"CPT"},{"id":6793,"precertRequired":false,"billingCode":"92928","codeType":"CPT"},{"id":6794,"precertRequired":false,"billingCode":"92929","codeType":"CPT"},{"id":6795,"precertRequired":false,"billingCode":"92933","codeType":"CPT"},{"id":6796,"precertRequired":false,"billingCode":"92934","codeType":"CPT"},{"id":6797,"precertRequired":false,"billingCode":"92937","codeType":"CPT"},{"id":6798,"precertRequired":false,"billingCode":"92938","codeType":"CPT"},{"id":6799,"precertRequired":false,"billingCode":"92941","codeType":"CPT"},{"id":6801,"precertRequired":false,"billingCode":"92944","codeType":"CPT"},{"id":6802,"precertRequired":false,"billingCode":"92950","codeType":"CPT"},{"id":6803,"precertRequired":false,"billingCode":"92953","codeType":"CPT"},{"id":6804,"precertRequired":false,"billingCode":"92960","codeType":"CPT"},{"id":6805,"precertRequired":false,"billingCode":"92961","codeType":"CPT"},{"id":6806,"precertRequired":false,"billingCode":"92970","codeType":"CPT"},{"id":6807,"precertRequired":false,"billingCode":"92971","codeType":"CPT"},{"id":6808,"precertRequired":false,"billingCode":"92973","codeType":"CPT"},{"id":6809,"precertRequired":false,"billingCode":"92974","codeType":"CPT"},{"id":6810,"precertRequired":false,"billingCode":"92975","codeType":"CPT"},{"id":6811,"precertRequired":false,"billingCode":"92977","codeType":"CPT"},{"id":6812,"precertRequired":false,"billingCode":"92978","codeType":"CPT"},{"id":6813,"precertRequired":false,"billingCode":"92979","codeType":"CPT"},{"id":6814,"precertRequired":false,"billingCode":"92986","codeType":"CPT"},{"id":6815,"precertRequired":false,"billingCode":"92987","codeType":"CPT"},{"id":6816,"precertRequired":false,"billingCode":"92990","codeType":"CPT"},{"id":6817,"precertRequired":false,"billingCode":"92992","codeType":"CPT"},{"id":6818,"precertRequired":false,"billingCode":"92993","codeType":"CPT"},{"id":6819,"precertRequired":false,"billingCode":"92997","codeType":"CPT"},{"id":6820,"precertRequired":false,"billingCode":"92998","codeType":"CPT"},{"id":6824,"precertRequired":false,"billingCode":"93015","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6828,"precertRequired":false,"billingCode":"93024","codeType":"CPT"},{"id":6829,"precertRequired":false,"billingCode":"93025","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":6834,"precertRequired":false,"billingCode":"93224","codeType":"CPT"},{"id":6835,"precertRequired":false,"billingCode":"93225","codeType":"CPT"},{"id":6836,"precertRequired":false,"billingCode":"93226","codeType":"CPT"},{"id":6837,"precertRequired":false,"billingCode":"93227","codeType":"CPT"},{"id":6838,"precertRequired":false,"billingCode":"93228","codeType":"CPT"},{"id":6839,"precertRequired":false,"billingCode":"93229","codeType":"CPT"},{"id":6840,"precertRequired":false,"billingCode":"93260","codeType":"CPT"},{"id":6841,"precertRequired":false,"billingCode":"93261","codeType":"CPT"},{"id":6842,"precertRequired":false,"billingCode":"93268","codeType":"CPT"},{"id":6843,"precertRequired":false,"billingCode":"93270","codeType":"CPT"},{"id":6844,"precertRequired":false,"billingCode":"93271","codeType":"CPT"},{"id":6845,"precertRequired":false,"billingCode":"93272","codeType":"CPT"},{"id":6846,"precertRequired":false,"billingCode":"93278","codeType":"CPT"},{"id":6847,"precertRequired":false,"billingCode":"93279","codeType":"CPT"},{"id":6848,"precertRequired":false,"billingCode":"93280","codeType":"CPT"},{"id":6849,"precertRequired":false,"billingCode":"93281","codeType":"CPT"},{"id":6850,"precertRequired":false,"billingCode":"93282","codeType":"CPT"},{"id":6851,"precertRequired":false,"billingCode":"93283","codeType":"CPT"},{"id":6852,"precertRequired":false,"billingCode":"93284","codeType":"CPT"},{"id":6853,"precertRequired":false,"billingCode":"93285","codeType":"CPT"},{"id":6854,"precertRequired":false,"billingCode":"93286","codeType":"CPT"},{"id":6855,"precertRequired":false,"billingCode":"93287","codeType":"CPT"},{"id":6856,"precertRequired":false,"billingCode":"93288","codeType":"CPT"},{"id":6857,"precertRequired":false,"billingCode":"93289","codeType":"CPT"},{"id":6858,"precertRequired":false,"billingCode":"93290","codeType":"CPT"},{"id":6859,"precertRequired":false,"billingCode":"93291","codeType":"CPT"},{"id":6860,"precertRequired":false,"billingCode":"93292","codeType":"CPT"},{"id":6861,"precertRequired":false,"billingCode":"93293","codeType":"CPT"},{"id":6862,"precertRequired":false,"billingCode":"93294","codeType":"CPT"},{"id":6863,"precertRequired":false,"billingCode":"93295","codeType":"CPT"},{"id":6864,"precertRequired":false,"billingCode":"93296","codeType":"CPT"},{"id":6865,"precertRequired":false,"billingCode":"93297","codeType":"CPT"},{"id":6866,"precertRequired":false,"billingCode":"93298","codeType":"CPT"},{"id":6867,"precertRequired":false,"billingCode":"93299","codeType":"CPT"},{"id":6868,"precertRequired":false,"billingCode":"93303","codeType":"CPT"},{"id":6869,"precertRequired":false,"billingCode":"93304","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6880,"precertRequired":false,"billingCode":"93320","codeType":"CPT"},{"id":6881,"precertRequired":false,"billingCode":"93321","codeType":"CPT"},{"id":6882,"precertRequired":false,"billingCode":"93325","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"},{"id":6886,"precertRequired":false,"billingCode":"93355","codeType":"CPT"},{"id":6887,"precertRequired":false,"billingCode":"93451","codeType":"CPT"},{"id":6888,"precertRequired":false,"billingCode":"93452","codeType":"CPT"},{"id":6889,"precertRequired":false,"billingCode":"93453","codeType":"CPT"},{"id":6890,"precertRequired":false,"billingCode":"93454","codeType":"CPT"},{"id":6891,"precertRequired":false,"billingCode":"93455","codeType":"CPT"},{"id":6892,"precertRequired":false,"billingCode":"93456","codeType":"CPT"},{"id":6893,"precertRequired":false,"billingCode":"93457","codeType":"CPT"},{"id":6894,"precertRequired":false,"billingCode":"93458","codeType":"CPT"},{"id":6895,"precertRequired":false,"billingCode":"93459","codeType":"CPT"},{"id":6896,"precertRequired":false,"billingCode":"93460","codeType":"CPT"},{"id":6897,"precertRequired":false,"billingCode":"93461","codeType":"CPT"},{"id":6898,"precertRequired":false,"billingCode":"93462","codeType":"CPT"},{"id":6899,"precertRequired":false,"billingCode":"93463","codeType":"CPT"},{"id":6900,"precertRequired":false,"billingCode":"93464","codeType":"CPT"},{"id":6917,"precertRequired":false,"billingCode":"93580","codeType":"CPT"},{"id":6918,"precertRequired":false,"billingCode":"93581","codeType":"CPT"},{"id":6921,"precertRequired":true,"billingCode":"93600","codeType":"CPT"},{"id":6922,"precertRequired":true,"billingCode":"93602","codeType":"CPT"},{"id":6923,"precertRequired":true,"billingCode":"93603","codeType":"CPT"},{"id":6924,"precertRequired":true,"billingCode":"93609","codeType":"CPT"},{"id":6925,"precertRequired":false,"billingCode":"93610","codeType":"CPT"},{"id":6926,"precertRequired":false,"billingCode":"93612","codeType":"CPT"},{"id":6927,"precertRequired":false,"billingCode":"93613","codeType":"CPT"},{"id":6928,"precertRequired":true,"billingCode":"93615","codeType":"CPT"},{"id":6929,"precertRequired":true,"billingCode":"93616","codeType":"CPT"},{"id":6930,"precertRequired":true,"billingCode":"93618","codeType":"CPT"},{"id":6931,"precertRequired":false,"billingCode":"93619","codeType":"CPT"},{"id":6932,"precertRequired":false,"billingCode":"93620","codeType":"CPT"},{"id":6933,"precertRequired":false,"billingCode":"93621","codeType":"CPT"},{"id":6934,"precertRequired":false,"billingCode":"93622","codeType":"CPT"},{"id":6935,"precertRequired":false,"billingCode":"93623","codeType":"CPT"},{"id":6936,"precertRequired":false,"billingCode":"93624","codeType":"CPT"},{"id":6937,"precertRequired":false,"billingCode":"93631","codeType":"CPT"},{"id":6938,"precertRequired":false,"billingCode":"93640","codeType":"CPT"},{"id":6939,"precertRequired":false,"billingCode":"93641","codeType":"CPT"},{"id":6940,"precertRequired":false,"billingCode":"93642","codeType":"CPT"},{"id":6941,"precertRequired":false,"billingCode":"93644","codeType":"CPT"},{"id":6942,"precertRequired":false,"billingCode":"93650","codeType":"CPT"},{"id":6943,"precertRequired":false,"billingCode":"93653","codeType":"CPT"},{"id":6944,"precertRequired":false,"billingCode":"93654","codeType":"CPT"},{"id":6945,"precertRequired":false,"billingCode":"93655","codeType":"CPT"},{"id":6946,"precertRequired":false,"billingCode":"93656","codeType":"CPT"},{"id":6947,"precertRequired":false,"billingCode":"93657","codeType":"CPT"},{"id":6948,"precertRequired":false,"billingCode":"93660","codeType":"CPT"},{"id":6949,"precertRequired":false,"billingCode":"93662","codeType":"CPT"},{"id":6950,"precertRequired":false,"billingCode":"93668","codeType":"CPT"},{"id":6951,"precertRequired":false,"billingCode":"93701","codeType":"CPT"},{"id":6952,"precertRequired":false,"billingCode":"93724","codeType":"CPT"},{"id":6953,"precertRequired":false,"billingCode":"93740","codeType":"CPT"},{"id":6954,"precertRequired":false,"billingCode":"93745","codeType":"CPT"},{"id":6955,"precertRequired":false,"billingCode":"93770","codeType":"CPT"},{"id":6956,"precertRequired":false,"billingCode":"93784","codeType":"CPT"},{"id":6957,"precertRequired":false,"billingCode":"93786","codeType":"CPT"},{"id":6958,"precertRequired":false,"billingCode":"93788","codeType":"CPT"},{"id":6959,"precertRequired":false,"billingCode":"93790","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7945,"precertRequired":false,"billingCode":"C1760","codeType":"HCPCS"},{"id":7951,"precertRequired":false,"billingCode":"C1874","codeType":"HCPCS"},{"id":7952,"precertRequired":false,"billingCode":"C1875","codeType":"HCPCS"},{"id":7953,"precertRequired":false,"billingCode":"C1876","codeType":"HCPCS"},{"id":7954,"precertRequired":false,"billingCode":"C1877","codeType":"HCPCS"},{"id":7986,"precertRequired":false,"billingCode":"C8928","codeType":"HCPCS"},{"id":7988,"precertRequired":false,"billingCode":"C8930","codeType":"HCPCS"},{"id":8169,"precertRequired":false,"billingCode":"G0269","codeType":"HCPCS"},{"id":8218,"precertRequired":false,"billingCode":"G0446","codeType":"HCPCS"},{"id":8477,"precertRequired":false,"billingCode":"J2502","codeType":"HCPCS"},{"id":8532,"precertRequired":false,"billingCode":"J7188","codeType":"HCPCS"},{"id":8533,"precertRequired":false,"billingCode":"J7205","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0011X"}]},{"id":77,"description":"Inpatient emergent admission post-catheterization for medical/surgical procedure (e.g. CABG) if required including necessary follow up visits in the global period.  ***VA notification is required if emergent procedure is necessary.  Please contact your local Community Care office within 72 hours who initiated the outpatient referral so that the appropriate notification can be made on behalf of the Veteran. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":78,"description":" Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"06-Cardiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0000X"}]},{"id":79,"description":"Cardiac rehabilitation, up to 36 visits, no more than 3x per week","frequency":3,"frequencyType":"week","visits":36,"codeRequired":"YES","clinicalServices":[{"clinicalService":"31-Intensive cardiac rehabilitation"}],"billingCodes":[{"id":6962,"precertRequired":false,"billingCode":"93797","codeType":"CPT"},{"id":6963,"precertRequired":false,"billingCode":"93798","codeType":"CPT"},{"id":8208,"precertRequired":false,"billingCode":"G0422","codeType":"HCPCS"},{"id":8209,"precertRequired":false,"billingCode":"G0423","codeType":"HCPCS"},{"id":8210,"precertRequired":false,"billingCode":"G0424","codeType":"HCPCS"}],"serviceHptcs":[]}]}},{"Seoc":{"id":28,"seocKey":23,"name":"Comprehensive Cardiology_PRCT","seocId":"MSC_COMPREHENSIVE CARDIOLOGY_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below as clinically indicated.\r\n","effectiveDate":"11-01-2017","endDate":"09-21-2018","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for referred condition\r\n2. Diagnostic imaging relevant to the referred condition\r\n3. Diagnostic studies and labs relevant to the referred condition\r\n4. One cardiac catheterization and PCI\r\n5. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n6. Anesthesia consultation related to the procedure\r\n7. Inpatient admission for emergent surgical procedure (e.g. bypass grafting, valve replacements, disection and/or cardiac aneurysm, AV fistula) if indicated\r\n8. Emergent inpatient admission for post-procedure bypass, cardiac valvular, aortic and vascular surgery if required. \r\n9. Cardiac rehabilitation x 36 visits no more than 3x per week\r\n10. Cardiology follow-up visits for this episode of care\r\n11. Initial outpatient evaluation and treatment for referred condition\r\n12. Diagnostic imaging relevant to the referred condition\r\n13. Diagnostic studies and labs relevant to the referred condition\r\n14. One cardiac catheterization and PCI\r\n15. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n16. Anesthesia consultation related to the procedure\r\n17. Inpatient admission for emergent surgical procedure (e.g. bypass grafting, valve replacements, disection and/or cardiac aneurysm, AV fistula) if indicated\r\n18. Emergent inpatient admission for post-procedure bypass, cardiac valvular, aortic and vascular surgery if required\r\n19. Cardiac rehabilitation x 36 visits no more than 3x per week\r\n20. Cardiology follow-up visits for this episode of care","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CARDIOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1309,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":200,"seocKey":24,"name":"Chemotherapy-outpatient_PRCT","seocId":"MSC_CHEMOTHERAPY-OUTPATIENT_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"02-14-2019","duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Outpatient chemotherapy for the medication, duration and frequency indicated by the oncologist\r\n3. Follow-up visits for this episode of care\r\n4. Follow-up images/studies/laboratories as required","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**Clinical trials and non-FDA approved treatments ARE NOT approved under this referral. If a clinical trial is indicated it will require VA review and approval via a SAR (Secondary Authorization Request) to ensure the trial is being conducted under an Investigational Drug (IND) application or the drug, biologicals or medical devices are prescribed under a compassionate use exemption, or the trial does not include any unapproved drugs, biologicals or medical devices.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.     \r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.         \r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CHEMOTHERAPY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RX0202X"}],"services":[{"id":776,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"90-Medical oncology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RX0202X"}]},{"id":777,"description":"Outpatient chemotherapy for the medication, duration and frequency indicated by the oncologist","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"90-Medical oncology"}],"billingCodes":[{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2114,"precertRequired":true,"billingCode":"32554","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2679,"precertRequired":false,"billingCode":"38220","codeType":"CPT"},{"id":2680,"precertRequired":false,"billingCode":"38221","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3423,"precertRequired":false,"billingCode":"51720","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":6538,"precertRequired":false,"billingCode":"90658","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7202,"precertRequired":false,"billingCode":"96401","codeType":"CPT"},{"id":7203,"precertRequired":false,"billingCode":"96402","codeType":"CPT"},{"id":7204,"precertRequired":false,"billingCode":"96405","codeType":"CPT"},{"id":7206,"precertRequired":false,"billingCode":"96409","codeType":"CPT"},{"id":7207,"precertRequired":false,"billingCode":"96411","codeType":"CPT"},{"id":7208,"precertRequired":false,"billingCode":"96413","codeType":"CPT"},{"id":7209,"precertRequired":false,"billingCode":"96415","codeType":"CPT"},{"id":7210,"precertRequired":false,"billingCode":"96416","codeType":"CPT"},{"id":7211,"precertRequired":false,"billingCode":"96417","codeType":"CPT"},{"id":7212,"precertRequired":false,"billingCode":"96420","codeType":"CPT"},{"id":7213,"precertRequired":false,"billingCode":"96422","codeType":"CPT"},{"id":7214,"precertRequired":false,"billingCode":"96423","codeType":"CPT"},{"id":7215,"precertRequired":false,"billingCode":"96425","codeType":"CPT"},{"id":7216,"precertRequired":false,"billingCode":"96440","codeType":"CPT"},{"id":7217,"precertRequired":false,"billingCode":"96446","codeType":"CPT"},{"id":7218,"precertRequired":false,"billingCode":"96450","codeType":"CPT"},{"id":7222,"precertRequired":false,"billingCode":"96542","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7429,"precertRequired":false,"billingCode":"99363","codeType":"CPT"},{"id":7430,"precertRequired":false,"billingCode":"99364","codeType":"CPT"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8524,"precertRequired":false,"billingCode":"J7042","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8577,"precertRequired":false,"billingCode":"J9000","codeType":"HCPCS"},{"id":8586,"precertRequired":false,"billingCode":"J9031","codeType":"HCPCS"},{"id":8592,"precertRequired":false,"billingCode":"J9040","codeType":"HCPCS"},{"id":8596,"precertRequired":false,"billingCode":"J9045","codeType":"HCPCS"},{"id":8600,"precertRequired":false,"billingCode":"J9060","codeType":"HCPCS"},{"id":8602,"precertRequired":false,"billingCode":"J9070","codeType":"HCPCS"},{"id":8604,"precertRequired":false,"billingCode":"J9100","codeType":"HCPCS"},{"id":8613,"precertRequired":false,"billingCode":"J9171","codeType":"HCPCS"},{"id":8617,"precertRequired":false,"billingCode":"J9181","codeType":"HCPCS"},{"id":8618,"precertRequired":false,"billingCode":"J9185","codeType":"HCPCS"},{"id":8619,"precertRequired":false,"billingCode":"J9190","codeType":"HCPCS"},{"id":8621,"precertRequired":false,"billingCode":"J9201","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8625,"precertRequired":false,"billingCode":"J9206","codeType":"HCPCS"},{"id":8627,"precertRequired":false,"billingCode":"J9208","codeType":"HCPCS"},{"id":8628,"precertRequired":false,"billingCode":"J9209","codeType":"HCPCS"},{"id":8631,"precertRequired":false,"billingCode":"J9213","codeType":"HCPCS"},{"id":8632,"precertRequired":false,"billingCode":"J9214","codeType":"HCPCS"},{"id":8635,"precertRequired":false,"billingCode":"J9217","codeType":"HCPCS"},{"id":8636,"precertRequired":false,"billingCode":"J9218","codeType":"HCPCS"},{"id":8643,"precertRequired":false,"billingCode":"J9250","codeType":"HCPCS"},{"id":8644,"precertRequired":false,"billingCode":"J9260","codeType":"HCPCS"},{"id":8650,"precertRequired":false,"billingCode":"J9267","codeType":"HCPCS"},{"id":8656,"precertRequired":false,"billingCode":"J9293","codeType":"HCPCS"},{"id":8666,"precertRequired":false,"billingCode":"J9310","codeType":"HCPCS"},{"id":8673,"precertRequired":false,"billingCode":"J9351","codeType":"HCPCS"},{"id":8678,"precertRequired":false,"billingCode":"J9360","codeType":"HCPCS"},{"id":8679,"precertRequired":false,"billingCode":"J9370","codeType":"HCPCS"},{"id":8681,"precertRequired":false,"billingCode":"J9390","codeType":"HCPCS"},{"id":8791,"precertRequired":false,"billingCode":"Q2050","codeType":"HCPCS"},{"id":8823,"precertRequired":false,"billingCode":"Q4081","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RX0202X"}]},{"id":778,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"90-Medical oncology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RX0202X"}]},{"id":779,"description":"Follow-up images/studies/laboratories as required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"90-Medical oncology"}],"billingCodes":[{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RX0202X"}]}]}},{"Seoc":{"id":27,"seocKey":24,"name":"Chemotherapy-outpatient_PRCT","seocId":"MSC_CHEMOTHERAPY-OUTPATIENT_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"01-02-2019","duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Outpatient chemotherapy for the medication, duration and frequency indicated by the oncologist\r\n3. Follow-up visits for this episode of care\r\n4. Follow-up images/studies/laboratories as required","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**Clinical trials and non-FDA approved treatments ARE NOT approved under this referral. If a clinical trial is indicated it will require VA review and approval via a SAR (Secondary Authorization Request) to ensure the trial is being conducted under an Investigational Drug (IND) application or the drug, biologicals or medical devices are prescribed under a compassionate use exemption, or the trial does not include any unapproved drugs, biologicals or medical devices.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.     \r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.         \r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"CHEMOTHERAPY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":92,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"90-Medical oncology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RX0202X"}]},{"id":93,"description":"Outpatient chemotherapy for the medication, duration and frequency indicated by the oncologist","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"90-Medical oncology"}],"billingCodes":[{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2114,"precertRequired":true,"billingCode":"32554","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2679,"precertRequired":false,"billingCode":"38220","codeType":"CPT"},{"id":2680,"precertRequired":false,"billingCode":"38221","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3423,"precertRequired":false,"billingCode":"51720","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":6538,"precertRequired":false,"billingCode":"90658","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7202,"precertRequired":false,"billingCode":"96401","codeType":"CPT"},{"id":7203,"precertRequired":false,"billingCode":"96402","codeType":"CPT"},{"id":7204,"precertRequired":false,"billingCode":"96405","codeType":"CPT"},{"id":7206,"precertRequired":false,"billingCode":"96409","codeType":"CPT"},{"id":7207,"precertRequired":false,"billingCode":"96411","codeType":"CPT"},{"id":7208,"precertRequired":false,"billingCode":"96413","codeType":"CPT"},{"id":7209,"precertRequired":false,"billingCode":"96415","codeType":"CPT"},{"id":7210,"precertRequired":false,"billingCode":"96416","codeType":"CPT"},{"id":7211,"precertRequired":false,"billingCode":"96417","codeType":"CPT"},{"id":7212,"precertRequired":false,"billingCode":"96420","codeType":"CPT"},{"id":7213,"precertRequired":false,"billingCode":"96422","codeType":"CPT"},{"id":7214,"precertRequired":false,"billingCode":"96423","codeType":"CPT"},{"id":7215,"precertRequired":false,"billingCode":"96425","codeType":"CPT"},{"id":7216,"precertRequired":false,"billingCode":"96440","codeType":"CPT"},{"id":7217,"precertRequired":false,"billingCode":"96446","codeType":"CPT"},{"id":7218,"precertRequired":false,"billingCode":"96450","codeType":"CPT"},{"id":7222,"precertRequired":false,"billingCode":"96542","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7429,"precertRequired":false,"billingCode":"99363","codeType":"CPT"},{"id":7430,"precertRequired":false,"billingCode":"99364","codeType":"CPT"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8524,"precertRequired":false,"billingCode":"J7042","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8577,"precertRequired":false,"billingCode":"J9000","codeType":"HCPCS"},{"id":8586,"precertRequired":false,"billingCode":"J9031","codeType":"HCPCS"},{"id":8592,"precertRequired":false,"billingCode":"J9040","codeType":"HCPCS"},{"id":8596,"precertRequired":false,"billingCode":"J9045","codeType":"HCPCS"},{"id":8600,"precertRequired":false,"billingCode":"J9060","codeType":"HCPCS"},{"id":8602,"precertRequired":false,"billingCode":"J9070","codeType":"HCPCS"},{"id":8604,"precertRequired":false,"billingCode":"J9100","codeType":"HCPCS"},{"id":8613,"precertRequired":false,"billingCode":"J9171","codeType":"HCPCS"},{"id":8617,"precertRequired":false,"billingCode":"J9181","codeType":"HCPCS"},{"id":8618,"precertRequired":false,"billingCode":"J9185","codeType":"HCPCS"},{"id":8619,"precertRequired":false,"billingCode":"J9190","codeType":"HCPCS"},{"id":8621,"precertRequired":false,"billingCode":"J9201","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8625,"precertRequired":false,"billingCode":"J9206","codeType":"HCPCS"},{"id":8627,"precertRequired":false,"billingCode":"J9208","codeType":"HCPCS"},{"id":8628,"precertRequired":false,"billingCode":"J9209","codeType":"HCPCS"},{"id":8631,"precertRequired":false,"billingCode":"J9213","codeType":"HCPCS"},{"id":8632,"precertRequired":false,"billingCode":"J9214","codeType":"HCPCS"},{"id":8635,"precertRequired":false,"billingCode":"J9217","codeType":"HCPCS"},{"id":8636,"precertRequired":false,"billingCode":"J9218","codeType":"HCPCS"},{"id":8643,"precertRequired":false,"billingCode":"J9250","codeType":"HCPCS"},{"id":8644,"precertRequired":false,"billingCode":"J9260","codeType":"HCPCS"},{"id":8650,"precertRequired":false,"billingCode":"J9267","codeType":"HCPCS"},{"id":8656,"precertRequired":false,"billingCode":"J9293","codeType":"HCPCS"},{"id":8666,"precertRequired":false,"billingCode":"J9310","codeType":"HCPCS"},{"id":8673,"precertRequired":false,"billingCode":"J9351","codeType":"HCPCS"},{"id":8678,"precertRequired":false,"billingCode":"J9360","codeType":"HCPCS"},{"id":8679,"precertRequired":false,"billingCode":"J9370","codeType":"HCPCS"},{"id":8681,"precertRequired":false,"billingCode":"J9390","codeType":"HCPCS"},{"id":8791,"precertRequired":false,"billingCode":"Q2050","codeType":"HCPCS"},{"id":8823,"precertRequired":false,"billingCode":"Q4081","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RX0202X"}]},{"id":94,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"90-Medical oncology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RX0202X"}]},{"id":95,"description":"Follow-up images/studies/laboratories as required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"90-Medical oncology"}],"billingCodes":[{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RX0202X"}]}]}},{"Seoc":{"id":1836,"seocKey":25,"name":"Chiropractic Initial_PRCT","seocId":"PMR_CHIROPRACTIC INITIAL_1.0.8_PRCT","versionNumber":"1.0.8","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult order.\r\n2.    Plain film x-ray of the region of complaint specified on the consult order if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.\r\n3.    Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":5835,"description":"Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult order.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":5836,"description":"2.    Plain film x-ray of the region of complaint specified on the consult order if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4506,"precertRequired":false,"billingCode":"73020","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4533,"precertRequired":false,"billingCode":"73501","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4535,"precertRequired":false,"billingCode":"73503","codeType":"CPT"},{"id":4536,"precertRequired":false,"billingCode":"73521","codeType":"CPT"},{"id":4537,"precertRequired":false,"billingCode":"73522","codeType":"CPT"},{"id":4538,"precertRequired":false,"billingCode":"73523","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"}],"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"}]},{"id":5837,"description":"Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","frequency":null,"frequencyType":"","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7237,"precertRequired":false,"billingCode":"97010","codeType":"CPT"},{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7239,"precertRequired":false,"billingCode":"97014","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"},{"id":12191,"precertRequired":true,"billingCode":"0552T","codeType":"CPT"},{"id":13485,"precertRequired":false,"billingCode":"20560","codeType":"CPT"},{"id":13486,"precertRequired":false,"billingCode":"20561","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":1718,"seocKey":25,"name":"Chiropractic Initial_PRCT","seocId":"PMR_CHIROPRACTIC INITIAL_1.0.7_PRCT","versionNumber":"1.0.7","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-24-2020","endDate":"06-08-2020","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.\r\n2. Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.\r\n3. Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote: *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":4905,"description":"Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":4906,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated. a) Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4506,"precertRequired":false,"billingCode":"73020","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4533,"precertRequired":false,"billingCode":"73501","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4535,"precertRequired":false,"billingCode":"73503","codeType":"CPT"},{"id":4536,"precertRequired":false,"billingCode":"73521","codeType":"CPT"},{"id":4537,"precertRequired":false,"billingCode":"73522","codeType":"CPT"},{"id":4538,"precertRequired":false,"billingCode":"73523","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"}],"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"}]},{"id":4907,"description":"Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","frequency":null,"frequencyType":"","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7237,"precertRequired":false,"billingCode":"97010","codeType":"CPT"},{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7239,"precertRequired":false,"billingCode":"97014","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"},{"id":12191,"precertRequired":true,"billingCode":"0552T","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":1656,"seocKey":25,"name":"Chiropractic Initial_PRCT","seocId":"PMR_CHIROPRACTIC INITIAL_1.0.6_PRCT","versionNumber":"1.0.6","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"11-12-2019","endDate":"01-24-2020","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.\r\n2. Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.\r\n3. Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote: *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","maxAllowableVisits":null,"disclaimer":"*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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":4646,"description":"Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":4647,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated. a) Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4506,"precertRequired":false,"billingCode":"73020","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4533,"precertRequired":false,"billingCode":"73501","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4535,"precertRequired":false,"billingCode":"73503","codeType":"CPT"},{"id":4536,"precertRequired":false,"billingCode":"73521","codeType":"CPT"},{"id":4537,"precertRequired":false,"billingCode":"73522","codeType":"CPT"},{"id":4538,"precertRequired":false,"billingCode":"73523","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"}],"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"}]},{"id":4648,"description":"Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","frequency":null,"frequencyType":"","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"},{"id":12191,"precertRequired":true,"billingCode":"0552T","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":544,"seocKey":25,"name":"Chiropractic Initial_PRCT","seocId":"PMR_CHIROPRACTIC INITIAL_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":"11-12-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.\r\n2. Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.\r\n3. Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote: *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","maxAllowableVisits":null,"disclaimer":"*All requests for additional therapeutic modalities require VA review. Additional chiropractic 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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":3140,"description":"Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"}],"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"}]},{"id":3141,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated. a) Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"}],"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"}]},{"id":3142,"description":"Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","frequency":null,"frequencyType":"week","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7261,"precertRequired":false,"billingCode":"97150","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7275,"precertRequired":false,"billingCode":"97533","codeType":"CPT"},{"id":7278,"precertRequired":false,"billingCode":"97542","codeType":"CPT"},{"id":7279,"precertRequired":false,"billingCode":"97545","codeType":"CPT"},{"id":7280,"precertRequired":false,"billingCode":"97546","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"}],"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"}]}]}},{"Seoc":{"id":437,"seocKey":25,"name":"Chiropractic Initial_PRCT","seocId":"PMR_CHIROPRACTIC INITIAL_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"05-21-2019","endDate":"07-28-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.\r\n2. Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.\r\n3. Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote: *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","maxAllowableVisits":null,"disclaimer":"*All requests for additional therapeutic modalities require VA review. Additional chiropractic 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*All requests for supplements will be routed through the VA.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":2363,"description":"Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"}],"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"}]},{"id":2364,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated. a) Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"}],"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"}]},{"id":2365,"description":"Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","frequency":null,"frequencyType":"week","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7261,"precertRequired":false,"billingCode":"97150","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7275,"precertRequired":false,"billingCode":"97533","codeType":"CPT"},{"id":7278,"precertRequired":false,"billingCode":"97542","codeType":"CPT"},{"id":7279,"precertRequired":false,"billingCode":"97545","codeType":"CPT"},{"id":7280,"precertRequired":false,"billingCode":"97546","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"}],"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"}]}]}},{"Seoc":{"id":202,"seocKey":25,"name":"Chiropractic Initial_PRCT","seocId":"PMR_CHIROPRACTIC INITIAL_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-03-2019","endDate":"05-21-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult\r\n2. Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach\r\n3. Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education","maxAllowableVisits":null,"disclaimer":"*All requests for additional therapeutic modalities require VA review. Additional chiropractic 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*All requests for supplements will be routed through the VA.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":783,"description":" Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":784,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated. a.Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"}],"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"}]},{"id":785,"description":"Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education","frequency":null,"frequencyType":"","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":132,"seocKey":25,"name":"Chiropractic Initial_PRCT","seocId":"PMR_CHIROPRACTIC INITIAL_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult\r\n2. Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach\r\n3. Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education","maxAllowableVisits":999,"disclaimer":"*All requests for additional therapeutic modalities require VA review. Additional chiropractic 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*All requests for supplements will be routed through the VA.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":99,"description":" Initial outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":100,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated. a.Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"}],"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"}]},{"id":101,"description":"Authorized up to twelve (12) chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education","frequency":null,"frequencyType":"","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":1,"seocKey":25,"name":"Chiropractic Care_PRCT","seocId":"PMR_CHIROPRACTIC CARE_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.\r\n","effectiveDate":"05-15-2017","endDate":"12-07-2018","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and manual manipulation therapy for the referred condition indicated on the consult.\r\n2. Standard imaging relevant to the referred condition should be completed at VA to extent possible.\r\n3. Office visits for this episode of care are limited to 12 visits per year. Chiropractic care justification must include a detailed plan with specific timeline linked to objective measurable improvement.\r\n4. Expectations of service for chiropractic treatment include:\r\na. Significant durable pain intensity decrease\r\nb. Functional improvement demonstrated by: clinically meaningful improvement on validated disease-specific outcomes instruments; return to work; and/or documented improvement in activities of daily living\r\n5. Documented decreased utilization of pain-related medications","maxAllowableVisits":12,"disclaimer":"** All requests for additional therapeutic modalities, including heat/cold modalities and massage therapy require VA review/approval.\r\n** All requests for supplements will be routed through the VA.\r\n** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1294,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1837,"seocKey":26,"name":"Chiropractic Continuation of Initial_PRCT","seocId":"PMR_CHIROPRACTIC CONTINUATION OF INITIAL_1.1.7_PRCT","versionNumber":"1.1.7","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.  The services below are a continuation of chiropractic care and require a prior evaluation and series of chiropractic care. In this situation, additional lasting improvement for this episode is expected. This includes the rare cases that have not resolved or plateaued within the initial 12-visit trial. Possible explanations for this include severe or emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.","effectiveDate":"06-08-2020","endDate":null,"duration":30,"REV":false,"PRCT":true,"proceduralOverview":"1.   Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult order.\r\n2.   Plain film x-ray of the region of complaint specified on the consult order if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.\r\n3.    Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":5838,"description":"Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult order.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":5839,"description":"Plain film x-ray of the region of complaint specified on the consult order if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4506,"precertRequired":false,"billingCode":"73020","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4533,"precertRequired":false,"billingCode":"73501","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4535,"precertRequired":false,"billingCode":"73503","codeType":"CPT"},{"id":4536,"precertRequired":false,"billingCode":"73521","codeType":"CPT"},{"id":4537,"precertRequired":false,"billingCode":"73522","codeType":"CPT"},{"id":4538,"precertRequired":false,"billingCode":"73523","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5840,"description":"Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7237,"precertRequired":false,"billingCode":"97010","codeType":"CPT"},{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7239,"precertRequired":false,"billingCode":"97014","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"},{"id":12191,"precertRequired":true,"billingCode":"0552T","codeType":"CPT"},{"id":13485,"precertRequired":false,"billingCode":"20560","codeType":"CPT"},{"id":13486,"precertRequired":false,"billingCode":"20561","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":1717,"seocKey":26,"name":"Chiropractic Continuation of Initial_PRCT","seocId":"PMR_CHIROPRACTIC CONTINUATION OF INITIAL_1.1.6_PRCT","versionNumber":"1.1.6","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult. The services below are a continuation of chiropractic care and require a prior evaluation and series of chiropractic care. In this situation, additional lasting improvement for this episode is expected. This includes the rare cases that have not resolved or plateaued within the initial 12-visit trial. Possible explanations for this include severe or emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.","effectiveDate":"01-24-2020","endDate":"06-08-2020","duration":30,"REV":false,"PRCT":true,"proceduralOverview":"1.    Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.\r\n2.   Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of  fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.\r\n3.    Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":4902,"description":"Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":4903,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4506,"precertRequired":false,"billingCode":"73020","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4533,"precertRequired":false,"billingCode":"73501","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4535,"precertRequired":false,"billingCode":"73503","codeType":"CPT"},{"id":4536,"precertRequired":false,"billingCode":"73521","codeType":"CPT"},{"id":4537,"precertRequired":false,"billingCode":"73522","codeType":"CPT"},{"id":4538,"precertRequired":false,"billingCode":"73523","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":4904,"description":"Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  \r\n*All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7237,"precertRequired":false,"billingCode":"97010","codeType":"CPT"},{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7239,"precertRequired":false,"billingCode":"97014","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"},{"id":12191,"precertRequired":true,"billingCode":"0552T","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":1655,"seocKey":26,"name":"Chiropractic Continuation of Initial_PRCT","seocId":"PMR_CHIROPRACTIC CONTINUATION OF INITIAL_1.1.5_PRCT","versionNumber":"1.1.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult. The services below are a continuation of chiropractic care and require a prior evaluation and series of chiropractic care. In this situation, additional lasting improvement for this episode is expected. This includes the rare cases that have not resolved or plateaued within the initial 12-visit trial. Possible explanations for this include severe or emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.","effectiveDate":"11-12-2019","endDate":"01-24-2020","duration":30,"REV":false,"PRCT":true,"proceduralOverview":"1.    Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.\r\n2.   Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of  fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.\r\n3.    Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","maxAllowableVisits":null,"disclaimer":"*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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":4643,"description":"Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":4644,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4506,"precertRequired":false,"billingCode":"73020","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4533,"precertRequired":false,"billingCode":"73501","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4535,"precertRequired":false,"billingCode":"73503","codeType":"CPT"},{"id":4536,"precertRequired":false,"billingCode":"73521","codeType":"CPT"},{"id":4537,"precertRequired":false,"billingCode":"73522","codeType":"CPT"},{"id":4538,"precertRequired":false,"billingCode":"73523","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":4645,"description":"Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  \r\n*All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"},{"id":12191,"precertRequired":true,"billingCode":"0552T","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":545,"seocKey":26,"name":"Chiropractic Continuation of Initial_PRCT","seocId":"PMR_CHIROPRACTIC CONTINUATION OF INITIAL_1.1.4_PRCT","versionNumber":"1.1.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult. The services below are a continuation of chiropractic care and require a prior evaluation and series of chiropractic care. In this situation, additional lasting improvement for this episode is expected. This includes the rare cases that have not resolved or plateaued within the initial 12-visit trial. Possible explanations for this include severe or emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.","effectiveDate":"07-28-2019","endDate":"11-12-2019","duration":30,"REV":false,"PRCT":true,"proceduralOverview":"1.    Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.\r\n2.   Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of  fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.\r\n3.    Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","maxAllowableVisits":null,"disclaimer":"*All requests for additional therapeutic modalities require VA review. Additional chiropractic 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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":3143,"description":"Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"}],"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"}]},{"id":3144,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3145,"description":"Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  \r\n*All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","frequency":null,"frequencyType":"week","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7261,"precertRequired":false,"billingCode":"97150","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7275,"precertRequired":false,"billingCode":"97533","codeType":"CPT"},{"id":7278,"precertRequired":false,"billingCode":"97542","codeType":"CPT"},{"id":7279,"precertRequired":false,"billingCode":"97545","codeType":"CPT"},{"id":7280,"precertRequired":false,"billingCode":"97546","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"}],"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"}]}]}},{"Seoc":{"id":427,"seocKey":26,"name":"Chiropractic Continuation of Initial_PRCT","seocId":"PMR_CHIROPRACTIC CONTINUATION OF INITIAL_1.1.3_PRCT","versionNumber":"1.1.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult. The services below are a continuation of chiropractic care and require a prior evaluation and series of chiropractic care. In this situation, additional lasting improvement for this episode is expected. This includes the rare cases that have not resolved or plateaued within the initial 12-visit trial. Possible explanations for this include severe or emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.","effectiveDate":"05-21-2019","endDate":"07-28-2019","duration":30,"REV":false,"PRCT":true,"proceduralOverview":"1.    Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.\r\n2.   Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of  fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.\r\n3.    Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  *All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","maxAllowableVisits":null,"disclaimer":"*All requests for additional therapeutic modalities require VA review. Additional chiropractic 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*All requests for supplements will be routed through the VA.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":2278,"description":"Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"}],"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"}]},{"id":2279,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated.\r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2280,"description":"Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote:  \r\n*All requests for additional therapeutic modalities require VA clinical review. Additional chiropractic 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","frequency":null,"frequencyType":"week","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7261,"precertRequired":false,"billingCode":"97150","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7275,"precertRequired":false,"billingCode":"97533","codeType":"CPT"},{"id":7278,"precertRequired":false,"billingCode":"97542","codeType":"CPT"},{"id":7279,"precertRequired":false,"billingCode":"97545","codeType":"CPT"},{"id":7280,"precertRequired":false,"billingCode":"97546","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"}],"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"}]}]}},{"Seoc":{"id":201,"seocKey":26,"name":"Chiropractic Continuation of Initial_PRCT","seocId":"PMR_CHIROPRACTIC CONTINUATION OF INITIAL_1.1.2_PRCT","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-03-2019","endDate":"05-21-2019","duration":30,"REV":false,"PRCT":true,"proceduralOverview":"The services below are a continuation of chiropractic care and require a prior evaluation and series of chiropractic care. In this situation, additional lasting improvement for this episode is expected. This includes the rare cases that have not resolved or plateaued within the initial 12-visit trial. Possible explanations for this include severe or emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.\r\n1. Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult\r\n2. Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated. \r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach\r\n3. Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education","maxAllowableVisits":null,"disclaimer":"*All requests for additional therapeutic modalities require VA review. Additional chiropractic 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*All requests for supplements will be routed through the VA.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":780,"description":"Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":781,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated. a.Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":782,"description":"Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":131,"seocKey":26,"name":"Chiropractic Continuation of Initial_PRCT","seocId":"PMR_CHIROPRACTIC CONTINUATION OF INITIAL_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":30,"REV":false,"PRCT":true,"proceduralOverview":"The services below are a continuation of chiropractic care and require a prior evaluation and series of chiropractic care. In this situation, additional lasting improvement for this episode is expected. This includes the rare cases that have not resolved or plateaued within the initial 12-visit trial. Possible explanations for this include severe or emerging complicating factors, substantial change in treatment plan, or unintended gaps in treatment plan.\r\n1. Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult\r\n2. Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated. \r\na. Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach\r\n3. Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education","maxAllowableVisits":999,"disclaimer":"*All requests for additional therapeutic modalities require VA review. Additional chiropractic 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*All requests for supplements will be routed through the VA.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":96,"description":"Additional outpatient evaluation and outpatient re-evaluation as clinically indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":97,"description":"Plain film x-ray of the region of complaint specified on the consult if not yet performed at the VA and is clinically indicated. a.Plain film x-ray imaging only when medically necessary based on widely-accepted indications such as clinical suspicion of fracture, dislocation, or other significant pathology. X-ray is not authorized for biomechanical/postural assessment, and/or determining manipulative technique approach.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":98,"description":"Six (6) Chiropractic Visits authorized. Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":1838,"seocKey":27,"name":"Chiropractic Pain Management_PRCT","seocId":"PMR_CHIROPRACTIC PAIN MANAGEMENT_1.2.7_PRCT","versionNumber":"1.2.7","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.   In this situation, additional lasting improvement beyond what was seen after the initial and/or continued trial is not expected. Patients have reported meaningful improvement of reasonable duration, but have plateaued and reached MMI from chiropractic care. Patients experience degradation in functional gains after some period when chiropractic care is withdrawn. All other indicated medical, psychological, behavioral and social interventions have been tried or considered. Appropriate active care and self-management strategies are part of the overall treatment plan and patients are compliant with recommendations.","effectiveDate":"06-08-2020","endDate":null,"duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.    Additional outpatient re-evaluation as clinically indicated on consult order.\r\n2.    Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote: Expectations of service for chiropractic chronic pain management include:\r\na. Assessment of patient function after a withdrawal of chiropractic care; AND\r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND\r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":5841,"description":"Additional outpatient re-evaluation as clinically indicated on consult order.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":5842,"description":"Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote: Expectations of service for chiropractic chronic pain management include:\r\na. Assessment of patient function after a withdrawal of chiropractic care; AND\r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND\r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","frequency":null,"frequencyType":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7237,"precertRequired":false,"billingCode":"97010","codeType":"CPT"},{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7239,"precertRequired":false,"billingCode":"97014","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"},{"id":12191,"precertRequired":true,"billingCode":"0552T","codeType":"CPT"},{"id":13485,"precertRequired":false,"billingCode":"20560","codeType":"CPT"},{"id":13486,"precertRequired":false,"billingCode":"20561","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":1719,"seocKey":27,"name":"Chiropractic Pain Management_PRCT","seocId":"PMR_CHIROPRACTIC PAIN MANAGEMENT_1.2.6_PRCT","versionNumber":"1.2.6","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult. In this situation, additional lasting improvement beyond what was seen after the initial and/or continued trial is not expected. Patients have reported meaningful improvement of reasonable duration, but have plateaued and reached MMI from chiropractic care. Patients experience degradation in functional gains after some period when chiropractic care is withdrawn. All other indicated medical, psychological, behavioral and social interventions have been tried or considered. Appropriate active care and self-management strategies are part of the overall treatment plan and patients are compliant with recommendations.","effectiveDate":"01-24-2020","endDate":"06-08-2020","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.    Additional outpatient re-evaluation as clinically indicated on consult.\r\n2.    Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education               \r\nNote: Expectations of service for chiropractic chronic pain management include: \r\na. Assessment of patient function after a withdrawal of chiropractic care; AND            \r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND      \r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":4908,"description":"Additional outpatient re-evaluation as clinically indicated on consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":4909,"description":"Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\nNote: Expectations of service for chiropractic chronic pain management include:\r\na. Assessment of patient function after a withdrawal of chiropractic care; AND\r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND\r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","frequency":null,"frequencyType":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7237,"precertRequired":false,"billingCode":"97010","codeType":"CPT"},{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7239,"precertRequired":false,"billingCode":"97014","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":7307,"precertRequired":false,"billingCode":"98929","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"},{"id":12191,"precertRequired":true,"billingCode":"0552T","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":1657,"seocKey":27,"name":"Chiropractic Pain Management_PRCT","seocId":"PMR_CHIROPRACTIC PAIN MANAGEMENT_1.2.5_PRCT","versionNumber":"1.2.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult. In this situation, additional lasting improvement beyond what was seen after the initial and/or continued trial is not expected. Patients have reported meaningful improvement of reasonable duration, but have plateaued and reached MMI from chiropractic care. Patients experience degradation in functional gains after some period when chiropractic care is withdrawn. All other indicated medical, psychological, behavioral and social interventions have been tried or considered. Appropriate active care and self-management strategies are part of the overall treatment plan and patients are compliant with recommendations.","effectiveDate":"11-12-2019","endDate":"01-24-2020","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.    Additional outpatient re-evaluation as clinically indicated on consult.\r\n2.    Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education               \r\nNote: Expectations of service for chiropractic chronic pain management include: \r\na. Assessment of patient function after a withdrawal of chiropractic care; AND            \r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND      \r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","maxAllowableVisits":null,"disclaimer":"*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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":4649,"description":"Additional outpatient re-evaluation as clinically indicated on consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":4650,"description":"Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education\r\na. Assessment of patient function after a withdrawal of chiropractic care; AND\r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND\r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","frequency":null,"frequencyType":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7299,"precertRequired":false,"billingCode":"97810","codeType":"CPT"},{"id":7300,"precertRequired":false,"billingCode":"97811","codeType":"CPT"},{"id":7301,"precertRequired":false,"billingCode":"97813","codeType":"CPT"},{"id":7302,"precertRequired":false,"billingCode":"97814","codeType":"CPT"},{"id":7307,"precertRequired":false,"billingCode":"98929","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"},{"id":12191,"precertRequired":true,"billingCode":"0552T","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":639,"seocKey":27,"name":"Chiropractic Pain Management_PRCT","seocId":"PMR_CHIROPRACTIC PAIN MANAGEMENT_1.2.4_PRCT","versionNumber":"1.2.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult. In this situation, additional lasting improvement beyond what was seen after the initial and/or continued trial is not expected. Patients have reported meaningful improvement of reasonable duration, but have plateaued and reached MMI from chiropractic care. Patients experience degradation in functional gains after some period when chiropractic care is withdrawn. All other indicated medical, psychological, behavioral and social interventions have been tried or considered. Appropriate active care and self-management strategies are part of the overall treatment plan and patients are compliant with recommendations.","effectiveDate":"07-28-2019","endDate":"11-12-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Additional outpatient re-evaluation as clinically indicated on consult.\r\n2. Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education                   \r\nNote: Expectations of service for chiropractic chronic pain management include:    \r\na. Assessment of patient function after a withdrawal of chiropractic care; AND                     \r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND               \r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","maxAllowableVisits":null,"disclaimer":"*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","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":3559,"description":"Additional outpatient re-evaluation as clinically indicated on consult.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"}],"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"}]},{"id":3560,"description":"Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education. Note: Expectations of service for chiropractic chronic pain management include:\r\na. Assessment of patient function after a withdrawal of chiropractic care; AND\r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND\r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","frequency":null,"frequencyType":"week","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7261,"precertRequired":false,"billingCode":"97150","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7275,"precertRequired":false,"billingCode":"97533","codeType":"CPT"},{"id":7278,"precertRequired":false,"billingCode":"97542","codeType":"CPT"},{"id":7279,"precertRequired":false,"billingCode":"97545","codeType":"CPT"},{"id":7280,"precertRequired":false,"billingCode":"97546","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"}],"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"}]}]}},{"Seoc":{"id":444,"seocKey":27,"name":"Chiropractic Pain Management_PRCT","seocId":"PMR_CHIROPRACTIC PAIN MANAGEMENT_1.2.3_PRCT","versionNumber":"1.2.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult. In this situation, additional lasting improvement beyond what was seen after the initial and/or continued trial is not expected. Patients have reported meaningful improvement of reasonable duration, but have plateaued and reached MMI from chiropractic care. Patients experience degradation in functional gains after some period when chiropractic care is withdrawn. All other indicated medical, psychological, behavioral and social interventions have been tried or considered. Appropriate active care and self-management strategies are part of the overall treatment plan and patients are compliant with recommendations.","effectiveDate":"05-21-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Additional outpatient re-evaluation as clinically indicated on consult.\r\n2. Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education                   \r\nNote: Expectations of service for chiropractic chronic pain management include:    \r\na. Assessment of patient function after a withdrawal of chiropractic care; AND                     \r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND               \r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","maxAllowableVisits":null,"disclaimer":"*All requests for additional therapeutic modalities require VA review. \r\n*All requests for supplements will be routed through the VA.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14 day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":2420,"description":"Additional outpatient re-evaluation as clinically indicated on consult.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"}],"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"}]},{"id":2421,"description":"Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education. Note: Expectations of service for chiropractic chronic pain management include:\r\na. Assessment of patient function after a withdrawal of chiropractic care; AND\r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND\r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","frequency":null,"frequencyType":"week","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7238,"precertRequired":false,"billingCode":"97012","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7249,"precertRequired":false,"billingCode":"97035","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7254,"precertRequired":false,"billingCode":"97113","codeType":"CPT"},{"id":7256,"precertRequired":false,"billingCode":"97116","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7258,"precertRequired":false,"billingCode":"97127","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7261,"precertRequired":false,"billingCode":"97150","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7275,"precertRequired":false,"billingCode":"97533","codeType":"CPT"},{"id":7278,"precertRequired":false,"billingCode":"97542","codeType":"CPT"},{"id":7279,"precertRequired":false,"billingCode":"97545","codeType":"CPT"},{"id":7280,"precertRequired":false,"billingCode":"97546","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"},{"id":8176,"precertRequired":false,"billingCode":"G0283","codeType":"HCPCS"}],"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"}]}]}},{"Seoc":{"id":203,"seocKey":27,"name":"Chiropractic Pain Management_PRCT","seocId":"PMR_CHIROPRACTIC PAIN MANAGEMENT_1.2.2_PRCT","versionNumber":"1.2.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-03-2019","endDate":"05-21-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"In this situation, additional lasting improvement beyond what was seen after the initial and/or continued trial is not expected. Patients have reported meaningful improvement of reasonable duration, but have plateaued and reached MMI from chiropractic care. Patients experience degradation in functional gains after some period when chiropractic care is withdrawn. All other indicated medical, psychological, behavioral and social interventions have been tried or considered. Appropriate active care and self-management strategies are part of the overall treatment plan and patients are compliant with recommendations. \r\n\r\n1. Additional outpatient re-evaluation as clinically indicated on consult\r\n2. Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education                          \r\nNote: Expectations of service for chiropractic chronic pain management include:            \r\na. Assessment of patient function after a withdrawal of chiropractic care; AND                       \r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND                  \r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","maxAllowableVisits":null,"disclaimer":"*All requests for additional therapeutic modalities require VA review.\r\n*All requests for supplements will be routed through the VA.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14 day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"111N00000X"}],"services":[{"id":786,"description":"Additional outpatient re-evaluation as clinically indicated on consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":787,"description":"Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education (see Procedural Overview no.2 for additional information)","frequency":null,"frequencyType":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":133,"seocKey":27,"name":"Chiropractic Pain Management_PRCT","seocId":"PMR_CHIROPRACTIC PAIN MANAGEMENT_1.2.1_PRCT","versionNumber":"1.2.1","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"In this situation, additional lasting improvement beyond what was seen after the initial and/or continued trial is not expected. Patients have reported meaningful improvement of reasonable duration, but have plateaued and reached MMI from chiropractic care. Patients experience degradation in functional gains after some period when chiropractic care is withdrawn. All other indicated medical, psychological, behavioral and social interventions have been tried or considered. Appropriate active care and self-management strategies are part of the overall treatment plan and patients are compliant with recommendations. \r\n\r\n1. Additional outpatient re-evaluation as clinically indicated on consult\r\n2. Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education                          \r\nNote: Expectations of service for chiropractic chronic pain management include:            \r\na. Assessment of patient function after a withdrawal of chiropractic care; AND                       \r\nb. Consideration of other indicated medical, psychological, behavioral, and/or social interventions; AND                  \r\nc. Inclusion of appropriate, individualized active care strategies such as home exercise and self-management approaches to empower patient self-efficacy","maxAllowableVisits":999,"disclaimer":"*All requests for additional therapeutic modalities require VA review.\r\n*All requests for supplements will be routed through the VA.\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14 day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Complementary & Integrative HC Services","categoryOfCare":"CHIROPRACTIC","serviceLine":"Physical Medicine and Rehabilitation","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":102,"description":"Additional outpatient re-evaluation as clinically indicated on consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"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"}]},{"id":103,"description":"Eight (8) authorized chiropractic visits.  Chiropractic services include: chiropractic manipulative treatment, manual therapy, therapeutic exercise, and/or neuromuscular re-education (see Procedural Overview no.2 for additional information)","frequency":null,"frequencyType":"","visits":8,"codeRequired":"YES","clinicalServices":[{"clinicalService":"35-Chiropractic"}],"billingCodes":[{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7257,"precertRequired":false,"billingCode":"97124","codeType":"CPT"},{"id":7260,"precertRequired":false,"billingCode":"97140","codeType":"CPT"},{"id":7308,"precertRequired":true,"billingCode":"98940","codeType":"CPT"},{"id":7309,"precertRequired":true,"billingCode":"98941","codeType":"CPT"},{"id":7310,"precertRequired":true,"billingCode":"98942","codeType":"CPT"},{"id":7311,"precertRequired":true,"billingCode":"98943","codeType":"CPT"}],"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"}]}]}},{"Seoc":{"id":62,"seocKey":28,"name":"Chronic Kidney Disease - Outpatient Education_PRCT","seocId":"MSC_CHRONIC KIDNEY DISEASE - OUTPATIENT EDUCATION_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"05-31-2018","endDate":"09-21-2018","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. Authorizes outpatient chronic kidney disease (CKD) education for six sessions per veteran with stage 4 or worse CKD on  kidney replacement options, medical nutritional  care, and related treatment of CKD\r\n2. All necessary training materials\r\n3. All necessary nutrition and other CKD- related health care  professional education services. Recommend SEOC group look at how this is billed by Medicare for further details.","maxAllowableVisits":999,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** All routine medications will be provided by the VA as prescribed by the consulting community contract nephrologist in accordance with the VA national medication formulary and non-formulary request process. \r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.","QASP":"General Care","categoryOfCare":"NEPHROLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1323,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":311,"seocKey":29,"name":"Chronic Pain management; IR-injections_PRCT","seocId":"MSC_CHRONIC PAIN MANAGEMENT; IR-INJECTIONS_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"02-19-2019","endDate":"05-23-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic images/laboratories/studies relevant to the referred condition\r\n3. Clinically indicated treatment/procedures to include:\r\n4. Epidural steroid injections; up to three (3) injections\r\n5. Medial branch blocks/Facet injections, multilevel; up to three (3) injections per side (left/right) in cervical and/or lumbar spine\r\n6. Anesthesia consultation related to a procedure\r\n7. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n8. Inpatient admission or observation status for complications related to a procedure\r\n9. Follow-up for this episode of care are expected to average up to 3 visits.\r\n10.  Follow-up images/studies/laboratories for the referred condition","maxAllowableVisits":null,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"PAIN MANAGEMENT","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"208VP0000X"},{"hptc":"208VP0014X"}],"services":[{"id":1382,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":1383,"description":"Diagnostic images/laboratories/studies relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":5054,"precertRequired":false,"billingCode":"80300","codeType":"CPT"},{"id":5055,"precertRequired":false,"billingCode":"80301","codeType":"CPT"},{"id":8227,"precertRequired":false,"billingCode":"G0477","codeType":"HCPCS"},{"id":8228,"precertRequired":false,"billingCode":"G0478","codeType":"HCPCS"},{"id":8229,"precertRequired":false,"billingCode":"G0479","codeType":"HCPCS"},{"id":8230,"precertRequired":false,"billingCode":"G0480","codeType":"HCPCS"},{"id":8231,"precertRequired":false,"billingCode":"G0481","codeType":"HCPCS"},{"id":8232,"precertRequired":false,"billingCode":"G0482","codeType":"HCPCS"},{"id":8233,"precertRequired":false,"billingCode":"G0483","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1384,"description":"Epidural steroid injections; up to three (3) injections","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":1373,"precertRequired":true,"billingCode":"27096","codeType":"CPT"},{"id":3896,"precertRequired":false,"billingCode":"62310","codeType":"CPT"},{"id":3897,"precertRequired":true,"billingCode":"62320","codeType":"CPT"},{"id":3898,"precertRequired":true,"billingCode":"62321","codeType":"CPT"},{"id":3899,"precertRequired":true,"billingCode":"62322","codeType":"CPT"},{"id":3900,"precertRequired":true,"billingCode":"62323","codeType":"CPT"},{"id":3914,"precertRequired":true,"billingCode":"64402","codeType":"CPT"},{"id":3915,"precertRequired":true,"billingCode":"64405","codeType":"CPT"},{"id":3916,"precertRequired":true,"billingCode":"64408","codeType":"CPT"},{"id":3917,"precertRequired":true,"billingCode":"64410","codeType":"CPT"},{"id":3918,"precertRequired":false,"billingCode":"64412","codeType":"CPT"},{"id":3919,"precertRequired":true,"billingCode":"64413","codeType":"CPT"},{"id":3920,"precertRequired":true,"billingCode":"64415","codeType":"CPT"},{"id":3921,"precertRequired":true,"billingCode":"64416","codeType":"CPT"},{"id":3922,"precertRequired":true,"billingCode":"64417","codeType":"CPT"},{"id":3923,"precertRequired":true,"billingCode":"64418","codeType":"CPT"},{"id":3924,"precertRequired":true,"billingCode":"64420","codeType":"CPT"},{"id":3925,"precertRequired":true,"billingCode":"64421","codeType":"CPT"},{"id":3926,"precertRequired":true,"billingCode":"64425","codeType":"CPT"},{"id":3927,"precertRequired":true,"billingCode":"64430","codeType":"CPT"},{"id":3928,"precertRequired":true,"billingCode":"64435","codeType":"CPT"},{"id":3929,"precertRequired":true,"billingCode":"64445","codeType":"CPT"},{"id":3930,"precertRequired":true,"billingCode":"64446","codeType":"CPT"},{"id":3931,"precertRequired":true,"billingCode":"64447","codeType":"CPT"},{"id":3932,"precertRequired":true,"billingCode":"64448","codeType":"CPT"},{"id":3934,"precertRequired":true,"billingCode":"64450","codeType":"CPT"},{"id":3935,"precertRequired":true,"billingCode":"64455","codeType":"CPT"},{"id":3939,"precertRequired":true,"billingCode":"64479","codeType":"CPT"},{"id":3940,"precertRequired":true,"billingCode":"64480","codeType":"CPT"},{"id":3941,"precertRequired":true,"billingCode":"64483","codeType":"CPT"},{"id":3942,"precertRequired":true,"billingCode":"64484","codeType":"CPT"},{"id":3943,"precertRequired":true,"billingCode":"64486","codeType":"CPT"},{"id":3944,"precertRequired":true,"billingCode":"64487","codeType":"CPT"},{"id":3945,"precertRequired":true,"billingCode":"64488","codeType":"CPT"},{"id":3946,"precertRequired":true,"billingCode":"64489","codeType":"CPT"},{"id":3947,"precertRequired":true,"billingCode":"64490","codeType":"CPT"},{"id":3948,"precertRequired":true,"billingCode":"64491","codeType":"CPT"},{"id":3949,"precertRequired":true,"billingCode":"64492","codeType":"CPT"},{"id":3950,"precertRequired":true,"billingCode":"64493","codeType":"CPT"},{"id":3951,"precertRequired":true,"billingCode":"64494","codeType":"CPT"},{"id":3952,"precertRequired":true,"billingCode":"64495","codeType":"CPT"},{"id":3987,"precertRequired":true,"billingCode":"64635","codeType":"CPT"},{"id":3988,"precertRequired":true,"billingCode":"64636","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4777,"precertRequired":true,"billingCode":"77003","codeType":"CPT"},{"id":8390,"precertRequired":true,"billingCode":"J0702","codeType":"HCPCS"},{"id":8406,"precertRequired":true,"billingCode":"J1020","codeType":"HCPCS"},{"id":8407,"precertRequired":true,"billingCode":"J1030","codeType":"HCPCS"},{"id":8408,"precertRequired":true,"billingCode":"J1040","codeType":"HCPCS"},{"id":8459,"precertRequired":true,"billingCode":"J2001","codeType":"HCPCS"},{"id":8504,"precertRequired":true,"billingCode":"J3301","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":1385,"description":"Medial branch blocks/Facet injections, multilevel; up to three (3) injections per side (left/right) in cervical and/or lumbar spine","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":3934,"precertRequired":true,"billingCode":"64450","codeType":"CPT"},{"id":3948,"precertRequired":true,"billingCode":"64491","codeType":"CPT"},{"id":3949,"precertRequired":true,"billingCode":"64492","codeType":"CPT"},{"id":3950,"precertRequired":true,"billingCode":"64493","codeType":"CPT"},{"id":3951,"precertRequired":true,"billingCode":"64494","codeType":"CPT"},{"id":3952,"precertRequired":true,"billingCode":"64495","codeType":"CPT"},{"id":3987,"precertRequired":true,"billingCode":"64635","codeType":"CPT"},{"id":3988,"precertRequired":true,"billingCode":"64636","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":1386,"description":"Anesthesia consultation related to a procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1387,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":1388,"description":"Inpatient admission or observation status for complications related to a procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":1389,"description":"Follow-up for this episode of care are expected to average up to 3 visits","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":1390,"description":"Follow-up images/studies/laboratories for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":204,"seocKey":29,"name":"Chronic Pain management; IR-injections_PRCT","seocId":"MSC_CHRONIC PAIN MANAGEMENT; IR-INJECTIONS_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"02-19-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic images/laboratories/studies relevant to the referred condition\r\n3. Clinically indicated treatment/procedures to include:\r\n4. Epidural steroid injections; up to three (3) injections\r\n5. Medial branch blocks/Facet injections, multilevel; up to three (3) injections per side (left/right) in cervical and/or lumbar spine\r\n6. Anesthesia consultation related to a procedure\r\n7. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n8. Inpatient admission or observation status for complications related to a procedure\r\n9.  Follow-up images/studies/laboratories for the referred condition","maxAllowableVisits":null,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"PAIN MANAGEMENT","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"208VP0000X"},{"hptc":"208VP0014X"}],"services":[{"id":788,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":789,"description":"Diagnostic images/laboratories/studies relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":5054,"precertRequired":false,"billingCode":"80300","codeType":"CPT"},{"id":5055,"precertRequired":false,"billingCode":"80301","codeType":"CPT"},{"id":8227,"precertRequired":false,"billingCode":"G0477","codeType":"HCPCS"},{"id":8228,"precertRequired":false,"billingCode":"G0478","codeType":"HCPCS"},{"id":8229,"precertRequired":false,"billingCode":"G0479","codeType":"HCPCS"},{"id":8230,"precertRequired":false,"billingCode":"G0480","codeType":"HCPCS"},{"id":8231,"precertRequired":false,"billingCode":"G0481","codeType":"HCPCS"},{"id":8232,"precertRequired":false,"billingCode":"G0482","codeType":"HCPCS"},{"id":8233,"precertRequired":false,"billingCode":"G0483","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":790,"description":"Epidural steroid injections; up to three (3) injections","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":1373,"precertRequired":true,"billingCode":"27096","codeType":"CPT"},{"id":3896,"precertRequired":false,"billingCode":"62310","codeType":"CPT"},{"id":3897,"precertRequired":true,"billingCode":"62320","codeType":"CPT"},{"id":3898,"precertRequired":true,"billingCode":"62321","codeType":"CPT"},{"id":3899,"precertRequired":true,"billingCode":"62322","codeType":"CPT"},{"id":3900,"precertRequired":true,"billingCode":"62323","codeType":"CPT"},{"id":3914,"precertRequired":true,"billingCode":"64402","codeType":"CPT"},{"id":3915,"precertRequired":true,"billingCode":"64405","codeType":"CPT"},{"id":3916,"precertRequired":true,"billingCode":"64408","codeType":"CPT"},{"id":3917,"precertRequired":true,"billingCode":"64410","codeType":"CPT"},{"id":3918,"precertRequired":false,"billingCode":"64412","codeType":"CPT"},{"id":3919,"precertRequired":true,"billingCode":"64413","codeType":"CPT"},{"id":3920,"precertRequired":true,"billingCode":"64415","codeType":"CPT"},{"id":3921,"precertRequired":true,"billingCode":"64416","codeType":"CPT"},{"id":3922,"precertRequired":true,"billingCode":"64417","codeType":"CPT"},{"id":3923,"precertRequired":true,"billingCode":"64418","codeType":"CPT"},{"id":3924,"precertRequired":true,"billingCode":"64420","codeType":"CPT"},{"id":3925,"precertRequired":true,"billingCode":"64421","codeType":"CPT"},{"id":3926,"precertRequired":true,"billingCode":"64425","codeType":"CPT"},{"id":3927,"precertRequired":true,"billingCode":"64430","codeType":"CPT"},{"id":3928,"precertRequired":true,"billingCode":"64435","codeType":"CPT"},{"id":3929,"precertRequired":true,"billingCode":"64445","codeType":"CPT"},{"id":3930,"precertRequired":true,"billingCode":"64446","codeType":"CPT"},{"id":3931,"precertRequired":true,"billingCode":"64447","codeType":"CPT"},{"id":3932,"precertRequired":true,"billingCode":"64448","codeType":"CPT"},{"id":3934,"precertRequired":true,"billingCode":"64450","codeType":"CPT"},{"id":3935,"precertRequired":true,"billingCode":"64455","codeType":"CPT"},{"id":3939,"precertRequired":true,"billingCode":"64479","codeType":"CPT"},{"id":3940,"precertRequired":true,"billingCode":"64480","codeType":"CPT"},{"id":3941,"precertRequired":true,"billingCode":"64483","codeType":"CPT"},{"id":3942,"precertRequired":true,"billingCode":"64484","codeType":"CPT"},{"id":3943,"precertRequired":true,"billingCode":"64486","codeType":"CPT"},{"id":3944,"precertRequired":true,"billingCode":"64487","codeType":"CPT"},{"id":3945,"precertRequired":true,"billingCode":"64488","codeType":"CPT"},{"id":3946,"precertRequired":true,"billingCode":"64489","codeType":"CPT"},{"id":3947,"precertRequired":true,"billingCode":"64490","codeType":"CPT"},{"id":3948,"precertRequired":true,"billingCode":"64491","codeType":"CPT"},{"id":3949,"precertRequired":true,"billingCode":"64492","codeType":"CPT"},{"id":3950,"precertRequired":true,"billingCode":"64493","codeType":"CPT"},{"id":3951,"precertRequired":true,"billingCode":"64494","codeType":"CPT"},{"id":3952,"precertRequired":true,"billingCode":"64495","codeType":"CPT"},{"id":3987,"precertRequired":true,"billingCode":"64635","codeType":"CPT"},{"id":3988,"precertRequired":true,"billingCode":"64636","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4777,"precertRequired":true,"billingCode":"77003","codeType":"CPT"},{"id":8390,"precertRequired":true,"billingCode":"J0702","codeType":"HCPCS"},{"id":8406,"precertRequired":true,"billingCode":"J1020","codeType":"HCPCS"},{"id":8407,"precertRequired":true,"billingCode":"J1030","codeType":"HCPCS"},{"id":8408,"precertRequired":true,"billingCode":"J1040","codeType":"HCPCS"},{"id":8459,"precertRequired":true,"billingCode":"J2001","codeType":"HCPCS"},{"id":8504,"precertRequired":true,"billingCode":"J3301","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":791,"description":"Medial branch blocks/Facet injections, multilevel; up to three (3) injections per side (left/right) in cervical and/or lumbar spine","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":3934,"precertRequired":true,"billingCode":"64450","codeType":"CPT"},{"id":3948,"precertRequired":true,"billingCode":"64491","codeType":"CPT"},{"id":3949,"precertRequired":true,"billingCode":"64492","codeType":"CPT"},{"id":3950,"precertRequired":true,"billingCode":"64493","codeType":"CPT"},{"id":3951,"precertRequired":true,"billingCode":"64494","codeType":"CPT"},{"id":3952,"precertRequired":true,"billingCode":"64495","codeType":"CPT"},{"id":3987,"precertRequired":true,"billingCode":"64635","codeType":"CPT"},{"id":3988,"precertRequired":true,"billingCode":"64636","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":792,"description":"Anesthesia consultation related to a procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":793,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":794,"description":"Inpatient admission or observation status for complications related to a procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":795,"description":"Follow-up for this episode of care are expected to average up to 3 visits","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":796,"description":"Follow-up images/studies/laboratories for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":2,"seocKey":29,"name":"Chronic Pain management; IR-injections_PRCT","seocId":"MSC_CHRONIC PAIN MANAGEMENT; IR-INJECTIONS_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"05-15-2017","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic images/laboratories/studies relevant to the referred condition\r\n3. Clinically indicated treatment/procedures to include:\r\n4. Epidural steroid injections; up to three (3) injections\r\n5. Medial branch blocks/Facet injections, multilevel; up to three (3) injections per side (left/right) in cervical and/or lumbar spine\r\n6. Anesthesia consultation related to a procedure\r\n7. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n8. Inpatient admission or observation status for complications related to a procedure\r\n9.  Follow-up images/studies/laboratories for the referred condition","maxAllowableVisits":999,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"PAIN MANAGEMENT","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":428,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":429,"description":"Diagnostic images/laboratories/studies relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":5054,"precertRequired":false,"billingCode":"80300","codeType":"CPT"},{"id":5055,"precertRequired":false,"billingCode":"80301","codeType":"CPT"},{"id":8227,"precertRequired":false,"billingCode":"G0477","codeType":"HCPCS"},{"id":8228,"precertRequired":false,"billingCode":"G0478","codeType":"HCPCS"},{"id":8229,"precertRequired":false,"billingCode":"G0479","codeType":"HCPCS"},{"id":8230,"precertRequired":false,"billingCode":"G0480","codeType":"HCPCS"},{"id":8231,"precertRequired":false,"billingCode":"G0481","codeType":"HCPCS"},{"id":8232,"precertRequired":false,"billingCode":"G0482","codeType":"HCPCS"},{"id":8233,"precertRequired":false,"billingCode":"G0483","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":430,"description":"Epidural steroid injections; up to three (3) injections","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":1373,"precertRequired":true,"billingCode":"27096","codeType":"CPT"},{"id":3896,"precertRequired":false,"billingCode":"62310","codeType":"CPT"},{"id":3897,"precertRequired":true,"billingCode":"62320","codeType":"CPT"},{"id":3898,"precertRequired":true,"billingCode":"62321","codeType":"CPT"},{"id":3899,"precertRequired":true,"billingCode":"62322","codeType":"CPT"},{"id":3900,"precertRequired":true,"billingCode":"62323","codeType":"CPT"},{"id":3914,"precertRequired":true,"billingCode":"64402","codeType":"CPT"},{"id":3915,"precertRequired":true,"billingCode":"64405","codeType":"CPT"},{"id":3916,"precertRequired":true,"billingCode":"64408","codeType":"CPT"},{"id":3917,"precertRequired":true,"billingCode":"64410","codeType":"CPT"},{"id":3918,"precertRequired":false,"billingCode":"64412","codeType":"CPT"},{"id":3919,"precertRequired":true,"billingCode":"64413","codeType":"CPT"},{"id":3920,"precertRequired":true,"billingCode":"64415","codeType":"CPT"},{"id":3921,"precertRequired":true,"billingCode":"64416","codeType":"CPT"},{"id":3922,"precertRequired":true,"billingCode":"64417","codeType":"CPT"},{"id":3923,"precertRequired":true,"billingCode":"64418","codeType":"CPT"},{"id":3924,"precertRequired":true,"billingCode":"64420","codeType":"CPT"},{"id":3925,"precertRequired":true,"billingCode":"64421","codeType":"CPT"},{"id":3926,"precertRequired":true,"billingCode":"64425","codeType":"CPT"},{"id":3927,"precertRequired":true,"billingCode":"64430","codeType":"CPT"},{"id":3928,"precertRequired":true,"billingCode":"64435","codeType":"CPT"},{"id":3929,"precertRequired":true,"billingCode":"64445","codeType":"CPT"},{"id":3930,"precertRequired":true,"billingCode":"64446","codeType":"CPT"},{"id":3931,"precertRequired":true,"billingCode":"64447","codeType":"CPT"},{"id":3932,"precertRequired":true,"billingCode":"64448","codeType":"CPT"},{"id":3934,"precertRequired":true,"billingCode":"64450","codeType":"CPT"},{"id":3935,"precertRequired":true,"billingCode":"64455","codeType":"CPT"},{"id":3939,"precertRequired":true,"billingCode":"64479","codeType":"CPT"},{"id":3940,"precertRequired":true,"billingCode":"64480","codeType":"CPT"},{"id":3941,"precertRequired":true,"billingCode":"64483","codeType":"CPT"},{"id":3942,"precertRequired":true,"billingCode":"64484","codeType":"CPT"},{"id":3943,"precertRequired":true,"billingCode":"64486","codeType":"CPT"},{"id":3944,"precertRequired":true,"billingCode":"64487","codeType":"CPT"},{"id":3945,"precertRequired":true,"billingCode":"64488","codeType":"CPT"},{"id":3946,"precertRequired":true,"billingCode":"64489","codeType":"CPT"},{"id":3947,"precertRequired":true,"billingCode":"64490","codeType":"CPT"},{"id":3948,"precertRequired":true,"billingCode":"64491","codeType":"CPT"},{"id":3949,"precertRequired":true,"billingCode":"64492","codeType":"CPT"},{"id":3950,"precertRequired":true,"billingCode":"64493","codeType":"CPT"},{"id":3951,"precertRequired":true,"billingCode":"64494","codeType":"CPT"},{"id":3952,"precertRequired":true,"billingCode":"64495","codeType":"CPT"},{"id":3987,"precertRequired":true,"billingCode":"64635","codeType":"CPT"},{"id":3988,"precertRequired":true,"billingCode":"64636","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4777,"precertRequired":true,"billingCode":"77003","codeType":"CPT"},{"id":8390,"precertRequired":true,"billingCode":"J0702","codeType":"HCPCS"},{"id":8406,"precertRequired":true,"billingCode":"J1020","codeType":"HCPCS"},{"id":8407,"precertRequired":true,"billingCode":"J1030","codeType":"HCPCS"},{"id":8408,"precertRequired":true,"billingCode":"J1040","codeType":"HCPCS"},{"id":8459,"precertRequired":true,"billingCode":"J2001","codeType":"HCPCS"},{"id":8504,"precertRequired":true,"billingCode":"J3301","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":431,"description":"Medial branch blocks/Facet injections, multilevel; up to three (3) injections per side (left/right) in cervical and/or lumbar spine","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":3934,"precertRequired":true,"billingCode":"64450","codeType":"CPT"},{"id":3948,"precertRequired":true,"billingCode":"64491","codeType":"CPT"},{"id":3949,"precertRequired":true,"billingCode":"64492","codeType":"CPT"},{"id":3950,"precertRequired":true,"billingCode":"64493","codeType":"CPT"},{"id":3951,"precertRequired":true,"billingCode":"64494","codeType":"CPT"},{"id":3952,"precertRequired":true,"billingCode":"64495","codeType":"CPT"},{"id":3987,"precertRequired":true,"billingCode":"64635","codeType":"CPT"},{"id":3988,"precertRequired":true,"billingCode":"64636","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":432,"description":"Anesthesia consultation related to a procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":433,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":434,"description":"Inpatient admission or observation status for complications related to a procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":435,"description":"Follow-up for this episode of care are expected to average up to 3 visits","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"72-Pain management"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0000X"}]},{"id":436,"description":"Follow-up images/studies/laboratories for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":205,"seocKey":30,"name":"Chronic Pain management; Spinal cord stimulator_PRCT","seocId":"MSC_CHRONIC PAIN MANAGEMENT; SPINAL CORD STIMULATOR_1.1.2_PRCT","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"05-23-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic images/laboratories/studies relevant to the patient referred condition\r\n3. Clinically indicated treatment/procedures to include:\r\n4. Spinal cord stimulator; SCS trial\r\n5. Permanent implant of spinal cord stimulator\r\n6. Anesthesia consultation related to the procedure\r\n7. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n8. Inpatient admission or observation status for complications related to the procedure\r\n9. Follow-up visits for this episode of care x 3 visits\r\n10. Follow-up images/studies/laboratories as clinically indicated","maxAllowableVisits":null,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"PAIN MANAGEMENT","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207L00000X"},{"hptc":"207LP2900X"},{"hptc":"207T00000X"},{"hptc":"207X00000X"},{"hptc":"2085R0202X"},{"hptc":"208VP0000X"}],"services":[{"id":797,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":798,"description":"Diagnostic images/laboratories/studies relevant to the patient referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":5054,"precertRequired":false,"billingCode":"80300","codeType":"CPT"},{"id":5055,"precertRequired":false,"billingCode":"80301","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":799,"description":" Spinal cord stimulator; SCS trial","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":800,"description":" Permanent implant of spinal cord stimulator","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":801,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":802,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":803,"description":"Inpatient admission or observation status for complications related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":804,"description":"Follow-up visits for this episode of care x 3 visits","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":805,"description":"Follow-up images/studies/laboratories as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":3,"seocKey":30,"name":"Chronic Pain management; Spinal cord stimulator_PRCT","seocId":"MSC_CHRONIC PAIN MANAGEMENT; SPINAL CORD STIMULATOR_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"05-15-2017","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic images/laboratories/studies relevant to the patient referred condition\r\n3. Clinically indicated treatment/procedures to include:\r\n4. Spinal cord stimulator; SCS trial\r\n5. Permanent implant of spinal cord stimulator\r\n6. Anesthesia consultation related to the procedure\r\n7. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n8. Inpatient admission or observation status for complications related to the procedure\r\n9. Follow-up visits for this episode of care x 3 visits\r\n10. Follow-up images/studies/laboratories as clinically indicated","maxAllowableVisits":999,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"PAIN MANAGEMENT","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":437,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":438,"description":"Diagnostic images/laboratories/studies relevant to the patient referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":5054,"precertRequired":false,"billingCode":"80300","codeType":"CPT"},{"id":5055,"precertRequired":false,"billingCode":"80301","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":439,"description":" Spinal cord stimulator; SCS trial","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":440,"description":" Permanent implant of spinal cord stimulator","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":441,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":442,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":443,"description":"Inpatient admission or observation status for complications related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":444,"description":"Follow-up visits for this episode of care x 3 visits","frequency":null,"frequencyType":"","visits":3,"codeRequired":"YES","clinicalServices":[{"clinicalService":"09-Interventional pain management"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"208VP0014X"}]},{"id":445,"description":"Follow-up images/studies/laboratories as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":489,"seocKey":31,"name":"Audiology Cochlear Implant Surgery and Follow Up_PRCT","seocId":"AUD_AUDIOLOGY COCHLEAR IMPLANT SURGERY AND FOLLOW UP_1.2.3_PRCT","versionNumber":"1.2.3","description":"This authorization covers services associated with all medical care listed below as for the referred condition. This SEOC does not cover osseointegrated hearing aids. Prior to authorization of cochlear implant surgery, cochlear implant candidacy documentation is required to be sent to the VA Centralized Audiology Team (please refer to disclaimer below).","effectiveDate":"07-28-2019","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Surgical evaluation as clinically indicated for the referred condition on the consult\r\n3. Immunizations as recommended by CDC\r\n4. Diagnostic imaging relevant to the referred condition on the consult\r\n5. Labs and pathology relevant to the referred condition on the consult\r\n6. Diagnostic studies relevant to the referred condition on the consult\r\n7. Anesthesia consultation related to the procedure\r\n8. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n9. One Cochlear Implant Surgery and hospitalization if required (inpatient admission or observation)\r\n10. Inpatient admission or observation status for complications related to the procedure       ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n11. Follow up visits with the surgeon\r\n12. Post-op imaging\r\n13. Post-operative cochlear implant follow up after the surgery with the audiologist for the initial activation and then at a minimum of 1 month, 3 months, 6 months, 9 months and 12 months post-procedure","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"207Y00000X"}],"services":[{"id":2819,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2820,"description":"Surgical evaluation as clinically indicated for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2821,"description":"Immunizations as recommended by CDC","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":8113,"precertRequired":false,"billingCode":"G0009","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2822,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2823,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":2824,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2825,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":8331,"precertRequired":false,"billingCode":"G9654","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":2826,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5121,"precertRequired":false,"billingCode":"80410","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2827,"description":"One Cochlear Implant Surgery and hospitalization if required (inpatient admission or observation).","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4364,"precertRequired":false,"billingCode":"69930","codeType":"CPT"},{"id":4365,"precertRequired":false,"billingCode":"69990","codeType":"CPT"},{"id":7133,"precertRequired":false,"billingCode":"95940","codeType":"CPT"},{"id":7134,"precertRequired":false,"billingCode":"95941","codeType":"CPT"},{"id":8698,"precertRequired":false,"billingCode":"L8614","codeType":"HCPCS"},{"id":8703,"precertRequired":false,"billingCode":"L8619","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2828,"description":"Inpatient admission or observation status for complications related to the procedure       ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2829,"description":"Follow up visits with the surgeon","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":2830,"description":"Post-op imaging","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2831,"description":"Post-operative cochlear implant follow up after the surgery with the audiologist for the initial activation and then at a minimum of 1 month, 3 months, 6 months, 9 months and 12 months post-procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":190,"seocKey":31,"name":"Audiology Cochlear Implant Surgery and Follow Up PRCT_PRCT","seocId":"AUD_AUDIOLOGY COCHLEAR IMPLANT SURGERY AND FOLLOW UP PRCT_1.2.2_PRCT","versionNumber":"1.2.2","description":"This authorization covers services associated with all medical care listed below as for the referred condition. This SEOC does not cover osseointegrated hearing aids. Prior to authorization of cochlear implant surgery, cochlear implant candidacy documentation is required to be sent to the VA Centralized Audiology Team (please refer to disclaimer below).","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Surgical evaluation as clinically indicated for the referred condition on the consult\r\n3. Immunizations as recommended by CDC\r\n4. Diagnostic imaging relevant to the referred condition on the consult\r\n5. Labs and pathology relevant to the referred condition on the consult\r\n6. Diagnostic studies relevant to the referred condition on the consult\r\n7. Anesthesia consultation related to the procedure\r\n8. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n9. One Cochlear Implant Surgery and hospitalization if required (inpatient admission or observation)\r\n10. Inpatient admission or observation status for complications related to the procedure       ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n11. Follow up visits with the surgeon\r\n12. Post-op imaging\r\n13. Post-operative cochlear implant follow up after the surgery with the audiologist for the initial activation and then at a minimum of 1 month, 3 months, 6 months, 9 months and 12 months post-procedure","maxAllowableVisits":null,"disclaimer":"*Device is included in the billing code. VA will not be providing the device, the community provider is reimbursed through the Medicare code for the devices.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prothetics department for provision.\r\n* Prior to authorization of implant surgery, cochlear implant candidacy documentation would be sent to the VA Centralized Audiology Team. Their phone number is (720) 497-2330 and their email is VACAT@va.gov \r\n* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"207Y00000X"}],"services":[{"id":700,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":701,"description":"Surgical evaluation as clinically indicated for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":702,"description":"Immunizations as recommended by CDC","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":8113,"precertRequired":false,"billingCode":"G0009","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":703,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":704,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":705,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":706,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":707,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5121,"precertRequired":false,"billingCode":"80410","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":708,"description":"One Cochlear Implant Surgery and hospitalization if required (inpatient admission or observation).","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4364,"precertRequired":false,"billingCode":"69930","codeType":"CPT"},{"id":4365,"precertRequired":false,"billingCode":"69990","codeType":"CPT"},{"id":7133,"precertRequired":false,"billingCode":"95940","codeType":"CPT"},{"id":8698,"precertRequired":false,"billingCode":"L8614","codeType":"HCPCS"},{"id":8703,"precertRequired":false,"billingCode":"L8619","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":709,"description":"Inpatient admission or observation status for complications related to the procedure       ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":710,"description":"Follow up visits with the surgeon","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":711,"description":" Post-op imaging","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":712,"description":"Post-operative cochlear implant follow up after the surgery with the audiologist for the initial activation and then at a minimum of 1 month, 3 months, 6 months, 9 months and 12 months post-procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":134,"seocKey":31,"name":"Audiology Cochlear Implant Surgery and Follow Up PRCT_PRCT","seocId":"AUD_AUDIOLOGY COCHLEAR IMPLANT SURGERY AND FOLLOW UP PRCT_1.2.1_PRCT","versionNumber":"1.2.1","description":"This authorization covers services associated with all medical care listed below as for the referred condition. This SEOC does not cover osseointegrated hearing aids. Prior to authorization of cochlear implant surgery, cochlear implant candidacy documentation is required to be sent to the VA Centralized Audiology Team (please refer to disclaimer below).","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Surgical evaluation as clinically indicated for the referred condition on the consult\r\n3. Immunizations as recommended by CDC\r\n4. Diagnostic imaging relevant to the referred condition on the consult\r\n5. Labs and pathology relevant to the referred condition on the consult\r\n6. Diagnostic studies relevant to the referred condition on the consult\r\n7. Anesthesia consultation related to the procedure\r\n8. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n9. One Cochlear Implant Surgery and hospitalization if required (inpatient admission or observation)\r\n10. Inpatient admission or observation status for complications related to the procedure       ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n11. Follow up visits with the surgeon\r\n12. Post-op imaging\r\n13. Post-operative cochlear implant follow up after the surgery with the audiologist for the initial activation and then at a minimum of 1 month, 3 months, 6 months, 9 months and 12 months post-procedure","maxAllowableVisits":999,"disclaimer":"*Device is included in the billing code. VA will not be providing the device, the community provider is reimbursed through the Medicare code for the devices.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prothetics department for provision.\r\n* Prior to authorization of implant surgery, cochlear implant candidacy documentation would be sent to the VA Centralized Audiology Team. Their phone number is (720) 497-2330 and their email is VACAT@va.gov \r\n* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"AUDIOLOGY","serviceLine":"Audiology","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":20,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":21,"description":"Surgical evaluation as clinically indicated for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":22,"description":"Immunizations as recommended by CDC","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":8113,"precertRequired":false,"billingCode":"G0009","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":23,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":24,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":25,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":26,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":27,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5121,"precertRequired":false,"billingCode":"80410","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":28,"description":"One Cochlear Implant Surgery and hospitalization if required (inpatient admission or observation).","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":4364,"precertRequired":false,"billingCode":"69930","codeType":"CPT"},{"id":4365,"precertRequired":false,"billingCode":"69990","codeType":"CPT"},{"id":7133,"precertRequired":false,"billingCode":"95940","codeType":"CPT"},{"id":8698,"precertRequired":false,"billingCode":"L8614","codeType":"HCPCS"},{"id":8703,"precertRequired":false,"billingCode":"L8619","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":29,"description":"Inpatient admission or observation status for complications related to the procedure       ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":30,"description":"Follow up visits with the surgeon","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":31,"description":" Post-op imaging","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":32,"description":"Post-operative cochlear implant follow up after the surgery with the audiologist for the initial activation and then at a minimum of 1 month, 3 months, 6 months, 9 months and 12 months post-procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"64-Audiologist (billing independently)"}],"billingCodes":[{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6751,"precertRequired":false,"billingCode":"92584","codeType":"CPT"},{"id":6755,"precertRequired":false,"billingCode":"92588","codeType":"CPT"},{"id":6764,"precertRequired":false,"billingCode":"92603","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6786,"precertRequired":false,"billingCode":"92633","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"231HA2400X"},{"HPTC":"231H00000X"}]}]}},{"Seoc":{"id":1877,"seocKey":32,"name":"Community Nursing Home Contract - VCA_PRCT","seocId":"NIC_COMMUNITY NURSING HOME CONTRACT - VCA_1.2.6_PRCT","versionNumber":"1.2.6","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult order.  Apply this episode of care when Veteran requires placement in a skilled or intermediate nursing facility for skilled care and/or rehabilitation services, end of life care, respite, or long term placement per Medicare/Medicaid guidelines. When a Veteran is placed by VA in a community nursing home for the purpose of hospice care, VA is responsible for the total cost of nursing home and hospice care. If a Veteran chooses to use their Medicare Hospice Benefit or another payer for the coverage of hospice care, VA continues to pay for the nursing home portion of the care","effectiveDate":"07-23-2020","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  All skilled or intermediate nursing facility services listed below:\r\na. Comprehensive evaluation for formulation of a treatment plan.\r\nb. Skilled nursing services as clinically necessary.\r\nc. Skilled rehabilitation services as clinically necessary, to potentially include physical therapy, occupational therapy, and speech therapy.\r\nd. Care in the absence of skilled needs, including restorative care as clinically necessary.  \r\ne. Semi-private room and board, medical provider services, respiratory therapy, non-rehabilitative care indicated by comprehensive evaluation and treatment plan, oral medications, medical and nursing supplies, X-rays, and routine laboratory tests.\r\nNote: Minimum data set (MDS) to occur per Medicare guidance for RUG IV","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CONTRACT NURSING HOME","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"314000000X"}],"services":[{"id":6016,"description":"All skilled or intermediate nursing facility services listed below:\r\na. Comprehensive evaluation for formulation of a treatment plan.\r\nb. Skilled nursing services as clinically necessary.\r\nc. Skilled rehabilitation services as clinically necessary, to potentially include physical therapy, occupational therapy, and speech therapy.\r\nd. Care in the absence of skilled needs, including restorative care as clinically necessary.  \r\ne. Semi-private room and board, respiratory therapy, non-rehabilitative care indicated by comprehensive evaluation and treatment plan, oral medications, medical and nursing supplies, X-rays, and routine laboratory tests.\r\nNote: Minimum data set (MDS) to occur per Medicare guidance for RUG IV","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A1-Skilled nursing facility"}],"billingCodes":[{"id":12961,"precertRequired":true,"billingCode":"RVX","codeType":"HIPPS"},{"id":12962,"precertRequired":true,"billingCode":"RVL","codeType":"HIPPS"},{"id":12963,"precertRequired":true,"billingCode":"RHX","codeType":"HIPPS"},{"id":12964,"precertRequired":true,"billingCode":"RHL","codeType":"HIPPS"},{"id":12965,"precertRequired":true,"billingCode":"RMX","codeType":"HIPPS"},{"id":12966,"precertRequired":true,"billingCode":"RML","codeType":"HIPPS"},{"id":12968,"precertRequired":true,"billingCode":"RUC","codeType":"HIPPS"},{"id":12969,"precertRequired":true,"billingCode":"RUB","codeType":"HIPPS"},{"id":12970,"precertRequired":true,"billingCode":"RUA","codeType":"HIPPS"},{"id":12971,"precertRequired":true,"billingCode":"RVB","codeType":"HIPPS"},{"id":12972,"precertRequired":true,"billingCode":"RVC","codeType":"HIPPS"},{"id":12973,"precertRequired":true,"billingCode":"RVA","codeType":"HIPPS"},{"id":12974,"precertRequired":true,"billingCode":"RHB","codeType":"HIPPS"},{"id":12975,"precertRequired":true,"billingCode":"RHA","codeType":"HIPPS"},{"id":12976,"precertRequired":true,"billingCode":"RMC","codeType":"HIPPS"},{"id":12977,"precertRequired":true,"billingCode":"RMB","codeType":"HIPPS"},{"id":12978,"precertRequired":true,"billingCode":"RMA","codeType":"HIPPS"},{"id":12979,"precertRequired":true,"billingCode":"RLB","codeType":"HIPPS"},{"id":12980,"precertRequired":true,"billingCode":"RLA","codeType":"HIPPS"},{"id":12981,"precertRequired":true,"billingCode":"ES3","codeType":"HIPPS"},{"id":12982,"precertRequired":true,"billingCode":"ES2","codeType":"HIPPS"},{"id":12983,"precertRequired":true,"billingCode":"ES1","codeType":"HIPPS"},{"id":12984,"precertRequired":true,"billingCode":"HE2","codeType":"HIPPS"},{"id":12985,"precertRequired":true,"billingCode":"HE1","codeType":"HIPPS"},{"id":12986,"precertRequired":true,"billingCode":"HD2","codeType":"HIPPS"},{"id":12987,"precertRequired":true,"billingCode":"HD1","codeType":"HIPPS"},{"id":12988,"precertRequired":true,"billingCode":"HC2","codeType":"HIPPS"},{"id":12989,"precertRequired":true,"billingCode":"HC1","codeType":"HIPPS"},{"id":12990,"precertRequired":true,"billingCode":"HB2","codeType":"HIPPS"},{"id":12991,"precertRequired":true,"billingCode":"HB1","codeType":"HIPPS"},{"id":12992,"precertRequired":true,"billingCode":"LE2","codeType":"HIPPS"},{"id":12993,"precertRequired":true,"billingCode":"LE1","codeType":"HIPPS"},{"id":12994,"precertRequired":true,"billingCode":"LD2","codeType":"HIPPS"},{"id":12995,"precertRequired":true,"billingCode":"LD1","codeType":"HIPPS"},{"id":12996,"precertRequired":true,"billingCode":"LC2","codeType":"HIPPS"},{"id":12997,"precertRequired":true,"billingCode":"LC1","codeType":"HIPPS"},{"id":12998,"precertRequired":true,"billingCode":"LB2","codeType":"HIPPS"},{"id":13000,"precertRequired":true,"billingCode":"RLX","codeType":"HIPPS"},{"id":13001,"precertRequired":true,"billingCode":"RHC","codeType":"HIPPS"},{"id":13002,"precertRequired":true,"billingCode":"CE2","codeType":"HIPPS"},{"id":13003,"precertRequired":true,"billingCode":"CE1","codeType":"HIPPS"},{"id":13004,"precertRequired":true,"billingCode":"CD2","codeType":"HIPPS"},{"id":13005,"precertRequired":true,"billingCode":"CD1","codeType":"HIPPS"},{"id":13006,"precertRequired":true,"billingCode":"CC2","codeType":"HIPPS"},{"id":13007,"precertRequired":true,"billingCode":"CC1","codeType":"HIPPS"},{"id":13008,"precertRequired":true,"billingCode":"CB2","codeType":"HIPPS"},{"id":13009,"precertRequired":true,"billingCode":"CB1","codeType":"HIPPS"},{"id":13010,"precertRequired":true,"billingCode":"CA2","codeType":"HIPPS"},{"id":13011,"precertRequired":true,"billingCode":"CA1","codeType":"HIPPS"},{"id":13012,"precertRequired":true,"billingCode":"BB2","codeType":"HIPPS"},{"id":13013,"precertRequired":true,"billingCode":"BB1","codeType":"HIPPS"},{"id":13014,"precertRequired":true,"billingCode":"BA2","codeType":"HIPPS"},{"id":13015,"precertRequired":true,"billingCode":"BA1","codeType":"HIPPS"},{"id":13016,"precertRequired":true,"billingCode":"PE2","codeType":"HIPPS"},{"id":13017,"precertRequired":true,"billingCode":"PE1","codeType":"HIPPS"},{"id":13018,"precertRequired":true,"billingCode":"PD2","codeType":"HIPPS"},{"id":13019,"precertRequired":true,"billingCode":"PD1","codeType":"HIPPS"},{"id":13020,"precertRequired":true,"billingCode":"PC2","codeType":"HIPPS"},{"id":13021,"precertRequired":true,"billingCode":"PC1","codeType":"HIPPS"},{"id":13022,"precertRequired":true,"billingCode":"PB2","codeType":"HIPPS"},{"id":13023,"precertRequired":true,"billingCode":"PB1","codeType":"HIPPS"},{"id":13024,"precertRequired":true,"billingCode":"PA2","codeType":"HIPPS"},{"id":13025,"precertRequired":true,"billingCode":"PA1","codeType":"HIPPS"},{"id":13026,"precertRequired":true,"billingCode":"LB1","codeType":"HIPPS"},{"id":13027,"precertRequired":true,"billingCode":"RUL","codeType":"HIPPS"},{"id":13028,"precertRequired":true,"billingCode":"RUX","codeType":"HIPPS"}],"serviceHptcs":[{"HPTC":"314000000X"}]}]}},{"Seoc":{"id":1821,"seocKey":32,"name":"Community Nursing Home Contract - VCA_PRCT","seocId":"NIC_COMMUNITY NURSING HOME CONTRACT - VCA_1.2.5_PRCT","versionNumber":"1.2.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult order.  Apply this episode of care when Veteran requires placement in a skilled or intermediate nursing facility for skilled care and/or rehabilitation services, end of life care, respite, or long term placement per Medicare/Medicaid guidelines.","effectiveDate":"06-08-2020","endDate":"07-23-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  All skilled or intermediate nursing facility services listed below:\r\na. Comprehensive evaluation for formulation of a treatment plan.\r\nb. Skilled nursing services as clinically necessary.\r\nc. Skilled rehabilitation services as clinically necessary, to potentially include physical therapy, occupational therapy, and speech therapy.\r\nd. Care in the absence of skilled needs, including restorative care as clinically necessary.  \r\ne. Semi-private room and board, respiratory therapy, non-rehabilitative care indicated by comprehensive evaluation and treatment plan, oral medications, medical and nursing supplies, X-rays, and routine laboratory tests.\r\nNote: Minimum data set (MDS) to occur per Medicare guidance for RUG IV","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CONTRACT NURSING HOME","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"314000000X"}],"services":[{"id":5775,"description":"All skilled or intermediate nursing facility services listed below:\r\na. Comprehensive evaluation for formulation of a treatment plan.\r\nb. Skilled nursing services as clinically necessary.\r\nc. Skilled rehabilitation services as clinically necessary, to potentially include physical therapy, occupational therapy, and speech therapy.\r\nd. Care in the absence of skilled needs, including restorative care as clinically necessary.  \r\ne. Semi-private room and board, respiratory therapy, non-rehabilitative care indicated by comprehensive evaluation and treatment plan, oral medications, medical and nursing supplies, X-rays, and routine laboratory tests.\r\nNote: Minimum data set (MDS) to occur per Medicare guidance for RUG IV","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A1-Skilled nursing facility"}],"billingCodes":[{"id":12961,"precertRequired":true,"billingCode":"RVX","codeType":"HIPPS"},{"id":12962,"precertRequired":true,"billingCode":"RVL","codeType":"HIPPS"},{"id":12963,"precertRequired":true,"billingCode":"RHX","codeType":"HIPPS"},{"id":12964,"precertRequired":true,"billingCode":"RHL","codeType":"HIPPS"},{"id":12965,"precertRequired":true,"billingCode":"RMX","codeType":"HIPPS"},{"id":12966,"precertRequired":true,"billingCode":"RML","codeType":"HIPPS"},{"id":12968,"precertRequired":true,"billingCode":"RUC","codeType":"HIPPS"},{"id":12969,"precertRequired":true,"billingCode":"RUB","codeType":"HIPPS"},{"id":12970,"precertRequired":true,"billingCode":"RUA","codeType":"HIPPS"},{"id":12971,"precertRequired":true,"billingCode":"RVB","codeType":"HIPPS"},{"id":12972,"precertRequired":true,"billingCode":"RVC","codeType":"HIPPS"},{"id":12973,"precertRequired":true,"billingCode":"RVA","codeType":"HIPPS"},{"id":12974,"precertRequired":true,"billingCode":"RHB","codeType":"HIPPS"},{"id":12975,"precertRequired":true,"billingCode":"RHA","codeType":"HIPPS"},{"id":12976,"precertRequired":true,"billingCode":"RMC","codeType":"HIPPS"},{"id":12977,"precertRequired":true,"billingCode":"RMB","codeType":"HIPPS"},{"id":12978,"precertRequired":true,"billingCode":"RMA","codeType":"HIPPS"},{"id":12979,"precertRequired":true,"billingCode":"RLB","codeType":"HIPPS"},{"id":12980,"precertRequired":true,"billingCode":"RLA","codeType":"HIPPS"},{"id":12981,"precertRequired":true,"billingCode":"ES3","codeType":"HIPPS"},{"id":12982,"precertRequired":true,"billingCode":"ES2","codeType":"HIPPS"},{"id":12983,"precertRequired":true,"billingCode":"ES1","codeType":"HIPPS"},{"id":12984,"precertRequired":true,"billingCode":"HE2","codeType":"HIPPS"},{"id":12985,"precertRequired":true,"billingCode":"HE1","codeType":"HIPPS"},{"id":12986,"precertRequired":true,"billingCode":"HD2","codeType":"HIPPS"},{"id":12987,"precertRequired":true,"billingCode":"HD1","codeType":"HIPPS"},{"id":12988,"precertRequired":true,"billingCode":"HC2","codeType":"HIPPS"},{"id":12989,"precertRequired":true,"billingCode":"HC1","codeType":"HIPPS"},{"id":12990,"precertRequired":true,"billingCode":"HB2","codeType":"HIPPS"},{"id":12991,"precertRequired":true,"billingCode":"HB1","codeType":"HIPPS"},{"id":12992,"precertRequired":true,"billingCode":"LE2","codeType":"HIPPS"},{"id":12993,"precertRequired":true,"billingCode":"LE1","codeType":"HIPPS"},{"id":12994,"precertRequired":true,"billingCode":"LD2","codeType":"HIPPS"},{"id":12995,"precertRequired":true,"billingCode":"LD1","codeType":"HIPPS"},{"id":12996,"precertRequired":true,"billingCode":"LC2","codeType":"HIPPS"},{"id":12997,"precertRequired":true,"billingCode":"LC1","codeType":"HIPPS"},{"id":12998,"precertRequired":true,"billingCode":"LB2","codeType":"HIPPS"},{"id":13000,"precertRequired":true,"billingCode":"RLX","codeType":"HIPPS"},{"id":13001,"precertRequired":true,"billingCode":"RHC","codeType":"HIPPS"},{"id":13002,"precertRequired":true,"billingCode":"CE2","codeType":"HIPPS"},{"id":13003,"precertRequired":true,"billingCode":"CE1","codeType":"HIPPS"},{"id":13004,"precertRequired":true,"billingCode":"CD2","codeType":"HIPPS"},{"id":13005,"precertRequired":true,"billingCode":"CD1","codeType":"HIPPS"},{"id":13006,"precertRequired":true,"billingCode":"CC2","codeType":"HIPPS"},{"id":13007,"precertRequired":true,"billingCode":"CC1","codeType":"HIPPS"},{"id":13008,"precertRequired":true,"billingCode":"CB2","codeType":"HIPPS"},{"id":13009,"precertRequired":true,"billingCode":"CB1","codeType":"HIPPS"},{"id":13010,"precertRequired":true,"billingCode":"CA2","codeType":"HIPPS"},{"id":13011,"precertRequired":true,"billingCode":"CA1","codeType":"HIPPS"},{"id":13012,"precertRequired":true,"billingCode":"BB2","codeType":"HIPPS"},{"id":13013,"precertRequired":true,"billingCode":"BB1","codeType":"HIPPS"},{"id":13014,"precertRequired":true,"billingCode":"BA2","codeType":"HIPPS"},{"id":13015,"precertRequired":true,"billingCode":"BA1","codeType":"HIPPS"},{"id":13016,"precertRequired":true,"billingCode":"PE2","codeType":"HIPPS"},{"id":13017,"precertRequired":true,"billingCode":"PE1","codeType":"HIPPS"},{"id":13018,"precertRequired":true,"billingCode":"PD2","codeType":"HIPPS"},{"id":13019,"precertRequired":true,"billingCode":"PD1","codeType":"HIPPS"},{"id":13020,"precertRequired":true,"billingCode":"PC2","codeType":"HIPPS"},{"id":13021,"precertRequired":true,"billingCode":"PC1","codeType":"HIPPS"},{"id":13022,"precertRequired":true,"billingCode":"PB2","codeType":"HIPPS"},{"id":13023,"precertRequired":true,"billingCode":"PB1","codeType":"HIPPS"},{"id":13024,"precertRequired":true,"billingCode":"PA2","codeType":"HIPPS"},{"id":13025,"precertRequired":true,"billingCode":"PA1","codeType":"HIPPS"},{"id":13026,"precertRequired":true,"billingCode":"LB1","codeType":"HIPPS"},{"id":13027,"precertRequired":true,"billingCode":"RUL","codeType":"HIPPS"},{"id":13028,"precertRequired":true,"billingCode":"RUX","codeType":"HIPPS"}],"serviceHptcs":[{"HPTC":"314000000X"}]}]}},{"Seoc":{"id":1670,"seocKey":32,"name":"Community Nursing Home VCA_PRCT","seocId":"NIC_COMMUNITY NURSING HOME VCA_1.2.4_PRCT","versionNumber":"1.2.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.  Apply this episode of care when Veteran requires placement in a skilled nursing facility for skilled care and/or rehabilitation services or an intermediate nursing facility for long term placement per Medicare/Medicaid guidelines.","effectiveDate":"01-24-2020","endDate":"06-08-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  All skilled or intermediate nursing facility services listed below:\r\na. Comprehensive evaluation for formulation of a treatment plan.\r\nb. Skilled nursing services as clinically necessary.\r\nc. Skilled rehabilitation services as clinically necessary, to potentially include physical therapy, occupational therapy, and speech therapy.\r\nd. Custodial care in the absence of skilled care needs, including restorative care as clinically necessary.\r\ne. Respite care as clinically necessary.\r\nf. End of Life/Hospice/Palliative care as clinically necessary.\r\ng. Semi-private room and board, respiratory therapy, non-rehabilitative care indicated by comprehensive evaluation and treatment plan, oral medications, medical and nursing supplies, X-rays, and routine laboratory tests.\r\nNote: Minimum data set (MDS) to occur per Medicare regulations","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CONTRACT NURSING HOME","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"314000000X"}],"services":[{"id":4698,"description":"All skilled or intermediate nursing facility services listed below:\r\na. Comprehensive evaluation for formulation of a treatment plan.\r\nb. Skilled nursing services as clinically necessary.\r\nc. Skilled rehabilitation services as clinically necessary, to potentially include physical therapy, occupational therapy, and speech therapy.\r\nd. Custodial care in the absence of skilled care needs, including restorative care as clinically necessary.\r\ne. Respite care as clinically necessary.\r\nf. End of Life/Hospice/Palliative care as clinically necessary.\r\ng. Semi-private room and board, respiratory therapy, non-rehabilitative care indicated by comprehensive evaluation and treatment plan, oral medications, medical and nursing supplies, X-rays, and routine laboratory tests.\r\nNote: Minimum data set (MDS) to occur per Medicare regulations","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A1-Skilled nursing facility"}],"billingCodes":[{"id":12961,"precertRequired":true,"billingCode":"RVX","codeType":"HIPPS"},{"id":12962,"precertRequired":true,"billingCode":"RVL","codeType":"HIPPS"},{"id":12963,"precertRequired":true,"billingCode":"RHX","codeType":"HIPPS"},{"id":12964,"precertRequired":true,"billingCode":"RHL","codeType":"HIPPS"},{"id":12965,"precertRequired":true,"billingCode":"RMX","codeType":"HIPPS"},{"id":12966,"precertRequired":true,"billingCode":"RML","codeType":"HIPPS"},{"id":12968,"precertRequired":true,"billingCode":"RUC","codeType":"HIPPS"},{"id":12969,"precertRequired":true,"billingCode":"RUB","codeType":"HIPPS"},{"id":12970,"precertRequired":true,"billingCode":"RUA","codeType":"HIPPS"},{"id":12971,"precertRequired":true,"billingCode":"RVB","codeType":"HIPPS"},{"id":12972,"precertRequired":true,"billingCode":"RVC","codeType":"HIPPS"},{"id":12973,"precertRequired":true,"billingCode":"RVA","codeType":"HIPPS"},{"id":12974,"precertRequired":true,"billingCode":"RHB","codeType":"HIPPS"},{"id":12975,"precertRequired":true,"billingCode":"RHA","codeType":"HIPPS"},{"id":12976,"precertRequired":true,"billingCode":"RMC","codeType":"HIPPS"},{"id":12977,"precertRequired":true,"billingCode":"RMB","codeType":"HIPPS"},{"id":12978,"precertRequired":true,"billingCode":"RMA","codeType":"HIPPS"},{"id":12979,"precertRequired":true,"billingCode":"RLB","codeType":"HIPPS"},{"id":12980,"precertRequired":true,"billingCode":"RLA","codeType":"HIPPS"},{"id":12981,"precertRequired":true,"billingCode":"ES3","codeType":"HIPPS"},{"id":12982,"precertRequired":true,"billingCode":"ES2","codeType":"HIPPS"},{"id":12983,"precertRequired":true,"billingCode":"ES1","codeType":"HIPPS"},{"id":12984,"precertRequired":true,"billingCode":"HE2","codeType":"HIPPS"},{"id":12985,"precertRequired":true,"billingCode":"HE1","codeType":"HIPPS"},{"id":12986,"precertRequired":true,"billingCode":"HD2","codeType":"HIPPS"},{"id":12987,"precertRequired":true,"billingCode":"HD1","codeType":"HIPPS"},{"id":12988,"precertRequired":true,"billingCode":"HC2","codeType":"HIPPS"},{"id":12989,"precertRequired":true,"billingCode":"HC1","codeType":"HIPPS"},{"id":12990,"precertRequired":true,"billingCode":"HB2","codeType":"HIPPS"},{"id":12991,"precertRequired":true,"billingCode":"HB1","codeType":"HIPPS"},{"id":12992,"precertRequired":true,"billingCode":"LE2","codeType":"HIPPS"},{"id":12993,"precertRequired":true,"billingCode":"LE1","codeType":"HIPPS"},{"id":12994,"precertRequired":true,"billingCode":"LD2","codeType":"HIPPS"},{"id":12995,"precertRequired":true,"billingCode":"LD1","codeType":"HIPPS"},{"id":12996,"precertRequired":true,"billingCode":"LC2","codeType":"HIPPS"},{"id":12997,"precertRequired":true,"billingCode":"LC1","codeType":"HIPPS"},{"id":12998,"precertRequired":true,"billingCode":"LB2","codeType":"HIPPS"},{"id":13000,"precertRequired":true,"billingCode":"RLX","codeType":"HIPPS"},{"id":13001,"precertRequired":true,"billingCode":"RHC","codeType":"HIPPS"},{"id":13002,"precertRequired":true,"billingCode":"CE2","codeType":"HIPPS"},{"id":13003,"precertRequired":true,"billingCode":"CE1","codeType":"HIPPS"},{"id":13004,"precertRequired":true,"billingCode":"CD2","codeType":"HIPPS"},{"id":13005,"precertRequired":true,"billingCode":"CD1","codeType":"HIPPS"},{"id":13006,"precertRequired":true,"billingCode":"CC2","codeType":"HIPPS"},{"id":13007,"precertRequired":true,"billingCode":"CC1","codeType":"HIPPS"},{"id":13008,"precertRequired":true,"billingCode":"CB2","codeType":"HIPPS"},{"id":13009,"precertRequired":true,"billingCode":"CB1","codeType":"HIPPS"},{"id":13010,"precertRequired":true,"billingCode":"CA2","codeType":"HIPPS"},{"id":13011,"precertRequired":true,"billingCode":"CA1","codeType":"HIPPS"},{"id":13012,"precertRequired":true,"billingCode":"BB2","codeType":"HIPPS"},{"id":13013,"precertRequired":true,"billingCode":"BB1","codeType":"HIPPS"},{"id":13014,"precertRequired":true,"billingCode":"BA2","codeType":"HIPPS"},{"id":13015,"precertRequired":true,"billingCode":"BA1","codeType":"HIPPS"},{"id":13016,"precertRequired":true,"billingCode":"PE2","codeType":"HIPPS"},{"id":13017,"precertRequired":true,"billingCode":"PE1","codeType":"HIPPS"},{"id":13018,"precertRequired":true,"billingCode":"PD2","codeType":"HIPPS"},{"id":13019,"precertRequired":true,"billingCode":"PD1","codeType":"HIPPS"},{"id":13020,"precertRequired":true,"billingCode":"PC2","codeType":"HIPPS"},{"id":13021,"precertRequired":true,"billingCode":"PC1","codeType":"HIPPS"},{"id":13022,"precertRequired":true,"billingCode":"PB2","codeType":"HIPPS"},{"id":13023,"precertRequired":true,"billingCode":"PB1","codeType":"HIPPS"},{"id":13024,"precertRequired":true,"billingCode":"PA2","codeType":"HIPPS"},{"id":13025,"precertRequired":true,"billingCode":"PA1","codeType":"HIPPS"},{"id":13026,"precertRequired":true,"billingCode":"LB1","codeType":"HIPPS"},{"id":13027,"precertRequired":true,"billingCode":"RUL","codeType":"HIPPS"},{"id":13028,"precertRequired":true,"billingCode":"RUX","codeType":"HIPPS"}],"serviceHptcs":[{"HPTC":"314000000X"}]}]}},{"Seoc":{"id":546,"seocKey":32,"name":"Community Nursing Home_PRCT","seocId":"NIC_COMMUNITY NURSING HOME_1.2.3_PRCT","versionNumber":"1.2.3","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"07-28-2019","endDate":"01-24-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Community Nursing Home care to include room and board, medications, supplies and care indicated by MDS rating within 7 days of admission.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"CONTRACT NURSING HOME","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"314000000X"}],"services":[{"id":3146,"description":"Community Nursing Home care to include room and board, medications, supplies and care indicated by MDS rating within 7 days of admission.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A1-Skilled nursing facility"}],"billingCodes":[{"id":7401,"precertRequired":true,"billingCode":"99304","codeType":"CPT"},{"id":7402,"precertRequired":true,"billingCode":"99305","codeType":"CPT"},{"id":7403,"precertRequired":true,"billingCode":"99306","codeType":"CPT"},{"id":7404,"precertRequired":false,"billingCode":"99307","codeType":"CPT"},{"id":7405,"precertRequired":false,"billingCode":"99308","codeType":"CPT"},{"id":7406,"precertRequired":false,"billingCode":"99309","codeType":"CPT"},{"id":7407,"precertRequired":false,"billingCode":"99310","codeType":"CPT"},{"id":7408,"precertRequired":false,"billingCode":"99315","codeType":"CPT"},{"id":7409,"precertRequired":false,"billingCode":"99316","codeType":"CPT"},{"id":7410,"precertRequired":false,"billingCode":"99318","codeType":"CPT"},{"id":8223,"precertRequired":false,"billingCode":"G0471","codeType":"HCPCS"},{"id":8876,"precertRequired":false,"billingCode":"R0070","codeType":"HCPCS"},{"id":8877,"precertRequired":false,"billingCode":"R0075","codeType":"HCPCS"},{"id":8878,"precertRequired":false,"billingCode":"R0076","codeType":"HCPCS"},{"id":9039,"precertRequired":false,"billingCode":"S9529","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"314000000X"}]}]}},{"Seoc":{"id":206,"seocKey":32,"name":"Community Nursing Home_PRCT","seocId":"NIC_COMMUNITY NURSING HOME_1.2.2_PRCT","versionNumber":"1.2.2","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Community Nursing Home care to include room and board, medications, supplies and care indicated by MDS rating within 7 days of admission.","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the referred patient condition require VA review and approval.\r\n**All routine medications are provided as part of CNH per diem or as indicated under local VA Medical Center contract.\r\n**Medications are provided as indicated within the authorization from the VA facility.","QASP":"General Care","categoryOfCare":"CONTRACT NURSING HOME","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"314000000X"}],"services":[{"id":806,"description":"Community Nursing Home care to include room and board, medications, supplies and care indicated by MDS rating within 7 days of admission.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A1-Skilled nursing facility"}],"billingCodes":[{"id":7401,"precertRequired":true,"billingCode":"99304","codeType":"CPT"},{"id":7402,"precertRequired":true,"billingCode":"99305","codeType":"CPT"},{"id":7403,"precertRequired":true,"billingCode":"99306","codeType":"CPT"},{"id":7404,"precertRequired":false,"billingCode":"99307","codeType":"CPT"},{"id":7405,"precertRequired":false,"billingCode":"99308","codeType":"CPT"},{"id":7406,"precertRequired":false,"billingCode":"99309","codeType":"CPT"},{"id":7407,"precertRequired":false,"billingCode":"99310","codeType":"CPT"},{"id":7408,"precertRequired":false,"billingCode":"99315","codeType":"CPT"},{"id":7409,"precertRequired":false,"billingCode":"99316","codeType":"CPT"},{"id":7410,"precertRequired":false,"billingCode":"99318","codeType":"CPT"},{"id":8223,"precertRequired":false,"billingCode":"G0471","codeType":"HCPCS"},{"id":8876,"precertRequired":false,"billingCode":"R0070","codeType":"HCPCS"},{"id":8877,"precertRequired":false,"billingCode":"R0075","codeType":"HCPCS"},{"id":8878,"precertRequired":false,"billingCode":"R0076","codeType":"HCPCS"},{"id":9039,"precertRequired":false,"billingCode":"S9529","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"314000000X"}]}]}},{"Seoc":{"id":63,"seocKey":32,"name":"Community Nursing Home_PRCT","seocId":"NIC_COMMUNITY NURSING HOME_1.2.1_PRCT","versionNumber":"1.2.1","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"05-31-2018","endDate":"01-02-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Community Nursing Home care to include room and board, medications, supplies and care indicated by MDS rating within 7 days of admission.","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the referred patient condition require VA review and approval.\r\n**All routine medications are provided as part of CNH per diem or as indicated under local VA Medical Center contract.\r\n**Medications are provided as indicated within the authorization from the VA facility.","QASP":"General Care","categoryOfCare":"CONTRACT NURSING HOME","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":372,"description":"Community Nursing Home care to include room and board, medications, supplies and care indicated by MDS rating within 7 days of admission.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A1-Skilled nursing facility"}],"billingCodes":[{"id":7401,"precertRequired":true,"billingCode":"99304","codeType":"CPT"},{"id":7402,"precertRequired":true,"billingCode":"99305","codeType":"CPT"},{"id":7403,"precertRequired":true,"billingCode":"99306","codeType":"CPT"},{"id":7404,"precertRequired":false,"billingCode":"99307","codeType":"CPT"},{"id":7405,"precertRequired":false,"billingCode":"99308","codeType":"CPT"},{"id":7406,"precertRequired":false,"billingCode":"99309","codeType":"CPT"},{"id":7407,"precertRequired":false,"billingCode":"99310","codeType":"CPT"},{"id":7408,"precertRequired":false,"billingCode":"99315","codeType":"CPT"},{"id":7409,"precertRequired":false,"billingCode":"99316","codeType":"CPT"},{"id":7410,"precertRequired":false,"billingCode":"99318","codeType":"CPT"},{"id":8223,"precertRequired":false,"billingCode":"G0471","codeType":"HCPCS"},{"id":8876,"precertRequired":false,"billingCode":"R0070","codeType":"HCPCS"},{"id":8877,"precertRequired":false,"billingCode":"R0075","codeType":"HCPCS"},{"id":8878,"precertRequired":false,"billingCode":"R0076","codeType":"HCPCS"},{"id":9039,"precertRequired":false,"billingCode":"S9529","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"314000000X"}]}]}},{"Seoc":{"id":29,"seocKey":33,"name":"Comprehensive Hematology/Radiation Oncology_PRCT","seocId":"MSC_COMPREHENSIVE HEMATOLOGY/RADIATION ONCOLOGY_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.\r\n","effectiveDate":"11-01-2017","endDate":"12-07-2018","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition per consult\r\n2. Diagnostic images\r\n3. Diagnostic studies, labs and pathology services relevant to the referred condition\r\n4. Surgical procedure clinically appropriate per consult\r\n5. Radiofrequency ablation if clinically indicated\r\n6. One visit for PET scan if clinically indicated\r\n7. One visit for planning CT relevant to the patient complaint/condition\r\n8. Radiation Therapy visits as clinically indicated by radiation oncologist\r\n9. Chemotherapy as clinically indicated\r\n10. Eight visits for follow-up visits for this episode of care\r\n11. Follow-up images/studies/laboratories as indicated\r\n12. Follow-up with a cardiologist as indicated","maxAllowableVisits":999,"disclaimer":"**Brachytherapy, Gamma knife, Proton Beam Therapy, TACE, Theraspheres, Y-90 and additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**Clinical trials and non-FDA approved treatments ARE NOT approved under this referral. If a clinical trial is indicated it will require VA review and approval to ensure the trial is being conducted under an Investigational Drug (IND) application or the drug, biologicals or medical devices are prescribed under a compassionate use exemption.\r\n**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"HEMATOLOGY/ONCOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1310,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1824,"seocKey":34,"name":"CT Myelogram_REV_PRCT","seocId":"RAD_CT MYELOGRAM_1.1.4_REV_PRCT","versionNumber":"1.1.4","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":60,"REV":true,"PRCT":true,"proceduralOverview":"1.  CT myelogram for referred condition indicated on consult order\r\n2.  Labs relevant to the study ordered on the consult order","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"RADIOLOGY CT SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"2085R0202X"},{"hptc":"2085R0204X"}],"services":[{"id":5782,"description":"CT myelogram for referred condition indicated on consult order","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"94-Interventional radiology"}],"billingCodes":[{"id":202,"precertRequired":true,"billingCode":"01935","codeType":"CPT"},{"id":203,"precertRequired":true,"billingCode":"01936","codeType":"CPT"},{"id":3886,"precertRequired":true,"billingCode":"62284","codeType":"CPT"},{"id":3892,"precertRequired":true,"billingCode":"62302","codeType":"CPT"},{"id":3893,"precertRequired":true,"billingCode":"62303","codeType":"CPT"},{"id":3894,"precertRequired":true,"billingCode":"62304","codeType":"CPT"},{"id":3895,"precertRequired":true,"billingCode":"62305","codeType":"CPT"},{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4497,"precertRequired":false,"billingCode":"72240","codeType":"CPT"},{"id":4498,"precertRequired":true,"billingCode":"72255","codeType":"CPT"},{"id":4499,"precertRequired":false,"billingCode":"72265","codeType":"CPT"},{"id":4500,"precertRequired":true,"billingCode":"72270","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085H0002X"},{"HPTC":"2085R0204X"}]},{"id":5783,"description":"Labs relevant to the study ordered on the consult order","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5465,"precertRequired":false,"billingCode":"82575","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]}]}},{"Seoc":{"id":547,"seocKey":34,"name":"CT Myelogram_PRCT","seocId":"RAD_CT MYELOGRAM_1.1.3_PRCT","versionNumber":"1.1.3","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. CT myelogram for referred condition indicated on consult","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"RADIOLOGY CT SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"2085R0202X"},{"hptc":"2085R0204X"}],"services":[{"id":3147,"description":"CT myelogram for referred condition indicated on consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"94-Interventional radiology"}],"billingCodes":[{"id":202,"precertRequired":true,"billingCode":"01935","codeType":"CPT"},{"id":203,"precertRequired":true,"billingCode":"01936","codeType":"CPT"},{"id":3886,"precertRequired":true,"billingCode":"62284","codeType":"CPT"},{"id":3892,"precertRequired":true,"billingCode":"62302","codeType":"CPT"},{"id":3893,"precertRequired":true,"billingCode":"62303","codeType":"CPT"},{"id":3894,"precertRequired":true,"billingCode":"62304","codeType":"CPT"},{"id":3895,"precertRequired":true,"billingCode":"62305","codeType":"CPT"},{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4497,"precertRequired":false,"billingCode":"72240","codeType":"CPT"},{"id":4498,"precertRequired":true,"billingCode":"72255","codeType":"CPT"},{"id":4499,"precertRequired":false,"billingCode":"72265","codeType":"CPT"},{"id":4500,"precertRequired":true,"billingCode":"72270","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085H0002X"},{"HPTC":"2085R0204X"}]}]}},{"Seoc":{"id":207,"seocKey":34,"name":"CT Myelogram_PRCT","seocId":"RAD_CT MYELOGRAM_1.1.2_PRCT","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-03-2019","endDate":"07-28-2019","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. CT myelogram for referred condition indicated on consult","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"RADIOLOGY CT SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"2085R0202X"},{"hptc":"2085R0204X"}],"services":[{"id":807,"description":"CT myelogram for referred condition indicated on consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"94-Interventional radiology"}],"billingCodes":[{"id":202,"precertRequired":true,"billingCode":"01935","codeType":"CPT"},{"id":203,"precertRequired":true,"billingCode":"01936","codeType":"CPT"},{"id":3886,"precertRequired":true,"billingCode":"62284","codeType":"CPT"},{"id":3892,"precertRequired":true,"billingCode":"62302","codeType":"CPT"},{"id":3893,"precertRequired":true,"billingCode":"62303","codeType":"CPT"},{"id":3894,"precertRequired":true,"billingCode":"62304","codeType":"CPT"},{"id":3895,"precertRequired":true,"billingCode":"62305","codeType":"CPT"},{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4497,"precertRequired":false,"billingCode":"72240","codeType":"CPT"},{"id":4498,"precertRequired":true,"billingCode":"72255","codeType":"CPT"},{"id":4499,"precertRequired":false,"billingCode":"72265","codeType":"CPT"},{"id":4500,"precertRequired":true,"billingCode":"72270","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085H0002X"},{"HPTC":"2085R0204X"}]}]}},{"Seoc":{"id":30,"seocKey":34,"name":"CT Myelogram_PRCT","seocId":"RAD_CT MYELOGRAM_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"01-03-2019","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. CT myelogram for referred condition indicated on consult","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"RADIOLOGY CT SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":499,"description":"CT myelogram for referred condition indicated on consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"94-Interventional radiology"}],"billingCodes":[{"id":202,"precertRequired":true,"billingCode":"01935","codeType":"CPT"},{"id":203,"precertRequired":true,"billingCode":"01936","codeType":"CPT"},{"id":3886,"precertRequired":true,"billingCode":"62284","codeType":"CPT"},{"id":3892,"precertRequired":true,"billingCode":"62302","codeType":"CPT"},{"id":3893,"precertRequired":true,"billingCode":"62303","codeType":"CPT"},{"id":3894,"precertRequired":true,"billingCode":"62304","codeType":"CPT"},{"id":3895,"precertRequired":true,"billingCode":"62305","codeType":"CPT"},{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4497,"precertRequired":false,"billingCode":"72240","codeType":"CPT"},{"id":4498,"precertRequired":true,"billingCode":"72255","codeType":"CPT"},{"id":4499,"precertRequired":false,"billingCode":"72265","codeType":"CPT"},{"id":4500,"precertRequired":true,"billingCode":"72270","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085H0002X"},{"HPTC":"2085R0204X"}]}]}},{"Seoc":{"id":1752,"seocKey":35,"name":"CT Scan_REV_PRCT","seocId":"RAD_CT SCAN_1.0.5_REV_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":60,"REV":true,"PRCT":true,"proceduralOverview":"1.  CT scan for the referred condition indicated on consult order\r\n2.  Labs relevant to the study ordered on the consult order","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"RADIOLOGY CT SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"2085R0202X"}],"services":[{"id":5232,"description":"CT scan for the referred condition indicated on consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":825,"precertRequired":false,"billingCode":"23350","codeType":"CPT"},{"id":923,"precertRequired":false,"billingCode":"24220","codeType":"CPT"},{"id":1044,"precertRequired":false,"billingCode":"25246","codeType":"CPT"},{"id":1373,"precertRequired":true,"billingCode":"27096","codeType":"CPT"},{"id":1614,"precertRequired":false,"billingCode":"27648","codeType":"CPT"},{"id":4391,"precertRequired":false,"billingCode":"70332","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4508,"precertRequired":false,"billingCode":"73040","codeType":"CPT"},{"id":4513,"precertRequired":false,"billingCode":"73085","codeType":"CPT"},{"id":4518,"precertRequired":false,"billingCode":"73115","codeType":"CPT"},{"id":4522,"precertRequired":false,"billingCode":"73200","codeType":"CPT"},{"id":4523,"precertRequired":false,"billingCode":"73201","codeType":"CPT"},{"id":4524,"precertRequired":false,"billingCode":"73202","codeType":"CPT"},{"id":4525,"precertRequired":false,"billingCode":"73206","codeType":"CPT"},{"id":4539,"precertRequired":false,"billingCode":"73525","codeType":"CPT"},{"id":4546,"precertRequired":false,"billingCode":"73580","codeType":"CPT"},{"id":4551,"precertRequired":false,"billingCode":"73615","codeType":"CPT"},{"id":4556,"precertRequired":false,"billingCode":"73700","codeType":"CPT"},{"id":4557,"precertRequired":false,"billingCode":"73701","codeType":"CPT"},{"id":4558,"precertRequired":false,"billingCode":"73702","codeType":"CPT"},{"id":4559,"precertRequired":false,"billingCode":"73706","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4598,"precertRequired":false,"billingCode":"74261","codeType":"CPT"},{"id":4599,"precertRequired":false,"billingCode":"74262","codeType":"CPT"},{"id":4600,"precertRequired":false,"billingCode":"74263","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4691,"precertRequired":false,"billingCode":"75989","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4779,"precertRequired":false,"billingCode":"77013","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4792,"precertRequired":false,"billingCode":"77071","codeType":"CPT"},{"id":4798,"precertRequired":false,"billingCode":"77078","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4925,"precertRequired":false,"billingCode":"78315","codeType":"CPT"},{"id":4933,"precertRequired":false,"billingCode":"78451","codeType":"CPT"},{"id":4934,"precertRequired":false,"billingCode":"78452","codeType":"CPT"},{"id":4943,"precertRequired":false,"billingCode":"78469","codeType":"CPT"},{"id":4950,"precertRequired":false,"billingCode":"78494","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":8179,"precertRequired":true,"billingCode":"G0297","codeType":"HCPCS"},{"id":12113,"precertRequired":true,"billingCode":"27369","codeType":"CPT"},{"id":12129,"precertRequired":false,"billingCode":"21116","codeType":"CPT"},{"id":12132,"precertRequired":true,"billingCode":"S8092","codeType":"HCPCS"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"},{"id":13321,"precertRequired":true,"billingCode":"70490","codeType":"CPT"},{"id":13322,"precertRequired":true,"billingCode":"70491","codeType":"CPT"},{"id":13323,"precertRequired":true,"billingCode":"70492","codeType":"CPT"},{"id":13324,"precertRequired":true,"billingCode":"70496","codeType":"CPT"},{"id":13325,"precertRequired":true,"billingCode":"70498","codeType":"CPT"},{"id":13336,"precertRequired":true,"billingCode":"77011","codeType":"CPT"},{"id":13412,"precertRequired":false,"billingCode":"78830","codeType":"CPT"},{"id":13413,"precertRequired":false,"billingCode":"78831","codeType":"CPT"},{"id":13414,"precertRequired":false,"billingCode":"78832","codeType":"CPT"},{"id":13457,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":13656,"precertRequired":true,"billingCode":"71260","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5233,"description":"Labs relevant to the study ordered on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5465,"precertRequired":false,"billingCode":"82575","codeType":"CPT"},{"id":5471,"precertRequired":false,"billingCode":"82610","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]}]}},{"Seoc":{"id":1653,"seocKey":35,"name":"CT Scan_REV_PRCT","seocId":"RAD_CT SCAN_1.0.4_REV_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-12-2019","endDate":"06-08-2020","duration":60,"REV":true,"PRCT":true,"proceduralOverview":"CT scan for the referred condition indicated on consult","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"RADIOLOGY CT SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"2085R0202X"}],"services":[{"id":4630,"description":"CT scan for the referred condition indicated on consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":825,"precertRequired":false,"billingCode":"23350","codeType":"CPT"},{"id":923,"precertRequired":false,"billingCode":"24220","codeType":"CPT"},{"id":1044,"precertRequired":false,"billingCode":"25246","codeType":"CPT"},{"id":1373,"precertRequired":true,"billingCode":"27096","codeType":"CPT"},{"id":1614,"precertRequired":false,"billingCode":"27648","codeType":"CPT"},{"id":4391,"precertRequired":false,"billingCode":"70332","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4508,"precertRequired":false,"billingCode":"73040","codeType":"CPT"},{"id":4513,"precertRequired":false,"billingCode":"73085","codeType":"CPT"},{"id":4518,"precertRequired":false,"billingCode":"73115","codeType":"CPT"},{"id":4522,"precertRequired":false,"billingCode":"73200","codeType":"CPT"},{"id":4523,"precertRequired":false,"billingCode":"73201","codeType":"CPT"},{"id":4524,"precertRequired":false,"billingCode":"73202","codeType":"CPT"},{"id":4525,"precertRequired":false,"billingCode":"73206","codeType":"CPT"},{"id":4539,"precertRequired":false,"billingCode":"73525","codeType":"CPT"},{"id":4546,"precertRequired":false,"billingCode":"73580","codeType":"CPT"},{"id":4551,"precertRequired":false,"billingCode":"73615","codeType":"CPT"},{"id":4556,"precertRequired":false,"billingCode":"73700","codeType":"CPT"},{"id":4557,"precertRequired":false,"billingCode":"73701","codeType":"CPT"},{"id":4558,"precertRequired":false,"billingCode":"73702","codeType":"CPT"},{"id":4559,"precertRequired":false,"billingCode":"73706","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4598,"precertRequired":false,"billingCode":"74261","codeType":"CPT"},{"id":4599,"precertRequired":false,"billingCode":"74262","codeType":"CPT"},{"id":4600,"precertRequired":false,"billingCode":"74263","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4691,"precertRequired":false,"billingCode":"75989","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4779,"precertRequired":false,"billingCode":"77013","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4792,"precertRequired":false,"billingCode":"77071","codeType":"CPT"},{"id":4798,"precertRequired":false,"billingCode":"77078","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4933,"precertRequired":false,"billingCode":"78451","codeType":"CPT"},{"id":4934,"precertRequired":false,"billingCode":"78452","codeType":"CPT"},{"id":4943,"precertRequired":false,"billingCode":"78469","codeType":"CPT"},{"id":4950,"precertRequired":false,"billingCode":"78494","codeType":"CPT"},{"id":4963,"precertRequired":false,"billingCode":"78607","codeType":"CPT"},{"id":4975,"precertRequired":false,"billingCode":"78710","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4988,"precertRequired":false,"billingCode":"78807","codeType":"CPT"},{"id":8179,"precertRequired":true,"billingCode":"G0297","codeType":"HCPCS"},{"id":11933,"precertRequired":false,"billingCode":"77011","codeType":"CPT"},{"id":12113,"precertRequired":true,"billingCode":"27369","codeType":"CPT"},{"id":12129,"precertRequired":false,"billingCode":"21116","codeType":"CPT"},{"id":12130,"precertRequired":false,"billingCode":"78647","codeType":"CPT"},{"id":12132,"precertRequired":true,"billingCode":"S8092","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":4631,"description":"Labs relevant to the study ordered on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5465,"precertRequired":false,"billingCode":"82575","codeType":"CPT"},{"id":5471,"precertRequired":false,"billingCode":"82610","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]}]}},{"Seoc":{"id":548,"seocKey":35,"name":"CT Scan_PRCT","seocId":"RAD_CT SCAN_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"07-28-2019","endDate":"11-12-2019","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. CT scan for the referred condition indicated on consult","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"RADIOLOGY CT SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"2085R0202X"}],"services":[{"id":3148,"description":"CT scan for the referred condition indicated on consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4522,"precertRequired":false,"billingCode":"73200","codeType":"CPT"},{"id":4523,"precertRequired":false,"billingCode":"73201","codeType":"CPT"},{"id":4524,"precertRequired":false,"billingCode":"73202","codeType":"CPT"},{"id":4525,"precertRequired":false,"billingCode":"73206","codeType":"CPT"},{"id":4556,"precertRequired":false,"billingCode":"73700","codeType":"CPT"},{"id":4557,"precertRequired":false,"billingCode":"73701","codeType":"CPT"},{"id":4558,"precertRequired":false,"billingCode":"73702","codeType":"CPT"},{"id":4559,"precertRequired":false,"billingCode":"73706","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4798,"precertRequired":false,"billingCode":"77078","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":7467,"precertRequired":false,"billingCode":"99441","codeType":"CPT"},{"id":7468,"precertRequired":false,"billingCode":"99442","codeType":"CPT"},{"id":7469,"precertRequired":false,"billingCode":"99443","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":208,"seocKey":35,"name":"CT Scan_PRCT","seocId":"RAD_CT SCAN_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-03-2019","endDate":"07-28-2019","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. CT scan for the referred condition indicated on consult","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"RADIOLOGY CT SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"2085R0202X"}],"services":[{"id":808,"description":"CT scan for the referred condition indicated on consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4522,"precertRequired":false,"billingCode":"73200","codeType":"CPT"},{"id":4523,"precertRequired":false,"billingCode":"73201","codeType":"CPT"},{"id":4524,"precertRequired":false,"billingCode":"73202","codeType":"CPT"},{"id":4525,"precertRequired":false,"billingCode":"73206","codeType":"CPT"},{"id":4556,"precertRequired":false,"billingCode":"73700","codeType":"CPT"},{"id":4557,"precertRequired":false,"billingCode":"73701","codeType":"CPT"},{"id":4558,"precertRequired":false,"billingCode":"73702","codeType":"CPT"},{"id":4559,"precertRequired":false,"billingCode":"73706","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4798,"precertRequired":false,"billingCode":"77078","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":7467,"precertRequired":false,"billingCode":"99441","codeType":"CPT"},{"id":7468,"precertRequired":false,"billingCode":"99442","codeType":"CPT"},{"id":7469,"precertRequired":false,"billingCode":"99443","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":31,"seocKey":35,"name":"CT Scan_PRCT","seocId":"RAD_CT SCAN_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"01-03-2019","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. CT scan for the referred condition indicated on consult","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"RADIOLOGY CT SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":500,"description":"CT scan for the referred condition indicated on consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4522,"precertRequired":false,"billingCode":"73200","codeType":"CPT"},{"id":4523,"precertRequired":false,"billingCode":"73201","codeType":"CPT"},{"id":4524,"precertRequired":false,"billingCode":"73202","codeType":"CPT"},{"id":4525,"precertRequired":false,"billingCode":"73206","codeType":"CPT"},{"id":4556,"precertRequired":false,"billingCode":"73700","codeType":"CPT"},{"id":4557,"precertRequired":false,"billingCode":"73701","codeType":"CPT"},{"id":4558,"precertRequired":false,"billingCode":"73702","codeType":"CPT"},{"id":4559,"precertRequired":false,"billingCode":"73706","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4635,"precertRequired":false,"billingCode":"75571","codeType":"CPT"},{"id":4636,"precertRequired":false,"billingCode":"75572","codeType":"CPT"},{"id":4637,"precertRequired":false,"billingCode":"75573","codeType":"CPT"},{"id":4638,"precertRequired":false,"billingCode":"75574","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4798,"precertRequired":false,"billingCode":"77078","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":7467,"precertRequired":false,"billingCode":"99441","codeType":"CPT"},{"id":7468,"precertRequired":false,"billingCode":"99442","codeType":"CPT"},{"id":7469,"precertRequired":false,"billingCode":"99443","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":1659,"seocKey":36,"name":"Dental Denture Services","seocId":"DEN_DENTAL DENTURE SERVICES_1.3.6","versionNumber":"1.3.6","description":"This authorization covers services for dental eligible Veterans as noted in the consult ONLY. It directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult ONLY.   Minimal impact procedural code substitutions are allowed from the authorized plan in the consult but the difference of the change must not exceed 1000 dollars. If the changes exceed the cost difference of 1000 dollars, then a new treatment plan must be submitted and must be approved by a VA Dentist PRIOR to performing any treatment","effectiveDate":"11-12-2019","endDate":null,"duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Full intraoral imaging, if indicated\r\n3. Maxillary and/or Mandibular Complete, Immediate and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included)\r\n* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":4657,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":12188,"precertRequired":false,"billingCode":"D9310","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":4658,"description":"Full intraoral imaging, if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":4659,"description":"Maxillary and/or Mandibular Complete, Immediate and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8035,"precertRequired":false,"billingCode":"D5110","codeType":"HCPCS"},{"id":8036,"precertRequired":false,"billingCode":"D5120","codeType":"HCPCS"},{"id":8037,"precertRequired":false,"billingCode":"D5130","codeType":"HCPCS"},{"id":8038,"precertRequired":false,"billingCode":"D5140","codeType":"HCPCS"},{"id":8039,"precertRequired":false,"billingCode":"D5211","codeType":"HCPCS"},{"id":8040,"precertRequired":false,"billingCode":"D5212","codeType":"HCPCS"},{"id":8041,"precertRequired":false,"billingCode":"D5213","codeType":"HCPCS"},{"id":8042,"precertRequired":false,"billingCode":"D5214","codeType":"HCPCS"},{"id":8043,"precertRequired":false,"billingCode":"D5221","codeType":"HCPCS"},{"id":8044,"precertRequired":false,"billingCode":"D5222","codeType":"HCPCS"},{"id":8045,"precertRequired":false,"billingCode":"D5223","codeType":"HCPCS"},{"id":8046,"precertRequired":false,"billingCode":"D5224","codeType":"HCPCS"},{"id":8047,"precertRequired":false,"billingCode":"D5225","codeType":"HCPCS"},{"id":8048,"precertRequired":false,"billingCode":"D5226","codeType":"HCPCS"},{"id":10961,"precertRequired":false,"billingCode":"D5282","codeType":"HCPCS"},{"id":10962,"precertRequired":false,"billingCode":"D5283","codeType":"HCPCS"},{"id":11005,"precertRequired":false,"billingCode":"D5876","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":515,"seocKey":36,"name":"Dental Denture Services","seocId":"DEN_DENTAL DENTURE SERVICES_1.3.5","versionNumber":"1.3.5","description":"Description: This authorization covers services for dental eligible Veterans associated with the approved dental plan of care on the consult which directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult for the specific services to be performed. Minimal impact procedural code substitutions are allowed as a change in the plan.  The cost difference of the change must not exceed 1000 dollars for the entire treatment plan. If any changes do not meet the aforementioned conditions, then a new treatment plan must be submitted and must be approved by a VA Dentist prior to performing any treatment.","effectiveDate":"06-26-2019","endDate":"11-12-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Full intraoral imaging, if indicated\r\n3. Maxillary and/or Mandibular Complete, Immediate and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included)","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\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*\tPharmacy prescribing requirements\r\n*\tDurable Medical Equipment (DME), Prosthetics, and Orthotics prescribing requirements\r\n*\tPrecertification (PRCT) process requirements\r\n*\tRequest for Services (RFS) requirements","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":2972,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2973,"description":"Full intraoral imaging, if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2974,"description":"Maxillary and/or Mandibular Complete, Immediate and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included)  **ONE MAXILLARY - ONE MANDIBLE","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8035,"precertRequired":false,"billingCode":"D5110","codeType":"HCPCS"},{"id":8036,"precertRequired":false,"billingCode":"D5120","codeType":"HCPCS"},{"id":8037,"precertRequired":false,"billingCode":"D5130","codeType":"HCPCS"},{"id":8038,"precertRequired":false,"billingCode":"D5140","codeType":"HCPCS"},{"id":8039,"precertRequired":false,"billingCode":"D5211","codeType":"HCPCS"},{"id":8040,"precertRequired":false,"billingCode":"D5212","codeType":"HCPCS"},{"id":8041,"precertRequired":false,"billingCode":"D5213","codeType":"HCPCS"},{"id":8042,"precertRequired":false,"billingCode":"D5214","codeType":"HCPCS"},{"id":8043,"precertRequired":false,"billingCode":"D5221","codeType":"HCPCS"},{"id":8044,"precertRequired":false,"billingCode":"D5222","codeType":"HCPCS"},{"id":8045,"precertRequired":false,"billingCode":"D5223","codeType":"HCPCS"},{"id":8046,"precertRequired":false,"billingCode":"D5224","codeType":"HCPCS"},{"id":8047,"precertRequired":false,"billingCode":"D5225","codeType":"HCPCS"},{"id":8048,"precertRequired":false,"billingCode":"D5226","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":355,"seocKey":36,"name":"Dental Denture Services","seocId":"DEN_DENTAL DENTURE SERVICES_1.3.4","versionNumber":"1.3.4","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"04-19-2019","endDate":"06-26-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Full intraoral imaging, if indicated\r\n3. Maxillary and/or Mandibular Complete, Immediate and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included)","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA\r\n* Urgent/emergent prescriptions can be provided for a  14-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1822,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1823,"description":"Full intraoral imaging, if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1825,"description":"Maxillary and/or Mandibular Complete, Immediate and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included)  **ONE MAXILLARY - ONE MANDIBLE","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8035,"precertRequired":false,"billingCode":"D5110","codeType":"HCPCS"},{"id":8036,"precertRequired":false,"billingCode":"D5120","codeType":"HCPCS"},{"id":8037,"precertRequired":false,"billingCode":"D5130","codeType":"HCPCS"},{"id":8038,"precertRequired":false,"billingCode":"D5140","codeType":"HCPCS"},{"id":8039,"precertRequired":false,"billingCode":"D5211","codeType":"HCPCS"},{"id":8040,"precertRequired":false,"billingCode":"D5212","codeType":"HCPCS"},{"id":8041,"precertRequired":false,"billingCode":"D5213","codeType":"HCPCS"},{"id":8042,"precertRequired":false,"billingCode":"D5214","codeType":"HCPCS"},{"id":8043,"precertRequired":false,"billingCode":"D5221","codeType":"HCPCS"},{"id":8044,"precertRequired":false,"billingCode":"D5222","codeType":"HCPCS"},{"id":8045,"precertRequired":false,"billingCode":"D5223","codeType":"HCPCS"},{"id":8046,"precertRequired":false,"billingCode":"D5224","codeType":"HCPCS"},{"id":8047,"precertRequired":false,"billingCode":"D5225","codeType":"HCPCS"},{"id":8048,"precertRequired":false,"billingCode":"D5226","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":297,"seocKey":36,"name":"Dental Denture Services","seocId":"DEN_DENTAL DENTURE SERVICES_1.3.3","versionNumber":"1.3.3","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"01-02-2019","endDate":"04-19-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Full intraoral imaging, if indicated\r\n3. Maxillary and/or Mandibular Complete, Immediate and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included)","maxAllowableVisits":999,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA\r\n* Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1251,"description":" Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1252,"description":"Full intraoral imaging, if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1253,"description":"Maxillary and/or Mandibular Complete, Immediate and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8035,"precertRequired":false,"billingCode":"D5110","codeType":"HCPCS"},{"id":8036,"precertRequired":false,"billingCode":"D5120","codeType":"HCPCS"},{"id":8037,"precertRequired":false,"billingCode":"D5130","codeType":"HCPCS"},{"id":8038,"precertRequired":false,"billingCode":"D5140","codeType":"HCPCS"},{"id":8039,"precertRequired":false,"billingCode":"D5211","codeType":"HCPCS"},{"id":8040,"precertRequired":false,"billingCode":"D5212","codeType":"HCPCS"},{"id":8041,"precertRequired":false,"billingCode":"D5213","codeType":"HCPCS"},{"id":8042,"precertRequired":false,"billingCode":"D5214","codeType":"HCPCS"},{"id":8043,"precertRequired":false,"billingCode":"D5221","codeType":"HCPCS"},{"id":8044,"precertRequired":false,"billingCode":"D5222","codeType":"HCPCS"},{"id":8045,"precertRequired":false,"billingCode":"D5223","codeType":"HCPCS"},{"id":8046,"precertRequired":false,"billingCode":"D5224","codeType":"HCPCS"},{"id":8047,"precertRequired":false,"billingCode":"D5225","codeType":"HCPCS"},{"id":8048,"precertRequired":false,"billingCode":"D5226","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":135,"seocKey":36,"name":"Dental Denture Services","seocId":"DEN_DENTAL DENTURE SERVICES_1.3.2","versionNumber":"1.3.2","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Full intraoral imaging, if indicated\r\n3. Maxillary and/or Mandibular Complete, Immediate and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included)","maxAllowableVisits":999,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA\r\n* Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":104,"description":" Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":105,"description":"Full intraoral imaging, if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":106,"description":"Maxillary and/or Mandibular Complete, Immediate and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8035,"precertRequired":false,"billingCode":"D5110","codeType":"HCPCS"},{"id":8036,"precertRequired":false,"billingCode":"D5120","codeType":"HCPCS"},{"id":8037,"precertRequired":false,"billingCode":"D5130","codeType":"HCPCS"},{"id":8038,"precertRequired":false,"billingCode":"D5140","codeType":"HCPCS"},{"id":8039,"precertRequired":false,"billingCode":"D5211","codeType":"HCPCS"},{"id":8040,"precertRequired":false,"billingCode":"D5212","codeType":"HCPCS"},{"id":8041,"precertRequired":false,"billingCode":"D5213","codeType":"HCPCS"},{"id":8042,"precertRequired":false,"billingCode":"D5214","codeType":"HCPCS"},{"id":8043,"precertRequired":false,"billingCode":"D5221","codeType":"HCPCS"},{"id":8044,"precertRequired":false,"billingCode":"D5222","codeType":"HCPCS"},{"id":8045,"precertRequired":false,"billingCode":"D5223","codeType":"HCPCS"},{"id":8046,"precertRequired":false,"billingCode":"D5224","codeType":"HCPCS"},{"id":8047,"precertRequired":false,"billingCode":"D5225","codeType":"HCPCS"},{"id":8048,"precertRequired":false,"billingCode":"D5226","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":66,"seocKey":36,"name":"Denture Services_PRCT","seocId":"DEN_DENTURE SERVICES_1.3.1_PRCT","versionNumber":"1.3.1","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"05-31-2018","endDate":"12-07-2018","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Full intraoral imaging, if indicated\r\n3. Maxillary and/or Mandibular Complete and/or Partial denture services for teeth number(s)/dental arches and modality as indicated on consultation (routine follow-up visits for adjustments for 3 months are included in the initial fee)","maxAllowableVisits":999,"disclaimer":"** No additional care is authorized prior to VA approval\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 7-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1326,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":296,"seocKey":37,"name":"Dental Emergency","seocId":"DEN_DENTAL EMERGENCY_1.6.3","versionNumber":"1.6.3","description":"This authorization covers services associated with all dental care listed below for the referral condition on the consult.","effectiveDate":"01-02-2019","endDate":"04-18-2019","duration":30,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation\r\n2. Intraoral periapical first radiographic image\r\n3. Intraoral periapical each additional radiographic image\r\n4. Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)\r\n5. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\r\n* All routine medications must be submitted to the patient complaint/condition require VA review and approval.\r\n* Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"},{"hptc":"1223S0112X"}],"services":[{"id":1246,"description":"Limited oral evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1247,"description":"Intraoral periapical first radiographic image","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1248,"description":"Intraoral periapical each additional radiographic image","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1249,"description":"Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8050,"precertRequired":false,"billingCode":"D7210","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1250,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":136,"seocKey":37,"name":"Dental Emergency","seocId":"DEN_DENTAL EMERGENCY_1.6.2","versionNumber":"1.6.2","description":"This authorization covers services associated with all dental care listed below for the referral condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":30,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation\r\n2. Intraoral periapical first radiographic image\r\n3. Intraoral periapical each additional radiographic image\r\n4. Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)\r\n5. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":999,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\r\n* All routine medications must be submitted to the patient complaint/condition require VA review and approval.\r\n* Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":107,"description":"Limited oral evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":108,"description":"Intraoral periapical first radiographic image","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":109,"description":"Intraoral periapical each additional radiographic image","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":110,"description":"Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8050,"precertRequired":false,"billingCode":"D7210","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":111,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":68,"seocKey":37,"name":"Emergency Dental_PRCT","seocId":"DEN_EMERGENCY DENTAL_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"05-31-2018","endDate":"12-07-2018","duration":30,"REV":false,"PRCT":true,"proceduralOverview":"1. Limited oral evaluation\r\n2. Intraoral periapical first radiographic image\r\n3. Intraoral periapical each additional radiographic image","maxAllowableVisits":999,"disclaimer":"** No additional care is authorized prior to VA approval\r\n** All routine medications will be provided by the VA.\r\n** Contact VA at xxx-xxx-xxxx for authorization of definitive emergent care\r\nUrgent/emergent prescriptions can be provided for a 7-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1327,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":532,"seocKey":38,"name":"Dental Initial Evaluation and Limited Treatment","seocId":"DEN_DENTAL INITIAL EVALUATION AND LIMITED TREATMENT_1.0.6","versionNumber":"1.0.6","description":"This authorization covers services associated with all dental care listed below as clinically necessary. * Total costs of provided care must not exceed 1000 dollars. Please refer to the plan of care noted in the consult for the specific services to be performed.  Any need for additional must be pre-approved and is not covered in this authorization.  All care is to be provided by the provider indicated on the referral.  If a referral to another provider is necessary, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.","effectiveDate":"06-26-2019","endDate":null,"duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1.  Comprehensive periodontal, comprehensive oral, and extensive oral evaluations.  Maximum of one (1)\r\n2.  Limited Oral Evaluations.  Maximum of two (2)\r\n3.  Bitewing Radiographs.  Maximum of one (1)\r\n4.  Extraoral Radiographs. Maximum of one (1)\r\n5.  Intraoral Radiographs - Full Image Series. Maximum of one (1)\r\n6.  Intraoral Radiographs - Periapical.  Maximum of twelve (12)\r\n7.  Maxillofacial Prosthodontics Fluoride Gel Carrier.  Maximum of one (1) per 24-month period \r\n8.  Direct restorations Maximum of four (4), distinct teeth/surfaces\r\n9.  Endodontic Care - Initial Treatment\r\n10.  Extractions.  Maximum of six (6)\r\n11.  Periodontal Care - Full Mouth Debridement. Maximum of one (1)\r\n12.  Periodontal Care - Periodontal Maintenance Procedures.  Maximum of two (2)\r\n13.  Periodontal Care - Scaling and Root.  1 quadrant per 24-month period, Maximum of four (4)\r\n14.  Prophylaxis. Maximum of two (2)\r\n15.  Prosthodontics (Removable) Adjustments. Maximum of two (2).  Note not by same provider within 3 months of prostheses delivery. \r\n16.  Prosthodontics (Removable) Repairs.  Maximum of one (1)\r\n17.  Recement crown. Maximum of one (1) same tooth\r\n18.  Topical Fluoride. Maximum of two (2)","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\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 * Request for Services (RFS) requirements","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":3082,"description":"Comprehensive periodontal, comprehensive oral, and extensive oral evaluations.  Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8004,"precertRequired":false,"billingCode":"D0180","codeType":"HCPCS"},{"id":8017,"precertRequired":false,"billingCode":"D0460","codeType":"HCPCS"},{"id":10733,"precertRequired":false,"billingCode":"D0160","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3083,"description":"Oral Evaluations.  Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":10734,"precertRequired":false,"billingCode":"D0170","codeType":"HCPCS"},{"id":10735,"precertRequired":false,"billingCode":"D0171","codeType":"HCPCS"},{"id":10736,"precertRequired":false,"billingCode":"D0190","codeType":"HCPCS"},{"id":10737,"precertRequired":false,"billingCode":"D0191","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3084,"description":"Bitewing Radiographs.  Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":10741,"precertRequired":false,"billingCode":"D0277","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3085,"description":"Extraoral Radiographs. Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3086,"description":"Intraoral Radiographs - Full Image Series. Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3087,"description":"Intraoral Radiographs - Periapical.  Maximum of twelve ( 12)","frequency":null,"frequencyType":"week","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3088,"description":"Maxillofacial Prosthodontics Fluoride Gel Carrier.  Maximum of one (1) per 24-month period","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":11040,"precertRequired":false,"billingCode":"D5986","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3089,"description":"Direct restorations Maximum of four (4), distinct teeth/surfaces","frequency":null,"frequencyType":"week","visits":4,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10811,"precertRequired":false,"billingCode":"D2140","codeType":"HCPCS"},{"id":10812,"precertRequired":false,"billingCode":"D2150","codeType":"HCPCS"},{"id":10813,"precertRequired":false,"billingCode":"D2160","codeType":"HCPCS"},{"id":10814,"precertRequired":false,"billingCode":"D2161","codeType":"HCPCS"},{"id":10816,"precertRequired":false,"billingCode":"D2330 ","codeType":"HCPCS"},{"id":10817,"precertRequired":false,"billingCode":"D2331","codeType":"HCPCS"},{"id":10818,"precertRequired":false,"billingCode":"D2332","codeType":"HCPCS"},{"id":10819,"precertRequired":false,"billingCode":"D2335","codeType":"HCPCS"},{"id":10821,"precertRequired":false,"billingCode":"D2391","codeType":"HCPCS"},{"id":10822,"precertRequired":false,"billingCode":"D2392","codeType":"HCPCS"},{"id":10823,"precertRequired":false,"billingCode":"D2393","codeType":"HCPCS"},{"id":10824,"precertRequired":false,"billingCode":"D2394","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3090,"description":"Endodontic Care - Initial Treatment","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8026,"precertRequired":false,"billingCode":"D3310","codeType":"HCPCS"},{"id":8027,"precertRequired":false,"billingCode":"D3320","codeType":"HCPCS"},{"id":8028,"precertRequired":false,"billingCode":"D3330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3091,"description":"Extractions.  Maximum of six (6)","frequency":null,"frequencyType":"week","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8049,"precertRequired":false,"billingCode":"D7140","codeType":"HCPCS"},{"id":8050,"precertRequired":false,"billingCode":"D7210","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3092,"description":"Periodontal Care - Full Mouth Debridement. Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8033,"precertRequired":false,"billingCode":"D4355","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3093,"description":"Periodontal Care - Periodontal Maintenance Procedures.  Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3094,"description":"Periodontal Care - Scaling and Root.  1 quadrant per 24-month period, Maximum of four (4)","frequency":null,"frequencyType":"week","visits":4,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10954,"precertRequired":false,"billingCode":"D4341","codeType":"HCPCS"},{"id":10955,"precertRequired":false,"billingCode":"D4342","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3095,"description":"Prophylaxis. Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":10795,"precertRequired":false,"billingCode":"D1351","codeType":"HCPCS"},{"id":10796,"precertRequired":false,"billingCode":"D1352","codeType":"HCPCS"},{"id":10797,"precertRequired":false,"billingCode":"D1353","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3096,"description":"Prosthodontics (Removable) Adjustments. Maximum of two (2).  Note not by same provider within 3 months of prostheses delivery.","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10963,"precertRequired":false,"billingCode":"D5410","codeType":"HCPCS"},{"id":10964,"precertRequired":false,"billingCode":"D5411","codeType":"HCPCS"},{"id":10965,"precertRequired":false,"billingCode":"D5421","codeType":"HCPCS"},{"id":10966,"precertRequired":false,"billingCode":"D5422","codeType":"HCPCS"},{"id":11306,"precertRequired":false,"billingCode":"D9932","codeType":"HCPCS"},{"id":11307,"precertRequired":false,"billingCode":"D9933","codeType":"HCPCS"},{"id":11308,"precertRequired":false,"billingCode":"D9934","codeType":"HCPCS"},{"id":11309,"precertRequired":false,"billingCode":"D9935","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3097,"description":"Prosthodontics (Removable) Repairs.  Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10967,"precertRequired":false,"billingCode":"D5511","codeType":"HCPCS"},{"id":10968,"precertRequired":false,"billingCode":"D5512","codeType":"HCPCS"},{"id":10969,"precertRequired":false,"billingCode":"D5520","codeType":"HCPCS"},{"id":10970,"precertRequired":false,"billingCode":"D5611","codeType":"HCPCS"},{"id":10971,"precertRequired":false,"billingCode":"D5612","codeType":"HCPCS"},{"id":10974,"precertRequired":false,"billingCode":"D5630","codeType":"HCPCS"},{"id":10975,"precertRequired":false,"billingCode":"D5640","codeType":"HCPCS"},{"id":10976,"precertRequired":false,"billingCode":"D5650","codeType":"HCPCS"},{"id":10977,"precertRequired":false,"billingCode":"D5660","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3098,"description":"Recement crown. Maximum of one (1) same tooth","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10864,"precertRequired":false,"billingCode":"D2910","codeType":"HCPCS"},{"id":10865,"precertRequired":false,"billingCode":"D2915","codeType":"HCPCS"},{"id":10866,"precertRequired":false,"billingCode":"D2920","codeType":"HCPCS"},{"id":11084,"precertRequired":false,"billingCode":"D6092","codeType":"HCPCS"},{"id":11085,"precertRequired":false,"billingCode":"D6093","codeType":"HCPCS"},{"id":11159,"precertRequired":false,"billingCode":"D6930","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":3099,"description":"Topical Flouride. Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":363,"seocKey":38,"name":"Dental Initial Evaluation and Limited Treatment","seocId":"DEN_DENTAL INITIAL EVALUATION AND LIMITED TREATMENT_1.0.5","versionNumber":"1.0.5","description":"This authorization covers services associated with all dental care listed below as clinically necessary. * Total costs of provided care must not exceed 1000 dollars. Please refer to the plan of care noted in the consult for the specific services to be performed.  Any need for additional must be pre-approved and is not covered in this authorization.  All care is to be provided by the provider indicated on the referral.  If a referral to another provider is necessary, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.","effectiveDate":"04-23-2019","endDate":"06-26-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1.  Comprehensive periodontal, comprehensive oral, and extensive oral evaluations.  Maximum of one (1)\r\n2.  Limited Oral Evaluations.  Maximum of two (2)\r\n3.  Bitewing Radiographs.  Maximum of one (1)\r\n4.  Extraoral Radiographs. Maximum of one (1)\r\n5.  Intraoral Radiographs - Full Image Series. Maximum of one (1)\r\n6.  Intraoral Radiographs - Periapical.  Maximum of twelve (12)\r\n7.  Maxillofacial Prosthodontics Fluoride Gel Carrier.  Maximum of one (1) per 24-month period \r\n8.  Direct restorations Maximum of four (4), distinct teeth/surfaces\r\n9.  Endodontic Care - Initial Treatment\r\n10.  Extractions.  Maximum of six (6)\r\n11.  Periodontal Care - Full Mouth Debridement. Maximum of one (1)\r\n12.  Periodontal Care - Periodontal Maintenance Procedures.  Maximum of two (2)\r\n13.  Periodontal Care - Scaling and Root.  1 quadrant per 24-month period, Maximum of four (4)\r\n14.  Prophylaxis. Maximum of two (2)\r\n15.  Prosthodontics (Removable) Adjustments. Maximum of two (2).  Note not by same provider within 3 months of prostheses delivery. \r\n16.  Prosthodontics (Removable) Repairs.  Maximum of one (1)\r\n17.  Recement crown. Maximum of one (1) same tooth\r\n18.  Topical Fluoride. Maximum of two (2)","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\r\n* Please return copies of images and suggested plan of care for VA review\r\n* All routine medications must be immediately faxed/provided to VA pharmacy to be dispensed timely by VA pharmacy. Non-formulary drug approval process may be required.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1890,"description":"Comprehensive periodontal, comprehensive oral, and extensive oral evaluations.  Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8004,"precertRequired":false,"billingCode":"D0180","codeType":"HCPCS"},{"id":8017,"precertRequired":false,"billingCode":"D0460","codeType":"HCPCS"},{"id":10733,"precertRequired":false,"billingCode":"D0160","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1891,"description":"Oral Evaluations.  Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":10734,"precertRequired":false,"billingCode":"D0170","codeType":"HCPCS"},{"id":10735,"precertRequired":false,"billingCode":"D0171","codeType":"HCPCS"},{"id":10736,"precertRequired":false,"billingCode":"D0190","codeType":"HCPCS"},{"id":10737,"precertRequired":false,"billingCode":"D0191","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1892,"description":"Bitewing Radiographs.  Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":10741,"precertRequired":false,"billingCode":"D0277","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1893,"description":"Extraoral Radiographs. Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1894,"description":"Intraoral Radiographs - Full Image Series. Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1895,"description":"Intraoral Radiographs - Periapical.  Maximum of twelve ( 12)","frequency":null,"frequencyType":"week","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1896,"description":"Maxillofacial Prosthodontics Fluoride Gel Carrier.  Maximum of one (1) per 24-month period","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":11040,"precertRequired":false,"billingCode":"D5986","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1897,"description":"Direct restorations Maximum of four (4), distinct teeth/surfaces","frequency":null,"frequencyType":"week","visits":4,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10811,"precertRequired":false,"billingCode":"D2140","codeType":"HCPCS"},{"id":10812,"precertRequired":false,"billingCode":"D2150","codeType":"HCPCS"},{"id":10813,"precertRequired":false,"billingCode":"D2160","codeType":"HCPCS"},{"id":10814,"precertRequired":false,"billingCode":"D2161","codeType":"HCPCS"},{"id":10816,"precertRequired":false,"billingCode":"D2330 ","codeType":"HCPCS"},{"id":10817,"precertRequired":false,"billingCode":"D2331","codeType":"HCPCS"},{"id":10818,"precertRequired":false,"billingCode":"D2332","codeType":"HCPCS"},{"id":10819,"precertRequired":false,"billingCode":"D2335","codeType":"HCPCS"},{"id":10821,"precertRequired":false,"billingCode":"D2391","codeType":"HCPCS"},{"id":10822,"precertRequired":false,"billingCode":"D2392","codeType":"HCPCS"},{"id":10823,"precertRequired":false,"billingCode":"D2393","codeType":"HCPCS"},{"id":10824,"precertRequired":false,"billingCode":"D2394","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1898,"description":"Endodontic Care - Initial Treatment","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8026,"precertRequired":false,"billingCode":"D3310","codeType":"HCPCS"},{"id":8027,"precertRequired":false,"billingCode":"D3320","codeType":"HCPCS"},{"id":8028,"precertRequired":false,"billingCode":"D3330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1899,"description":"Extractions.  Maximum of six (6)","frequency":null,"frequencyType":"week","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8049,"precertRequired":false,"billingCode":"D7140","codeType":"HCPCS"},{"id":8050,"precertRequired":false,"billingCode":"D7210","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1900,"description":"Periodontal Care - Full Mouth Debridement. Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8033,"precertRequired":false,"billingCode":"D4355","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1901,"description":"Periodontal Care - Periodontal Maintenance Procedures.  Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1902,"description":"Periodontal Care - Scaling and Root.  1 quadrant per 24-month period, Maximum of four (4)","frequency":null,"frequencyType":"week","visits":4,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10954,"precertRequired":false,"billingCode":"D4341","codeType":"HCPCS"},{"id":10955,"precertRequired":false,"billingCode":"D4342","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1903,"description":"Prophylaxis. Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":10795,"precertRequired":false,"billingCode":"D1351","codeType":"HCPCS"},{"id":10796,"precertRequired":false,"billingCode":"D1352","codeType":"HCPCS"},{"id":10797,"precertRequired":false,"billingCode":"D1353","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1904,"description":"Prosthodontics (Removable) Adjustments. Maximum of two (2).  Note not by same provider within 3 months of prostheses delivery.","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10963,"precertRequired":false,"billingCode":"D5410","codeType":"HCPCS"},{"id":10964,"precertRequired":false,"billingCode":"D5411","codeType":"HCPCS"},{"id":10965,"precertRequired":false,"billingCode":"D5421","codeType":"HCPCS"},{"id":10966,"precertRequired":false,"billingCode":"D5422","codeType":"HCPCS"},{"id":11306,"precertRequired":false,"billingCode":"D9932","codeType":"HCPCS"},{"id":11307,"precertRequired":false,"billingCode":"D9933","codeType":"HCPCS"},{"id":11308,"precertRequired":false,"billingCode":"D9934","codeType":"HCPCS"},{"id":11309,"precertRequired":false,"billingCode":"D9935","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1905,"description":"Prosthodontics (Removable) Repairs.  Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10967,"precertRequired":false,"billingCode":"D5511","codeType":"HCPCS"},{"id":10968,"precertRequired":false,"billingCode":"D5512","codeType":"HCPCS"},{"id":10969,"precertRequired":false,"billingCode":"D5520","codeType":"HCPCS"},{"id":10970,"precertRequired":false,"billingCode":"D5611","codeType":"HCPCS"},{"id":10971,"precertRequired":false,"billingCode":"D5612","codeType":"HCPCS"},{"id":10974,"precertRequired":false,"billingCode":"D5630","codeType":"HCPCS"},{"id":10975,"precertRequired":false,"billingCode":"D5640","codeType":"HCPCS"},{"id":10976,"precertRequired":false,"billingCode":"D5650","codeType":"HCPCS"},{"id":10977,"precertRequired":false,"billingCode":"D5660","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1906,"description":"Recement crown. Maximum of one (1) same tooth","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10864,"precertRequired":false,"billingCode":"D2910","codeType":"HCPCS"},{"id":10865,"precertRequired":false,"billingCode":"D2915","codeType":"HCPCS"},{"id":10866,"precertRequired":false,"billingCode":"D2920","codeType":"HCPCS"},{"id":11084,"precertRequired":false,"billingCode":"D6092","codeType":"HCPCS"},{"id":11085,"precertRequired":false,"billingCode":"D6093","codeType":"HCPCS"},{"id":11159,"precertRequired":false,"billingCode":"D6930","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1907,"description":"Topical Flouride. Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":354,"seocKey":38,"name":"Dental Initial Evaluation and Limited Treatment","seocId":"DEN_DENTAL INITIAL EVALUATION AND LIMITED TREATMENT_1.0.4","versionNumber":"1.0.4","description":"This authorization covers services associated with all dental care listed below as clinically necessary. * Total costs of provided care must not exceed 1000 dollars. Please refer to the plan of care noted in the consult for the specific services to be performed.  Any need for additional must be pre-approved and is not covered in this authorization.  All care is to be provided by the provider indicated on the referral.  If a referral to another provider is necessary, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.","effectiveDate":"04-19-2019","endDate":"04-23-2019","duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1.  Comprehensive periodontal, comprehensive oral, and extensive oral evaluations.  Maximum of one (1)\r\n2.  Limited Oral Evaluations.  Maximum of two (2)\r\n3.  Bitewing Radiographs.  Maximum of one (1)\r\n4.  Extraoral Radiographs. Maximum of one (1)\r\n5.  Intraoral Radiographs - Full Image Series. Maximum of one (1)\r\n6.  Intraoral Radiographs - Periapical.  Maximum of twelve (12)\r\n7.  Maxillofacial Prosthodontics Fluoride Gel Carrier.  Maximum of one (1) per 24-month period \r\n8.  Direct restorations Maximum of four (4), distinct teeth/surfaces\r\n9.  Endodontic Care - Initial Treatment\r\n10.  Extractions.  Maximum of six (6)\r\n11.  Periodontal Care - Full Mouth Debridement. Maximum of one (1)\r\n12.  Periodontal Care - Periodontal Maintenance Procedures.  Maximum of two (2)\r\n13.  Periodontal Care - Scaling and Root.  1 quadrant per 24-month period, Maximum of four (4)\r\n14.  Prophylaxis. Maximum of two (2)\r\n15.  Prosthodontics (Removable) Adjustments. Maximum of two (2).  Note not by same provider within 3 months of prostheses delivery. \r\n16.  Prosthodontics (Removable) Repairs.  Maximum of one (1)\r\n17.  Recement crown. Maximum of one (1) same tooth\r\n18.  Topical Fluoride. Maximum of two (2)","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\r\n* Please return copies of images and suggested plan of care for VA review\r\n* All routine medications must be immediately faxed/provided to VA pharmacy to be dispensed timely by VA pharmacy. Non-formulary drug approval process may be required.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1804,"description":"Comprehensive periodontal, comprehensive oral, and extensive oral evaluations.  Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8004,"precertRequired":false,"billingCode":"D0180","codeType":"HCPCS"},{"id":10733,"precertRequired":false,"billingCode":"D0160","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1805,"description":"Oral Evaluations.  Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":10734,"precertRequired":false,"billingCode":"D0170","codeType":"HCPCS"},{"id":10735,"precertRequired":false,"billingCode":"D0171","codeType":"HCPCS"},{"id":10736,"precertRequired":false,"billingCode":"D0190","codeType":"HCPCS"},{"id":10737,"precertRequired":false,"billingCode":"D0191","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1806,"description":"Bitewing Radiographs.  Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":10741,"precertRequired":false,"billingCode":"D0277","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1807,"description":"Extraoral Radiographs. Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1808,"description":"Intraoral Radiographs - Full Image Series. Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1809,"description":"Intraoral Radiographs - Periapical.  Maximum of twelve ( 12)","frequency":null,"frequencyType":"week","visits":12,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1810,"description":"Maxillofacial Prosthodontics Fluoride Gel Carrier.  Maximum of one (1) per 24-month period","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":11040,"precertRequired":false,"billingCode":"D5986","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1811,"description":"Direct restorations Maximum of four (4), distinct teeth/surfaces","frequency":null,"frequencyType":"week","visits":4,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10811,"precertRequired":false,"billingCode":"D2140","codeType":"HCPCS"},{"id":10812,"precertRequired":false,"billingCode":"D2150","codeType":"HCPCS"},{"id":10813,"precertRequired":false,"billingCode":"D2160","codeType":"HCPCS"},{"id":10814,"precertRequired":false,"billingCode":"D2161","codeType":"HCPCS"},{"id":10816,"precertRequired":false,"billingCode":"D2330 ","codeType":"HCPCS"},{"id":10817,"precertRequired":false,"billingCode":"D2331","codeType":"HCPCS"},{"id":10818,"precertRequired":false,"billingCode":"D2332","codeType":"HCPCS"},{"id":10819,"precertRequired":false,"billingCode":"D2335","codeType":"HCPCS"},{"id":10821,"precertRequired":false,"billingCode":"D2391","codeType":"HCPCS"},{"id":10822,"precertRequired":false,"billingCode":"D2392","codeType":"HCPCS"},{"id":10823,"precertRequired":false,"billingCode":"D2393","codeType":"HCPCS"},{"id":10824,"precertRequired":false,"billingCode":"D2394","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1812,"description":"Endodontic Care - Initial Treatment","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8026,"precertRequired":false,"billingCode":"D3310","codeType":"HCPCS"},{"id":8027,"precertRequired":false,"billingCode":"D3320","codeType":"HCPCS"},{"id":8028,"precertRequired":false,"billingCode":"D3330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1813,"description":"Extractions.  Maximum of six (6)","frequency":null,"frequencyType":"week","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8049,"precertRequired":false,"billingCode":"D7140","codeType":"HCPCS"},{"id":8050,"precertRequired":false,"billingCode":"D7210","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1814,"description":"Periodontal Care - Full Mouth Debridement. Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8033,"precertRequired":false,"billingCode":"D4355","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1815,"description":"Periodontal Care - Periodontal Maintenance Procedures.  Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1816,"description":"Periodontal Care - Scaling and Root.  1 quadrant per 24-month period, Maximum of four (4)","frequency":null,"frequencyType":"week","visits":4,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10954,"precertRequired":false,"billingCode":"D4341","codeType":"HCPCS"},{"id":10955,"precertRequired":false,"billingCode":"D4342","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1817,"description":"Prophylaxis. Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":10795,"precertRequired":false,"billingCode":"D1351","codeType":"HCPCS"},{"id":10796,"precertRequired":false,"billingCode":"D1352","codeType":"HCPCS"},{"id":10797,"precertRequired":false,"billingCode":"D1353","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1818,"description":"Prosthodontics (Removable) Adjustments. Maximum of two (2).  Note not by same provider within 3 months of prostheses delivery.","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10963,"precertRequired":false,"billingCode":"D5410","codeType":"HCPCS"},{"id":10964,"precertRequired":false,"billingCode":"D5411","codeType":"HCPCS"},{"id":10965,"precertRequired":false,"billingCode":"D5421","codeType":"HCPCS"},{"id":10966,"precertRequired":false,"billingCode":"D5422","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1819,"description":"Prosthodontics (Removable) Repairs.  Maximum of one (1)","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10967,"precertRequired":false,"billingCode":"D5511","codeType":"HCPCS"},{"id":10968,"precertRequired":false,"billingCode":"D5512","codeType":"HCPCS"},{"id":10969,"precertRequired":false,"billingCode":"D5520","codeType":"HCPCS"},{"id":10970,"precertRequired":false,"billingCode":"D5611","codeType":"HCPCS"},{"id":10971,"precertRequired":false,"billingCode":"D5612","codeType":"HCPCS"},{"id":10974,"precertRequired":false,"billingCode":"D5630","codeType":"HCPCS"},{"id":10975,"precertRequired":false,"billingCode":"D5640","codeType":"HCPCS"},{"id":10976,"precertRequired":false,"billingCode":"D5650","codeType":"HCPCS"},{"id":10977,"precertRequired":false,"billingCode":"D5660","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1820,"description":"Recement crown. Maximum of one (1) same tooth","frequency":null,"frequencyType":"week","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":10864,"precertRequired":false,"billingCode":"D2910","codeType":"HCPCS"},{"id":10865,"precertRequired":false,"billingCode":"D2915","codeType":"HCPCS"},{"id":10866,"precertRequired":false,"billingCode":"D2920","codeType":"HCPCS"},{"id":11084,"precertRequired":false,"billingCode":"D6092","codeType":"HCPCS"},{"id":11085,"precertRequired":false,"billingCode":"D6093","codeType":"HCPCS"},{"id":11159,"precertRequired":false,"billingCode":"D6930","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1821,"description":"Topical Flouride. Maximum of two (2)","frequency":null,"frequencyType":"week","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":295,"seocKey":38,"name":"Dental Initial Evaluation","seocId":"DEN_DENTAL INITIAL EVALUATION_1.0.3","versionNumber":"1.0.3","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"01-02-2019","endDate":"04-19-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Comprehensive oral evaluation or comprehensive peridontal evaluation\r\n2. If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* Please return copies of images and suggested plan of care for VA review\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1244,"description":"Comprehensive oral evaluation or comprehensive peridontal evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8004,"precertRequired":false,"billingCode":"D0180","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1245,"description":"If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":137,"seocKey":38,"name":"Dental Initial Evaluation","seocId":"DEN_DENTAL INITIAL EVALUATION_1.0.2","versionNumber":"1.0.2","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Comprehensive oral evaluation or comprehensive peridontal evaluation\r\n2. If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images","maxAllowableVisits":999,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* Please return copies of images and suggested plan of care for VA review\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":112,"description":"Comprehensive oral evaluation or comprehensive peridontal evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8004,"precertRequired":false,"billingCode":"D0180","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":113,"description":"If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":77,"seocKey":38,"name":"Initial Evaluation_PRCT","seocId":"DEN_INITIAL EVALUATION_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"05-31-2018","endDate":"12-07-2018","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. Comprehensive oral evaluation or comprehensive peridontal evaluation\r\n2. If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images","maxAllowableVisits":1,"disclaimer":"** No additional care is authorized prior to VA approval\r\n** All routine medications will be provided by the VA.\r\n** Please return copies of images and suggested plan of care for VA review\r\nUrgent/emergent prescriptions can be provided for a 7-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1328,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1697,"seocKey":39,"name":"Dental Oral Lesion","seocId":"DEN_DENTAL ORAL LESION_1.5.5","versionNumber":"1.5.5","description":"This authorization covers services for dental eligible Veterans as noted in the consult ONLY. It directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult ONLY.   Minimal impact procedural code substitutions are allowed from the authorized plan in the consult but the difference of the change must not exceed $1000. If the changes exceed the cost difference of $1000, then a new treatment plan must be submitted and must be approved by a VA Dentist PRIOR to performing any treatment","effectiveDate":"01-24-2020","endDate":null,"duration":180,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited Oral Evaluation (initial)\r\n2. Resection of oral lesion, as clinically indicated on consult\r\n3. Biopsy and pathology services for oral lesion noted on consultation\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated\r\n5. Follow up office visits as related to episode of care\r\n* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.","maxAllowableVisits":null,"disclaimer":"*Please visit the VHA storefront, \r\nwww.va.gov/COMMUNITYCARE/providers/index.asp, \r\nfor 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","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"},{"hptc":"1223S0112X"}],"services":[{"id":4795,"description":"Limited Oral Evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"},{"id":12188,"precertRequired":false,"billingCode":"D9310","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":4796,"description":"Resection of oral lesion, as clinically indicated on consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8055,"precertRequired":false,"billingCode":"D7285","codeType":"HCPCS"},{"id":8056,"precertRequired":false,"billingCode":"D7286","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":4797,"description":"Biopsy and pathology services for oral lesion noted on consultation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8057,"precertRequired":false,"billingCode":"D7410","codeType":"HCPCS"},{"id":8058,"precertRequired":false,"billingCode":"D7411","codeType":"HCPCS"},{"id":8059,"precertRequired":false,"billingCode":"D7412","codeType":"HCPCS"},{"id":8060,"precertRequired":false,"billingCode":"D7413","codeType":"HCPCS"},{"id":8061,"precertRequired":false,"billingCode":"D7414","codeType":"HCPCS"},{"id":10789,"precertRequired":false,"billingCode":"D0502","codeType":"HCPCS"},{"id":12190,"precertRequired":false,"billingCode":"D7415","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":4798,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":4799,"description":"Follow up office visits as related to episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]}]}},{"Seoc":{"id":1660,"seocKey":39,"name":"Dental Oral Lesion","seocId":"DEN_DENTAL ORAL LESION_1.5.4","versionNumber":"1.5.4","description":"This authorization covers services for dental eligible Veterans as noted in the consult ONLY. It directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult ONLY.   Minimal impact procedural code substitutions are allowed from the authorized plan in the consult but the difference of the change must not exceed 1000 dollars. If the changes exceed the cost difference of 1000 dollars, then a new treatment plan must be submitted and must be approved by a VA Dentist PRIOR to performing any treatment","effectiveDate":"11-12-2019","endDate":"01-24-2020","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited Oral Evaluation (initial)\r\n2. Resection of oral lesion, as clinically indicated on consult\r\n3. Biopsy and pathology services for oral lesion noted on consultation\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated\r\n5. Follow up office visits as related to episode of care\r\n* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"},{"hptc":"1223S0112X"}],"services":[{"id":4660,"description":"Limited Oral Evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"},{"id":12188,"precertRequired":false,"billingCode":"D9310","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":4661,"description":"Resection of oral lesion, as clinically indicated on consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8055,"precertRequired":false,"billingCode":"D7285","codeType":"HCPCS"},{"id":8056,"precertRequired":false,"billingCode":"D7286","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":4662,"description":"Biopsy and pathology services for oral lesion noted on consultation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8057,"precertRequired":false,"billingCode":"D7410","codeType":"HCPCS"},{"id":8058,"precertRequired":false,"billingCode":"D7411","codeType":"HCPCS"},{"id":8059,"precertRequired":false,"billingCode":"D7412","codeType":"HCPCS"},{"id":8060,"precertRequired":false,"billingCode":"D7413","codeType":"HCPCS"},{"id":8061,"precertRequired":false,"billingCode":"D7414","codeType":"HCPCS"},{"id":10789,"precertRequired":false,"billingCode":"D0502","codeType":"HCPCS"},{"id":12190,"precertRequired":false,"billingCode":"D7415","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":4663,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":4664,"description":"Follow up office visits as related to episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]}]}},{"Seoc":{"id":509,"seocKey":39,"name":"Dental Oral Lesion","seocId":"DEN_DENTAL ORAL LESION_1.5.3","versionNumber":"1.5.3","description":"Description: This authorization covers services for dental eligible Veterans associated with the approved dental plan of care on the consult which directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult for the specific services to be performed. Minimal impact procedural code substitutions are allowed as a change in the plan.  The cost difference of the change must not exceed 1000 dollars for the entire treatment plan. If any changes do not meet the aforementioned conditions, then a new treatment plan must be submitted and must be approved by a VA Dentist prior to performing any treatment.","effectiveDate":"06-26-2019","endDate":"11-12-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited Oral Evaluation (initial)\r\n2. Resection of oral lesion, as clinically indicated on consult\r\n3. Biopsy and pathology services for oral lesion noted on consultation\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated\r\n5. Follow up office visits as related to episode of care","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\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*\tPharmacy prescribing requirements\r\n*\tDurable Medical Equipment (DME), Prosthetics, and Orthotics prescribing requirements\r\n*\tPrecertification (PRCT) process requirements\r\n*\tRequest for Services (RFS) requirements","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"},{"hptc":"1223S0112X"}],"services":[{"id":2950,"description":"Limited Oral Evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":2951,"description":"Resection of oral lesion, as clinically indicated on consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8057,"precertRequired":false,"billingCode":"D7410","codeType":"HCPCS"},{"id":8058,"precertRequired":false,"billingCode":"D7411","codeType":"HCPCS"},{"id":8059,"precertRequired":false,"billingCode":"D7412","codeType":"HCPCS"},{"id":8060,"precertRequired":false,"billingCode":"D7413","codeType":"HCPCS"},{"id":8061,"precertRequired":false,"billingCode":"D7414","codeType":"HCPCS"},{"id":8062,"precertRequired":false,"billingCode":"D7415","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":2952,"description":"Biopsy and pathology services for oral lesion noted on consultation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8055,"precertRequired":false,"billingCode":"D7285","codeType":"HCPCS"},{"id":8056,"precertRequired":false,"billingCode":"D7286","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":2953,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2954,"description":"Follow up office visits as related to episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]}]}},{"Seoc":{"id":294,"seocKey":39,"name":"Dental Oral Lesion","seocId":"DEN_DENTAL ORAL LESION_1.5.2","versionNumber":"1.5.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-02-2019","endDate":"06-26-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited Oral Evaluation (initial)\r\n2. Resection of oral lesion, as clinically indicated on consult\r\n3. Biopsy and pathology services for oral lesion noted on consultation\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated\r\n5. Follow up office visits as related to episode of care","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* DME, prosthetics and orthotics orders must be submitted to the local Va facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"},{"hptc":"1223S0112X"}],"services":[{"id":1239,"description":"Limited Oral Evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":1240,"description":"Resection of oral lesion, as clinically indicated on consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8057,"precertRequired":false,"billingCode":"D7410","codeType":"HCPCS"},{"id":8058,"precertRequired":false,"billingCode":"D7411","codeType":"HCPCS"},{"id":8059,"precertRequired":false,"billingCode":"D7412","codeType":"HCPCS"},{"id":8060,"precertRequired":false,"billingCode":"D7413","codeType":"HCPCS"},{"id":8061,"precertRequired":false,"billingCode":"D7414","codeType":"HCPCS"},{"id":8062,"precertRequired":false,"billingCode":"D7415","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":1241,"description":"Biopsy and pathology services for oral lesion noted on consultation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8055,"precertRequired":false,"billingCode":"D7285","codeType":"HCPCS"},{"id":8056,"precertRequired":false,"billingCode":"D7286","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":1242,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1243,"description":"Follow up office visits as related to episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]}]}},{"Seoc":{"id":138,"seocKey":39,"name":"Dental Oral Lesion","seocId":"DEN_DENTAL ORAL LESION_1.5.1","versionNumber":"1.5.1","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited Oral Evaluation (initial)\r\n2. Resection of oral lesion, as clinically indicated on consult\r\n3. Biopsy and pathology services for oral lesion noted on consultation\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated\r\n5. Follow up office visits as related to episode of care","maxAllowableVisits":999,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* DME, prosthetics and orthotics orders must be submitted to the local Va facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":114,"description":"Limited Oral Evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":115,"description":"Resection of oral lesion, as clinically indicated on consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8057,"precertRequired":false,"billingCode":"D7410","codeType":"HCPCS"},{"id":8058,"precertRequired":false,"billingCode":"D7411","codeType":"HCPCS"},{"id":8059,"precertRequired":false,"billingCode":"D7412","codeType":"HCPCS"},{"id":8060,"precertRequired":false,"billingCode":"D7413","codeType":"HCPCS"},{"id":8061,"precertRequired":false,"billingCode":"D7414","codeType":"HCPCS"},{"id":8062,"precertRequired":false,"billingCode":"D7415","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":116,"description":"Biopsy and pathology services for oral lesion noted on consultation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8055,"precertRequired":false,"billingCode":"D7285","codeType":"HCPCS"},{"id":8056,"precertRequired":false,"billingCode":"D7286","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":117,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":118,"description":"Follow up office visits as related to episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]}]}},{"Seoc":{"id":1661,"seocKey":40,"name":"Dental Perio Preventative Care","seocId":"DEN_DENTAL PERIO PREVENTATIVE CARE_1.2.6","versionNumber":"1.2.6","description":"This authorization covers services for dental eligible Veterans as noted in the consult ONLY. It directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult ONLY.   Minimal impact procedural code substitutions are allowed from the authorized plan in the consult but the difference of the change must not exceed 1000 dollars. If the changes exceed the cost difference of 1000 dollars, then a new treatment plan must be submitted and must be approved by a VA Dentist PRIOR to performing any treatment","effectiveDate":"11-12-2019","endDate":null,"duration":365,"REV":false,"PRCT":false,"proceduralOverview":"1. Periodontal maintenance\r\n2. Periodic oral evaluation  - or -  comprehensive periodontal evaluation\r\n* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":4665,"description":"Periodontal maintenance","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"},{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":4666,"description":"Periodic oral evaluation  - or -  comprehensive periodontal evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8004,"precertRequired":false,"billingCode":"D0180","codeType":"HCPCS"},{"id":12188,"precertRequired":false,"billingCode":"D9310","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":510,"seocKey":40,"name":"Dental Perio Preventative Care","seocId":"DEN_DENTAL PERIO PREVENTATIVE CARE_1.2.5","versionNumber":"1.2.5","description":"Description: This authorization covers services for dental eligible Veterans associated with the approved dental plan of care on the consult which directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult for the specific services to be performed. Minimal impact procedural code substitutions are allowed as a change in the plan.  The cost difference of the change must not exceed 1000 dollars for the entire treatment plan. If any changes do not meet the aforementioned conditions, then a new treatment plan must be submitted and must be approved by a VA Dentist prior to performing any treatment.","effectiveDate":"06-26-2019","endDate":"11-12-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Periodontal maintenance\r\n2. Periodic oral evaluation  - or -  comprehensive periodontal evaluation","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\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*\tPharmacy prescribing requirements\r\n*\tDurable Medical Equipment (DME), Prosthetics, and Orthotics prescribing requirements\r\n*\tPrecertification (PRCT) process requirements\r\n*\tRequest for Services (RFS) requirements","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":2955,"description":"Periodontal maintenance---Code usage not to exceed 4x annually","frequency":4,"frequencyType":"year","visits":4,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2956,"description":"Periodic oral evaluation  Code usage not to exceed 2x/annually- or - comprehensive periodontal evaluation-- Code usage not to exceed 2x annually","frequency":2,"frequencyType":"year","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8004,"precertRequired":false,"billingCode":"D0180","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":356,"seocKey":40,"name":"Dental Perio Preventative Care","seocId":"DEN_DENTAL PERIO PREVENTATIVE CARE_1.2.4","versionNumber":"1.2.4","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"04-19-2019","endDate":"06-26-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Periodontal maintenance\r\n2. Periodic oral evaluation  - or -  comprehensive periodontal evaluation","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1826,"description":"Periodontal maintenance---Code usage not to exceed 4x annually","frequency":4,"frequencyType":"year","visits":4,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1827,"description":"Periodic oral evaluation  Code usage not to exceed 2x/annually- or - comprehensive periodontal evaluation-- Code usage not to exceed 2x annually","frequency":2,"frequencyType":"year","visits":2,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8004,"precertRequired":false,"billingCode":"D0180","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":293,"seocKey":40,"name":"Dental Perio Preventative Care","seocId":"DEN_DENTAL PERIO PREVENTATIVE CARE_1.2.3","versionNumber":"1.2.3","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"01-02-2019","endDate":"04-19-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Periodontal maintenance\r\n2. Periodic oral evaluation  - or -  comprehensive periodontal evaluation","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1237,"description":"Periodontal maintenance","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1238,"description":"Periodic oral evaluation  - or -  comprehensive periodontal evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8004,"precertRequired":false,"billingCode":"D0180","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":139,"seocKey":40,"name":"Dental Perio Preventative Care","seocId":"DEN_DENTAL PERIO PREVENTATIVE CARE_1.2.2","versionNumber":"1.2.2","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Periodontal maintenance\r\n2. Periodic oral evaluation  - or -  comprehensive periodontal evaluation","maxAllowableVisits":999,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":119,"description":"Periodontal maintenance","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":120,"description":"Periodic oral evaluation  - or -  comprehensive periodontal evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8004,"precertRequired":false,"billingCode":"D0180","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":64,"seocKey":40,"name":"Dental Perio Preventative Care_PRCT","seocId":"DEN_DENTAL PERIO PREVENTATIVE CARE_1.2.1_PRCT","versionNumber":"1.2.1","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"05-31-2018","endDate":"12-07-2018","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. Periodontal maintenance\r\n2. Periodic oral evaluation  - or -  comprehensive periodontal evaluation","maxAllowableVisits":999,"disclaimer":"** No additional care is authorized prior to VA approval\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 7-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1324,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":511,"seocKey":41,"name":"Dental Regular Preventative Care","seocId":"DEN_DENTAL REGULAR PREVENTATIVE CARE_1.1.5","versionNumber":"1.1.5","description":"Description: This authorization covers services for dental eligible Veterans associated with the approved dental plan of care on the consult which directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult for the specific services to be performed. Minimal impact procedural code substitutions are allowed as a change in the plan.  The cost difference of the change must not exceed 1000 dollars for the entire treatment plan. If any changes do not meet the aforementioned conditions, then a new treatment plan must be submitted and must be approved by a VA Dentist prior to performing any treatment.","effectiveDate":"06-26-2019","endDate":null,"duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Prophylaxis adult - or - Scaling in presence of moderate/severe inflammation\r\n2. Periodic oral evaluation\r\n3. If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\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*\tPharmacy prescribing requirements\r\n*\tDurable Medical Equipment (DME), Prosthetics, and Orthotics prescribing requirements\r\n*\tPrecertification (PRCT) process requirements\r\n*\tRequest for Services (RFS) requirements","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":2957,"description":"Prophylaxis adult - or - Scaling in presence of moderate/severe inflammation","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"},{"id":8021,"precertRequired":false,"billingCode":"D1310","codeType":"HCPCS"},{"id":8022,"precertRequired":false,"billingCode":"D1320","codeType":"HCPCS"},{"id":8023,"precertRequired":false,"billingCode":"D1330","codeType":"HCPCS"},{"id":8032,"precertRequired":false,"billingCode":"D4346","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2958,"description":"Periodic oral evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8015,"precertRequired":false,"billingCode":"D0425","codeType":"HCPCS"},{"id":8016,"precertRequired":false,"billingCode":"D0431","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2959,"description":"If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"},{"id":8013,"precertRequired":false,"billingCode":"D0340","codeType":"HCPCS"},{"id":8014,"precertRequired":false,"billingCode":"D0350","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2960,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":357,"seocKey":41,"name":"Dental Regular Preventative Care","seocId":"DEN_DENTAL REGULAR PREVENTATIVE CARE_1.1.4","versionNumber":"1.1.4","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"04-19-2019","endDate":"06-26-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Prophylaxis adult - or - Scaling in presence of moderate/severe inflammation\r\n2. Periodic oral evaluation\r\n3. If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n**Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n *The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1828,"description":"Prophylaxis adult - or - Scaling in presence of moderate/severe inflammation","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"},{"id":8021,"precertRequired":false,"billingCode":"D1310","codeType":"HCPCS"},{"id":8022,"precertRequired":false,"billingCode":"D1320","codeType":"HCPCS"},{"id":8023,"precertRequired":false,"billingCode":"D1330","codeType":"HCPCS"},{"id":8032,"precertRequired":false,"billingCode":"D4346","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1829,"description":"Periodic oral evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8015,"precertRequired":false,"billingCode":"D0425","codeType":"HCPCS"},{"id":8016,"precertRequired":false,"billingCode":"D0431","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1830,"description":"If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"},{"id":8013,"precertRequired":false,"billingCode":"D0340","codeType":"HCPCS"},{"id":8014,"precertRequired":false,"billingCode":"D0350","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1831,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":292,"seocKey":41,"name":"Dental Regular Preventative Care","seocId":"DEN_DENTAL REGULAR PREVENTATIVE CARE_1.1.3","versionNumber":"1.1.3","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"01-02-2019","endDate":"04-19-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Prophylaxis adult - or - Scaling in presence of moderate/severe inflammation\r\n2. Periodic oral evaluation\r\n3. If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1233,"description":"Prophylaxis adult - or - Scaling in presence of moderate/severe inflammation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"},{"id":8021,"precertRequired":false,"billingCode":"D1310","codeType":"HCPCS"},{"id":8022,"precertRequired":false,"billingCode":"D1320","codeType":"HCPCS"},{"id":8023,"precertRequired":false,"billingCode":"D1330","codeType":"HCPCS"},{"id":8032,"precertRequired":false,"billingCode":"D4346","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1234,"description":"Periodic oral evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8015,"precertRequired":false,"billingCode":"D0425","codeType":"HCPCS"},{"id":8016,"precertRequired":false,"billingCode":"D0431","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1235,"description":"If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"},{"id":8013,"precertRequired":false,"billingCode":"D0340","codeType":"HCPCS"},{"id":8014,"precertRequired":false,"billingCode":"D0350","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1236,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":140,"seocKey":41,"name":"Dental Regular Preventative Care","seocId":"DEN_DENTAL REGULAR PREVENTATIVE CARE_1.1.2","versionNumber":"1.1.2","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Prophylaxis adult - or - Scaling in presence of moderate/severe inflammation\r\n2. Periodic oral evaluation\r\n3. If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":999,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":121,"description":"Prophylaxis adult - or - Scaling in presence of moderate/severe inflammation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"},{"id":8021,"precertRequired":false,"billingCode":"D1310","codeType":"HCPCS"},{"id":8022,"precertRequired":false,"billingCode":"D1320","codeType":"HCPCS"},{"id":8023,"precertRequired":false,"billingCode":"D1330","codeType":"HCPCS"},{"id":8032,"precertRequired":false,"billingCode":"D4346","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":122,"description":"Periodic oral evaluation","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8001,"precertRequired":false,"billingCode":"D0120","codeType":"HCPCS"},{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8015,"precertRequired":false,"billingCode":"D0425","codeType":"HCPCS"},{"id":8016,"precertRequired":false,"billingCode":"D0431","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":123,"description":"If imaging is indicated: Intraoral complete radiographic series - or - Bitewings (4 images) and Panoramic radigraphic images","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"},{"id":8013,"precertRequired":false,"billingCode":"D0340","codeType":"HCPCS"},{"id":8014,"precertRequired":false,"billingCode":"D0350","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":124,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":65,"seocKey":41,"name":"Dental Regular Preventative Care_PRCT","seocId":"DEN_DENTAL REGULAR PREVENTATIVE CARE_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"05-31-2018","endDate":"12-07-2018","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. Prophylaxis adult - or - Scaling in presence of moderate/severe inflammation\r\n2. Periodic oral evaluation","maxAllowableVisits":999,"disclaimer":"** No additional care is authorized prior to VA approval\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 7-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1325,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":512,"seocKey":42,"name":"Dental Routine Cleaning","seocId":"DEN_DENTAL ROUTINE CLEANING_1.4.5","versionNumber":"1.4.5","description":"Description: This authorization covers services for dental eligible Veterans associated with the approved dental plan of care on the consult which directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult for the specific services to be performed. Minimal impact procedural code substitutions are allowed as a change in the plan.  The cost difference of the change must not exceed 1000 dollars for the entire treatment plan. If any changes do not meet the aforementioned conditions, then a new treatment plan must be submitted and must be approved by a VA Dentist prior to performing any treatment.","effectiveDate":"06-26-2019","endDate":null,"duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial dental exam and routine cleaning\r\n2. Dental x-rays as clinically indicated\r\n3. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit ADA standard form to the Facility Community Care Office who authorized this initial referral.\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*\tPharmacy prescribing requirements\r\n*\tDurable Medical Equipment (DME), Prosthetics, and Orthotics prescribing requirements\r\n*\tPrecertification (PRCT) process requirements\r\n*\tRequest for Services (RFS) requirements","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":2961,"description":"Initial dental exam and routine cleaning","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"},{"id":8021,"precertRequired":false,"billingCode":"D1310","codeType":"HCPCS"},{"id":8022,"precertRequired":false,"billingCode":"D1320","codeType":"HCPCS"},{"id":8023,"precertRequired":false,"billingCode":"D1330","codeType":"HCPCS"},{"id":8032,"precertRequired":false,"billingCode":"D4346","codeType":"HCPCS"},{"id":8033,"precertRequired":false,"billingCode":"D4355","codeType":"HCPCS"},{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2962,"description":"Dental x-rays as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2963,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":358,"seocKey":42,"name":"Dental Routine Cleaning","seocId":"DEN_DENTAL ROUTINE CLEANING_1.4.4","versionNumber":"1.4.4","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"04-19-2019","endDate":"06-26-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial dental exam and routine cleaning\r\n2. Dental x-rays as clinically indicated\r\n3. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit ADA standard form to the Facility Community Care Office who authorized this initial referral.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* DME, prosthetics and orthotics orders must be submitted to the local Va facility prosthetics department for provision. \r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1832,"description":"Initial dental exam and routine cleaning","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"},{"id":8021,"precertRequired":false,"billingCode":"D1310","codeType":"HCPCS"},{"id":8022,"precertRequired":false,"billingCode":"D1320","codeType":"HCPCS"},{"id":8023,"precertRequired":false,"billingCode":"D1330","codeType":"HCPCS"},{"id":8032,"precertRequired":false,"billingCode":"D4346","codeType":"HCPCS"},{"id":8033,"precertRequired":false,"billingCode":"D4355","codeType":"HCPCS"},{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1833,"description":"Dental x-rays as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1834,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":291,"seocKey":42,"name":"Dental Routine Cleaning","seocId":"DEN_DENTAL ROUTINE CLEANING_1.4.3","versionNumber":"1.4.3","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"01-02-2019","endDate":"04-19-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial dental exam and routine cleaning\r\n2. Dental x-rays as clinically indicated\r\n3. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* DME, prosthetics and orthotics orders must be submitted to the local Va facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1230,"description":"Initial dental exam and routine cleaning","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"},{"id":8022,"precertRequired":false,"billingCode":"D1320","codeType":"HCPCS"},{"id":8023,"precertRequired":false,"billingCode":"D1330","codeType":"HCPCS"},{"id":8032,"precertRequired":false,"billingCode":"D4346","codeType":"HCPCS"},{"id":8033,"precertRequired":false,"billingCode":"D4355","codeType":"HCPCS"},{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1231,"description":"Dental x-rays as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1232,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":141,"seocKey":42,"name":"Dental Routine Cleaning","seocId":"DEN_DENTAL ROUTINE CLEANING_1.4.2","versionNumber":"1.4.2","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Initial dental exam and routine cleaning\r\n2. Dental x-rays as clinically indicated\r\n3. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":999,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* DME, prosthetics and orthotics orders must be submitted to the local Va facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":125,"description":"Initial dental exam and routine cleaning","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8003,"precertRequired":false,"billingCode":"D0150","codeType":"HCPCS"},{"id":8018,"precertRequired":false,"billingCode":"D1110","codeType":"HCPCS"},{"id":8019,"precertRequired":false,"billingCode":"D1206","codeType":"HCPCS"},{"id":8020,"precertRequired":false,"billingCode":"D1208","codeType":"HCPCS"},{"id":8022,"precertRequired":false,"billingCode":"D1320","codeType":"HCPCS"},{"id":8023,"precertRequired":false,"billingCode":"D1330","codeType":"HCPCS"},{"id":8032,"precertRequired":false,"billingCode":"D4346","codeType":"HCPCS"},{"id":8033,"precertRequired":false,"billingCode":"D4355","codeType":"HCPCS"},{"id":8034,"precertRequired":false,"billingCode":"D4910","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":126,"description":"Dental x-rays as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8005,"precertRequired":false,"billingCode":"D0210","codeType":"HCPCS"},{"id":8008,"precertRequired":false,"billingCode":"D0270","codeType":"HCPCS"},{"id":8009,"precertRequired":false,"billingCode":"D0272","codeType":"HCPCS"},{"id":8010,"precertRequired":false,"billingCode":"D0273","codeType":"HCPCS"},{"id":8011,"precertRequired":false,"billingCode":"D0274","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":127,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":107,"seocKey":42,"name":"Dental Routine Cleaning_PRCT","seocId":"DEN_DENTAL ROUTINE CLEANING_1.4.1_PRCT","versionNumber":"1.4.1","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"09-21-2018","endDate":"12-07-2018","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial dental exam and routine cleaning\r\n2. Dental x-rays as clinically indicated","maxAllowableVisits":1,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 7-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1337,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1825,"seocKey":43,"name":"Dental Specialty Endodontics","seocId":"DEN_DENTAL SPECIALTY ENDODONTICS_1.7.7","versionNumber":"1.7.7","description":"This authorization covers services for dental eligible Veterans as noted in the consult order ONLY. It directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult order ONLY.   Minimal impact procedural code substitutions are allowed from the authorized plan in the consult order but the difference of the change must not exceed $1000. If the changes exceed the cost difference of $1000, then a new treatment plan must be submitted and must be approved by a VA Dentist PRIOR to performing any treatment","effectiveDate":"06-08-2020","endDate":null,"duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Pulp Vitality Test\r\n3.  Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)\r\n4. Local anesthesia, sedation, non-iv sedation as clinically indicated\r\n* No additional care is authorized prior to VA approval.  If additional care is needed, please submit ADA standard form to the Facility Community Care Office who authorized this initial referral.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":5784,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"},{"id":10747,"precertRequired":false,"billingCode":"D0364","codeType":"HCPCS"},{"id":12188,"precertRequired":false,"billingCode":"D9310","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":5785,"description":"Pulp Vitality Test","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8017,"precertRequired":false,"billingCode":"D0460","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":5786,"description":"Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8024,"precertRequired":false,"billingCode":"D2954","codeType":"HCPCS"},{"id":8025,"precertRequired":false,"billingCode":"D2957","codeType":"HCPCS"},{"id":8026,"precertRequired":false,"billingCode":"D3310","codeType":"HCPCS"},{"id":8027,"precertRequired":false,"billingCode":"D3320","codeType":"HCPCS"},{"id":8028,"precertRequired":false,"billingCode":"D3330","codeType":"HCPCS"},{"id":8029,"precertRequired":false,"billingCode":"D3346","codeType":"HCPCS"},{"id":8030,"precertRequired":false,"billingCode":"D3347","codeType":"HCPCS"},{"id":8031,"precertRequired":false,"billingCode":"D3348","codeType":"HCPCS"},{"id":10877,"precertRequired":false,"billingCode":"D2950","codeType":"HCPCS"},{"id":10893,"precertRequired":false,"billingCode":"D3110","codeType":"HCPCS"},{"id":10894,"precertRequired":false,"billingCode":"D3120","codeType":"HCPCS"},{"id":10895,"precertRequired":false,"billingCode":"D3220","codeType":"HCPCS"},{"id":10896,"precertRequired":false,"billingCode":"D3221","codeType":"HCPCS"},{"id":10897,"precertRequired":false,"billingCode":"D3222","codeType":"HCPCS"},{"id":10898,"precertRequired":false,"billingCode":"D3230","codeType":"HCPCS"},{"id":10899,"precertRequired":false,"billingCode":"D3240","codeType":"HCPCS"},{"id":10900,"precertRequired":false,"billingCode":"D3331","codeType":"HCPCS"},{"id":10901,"precertRequired":false,"billingCode":"D3332","codeType":"HCPCS"},{"id":10902,"precertRequired":false,"billingCode":"D3333","codeType":"HCPCS"},{"id":10903,"precertRequired":false,"billingCode":"D3351","codeType":"HCPCS"},{"id":10904,"precertRequired":false,"billingCode":"D3352","codeType":"HCPCS"},{"id":10905,"precertRequired":false,"billingCode":"D3353","codeType":"HCPCS"},{"id":10906,"precertRequired":false,"billingCode":"D3355","codeType":"HCPCS"},{"id":10907,"precertRequired":false,"billingCode":"D3356","codeType":"HCPCS"},{"id":10908,"precertRequired":false,"billingCode":"D3357","codeType":"HCPCS"},{"id":10909,"precertRequired":false,"billingCode":"D3410","codeType":"HCPCS"},{"id":10910,"precertRequired":false,"billingCode":"D3421","codeType":"HCPCS"},{"id":10911,"precertRequired":false,"billingCode":"D3425","codeType":"HCPCS"},{"id":10912,"precertRequired":false,"billingCode":"D3426","codeType":"HCPCS"},{"id":10913,"precertRequired":false,"billingCode":"D3427","codeType":"HCPCS"},{"id":10914,"precertRequired":false,"billingCode":"D3428","codeType":"HCPCS"},{"id":10915,"precertRequired":false,"billingCode":"D3429","codeType":"HCPCS"},{"id":10916,"precertRequired":false,"billingCode":"D3430","codeType":"HCPCS"},{"id":10917,"precertRequired":false,"billingCode":"D3431","codeType":"HCPCS"},{"id":10918,"precertRequired":false,"billingCode":"D3432","codeType":"HCPCS"},{"id":10919,"precertRequired":false,"billingCode":"D3450","codeType":"HCPCS"},{"id":10920,"precertRequired":false,"billingCode":"D3460","codeType":"HCPCS"},{"id":10921,"precertRequired":false,"billingCode":"D3470","codeType":"HCPCS"},{"id":10922,"precertRequired":false,"billingCode":"D3910","codeType":"HCPCS"},{"id":10923,"precertRequired":false,"billingCode":"D3920","codeType":"HCPCS"},{"id":10924,"precertRequired":false,"billingCode":"D3950","codeType":"HCPCS"},{"id":10925,"precertRequired":false,"billingCode":"D3999","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":5787,"description":"Local anesthesia, sedation, non-iv sedation as clinically indicated\r\n* No additional care is authorized prior to VA approval.  If additional care is needed, please submit ADA standard form to the Facility Community Care Office who authorized this initial referral.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":1662,"seocKey":43,"name":"Dental Specialty Endodontics","seocId":"DEN_DENTAL SPECIALTY ENDODONTICS_1.7.6","versionNumber":"1.7.6","description":"This authorization covers services for dental eligible Veterans as noted in the consult ONLY. It directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult ONLY.   Minimal impact procedural code substitutions are allowed from the authorized plan in the consult but the difference of the change must not exceed 1000 dollars. If the changes exceed the cost difference of 1000 dollars, then a new treatment plan must be submitted and must be approved by a VA Dentist PRIOR to performing any treatment","effectiveDate":"11-12-2019","endDate":"06-08-2020","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Pulp Vitality Test\r\n3. Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)\r\n4. Local anesthesia, sedation, non-iv sedation as clinically indicated\r\n* No additional care is authorized prior to VA approval.  If additional care is needed, please submit ADA standard form to the Facility Community Care Office who authorized this initial referral.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":4667,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"},{"id":12188,"precertRequired":false,"billingCode":"D9310","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":4668,"description":"Pulp Vitality Test","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8017,"precertRequired":false,"billingCode":"D0460","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":4669,"description":"Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8024,"precertRequired":false,"billingCode":"D2954","codeType":"HCPCS"},{"id":8025,"precertRequired":false,"billingCode":"D2957","codeType":"HCPCS"},{"id":8026,"precertRequired":false,"billingCode":"D3310","codeType":"HCPCS"},{"id":8027,"precertRequired":false,"billingCode":"D3320","codeType":"HCPCS"},{"id":8028,"precertRequired":false,"billingCode":"D3330","codeType":"HCPCS"},{"id":8029,"precertRequired":false,"billingCode":"D3346","codeType":"HCPCS"},{"id":8030,"precertRequired":false,"billingCode":"D3347","codeType":"HCPCS"},{"id":8031,"precertRequired":false,"billingCode":"D3348","codeType":"HCPCS"},{"id":10893,"precertRequired":false,"billingCode":"D3110","codeType":"HCPCS"},{"id":10894,"precertRequired":false,"billingCode":"D3120","codeType":"HCPCS"},{"id":10895,"precertRequired":false,"billingCode":"D3220","codeType":"HCPCS"},{"id":10896,"precertRequired":false,"billingCode":"D3221","codeType":"HCPCS"},{"id":10897,"precertRequired":false,"billingCode":"D3222","codeType":"HCPCS"},{"id":10898,"precertRequired":false,"billingCode":"D3230","codeType":"HCPCS"},{"id":10899,"precertRequired":false,"billingCode":"D3240","codeType":"HCPCS"},{"id":10900,"precertRequired":false,"billingCode":"D3331","codeType":"HCPCS"},{"id":10901,"precertRequired":false,"billingCode":"D3332","codeType":"HCPCS"},{"id":10902,"precertRequired":false,"billingCode":"D3333","codeType":"HCPCS"},{"id":10903,"precertRequired":false,"billingCode":"D3351","codeType":"HCPCS"},{"id":10904,"precertRequired":false,"billingCode":"D3352","codeType":"HCPCS"},{"id":10905,"precertRequired":false,"billingCode":"D3353","codeType":"HCPCS"},{"id":10906,"precertRequired":false,"billingCode":"D3355","codeType":"HCPCS"},{"id":10907,"precertRequired":false,"billingCode":"D3356","codeType":"HCPCS"},{"id":10908,"precertRequired":false,"billingCode":"D3357","codeType":"HCPCS"},{"id":10909,"precertRequired":false,"billingCode":"D3410","codeType":"HCPCS"},{"id":10910,"precertRequired":false,"billingCode":"D3421","codeType":"HCPCS"},{"id":10911,"precertRequired":false,"billingCode":"D3425","codeType":"HCPCS"},{"id":10912,"precertRequired":false,"billingCode":"D3426","codeType":"HCPCS"},{"id":10913,"precertRequired":false,"billingCode":"D3427","codeType":"HCPCS"},{"id":10914,"precertRequired":false,"billingCode":"D3428","codeType":"HCPCS"},{"id":10915,"precertRequired":false,"billingCode":"D3429","codeType":"HCPCS"},{"id":10916,"precertRequired":false,"billingCode":"D3430","codeType":"HCPCS"},{"id":10917,"precertRequired":false,"billingCode":"D3431","codeType":"HCPCS"},{"id":10918,"precertRequired":false,"billingCode":"D3432","codeType":"HCPCS"},{"id":10919,"precertRequired":false,"billingCode":"D3450","codeType":"HCPCS"},{"id":10920,"precertRequired":false,"billingCode":"D3460","codeType":"HCPCS"},{"id":10921,"precertRequired":false,"billingCode":"D3470","codeType":"HCPCS"},{"id":10922,"precertRequired":false,"billingCode":"D3910","codeType":"HCPCS"},{"id":10923,"precertRequired":false,"billingCode":"D3920","codeType":"HCPCS"},{"id":10924,"precertRequired":false,"billingCode":"D3950","codeType":"HCPCS"},{"id":10925,"precertRequired":false,"billingCode":"D3999","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":4670,"description":"Local anesthesia, sedation, non-iv sedation as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":513,"seocKey":43,"name":"Dental Specialty Endodontics","seocId":"DEN_DENTAL SPECIALTY ENDODONTICS_1.7.5","versionNumber":"1.7.5","description":"Description: This authorization covers services for dental eligible Veterans associated with the approved dental plan of care on the consult which directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult for the specific services to be performed. Minimal impact procedural code substitutions are allowed as a change in the plan.  The cost difference of the change must not exceed 1000 dollars for the entire treatment plan. If any changes do not meet the aforementioned conditions, then a new treatment plan must be submitted and must be approved by a VA Dentist prior to performing any treatment.","effectiveDate":"06-26-2019","endDate":"11-12-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Pulp Vitality Test\r\n3. Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)\r\n4. Local anesthesia, sedation, non-iv sedation as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit ADA standard form to the Facility Community Care Office who authorized this initial referral.\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*\tPharmacy prescribing requirements\r\n*\tDurable Medical Equipment (DME), Prosthetics, and Orthotics prescribing requirements\r\n*\tPrecertification (PRCT) process requirements\r\n*\tRequest for Services (RFS) requirements","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":2964,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2965,"description":"Pulp Vitality Test","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8017,"precertRequired":false,"billingCode":"D0460","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2966,"description":"Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)     **Endodontic therapy includes all appointments and intra-operative radiographs necessary to complete treatment; Does not include evaluation or initial diagnostic image(s)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8024,"precertRequired":false,"billingCode":"D2954","codeType":"HCPCS"},{"id":8025,"precertRequired":false,"billingCode":"D2957","codeType":"HCPCS"},{"id":8026,"precertRequired":false,"billingCode":"D3310","codeType":"HCPCS"},{"id":8027,"precertRequired":false,"billingCode":"D3320","codeType":"HCPCS"},{"id":8028,"precertRequired":false,"billingCode":"D3330","codeType":"HCPCS"},{"id":8029,"precertRequired":false,"billingCode":"D3346","codeType":"HCPCS"},{"id":8030,"precertRequired":false,"billingCode":"D3347","codeType":"HCPCS"},{"id":8031,"precertRequired":false,"billingCode":"D3348","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":2967,"description":"Local anesthesia, sedation, non-iv sedation as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":359,"seocKey":43,"name":"Dental Specialty Endodontics","seocId":"DEN_DENTAL SPECIALTY ENDODONTICS_1.7.4","versionNumber":"1.7.4","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"04-19-2019","endDate":"06-26-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Pulp Vitality Test\r\n3. Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)\r\n4. Local anesthesia, sedation, non-iv sedation as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit ADA standard form to the Facility Community Care Office who authorized this initial referral.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1835,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1836,"description":"Pulp Vitality Test","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8017,"precertRequired":false,"billingCode":"D0460","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1837,"description":"Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)     **Endodontic therapy includes all appointments and intra-operative radiographs necessary to complete treatment; Does not include evaluation or initial diagnostic image(s)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8024,"precertRequired":false,"billingCode":"D2954","codeType":"HCPCS"},{"id":8025,"precertRequired":false,"billingCode":"D2957","codeType":"HCPCS"},{"id":8026,"precertRequired":false,"billingCode":"D3310","codeType":"HCPCS"},{"id":8027,"precertRequired":false,"billingCode":"D3320","codeType":"HCPCS"},{"id":8028,"precertRequired":false,"billingCode":"D3330","codeType":"HCPCS"},{"id":8029,"precertRequired":false,"billingCode":"D3346","codeType":"HCPCS"},{"id":8030,"precertRequired":false,"billingCode":"D3347","codeType":"HCPCS"},{"id":8031,"precertRequired":false,"billingCode":"D3348","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1838,"description":"Local anesthesia, sedation, non-iv sedation as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":290,"seocKey":43,"name":"Dental Specialty Endodontics","seocId":"DEN_DENTAL SPECIALTY ENDODONTICS_1.7.3","versionNumber":"1.7.3","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"01-02-2019","endDate":"04-19-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Pulp Vitality Test\r\n3. Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)\r\n4. Local anesthesia, sedation, non-iv sedation as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"}],"services":[{"id":1226,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1227,"description":"Pulp Vitality Test","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8017,"precertRequired":false,"billingCode":"D0460","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1228,"description":"Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8024,"precertRequired":false,"billingCode":"D2954","codeType":"HCPCS"},{"id":8025,"precertRequired":false,"billingCode":"D2957","codeType":"HCPCS"},{"id":8026,"precertRequired":false,"billingCode":"D3310","codeType":"HCPCS"},{"id":8027,"precertRequired":false,"billingCode":"D3320","codeType":"HCPCS"},{"id":8028,"precertRequired":false,"billingCode":"D3330","codeType":"HCPCS"},{"id":8029,"precertRequired":false,"billingCode":"D3346","codeType":"HCPCS"},{"id":8030,"precertRequired":false,"billingCode":"D3347","codeType":"HCPCS"},{"id":8031,"precertRequired":false,"billingCode":"D3348","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":1229,"description":"Local anesthesia, sedation, non-iv sedation as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":142,"seocKey":43,"name":"Dental Specialty Endodontics","seocId":"DEN_DENTAL SPECIALTY ENDODONTICS_1.7.2","versionNumber":"1.7.2","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Pulp Vitality Test\r\n3. Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)\r\n4. Local anesthesia, sedation, non-iv sedation as clinically indicated","maxAllowableVisits":999,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":128,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":129,"description":"Pulp Vitality Test","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8017,"precertRequired":false,"billingCode":"D0460","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":130,"description":"Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8024,"precertRequired":false,"billingCode":"D2954","codeType":"HCPCS"},{"id":8025,"precertRequired":false,"billingCode":"D2957","codeType":"HCPCS"},{"id":8026,"precertRequired":false,"billingCode":"D3310","codeType":"HCPCS"},{"id":8027,"precertRequired":false,"billingCode":"D3320","codeType":"HCPCS"},{"id":8028,"precertRequired":false,"billingCode":"D3330","codeType":"HCPCS"},{"id":8029,"precertRequired":false,"billingCode":"D3346","codeType":"HCPCS"},{"id":8030,"precertRequired":false,"billingCode":"D3347","codeType":"HCPCS"},{"id":8031,"precertRequired":false,"billingCode":"D3348","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]},{"id":131,"description":"Local anesthesia, sedation, non-iv sedation as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"C5-Dentist"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"122300000X"}]}]}},{"Seoc":{"id":94,"seocKey":43,"name":"Specialty Endodontics_PRCT","seocId":"DEN_SPECIALTY ENDODONTICS_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"05-31-2018","endDate":"12-07-2018","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Endodontic therapy anterior tooth, premolar tooth, or molar tooth for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits and intraprocedural imaging)","maxAllowableVisits":999,"disclaimer":"** No additional care is authorized prior to VA approval\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 7-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL TESTS, PROCEDURES, STUDIES","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1335,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1663,"seocKey":44,"name":"Dental Specialty Extractions","seocId":"DEN_DENTAL SPECIALTY EXTRACTIONS_1.8.6","versionNumber":"1.8.6","description":"This authorization covers services for dental eligible Veterans as noted in the consult ONLY. It directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult ONLY.   Minimal impact procedural code substitutions are allowed from the authorized plan in the consult but the difference of the change must not exceed 1000 dollars. If the changes exceed the cost difference of 1000 dollars, then a new treatment plan must be submitted and must be approved by a VA Dentist PRIOR to performing any treatment","effectiveDate":"11-12-2019","endDate":null,"duration":90,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)\r\n3. If imaging is indicated: Panoramic radiographic images or periapical images relevant to the referred care on the consult\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated\r\n* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"},{"hptc":"1223S0112X"}],"services":[{"id":4671,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"},{"id":12188,"precertRequired":false,"billingCode":"D9310","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":4672,"description":"Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8049,"precertRequired":false,"billingCode":"D7140","codeType":"HCPCS"},{"id":8050,"precertRequired":false,"billingCode":"D7210","codeType":"HCPCS"},{"id":8051,"precertRequired":false,"billingCode":"D7220","codeType":"HCPCS"},{"id":8052,"precertRequired":false,"billingCode":"D7230","codeType":"HCPCS"},{"id":8053,"precertRequired":false,"billingCode":"D7240","codeType":"HCPCS"},{"id":8054,"precertRequired":false,"billingCode":"D7241","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":4673,"description":"If imaging is indicated: Panoramic radiographic images or periapical images relevant to the referred care on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":4674,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]}]}},{"Seoc":{"id":514,"seocKey":44,"name":"Dental Specialty Extractions","seocId":"DEN_DENTAL SPECIALTY EXTRACTIONS_1.8.5","versionNumber":"1.8.5","description":"Description: This authorization covers services for dental eligible Veterans associated with the approved dental plan of care on the consult which directs the specific services to be performed for this referral. Please refer to the plan of care noted in the consult for the specific services to be performed. Minimal impact procedural code substitutions are allowed as a change in the plan.  The cost difference of the change must not exceed 1000 dollars for the entire treatment plan. If any changes do not meet the aforementioned conditions, then a new treatment plan must be submitted and must be approved by a VA Dentist prior to performing any treatment.","effectiveDate":"06-26-2019","endDate":"11-12-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)\r\n3. If imaging is indicated: Panoramic radiographic images or periapical images relevant to the referred care on the consult\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\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*\tPharmacy prescribing requirements\r\n*\tDurable Medical Equipment (DME), Prosthetics, and Orthotics prescribing requirements\r\n*\tPrecertification (PRCT) process requirements\r\n*\tRequest for Services (RFS) requirements","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"},{"hptc":"1223S0112X"}],"services":[{"id":2968,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":2969,"description":"Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8049,"precertRequired":false,"billingCode":"D7140","codeType":"HCPCS"},{"id":8050,"precertRequired":false,"billingCode":"D7210","codeType":"HCPCS"},{"id":8051,"precertRequired":false,"billingCode":"D7220","codeType":"HCPCS"},{"id":8052,"precertRequired":false,"billingCode":"D7230","codeType":"HCPCS"},{"id":8053,"precertRequired":false,"billingCode":"D7240","codeType":"HCPCS"},{"id":8054,"precertRequired":false,"billingCode":"D7241","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":2970,"description":"If imaging is indicated: Panoramic radiographic images or periapical images relevant to the referred care on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":2971,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]}]}},{"Seoc":{"id":360,"seocKey":44,"name":"Dental Specialty Extractions","seocId":"DEN_DENTAL SPECIALTY EXTRACTIONS_1.8.4","versionNumber":"1.8.4","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"04-19-2019","endDate":"06-26-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)\r\n3. If imaging is indicated: Panoramic radiographic images or periapical images relevant to the referred care on the consult\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Facility Community Care Office who authorized this initial referral.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"},{"hptc":"1223S0112X"}],"services":[{"id":1839,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":1840,"description":"Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8049,"precertRequired":false,"billingCode":"D7140","codeType":"HCPCS"},{"id":8050,"precertRequired":false,"billingCode":"D7210","codeType":"HCPCS"},{"id":8051,"precertRequired":false,"billingCode":"D7220","codeType":"HCPCS"},{"id":8052,"precertRequired":false,"billingCode":"D7230","codeType":"HCPCS"},{"id":8053,"precertRequired":false,"billingCode":"D7240","codeType":"HCPCS"},{"id":8054,"precertRequired":false,"billingCode":"D7241","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":1841,"description":"If imaging is indicated: Panoramic radiographic images or periapical images relevant to the referred care on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":1842,"description":"Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]}]}},{"Seoc":{"id":289,"seocKey":44,"name":"Dental Specialty Extractions","seocId":"DEN_DENTAL SPECIALTY EXTRACTIONS_1.8.3","versionNumber":"1.8.3","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"01-02-2019","endDate":"04-19-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)\r\n3. If imaging is indicated: Panoramic radiographic images or periapical images relevant to the referred care on the consult\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":null,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"122300000X"},{"hptc":"1223S0112X"}],"services":[{"id":1222,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":1223,"description":"Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8049,"precertRequired":false,"billingCode":"D7140","codeType":"HCPCS"},{"id":8050,"precertRequired":false,"billingCode":"D7210","codeType":"HCPCS"},{"id":8051,"precertRequired":false,"billingCode":"D7220","codeType":"HCPCS"},{"id":8052,"precertRequired":false,"billingCode":"D7230","codeType":"HCPCS"},{"id":8053,"precertRequired":false,"billingCode":"D7240","codeType":"HCPCS"},{"id":8054,"precertRequired":false,"billingCode":"D7241","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":1224,"description":"If imaging is indicated: Panoramic radiographic images or periapical images relevant to the referred care on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":1225,"description":" Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]}]}},{"Seoc":{"id":143,"seocKey":44,"name":"Dental Specialty Extractions","seocId":"DEN_DENTAL SPECIALTY EXTRACTIONS_1.8.2","versionNumber":"1.8.2","description":"This authorization covers services associated with all dental care for the referral condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)\r\n3. If imaging is indicated: Panoramic radiographic images or periapical images relevant to the referred care on the consult\r\n4. Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","maxAllowableVisits":999,"disclaimer":"* No additional care is authorized prior to VA approval.  If additional care is needed, please submit the ADA standard form to the Local Office of Community Care who authorized this initial referral.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 7-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":132,"description":"Limited oral evaluation (initial)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8002,"precertRequired":false,"billingCode":"D0140","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":133,"description":"Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8049,"precertRequired":false,"billingCode":"D7140","codeType":"HCPCS"},{"id":8050,"precertRequired":false,"billingCode":"D7210","codeType":"HCPCS"},{"id":8051,"precertRequired":false,"billingCode":"D7220","codeType":"HCPCS"},{"id":8052,"precertRequired":false,"billingCode":"D7230","codeType":"HCPCS"},{"id":8053,"precertRequired":false,"billingCode":"D7240","codeType":"HCPCS"},{"id":8054,"precertRequired":false,"billingCode":"D7241","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":134,"description":"If imaging is indicated: Panoramic radiographic images or periapical images relevant to the referred care on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8006,"precertRequired":false,"billingCode":"D0220","codeType":"HCPCS"},{"id":8007,"precertRequired":false,"billingCode":"D0230","codeType":"HCPCS"},{"id":8012,"precertRequired":false,"billingCode":"D0330","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]},{"id":135,"description":" Local anesthesia, sedation, non-iv sedation or anesthesia as clinically indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"19-Oral surgery (dentists only)"}],"billingCodes":[{"id":8063,"precertRequired":false,"billingCode":"D9215","codeType":"HCPCS"},{"id":8064,"precertRequired":false,"billingCode":"D9219","codeType":"HCPCS"},{"id":8065,"precertRequired":false,"billingCode":"D9222","codeType":"HCPCS"},{"id":8066,"precertRequired":false,"billingCode":"D9223","codeType":"HCPCS"},{"id":8067,"precertRequired":false,"billingCode":"D9230","codeType":"HCPCS"},{"id":8068,"precertRequired":false,"billingCode":"D9239","codeType":"HCPCS"},{"id":8069,"precertRequired":false,"billingCode":"D9243","codeType":"HCPCS"},{"id":8070,"precertRequired":false,"billingCode":"D9248","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"1223S0112X"}]}]}},{"Seoc":{"id":95,"seocKey":44,"name":"Specialty Extractions_PRCT","seocId":"DEN_SPECIALTY EXTRACTIONS_1.2.1_PRCT","versionNumber":"1.2.1","description":"This authorization covers services associated with all dental care listed below as clinically necessary","effectiveDate":"05-31-2018","endDate":"12-07-2018","duration":60,"REV":false,"PRCT":true,"proceduralOverview":"1. Limited oral evaluation (initial)\r\n2. Extracted erupted tooth or surgical tooth extraction for teeth number(s) and modality as indicated on consultation (includes routine follow-up visits)","maxAllowableVisits":999,"disclaimer":"** No additional care is authorized prior to VA approval\r\n** All routine medications will be provided by the VA.\r\n** Request for anesthesia, with the exception of local anesthesia, requires separate authorization\r\nUrgent/emergent prescriptions can be provided for a 7-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"Specialty Dentistry","categoryOfCare":"DENTAL TESTS, PROCEDURES, STUDIES","serviceLine":"Dental Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1336,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1883,"seocKey":45,"name":"Dermatology Comprehensive_PRCT","seocId":"MSC_DERMATOLOGY COMPREHENSIVE_1.0.7_PRCT","versionNumber":"1.0.7","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order. ** Please note this SEOC does not cover cosmetic procedures that are not considered medically necessary or correct a functional disability as they are excluded from the Medical Benefits Package.  This SEOC does not cover MOHS.  A specific MOHS approval and standard episode of care is required.","effectiveDate":"07-23-2020","endDate":null,"duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation (including full body exam) and treatment for the referred condition on the consult order\r\n2.   Diagnostic imaging relevant to the referred condition on the consult order\r\n3.   Labs and pathology relevant to the referred condition on the consult order\r\n4.   Procedures relevant to the referred condition on the consult order including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies, etc.), excision, excimer laser, photodynamic therapy, UVB therapy, debridement.  \r\nNote:  MOHS is not approved in this episode of care.  A specific MOHS approval and standard episode of care is required. \r\nNote: This SEOC does not not cover the removal of skin tags, seborrheic keratosis and other benign skin lesions unless they are bleeding, painful, or changing.\r\n5.    Follow-up visits for this episode of care\r\n6.    Follow up biopsy if clinically required as related to this episode of care\r\nNOTE: Superficial Radiation Therapy (SRT) is not covered in this episode of care.  SRT is only to be performed and approved by a radiation oncologist and not a dermatologist. SRT must be requested through a request for services and approved with the radiation therapy episode of care. \r\n  *Additional consultations needed relevant to the patient complaint/condition require VA review and approval including MOH's and/or a referral to another specialty for secondary/complex closure","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"DERMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207N00000X"}],"services":[{"id":6032,"description":"Initial outpatient evaluation (including full body exam) and treatment for the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":6033,"description":"Diagnostic imaging relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4722,"precertRequired":false,"billingCode":"76641","codeType":"CPT"},{"id":4723,"precertRequired":false,"billingCode":"76642","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":6034,"description":"Labs and pathology relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5364,"precertRequired":true,"billingCode":"81599","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6120,"precertRequired":false,"billingCode":"87101","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6338,"precertRequired":false,"billingCode":"88104","codeType":"CPT"},{"id":6339,"precertRequired":false,"billingCode":"88106","codeType":"CPT"},{"id":6340,"precertRequired":false,"billingCode":"88108","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6419,"precertRequired":false,"billingCode":"88333","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6424,"precertRequired":false,"billingCode":"88346","codeType":"CPT"},{"id":6426,"precertRequired":false,"billingCode":"88350","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":6035,"description":"Procedures relevant to the referred condition on the consult order including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies, etc.), excision, excimer laser, photodynamic therapy, UVB therapy, debridement.  \r\nNote:  MOHS is not approved in this episode of care.  A specific MOHS approval and standard episode of care is required. \r\nNote: This SEOC does not not cover the removal of skin tags, seborrheic keratosis and other benign skin lesions unless they are bleeding, painful, or changing.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":36,"precertRequired":false,"billingCode":"00400","codeType":"CPT"},{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":226,"precertRequired":false,"billingCode":"10040","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":252,"precertRequired":false,"billingCode":"11055","codeType":"CPT"},{"id":253,"precertRequired":false,"billingCode":"11056","codeType":"CPT"},{"id":254,"precertRequired":false,"billingCode":"11057","codeType":"CPT"},{"id":259,"precertRequired":false,"billingCode":"11300","codeType":"CPT"},{"id":260,"precertRequired":false,"billingCode":"11301","codeType":"CPT"},{"id":261,"precertRequired":false,"billingCode":"11302","codeType":"CPT"},{"id":262,"precertRequired":false,"billingCode":"11303","codeType":"CPT"},{"id":263,"precertRequired":false,"billingCode":"11305","codeType":"CPT"},{"id":264,"precertRequired":false,"billingCode":"11306","codeType":"CPT"},{"id":265,"precertRequired":false,"billingCode":"11307","codeType":"CPT"},{"id":266,"precertRequired":false,"billingCode":"11308","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":268,"precertRequired":false,"billingCode":"11311","codeType":"CPT"},{"id":269,"precertRequired":false,"billingCode":"11312","codeType":"CPT"},{"id":270,"precertRequired":false,"billingCode":"11313","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":313,"precertRequired":false,"billingCode":"11719","codeType":"CPT"},{"id":314,"precertRequired":false,"billingCode":"11720","codeType":"CPT"},{"id":315,"precertRequired":false,"billingCode":"11721","codeType":"CPT"},{"id":316,"precertRequired":false,"billingCode":"11730","codeType":"CPT"},{"id":317,"precertRequired":false,"billingCode":"11732","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":319,"precertRequired":false,"billingCode":"11750","codeType":"CPT"},{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":321,"precertRequired":false,"billingCode":"11760","codeType":"CPT"},{"id":322,"precertRequired":false,"billingCode":"11762","codeType":"CPT"},{"id":323,"precertRequired":false,"billingCode":"11765","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":374,"precertRequired":false,"billingCode":"13120","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":384,"precertRequired":false,"billingCode":"14000","codeType":"CPT"},{"id":386,"precertRequired":false,"billingCode":"14020","codeType":"CPT"},{"id":387,"precertRequired":false,"billingCode":"14021","codeType":"CPT"},{"id":388,"precertRequired":true,"billingCode":"14040","codeType":"CPT"},{"id":389,"precertRequired":false,"billingCode":"14041","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":392,"precertRequired":true,"billingCode":"14301","codeType":"CPT"},{"id":393,"precertRequired":false,"billingCode":"14302","codeType":"CPT"},{"id":405,"precertRequired":false,"billingCode":"15221","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":418,"precertRequired":false,"billingCode":"15576","codeType":"CPT"},{"id":422,"precertRequired":false,"billingCode":"15630","codeType":"CPT"},{"id":425,"precertRequired":false,"billingCode":"15731","codeType":"CPT"},{"id":437,"precertRequired":false,"billingCode":"15780","codeType":"CPT"},{"id":438,"precertRequired":false,"billingCode":"15781","codeType":"CPT"},{"id":439,"precertRequired":false,"billingCode":"15782","codeType":"CPT"},{"id":440,"precertRequired":false,"billingCode":"15783","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":474,"precertRequired":false,"billingCode":"17106","codeType":"CPT"},{"id":475,"precertRequired":false,"billingCode":"17107","codeType":"CPT"},{"id":476,"precertRequired":false,"billingCode":"17108","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":646,"precertRequired":false,"billingCode":"21235","codeType":"CPT"},{"id":1923,"precertRequired":false,"billingCode":"29580","codeType":"CPT"},{"id":1924,"precertRequired":false,"billingCode":"29581","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3511,"precertRequired":false,"billingCode":"54056","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":3996,"precertRequired":true,"billingCode":"64650","codeType":"CPT"},{"id":3997,"precertRequired":true,"billingCode":"64653","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7204,"precertRequired":false,"billingCode":"96405","codeType":"CPT"},{"id":7205,"precertRequired":false,"billingCode":"96406","codeType":"CPT"},{"id":7224,"precertRequired":false,"billingCode":"96567","codeType":"CPT"},{"id":7225,"precertRequired":false,"billingCode":"96900","codeType":"CPT"},{"id":7226,"precertRequired":false,"billingCode":"96910","codeType":"CPT"},{"id":7227,"precertRequired":false,"billingCode":"96912","codeType":"CPT"},{"id":7228,"precertRequired":false,"billingCode":"96920","codeType":"CPT"},{"id":7229,"precertRequired":false,"billingCode":"96921","codeType":"CPT"},{"id":7230,"precertRequired":false,"billingCode":"96922","codeType":"CPT"},{"id":7231,"precertRequired":false,"billingCode":"96931","codeType":"CPT"},{"id":7232,"precertRequired":false,"billingCode":"96932","codeType":"CPT"},{"id":7233,"precertRequired":false,"billingCode":"96933","codeType":"CPT"},{"id":7234,"precertRequired":false,"billingCode":"96934","codeType":"CPT"},{"id":7235,"precertRequired":false,"billingCode":"96935","codeType":"CPT"},{"id":7236,"precertRequired":false,"billingCode":"96936","codeType":"CPT"},{"id":7245,"precertRequired":false,"billingCode":"97028","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":7282,"precertRequired":false,"billingCode":"97598","codeType":"CPT"},{"id":8211,"precertRequired":false,"billingCode":"G0429","codeType":"HCPCS"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9168,"precertRequired":true,"billingCode":"15004","codeType":"CPT"},{"id":9169,"precertRequired":true,"billingCode":"15005","codeType":"CPT"},{"id":9172,"precertRequired":true,"billingCode":"15120","codeType":"CPT"},{"id":9955,"precertRequired":false,"billingCode":"15003","codeType":"CPT"},{"id":10720,"precertRequired":false,"billingCode":"17340","codeType":"CPT"},{"id":10721,"precertRequired":false,"billingCode":"17360","codeType":"CPT"},{"id":10722,"precertRequired":true,"billingCode":"17380","codeType":"CPT"},{"id":10723,"precertRequired":false,"billingCode":"96573","codeType":"CPT"},{"id":10724,"precertRequired":false,"billingCode":"96902","codeType":"CPT"},{"id":10725,"precertRequired":false,"billingCode":"96904","codeType":"CPT"},{"id":13487,"precertRequired":false,"billingCode":"96574","codeType":"CPT"},{"id":13488,"precertRequired":false,"billingCode":"G9651","codeType":"DRG"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":6036,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":6037,"description":"Follow up biopsy if clinically required as related to this episode of care\r\nNOTE: Superficial Radiation Therapy (SRT) is not covered in this episode of care.  SRT is only to be performed and approved by a radiation oncologist and not a dermatologist. SRT must be requested through a request for services and approved with the radiation therapy episode of care. \r\n  *Additional consultations needed relevant to the patient complaint/condition require VA review and approval including MOH's and/or a referral to another specialty for secondary/complex closure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6357,"precertRequired":false,"billingCode":"88161","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]}]}},{"Seoc":{"id":1835,"seocKey":45,"name":"Dermatology Comprehensive_PRCT","seocId":"MSC_DERMATOLOGY COMPREHENSIVE_1.0.6_PRCT","versionNumber":"1.0.6","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order. ** Please note this SEOC does not cover cosmetic procedures that are not considered medically necessary or correct a functional disability as they are excluded from the Medical Benefits Package.  This SEOC does not cover MOHS.  A specific MOHS approval and standard episode of care is required.","effectiveDate":"06-08-2020","endDate":"07-23-2020","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation (including full body exam) and treatment for the referred condition on the consult\r\n2.    Diagnostic imaging relevant to the referred condition on the consult\r\n3.   Labs and pathology relevant to the referred condition on the consult \r\n4.    Procedures relevant to the referred condition on the consult including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies, etc.), excision, excimer laser, photodynamic therapy, UVB therapy, debridement.  Note:  MOHS is not approved in this episode of care.  A specific MOHS approval and standard episode of care is required. \r\n5.    Follow-up visits for this episode of care\r\n6.    Follow up biopsy if clinically required as related to this episode of care\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval including MOH's and/or a referral to another specialty for secondary/complex closure","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"DERMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207N00000X"}],"services":[{"id":5829,"description":"Initial outpatient evaluation (including full body exam) and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":5830,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4722,"precertRequired":false,"billingCode":"76641","codeType":"CPT"},{"id":4723,"precertRequired":false,"billingCode":"76642","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5831,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5364,"precertRequired":true,"billingCode":"81599","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6120,"precertRequired":false,"billingCode":"87101","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6338,"precertRequired":false,"billingCode":"88104","codeType":"CPT"},{"id":6339,"precertRequired":false,"billingCode":"88106","codeType":"CPT"},{"id":6340,"precertRequired":false,"billingCode":"88108","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6424,"precertRequired":false,"billingCode":"88346","codeType":"CPT"},{"id":6426,"precertRequired":false,"billingCode":"88350","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5832,"description":"Procedures relevant to the referred condition on the consult including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies, etc.), excision, excimer laser, photodynamic therapy, UVB therapy, debridement.  Note:  MOHS is not approved in this episode of care.  A specific MOHS approval and standard episode of care is required.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":36,"precertRequired":false,"billingCode":"00400","codeType":"CPT"},{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":226,"precertRequired":false,"billingCode":"10040","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":252,"precertRequired":false,"billingCode":"11055","codeType":"CPT"},{"id":253,"precertRequired":false,"billingCode":"11056","codeType":"CPT"},{"id":254,"precertRequired":false,"billingCode":"11057","codeType":"CPT"},{"id":257,"precertRequired":false,"billingCode":"11200","codeType":"CPT"},{"id":258,"precertRequired":false,"billingCode":"11201","codeType":"CPT"},{"id":259,"precertRequired":false,"billingCode":"11300","codeType":"CPT"},{"id":260,"precertRequired":false,"billingCode":"11301","codeType":"CPT"},{"id":261,"precertRequired":false,"billingCode":"11302","codeType":"CPT"},{"id":262,"precertRequired":false,"billingCode":"11303","codeType":"CPT"},{"id":263,"precertRequired":false,"billingCode":"11305","codeType":"CPT"},{"id":264,"precertRequired":false,"billingCode":"11306","codeType":"CPT"},{"id":265,"precertRequired":false,"billingCode":"11307","codeType":"CPT"},{"id":266,"precertRequired":false,"billingCode":"11308","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":268,"precertRequired":false,"billingCode":"11311","codeType":"CPT"},{"id":269,"precertRequired":false,"billingCode":"11312","codeType":"CPT"},{"id":270,"precertRequired":false,"billingCode":"11313","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":313,"precertRequired":false,"billingCode":"11719","codeType":"CPT"},{"id":314,"precertRequired":false,"billingCode":"11720","codeType":"CPT"},{"id":315,"precertRequired":false,"billingCode":"11721","codeType":"CPT"},{"id":316,"precertRequired":false,"billingCode":"11730","codeType":"CPT"},{"id":317,"precertRequired":false,"billingCode":"11732","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":319,"precertRequired":false,"billingCode":"11750","codeType":"CPT"},{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":321,"precertRequired":false,"billingCode":"11760","codeType":"CPT"},{"id":322,"precertRequired":false,"billingCode":"11762","codeType":"CPT"},{"id":323,"precertRequired":false,"billingCode":"11765","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":374,"precertRequired":false,"billingCode":"13120","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":386,"precertRequired":false,"billingCode":"14020","codeType":"CPT"},{"id":387,"precertRequired":false,"billingCode":"14021","codeType":"CPT"},{"id":388,"precertRequired":true,"billingCode":"14040","codeType":"CPT"},{"id":389,"precertRequired":false,"billingCode":"14041","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":392,"precertRequired":true,"billingCode":"14301","codeType":"CPT"},{"id":393,"precertRequired":false,"billingCode":"14302","codeType":"CPT"},{"id":405,"precertRequired":false,"billingCode":"15221","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":418,"precertRequired":false,"billingCode":"15576","codeType":"CPT"},{"id":422,"precertRequired":false,"billingCode":"15630","codeType":"CPT"},{"id":425,"precertRequired":false,"billingCode":"15731","codeType":"CPT"},{"id":437,"precertRequired":false,"billingCode":"15780","codeType":"CPT"},{"id":438,"precertRequired":false,"billingCode":"15781","codeType":"CPT"},{"id":439,"precertRequired":false,"billingCode":"15782","codeType":"CPT"},{"id":440,"precertRequired":false,"billingCode":"15783","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":474,"precertRequired":false,"billingCode":"17106","codeType":"CPT"},{"id":475,"precertRequired":false,"billingCode":"17107","codeType":"CPT"},{"id":476,"precertRequired":false,"billingCode":"17108","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":646,"precertRequired":false,"billingCode":"21235","codeType":"CPT"},{"id":1923,"precertRequired":false,"billingCode":"29580","codeType":"CPT"},{"id":1924,"precertRequired":false,"billingCode":"29581","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3511,"precertRequired":false,"billingCode":"54056","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":3996,"precertRequired":true,"billingCode":"64650","codeType":"CPT"},{"id":3997,"precertRequired":true,"billingCode":"64653","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7204,"precertRequired":false,"billingCode":"96405","codeType":"CPT"},{"id":7205,"precertRequired":false,"billingCode":"96406","codeType":"CPT"},{"id":7224,"precertRequired":false,"billingCode":"96567","codeType":"CPT"},{"id":7225,"precertRequired":false,"billingCode":"96900","codeType":"CPT"},{"id":7226,"precertRequired":false,"billingCode":"96910","codeType":"CPT"},{"id":7227,"precertRequired":false,"billingCode":"96912","codeType":"CPT"},{"id":7228,"precertRequired":false,"billingCode":"96920","codeType":"CPT"},{"id":7229,"precertRequired":false,"billingCode":"96921","codeType":"CPT"},{"id":7230,"precertRequired":false,"billingCode":"96922","codeType":"CPT"},{"id":7231,"precertRequired":false,"billingCode":"96931","codeType":"CPT"},{"id":7232,"precertRequired":false,"billingCode":"96932","codeType":"CPT"},{"id":7233,"precertRequired":false,"billingCode":"96933","codeType":"CPT"},{"id":7234,"precertRequired":false,"billingCode":"96934","codeType":"CPT"},{"id":7235,"precertRequired":false,"billingCode":"96935","codeType":"CPT"},{"id":7236,"precertRequired":false,"billingCode":"96936","codeType":"CPT"},{"id":7245,"precertRequired":false,"billingCode":"97028","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":7282,"precertRequired":false,"billingCode":"97598","codeType":"CPT"},{"id":8211,"precertRequired":false,"billingCode":"G0429","codeType":"HCPCS"},{"id":8771,"precertRequired":false,"billingCode":"Q0112","codeType":"HCPCS"},{"id":8786,"precertRequired":false,"billingCode":"Q2026","codeType":"HCPCS"},{"id":8787,"precertRequired":false,"billingCode":"Q2028","codeType":"HCPCS"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9168,"precertRequired":true,"billingCode":"15004","codeType":"CPT"},{"id":9169,"precertRequired":true,"billingCode":"15005","codeType":"CPT"},{"id":9172,"precertRequired":true,"billingCode":"15120","codeType":"CPT"},{"id":9955,"precertRequired":false,"billingCode":"15003","codeType":"CPT"},{"id":10720,"precertRequired":false,"billingCode":"17340","codeType":"CPT"},{"id":10721,"precertRequired":false,"billingCode":"17360","codeType":"CPT"},{"id":10722,"precertRequired":true,"billingCode":"17380","codeType":"CPT"},{"id":10723,"precertRequired":false,"billingCode":"96573","codeType":"CPT"},{"id":10724,"precertRequired":false,"billingCode":"96902","codeType":"CPT"},{"id":10725,"precertRequired":false,"billingCode":"96904","codeType":"CPT"},{"id":13487,"precertRequired":false,"billingCode":"96574","codeType":"CPT"},{"id":13488,"precertRequired":false,"billingCode":"G9651","codeType":"DRG"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":5833,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":5834,"description":"Follow up biopsy if clinically required as related to this episode of care\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval including MOH's and/or a referral to another specialty for secondary/complex closure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6357,"precertRequired":false,"billingCode":"88161","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]}]}},{"Seoc":{"id":530,"seocKey":45,"name":"Dermatology Comprehensive_PRCT","seocId":"MSC_DERMATOLOGY COMPREHENSIVE_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult. ** Please note this SEOC does not cover cosmetic procedures that are not considered medically necessary or correct a functional disability as they are excluded from the Medical Benefits Package.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation (including full body exam) and treatment for the referred condition on the consult\r\n2.    Diagnostic imaging relevant to the referred condition on the consult\r\n3.   Labs and pathology relevant to the referred condition on the consult \r\n4.   Procedures relevant to the referred condition on the consult including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies etc), excision, excimer laser, photodynamic therapy, UVB therapy, debridement\r\n5.    Follow-up visits for this episode of care\r\n6.    Follow up biopsy if clinically required as related to this episode of care","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval including MOH's and/or a referral to another specialty for secondary/complex closure\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","QASP":"General Care","categoryOfCare":"DERMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207N00000X"}],"services":[{"id":3075,"description":"Initial outpatient evaluation (including full body exam) and treatment for the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":3076,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4722,"precertRequired":false,"billingCode":"76641","codeType":"CPT"},{"id":4723,"precertRequired":false,"billingCode":"76642","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3077,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6120,"precertRequired":false,"billingCode":"87101","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6338,"precertRequired":false,"billingCode":"88104","codeType":"CPT"},{"id":6339,"precertRequired":false,"billingCode":"88106","codeType":"CPT"},{"id":6340,"precertRequired":false,"billingCode":"88108","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6424,"precertRequired":false,"billingCode":"88346","codeType":"CPT"},{"id":6426,"precertRequired":false,"billingCode":"88350","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":3078,"description":"Procedures relevant to the referred condition on the consult including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies etc), excision, excimer laser, photodynamic therapy, UVB therapy, debridement","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":36,"precertRequired":false,"billingCode":"00400","codeType":"CPT"},{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":226,"precertRequired":false,"billingCode":"10040","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":252,"precertRequired":false,"billingCode":"11055","codeType":"CPT"},{"id":253,"precertRequired":false,"billingCode":"11056","codeType":"CPT"},{"id":254,"precertRequired":false,"billingCode":"11057","codeType":"CPT"},{"id":257,"precertRequired":false,"billingCode":"11200","codeType":"CPT"},{"id":258,"precertRequired":false,"billingCode":"11201","codeType":"CPT"},{"id":259,"precertRequired":false,"billingCode":"11300","codeType":"CPT"},{"id":260,"precertRequired":false,"billingCode":"11301","codeType":"CPT"},{"id":261,"precertRequired":false,"billingCode":"11302","codeType":"CPT"},{"id":262,"precertRequired":false,"billingCode":"11303","codeType":"CPT"},{"id":263,"precertRequired":false,"billingCode":"11305","codeType":"CPT"},{"id":264,"precertRequired":false,"billingCode":"11306","codeType":"CPT"},{"id":265,"precertRequired":false,"billingCode":"11307","codeType":"CPT"},{"id":266,"precertRequired":false,"billingCode":"11308","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":268,"precertRequired":false,"billingCode":"11311","codeType":"CPT"},{"id":269,"precertRequired":false,"billingCode":"11312","codeType":"CPT"},{"id":270,"precertRequired":false,"billingCode":"11313","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":313,"precertRequired":false,"billingCode":"11719","codeType":"CPT"},{"id":314,"precertRequired":false,"billingCode":"11720","codeType":"CPT"},{"id":315,"precertRequired":false,"billingCode":"11721","codeType":"CPT"},{"id":316,"precertRequired":false,"billingCode":"11730","codeType":"CPT"},{"id":317,"precertRequired":false,"billingCode":"11732","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":319,"precertRequired":false,"billingCode":"11750","codeType":"CPT"},{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":321,"precertRequired":false,"billingCode":"11760","codeType":"CPT"},{"id":322,"precertRequired":false,"billingCode":"11762","codeType":"CPT"},{"id":323,"precertRequired":false,"billingCode":"11765","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":374,"precertRequired":false,"billingCode":"13120","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":386,"precertRequired":false,"billingCode":"14020","codeType":"CPT"},{"id":387,"precertRequired":false,"billingCode":"14021","codeType":"CPT"},{"id":388,"precertRequired":true,"billingCode":"14040","codeType":"CPT"},{"id":389,"precertRequired":false,"billingCode":"14041","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":392,"precertRequired":true,"billingCode":"14301","codeType":"CPT"},{"id":393,"precertRequired":false,"billingCode":"14302","codeType":"CPT"},{"id":405,"precertRequired":false,"billingCode":"15221","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":418,"precertRequired":false,"billingCode":"15576","codeType":"CPT"},{"id":422,"precertRequired":false,"billingCode":"15630","codeType":"CPT"},{"id":425,"precertRequired":false,"billingCode":"15731","codeType":"CPT"},{"id":437,"precertRequired":false,"billingCode":"15780","codeType":"CPT"},{"id":438,"precertRequired":false,"billingCode":"15781","codeType":"CPT"},{"id":439,"precertRequired":false,"billingCode":"15782","codeType":"CPT"},{"id":440,"precertRequired":false,"billingCode":"15783","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":474,"precertRequired":false,"billingCode":"17106","codeType":"CPT"},{"id":476,"precertRequired":false,"billingCode":"17108","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":646,"precertRequired":false,"billingCode":"21235","codeType":"CPT"},{"id":1923,"precertRequired":false,"billingCode":"29580","codeType":"CPT"},{"id":1924,"precertRequired":false,"billingCode":"29581","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3511,"precertRequired":false,"billingCode":"54056","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":3996,"precertRequired":true,"billingCode":"64650","codeType":"CPT"},{"id":3997,"precertRequired":true,"billingCode":"64653","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7204,"precertRequired":false,"billingCode":"96405","codeType":"CPT"},{"id":7205,"precertRequired":false,"billingCode":"96406","codeType":"CPT"},{"id":7224,"precertRequired":false,"billingCode":"96567","codeType":"CPT"},{"id":7225,"precertRequired":false,"billingCode":"96900","codeType":"CPT"},{"id":7226,"precertRequired":false,"billingCode":"96910","codeType":"CPT"},{"id":7227,"precertRequired":false,"billingCode":"96912","codeType":"CPT"},{"id":7228,"precertRequired":false,"billingCode":"96920","codeType":"CPT"},{"id":7229,"precertRequired":false,"billingCode":"96921","codeType":"CPT"},{"id":7230,"precertRequired":false,"billingCode":"96922","codeType":"CPT"},{"id":7231,"precertRequired":false,"billingCode":"96931","codeType":"CPT"},{"id":7232,"precertRequired":false,"billingCode":"96932","codeType":"CPT"},{"id":7233,"precertRequired":false,"billingCode":"96933","codeType":"CPT"},{"id":7234,"precertRequired":false,"billingCode":"96934","codeType":"CPT"},{"id":7235,"precertRequired":false,"billingCode":"96935","codeType":"CPT"},{"id":7236,"precertRequired":false,"billingCode":"96936","codeType":"CPT"},{"id":7245,"precertRequired":false,"billingCode":"97028","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":7282,"precertRequired":false,"billingCode":"97598","codeType":"CPT"},{"id":8211,"precertRequired":false,"billingCode":"G0429","codeType":"HCPCS"},{"id":8390,"precertRequired":true,"billingCode":"J0702","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8504,"precertRequired":true,"billingCode":"J3301","codeType":"HCPCS"},{"id":8771,"precertRequired":false,"billingCode":"Q0112","codeType":"HCPCS"},{"id":8786,"precertRequired":false,"billingCode":"Q2026","codeType":"HCPCS"},{"id":8787,"precertRequired":false,"billingCode":"Q2028","codeType":"HCPCS"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9168,"precertRequired":true,"billingCode":"15004","codeType":"CPT"},{"id":9169,"precertRequired":true,"billingCode":"15005","codeType":"CPT"},{"id":9172,"precertRequired":true,"billingCode":"15120","codeType":"CPT"},{"id":9843,"precertRequired":false,"billingCode":"J7308","codeType":"HCPCS"},{"id":9955,"precertRequired":false,"billingCode":"15003","codeType":"CPT"},{"id":10720,"precertRequired":false,"billingCode":"17340","codeType":"CPT"},{"id":10721,"precertRequired":false,"billingCode":"17360","codeType":"CPT"},{"id":10722,"precertRequired":true,"billingCode":"17380","codeType":"CPT"},{"id":10723,"precertRequired":false,"billingCode":"96573","codeType":"CPT"},{"id":10724,"precertRequired":false,"billingCode":"96902","codeType":"CPT"},{"id":10725,"precertRequired":false,"billingCode":"96904","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":3079,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7320,"precertRequired":false,"billingCode":"99024","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":3080,"description":"Follow up biopsy if clinically required as related to this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6357,"precertRequired":false,"billingCode":"88161","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]}]}},{"Seoc":{"id":341,"seocKey":45,"name":"Dermatology Comprehensive_PRCT","seocId":"MSC_DERMATOLOGY COMPREHENSIVE_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult. ** Please note this SEOC does not cover cosmetic procedures that are not considered medically necessary or correct a functional disability as they are excluded from the Medical Benefits Package.","effectiveDate":"04-16-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation (including full body exam) and treatment for the referred condition on the consult\r\n2.    Diagnostic imaging relevant to the referred condition on the consult\r\n3.   Labs and pathology relevant to the referred condition on the consult \r\n4.   Procedures relevant to the referred condition on the consult including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies etc), excision, excimer laser, photodynamic therapy, UVB therapy, debridement\r\n5.    Follow-up visits for this episode of care\r\n6.    Follow up biopsy if clinically required as related to this episode of care","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval including MOH's and/or a referral to another specialty for secondary/complex closure\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"DERMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207N00000X"}],"services":[{"id":1750,"description":"Initial outpatient evaluation (including full body exam) and treatment for the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":1751,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4722,"precertRequired":false,"billingCode":"76641","codeType":"CPT"},{"id":4723,"precertRequired":false,"billingCode":"76642","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1752,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6120,"precertRequired":false,"billingCode":"87101","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6338,"precertRequired":false,"billingCode":"88104","codeType":"CPT"},{"id":6339,"precertRequired":false,"billingCode":"88106","codeType":"CPT"},{"id":6340,"precertRequired":false,"billingCode":"88108","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6424,"precertRequired":false,"billingCode":"88346","codeType":"CPT"},{"id":6426,"precertRequired":false,"billingCode":"88350","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1753,"description":"Procedures relevant to the referred condition on the consult including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies etc), excision, excimer laser, photodynamic therapy, UVB therapy, debridement","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":36,"precertRequired":false,"billingCode":"00400","codeType":"CPT"},{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":226,"precertRequired":false,"billingCode":"10040","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":252,"precertRequired":false,"billingCode":"11055","codeType":"CPT"},{"id":253,"precertRequired":false,"billingCode":"11056","codeType":"CPT"},{"id":254,"precertRequired":false,"billingCode":"11057","codeType":"CPT"},{"id":257,"precertRequired":false,"billingCode":"11200","codeType":"CPT"},{"id":258,"precertRequired":false,"billingCode":"11201","codeType":"CPT"},{"id":259,"precertRequired":false,"billingCode":"11300","codeType":"CPT"},{"id":260,"precertRequired":false,"billingCode":"11301","codeType":"CPT"},{"id":261,"precertRequired":false,"billingCode":"11302","codeType":"CPT"},{"id":262,"precertRequired":false,"billingCode":"11303","codeType":"CPT"},{"id":263,"precertRequired":false,"billingCode":"11305","codeType":"CPT"},{"id":264,"precertRequired":false,"billingCode":"11306","codeType":"CPT"},{"id":265,"precertRequired":false,"billingCode":"11307","codeType":"CPT"},{"id":266,"precertRequired":false,"billingCode":"11308","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":268,"precertRequired":false,"billingCode":"11311","codeType":"CPT"},{"id":269,"precertRequired":false,"billingCode":"11312","codeType":"CPT"},{"id":270,"precertRequired":false,"billingCode":"11313","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":313,"precertRequired":false,"billingCode":"11719","codeType":"CPT"},{"id":314,"precertRequired":false,"billingCode":"11720","codeType":"CPT"},{"id":315,"precertRequired":false,"billingCode":"11721","codeType":"CPT"},{"id":316,"precertRequired":false,"billingCode":"11730","codeType":"CPT"},{"id":317,"precertRequired":false,"billingCode":"11732","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":319,"precertRequired":false,"billingCode":"11750","codeType":"CPT"},{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":321,"precertRequired":false,"billingCode":"11760","codeType":"CPT"},{"id":322,"precertRequired":false,"billingCode":"11762","codeType":"CPT"},{"id":323,"precertRequired":false,"billingCode":"11765","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":374,"precertRequired":false,"billingCode":"13120","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":386,"precertRequired":false,"billingCode":"14020","codeType":"CPT"},{"id":387,"precertRequired":false,"billingCode":"14021","codeType":"CPT"},{"id":388,"precertRequired":true,"billingCode":"14040","codeType":"CPT"},{"id":389,"precertRequired":false,"billingCode":"14041","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":392,"precertRequired":true,"billingCode":"14301","codeType":"CPT"},{"id":393,"precertRequired":false,"billingCode":"14302","codeType":"CPT"},{"id":405,"precertRequired":false,"billingCode":"15221","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":418,"precertRequired":false,"billingCode":"15576","codeType":"CPT"},{"id":422,"precertRequired":false,"billingCode":"15630","codeType":"CPT"},{"id":425,"precertRequired":false,"billingCode":"15731","codeType":"CPT"},{"id":437,"precertRequired":false,"billingCode":"15780","codeType":"CPT"},{"id":438,"precertRequired":false,"billingCode":"15781","codeType":"CPT"},{"id":439,"precertRequired":false,"billingCode":"15782","codeType":"CPT"},{"id":440,"precertRequired":false,"billingCode":"15783","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":474,"precertRequired":false,"billingCode":"17106","codeType":"CPT"},{"id":476,"precertRequired":false,"billingCode":"17108","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":646,"precertRequired":false,"billingCode":"21235","codeType":"CPT"},{"id":1923,"precertRequired":false,"billingCode":"29580","codeType":"CPT"},{"id":1924,"precertRequired":false,"billingCode":"29581","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3511,"precertRequired":false,"billingCode":"54056","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":3996,"precertRequired":true,"billingCode":"64650","codeType":"CPT"},{"id":3997,"precertRequired":true,"billingCode":"64653","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7204,"precertRequired":false,"billingCode":"96405","codeType":"CPT"},{"id":7205,"precertRequired":false,"billingCode":"96406","codeType":"CPT"},{"id":7224,"precertRequired":false,"billingCode":"96567","codeType":"CPT"},{"id":7225,"precertRequired":false,"billingCode":"96900","codeType":"CPT"},{"id":7226,"precertRequired":false,"billingCode":"96910","codeType":"CPT"},{"id":7227,"precertRequired":false,"billingCode":"96912","codeType":"CPT"},{"id":7228,"precertRequired":false,"billingCode":"96920","codeType":"CPT"},{"id":7229,"precertRequired":false,"billingCode":"96921","codeType":"CPT"},{"id":7230,"precertRequired":false,"billingCode":"96922","codeType":"CPT"},{"id":7231,"precertRequired":false,"billingCode":"96931","codeType":"CPT"},{"id":7232,"precertRequired":false,"billingCode":"96932","codeType":"CPT"},{"id":7233,"precertRequired":false,"billingCode":"96933","codeType":"CPT"},{"id":7234,"precertRequired":false,"billingCode":"96934","codeType":"CPT"},{"id":7235,"precertRequired":false,"billingCode":"96935","codeType":"CPT"},{"id":7236,"precertRequired":false,"billingCode":"96936","codeType":"CPT"},{"id":7245,"precertRequired":false,"billingCode":"97028","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":7282,"precertRequired":false,"billingCode":"97598","codeType":"CPT"},{"id":8211,"precertRequired":false,"billingCode":"G0429","codeType":"HCPCS"},{"id":8329,"precertRequired":false,"billingCode":"G9649","codeType":"HCPCS"},{"id":8330,"precertRequired":false,"billingCode":"G9651","codeType":"HCPCS"},{"id":8390,"precertRequired":true,"billingCode":"J0702","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8504,"precertRequired":true,"billingCode":"J3301","codeType":"HCPCS"},{"id":8771,"precertRequired":false,"billingCode":"Q0112","codeType":"HCPCS"},{"id":8786,"precertRequired":false,"billingCode":"Q2026","codeType":"HCPCS"},{"id":8787,"precertRequired":false,"billingCode":"Q2028","codeType":"HCPCS"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9168,"precertRequired":true,"billingCode":"15004","codeType":"CPT"},{"id":9169,"precertRequired":true,"billingCode":"15005","codeType":"CPT"},{"id":9172,"precertRequired":true,"billingCode":"15120","codeType":"CPT"},{"id":9843,"precertRequired":false,"billingCode":"J7308","codeType":"HCPCS"},{"id":9955,"precertRequired":false,"billingCode":"15003","codeType":"CPT"},{"id":10720,"precertRequired":false,"billingCode":"17340","codeType":"CPT"},{"id":10721,"precertRequired":false,"billingCode":"17360","codeType":"CPT"},{"id":10722,"precertRequired":true,"billingCode":"17380","codeType":"CPT"},{"id":10723,"precertRequired":false,"billingCode":"96573","codeType":"CPT"},{"id":10724,"precertRequired":false,"billingCode":"96902","codeType":"CPT"},{"id":10725,"precertRequired":false,"billingCode":"96904","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":1754,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7320,"precertRequired":false,"billingCode":"99024","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":1755,"description":"Follow up biopsy if clinically required as related to this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6357,"precertRequired":false,"billingCode":"88161","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]}]}},{"Seoc":{"id":288,"seocKey":45,"name":"Dermatology Comprehensive_PRCT","seocId":"MSC_DERMATOLOGY COMPREHENSIVE_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.  Please note this SEOC does not cover cosmetic procedures that are not considered medically necessary or correct a functional disability as they are excluded from the Medical Benefits Package.","effectiveDate":"01-02-2019","endDate":"04-16-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Labs and pathology relevant to the referred condition on the consult\r\n4. Procedures relevant to the referred condition on the consult including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies etc), excision, excimer laser, photodynamic therapy, UVB therapy, debridement\r\n5. Follow-up visits for this episode of care\r\n6. Follow up biopsy if clinically required as related to this episode of care","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval including MOH's and/or a referral to another specialty for secondary/complex closure\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"DERMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207N00000X"}],"services":[{"id":1216,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":1217,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4722,"precertRequired":false,"billingCode":"76641","codeType":"CPT"},{"id":4723,"precertRequired":false,"billingCode":"76642","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1218,"description":"Labs and pathology relevant to the referred condition on the consult ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6338,"precertRequired":false,"billingCode":"88104","codeType":"CPT"},{"id":6339,"precertRequired":false,"billingCode":"88106","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1219,"description":"Procedures relevant to the referred condition on the consult including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies etc), excision, excimer laser, photodynamic therapy, UVB therapy, debridement","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":226,"precertRequired":false,"billingCode":"10040","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":252,"precertRequired":false,"billingCode":"11055","codeType":"CPT"},{"id":253,"precertRequired":false,"billingCode":"11056","codeType":"CPT"},{"id":254,"precertRequired":false,"billingCode":"11057","codeType":"CPT"},{"id":255,"precertRequired":false,"billingCode":"11100","codeType":"CPT"},{"id":256,"precertRequired":false,"billingCode":"11101","codeType":"CPT"},{"id":257,"precertRequired":false,"billingCode":"11200","codeType":"CPT"},{"id":258,"precertRequired":false,"billingCode":"11201","codeType":"CPT"},{"id":259,"precertRequired":false,"billingCode":"11300","codeType":"CPT"},{"id":260,"precertRequired":false,"billingCode":"11301","codeType":"CPT"},{"id":261,"precertRequired":false,"billingCode":"11302","codeType":"CPT"},{"id":262,"precertRequired":false,"billingCode":"11303","codeType":"CPT"},{"id":263,"precertRequired":false,"billingCode":"11305","codeType":"CPT"},{"id":264,"precertRequired":false,"billingCode":"11306","codeType":"CPT"},{"id":265,"precertRequired":false,"billingCode":"11307","codeType":"CPT"},{"id":266,"precertRequired":false,"billingCode":"11308","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":268,"precertRequired":false,"billingCode":"11311","codeType":"CPT"},{"id":269,"precertRequired":false,"billingCode":"11312","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":313,"precertRequired":false,"billingCode":"11719","codeType":"CPT"},{"id":314,"precertRequired":false,"billingCode":"11720","codeType":"CPT"},{"id":315,"precertRequired":false,"billingCode":"11721","codeType":"CPT"},{"id":316,"precertRequired":false,"billingCode":"11730","codeType":"CPT"},{"id":317,"precertRequired":false,"billingCode":"11732","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":319,"precertRequired":false,"billingCode":"11750","codeType":"CPT"},{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":321,"precertRequired":false,"billingCode":"11760","codeType":"CPT"},{"id":322,"precertRequired":false,"billingCode":"11762","codeType":"CPT"},{"id":323,"precertRequired":false,"billingCode":"11765","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":437,"precertRequired":false,"billingCode":"15780","codeType":"CPT"},{"id":438,"precertRequired":false,"billingCode":"15781","codeType":"CPT"},{"id":439,"precertRequired":false,"billingCode":"15782","codeType":"CPT"},{"id":440,"precertRequired":false,"billingCode":"15783","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7204,"precertRequired":false,"billingCode":"96405","codeType":"CPT"},{"id":7205,"precertRequired":false,"billingCode":"96406","codeType":"CPT"},{"id":7224,"precertRequired":false,"billingCode":"96567","codeType":"CPT"},{"id":7225,"precertRequired":false,"billingCode":"96900","codeType":"CPT"},{"id":7226,"precertRequired":false,"billingCode":"96910","codeType":"CPT"},{"id":7227,"precertRequired":false,"billingCode":"96912","codeType":"CPT"},{"id":7228,"precertRequired":false,"billingCode":"96920","codeType":"CPT"},{"id":7229,"precertRequired":false,"billingCode":"96921","codeType":"CPT"},{"id":7230,"precertRequired":false,"billingCode":"96922","codeType":"CPT"},{"id":7231,"precertRequired":false,"billingCode":"96931","codeType":"CPT"},{"id":7232,"precertRequired":false,"billingCode":"96932","codeType":"CPT"},{"id":7233,"precertRequired":false,"billingCode":"96933","codeType":"CPT"},{"id":7234,"precertRequired":false,"billingCode":"96934","codeType":"CPT"},{"id":7235,"precertRequired":false,"billingCode":"96935","codeType":"CPT"},{"id":7236,"precertRequired":false,"billingCode":"96936","codeType":"CPT"},{"id":8211,"precertRequired":false,"billingCode":"G0429","codeType":"HCPCS"},{"id":8329,"precertRequired":false,"billingCode":"G9649","codeType":"HCPCS"},{"id":8330,"precertRequired":false,"billingCode":"G9651","codeType":"HCPCS"},{"id":8771,"precertRequired":false,"billingCode":"Q0112","codeType":"HCPCS"},{"id":8786,"precertRequired":false,"billingCode":"Q2026","codeType":"HCPCS"},{"id":8787,"precertRequired":false,"billingCode":"Q2028","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":1220,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":1221,"description":"Follow up biopsy if clinically required as related to this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"22-Pathology"}],"billingCodes":[{"id":255,"precertRequired":false,"billingCode":"11100","codeType":"CPT"},{"id":256,"precertRequired":false,"billingCode":"11101","codeType":"CPT"},{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207ZC0500X"},{"HPTC":"207ZI0100X"},{"HPTC":"207ZH0000X"},{"HPTC":"207ZD0900X"},{"HPTC":"207ZB0001X"},{"HPTC":"207ZN0500X"},{"HPTC":"207ZM0300X"},{"HPTC":"207ZP0213X"},{"HPTC":"207ZP0104X"},{"HPTC":"207ZP0101X"},{"HPTC":"207ZP0102X"},{"HPTC":"207ZF0201X"},{"HPTC":"207ZC0006X"},{"HPTC":"207ZP0105X"},{"HPTC":"207ZP0007X"}]}]}},{"Seoc":{"id":144,"seocKey":45,"name":"Dermatology Comprehensive_PRCT","seocId":"MSC_DERMATOLOGY COMPREHENSIVE_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.  Please note this SEOC does not cover cosmetic procedures that are not considered medically necessary or correct a functional disability as they are excluded from the Medical Benefits Package.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Labs and pathology relevant to the referred condition on the consult\r\n4. Procedures relevant to the referred condition on the consult including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies etc), excision, excimer laser, photodynamic therapy, UVB therapy, debridement\r\n5. Follow-up visits for this episode of care\r\n6. Follow up biopsy if clinically required as related to this episode of care","maxAllowableVisits":999,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval including MOH's and/or a referral to another specialty for secondary/complex closure\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"DERMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":136,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":137,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4722,"precertRequired":false,"billingCode":"76641","codeType":"CPT"},{"id":4723,"precertRequired":false,"billingCode":"76642","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":138,"description":"Labs and pathology relevant to the referred condition on the consult ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6338,"precertRequired":false,"billingCode":"88104","codeType":"CPT"},{"id":6339,"precertRequired":false,"billingCode":"88106","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":139,"description":"Procedures relevant to the referred condition on the consult including but not limited to: cryotherapy, biopsy (including excisional, shave, punch biopsies etc), excision, excimer laser, photodynamic therapy, UVB therapy, debridement","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":226,"precertRequired":false,"billingCode":"10040","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":252,"precertRequired":false,"billingCode":"11055","codeType":"CPT"},{"id":253,"precertRequired":false,"billingCode":"11056","codeType":"CPT"},{"id":254,"precertRequired":false,"billingCode":"11057","codeType":"CPT"},{"id":255,"precertRequired":false,"billingCode":"11100","codeType":"CPT"},{"id":256,"precertRequired":false,"billingCode":"11101","codeType":"CPT"},{"id":257,"precertRequired":false,"billingCode":"11200","codeType":"CPT"},{"id":258,"precertRequired":false,"billingCode":"11201","codeType":"CPT"},{"id":259,"precertRequired":false,"billingCode":"11300","codeType":"CPT"},{"id":260,"precertRequired":false,"billingCode":"11301","codeType":"CPT"},{"id":261,"precertRequired":false,"billingCode":"11302","codeType":"CPT"},{"id":262,"precertRequired":false,"billingCode":"11303","codeType":"CPT"},{"id":263,"precertRequired":false,"billingCode":"11305","codeType":"CPT"},{"id":264,"precertRequired":false,"billingCode":"11306","codeType":"CPT"},{"id":265,"precertRequired":false,"billingCode":"11307","codeType":"CPT"},{"id":266,"precertRequired":false,"billingCode":"11308","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":268,"precertRequired":false,"billingCode":"11311","codeType":"CPT"},{"id":269,"precertRequired":false,"billingCode":"11312","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":313,"precertRequired":false,"billingCode":"11719","codeType":"CPT"},{"id":314,"precertRequired":false,"billingCode":"11720","codeType":"CPT"},{"id":315,"precertRequired":false,"billingCode":"11721","codeType":"CPT"},{"id":316,"precertRequired":false,"billingCode":"11730","codeType":"CPT"},{"id":317,"precertRequired":false,"billingCode":"11732","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":319,"precertRequired":false,"billingCode":"11750","codeType":"CPT"},{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":321,"precertRequired":false,"billingCode":"11760","codeType":"CPT"},{"id":322,"precertRequired":false,"billingCode":"11762","codeType":"CPT"},{"id":323,"precertRequired":false,"billingCode":"11765","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":437,"precertRequired":false,"billingCode":"15780","codeType":"CPT"},{"id":438,"precertRequired":false,"billingCode":"15781","codeType":"CPT"},{"id":439,"precertRequired":false,"billingCode":"15782","codeType":"CPT"},{"id":440,"precertRequired":false,"billingCode":"15783","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7204,"precertRequired":false,"billingCode":"96405","codeType":"CPT"},{"id":7205,"precertRequired":false,"billingCode":"96406","codeType":"CPT"},{"id":7224,"precertRequired":false,"billingCode":"96567","codeType":"CPT"},{"id":7225,"precertRequired":false,"billingCode":"96900","codeType":"CPT"},{"id":7226,"precertRequired":false,"billingCode":"96910","codeType":"CPT"},{"id":7227,"precertRequired":false,"billingCode":"96912","codeType":"CPT"},{"id":7228,"precertRequired":false,"billingCode":"96920","codeType":"CPT"},{"id":7229,"precertRequired":false,"billingCode":"96921","codeType":"CPT"},{"id":7230,"precertRequired":false,"billingCode":"96922","codeType":"CPT"},{"id":7231,"precertRequired":false,"billingCode":"96931","codeType":"CPT"},{"id":7232,"precertRequired":false,"billingCode":"96932","codeType":"CPT"},{"id":7233,"precertRequired":false,"billingCode":"96933","codeType":"CPT"},{"id":7234,"precertRequired":false,"billingCode":"96934","codeType":"CPT"},{"id":7235,"precertRequired":false,"billingCode":"96935","codeType":"CPT"},{"id":7236,"precertRequired":false,"billingCode":"96936","codeType":"CPT"},{"id":8211,"precertRequired":false,"billingCode":"G0429","codeType":"HCPCS"},{"id":8329,"precertRequired":false,"billingCode":"G9649","codeType":"HCPCS"},{"id":8330,"precertRequired":false,"billingCode":"G9651","codeType":"HCPCS"},{"id":8771,"precertRequired":false,"billingCode":"Q0112","codeType":"HCPCS"},{"id":8786,"precertRequired":false,"billingCode":"Q2026","codeType":"HCPCS"},{"id":8787,"precertRequired":false,"billingCode":"Q2028","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":140,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"07-Dermatology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207NI0002X"},{"HPTC":"207NS0135X"},{"HPTC":"207N00000X"},{"HPTC":"207NP0225X"},{"HPTC":"207ND0900X"},{"HPTC":"207ND0101X"}]},{"id":141,"description":"Follow up biopsy if clinically required as related to this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"22-Pathology"}],"billingCodes":[{"id":255,"precertRequired":false,"billingCode":"11100","codeType":"CPT"},{"id":256,"precertRequired":false,"billingCode":"11101","codeType":"CPT"},{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207ZC0500X"},{"HPTC":"207ZI0100X"},{"HPTC":"207ZH0000X"},{"HPTC":"207ZD0900X"},{"HPTC":"207ZB0001X"},{"HPTC":"207ZN0500X"},{"HPTC":"207ZM0300X"},{"HPTC":"207ZP0213X"},{"HPTC":"207ZP0104X"},{"HPTC":"207ZP0101X"},{"HPTC":"207ZP0102X"},{"HPTC":"207ZF0201X"},{"HPTC":"207ZC0006X"},{"HPTC":"207ZP0105X"},{"HPTC":"207ZP0007X"}]}]}},{"Seoc":{"id":32,"seocKey":45,"name":"Dermatology-Skin illnesses/disorders/biopsy_PRCT","seocId":"MSC_DERMATOLOGY-SKIN ILLNESSES/DISORDERS/BIOPSY_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"12-07-2018","duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Diagnostic studies relevant to the referred condition\r\n3. Pathology services relevant to the referred condition\r\n4. Consultation to MOHS surgery as clinically required\r\n5. Cryoablation if clinically required\r\n6. Excisional biopsy if clinically required\r\n7. MOHS surgery\r\n8. Two (2) visits for photodynamic therapy\r\n9. Follow-up visits for this episode of care\r\n10. Follow up biopsy if clinically required","maxAllowableVisits":8,"disclaimer":"**Additional consultation needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"DERMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1311,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":525,"seocKey":46,"name":"DEXA Scan","seocId":"RAD_DEXA SCAN_1.0.3","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult","effectiveDate":"07-28-2019","endDate":null,"duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. One DEXA Scan as deemed medically necessary to measure bone density and risk for fracture, as well as for diagnosing osteoporosis\r\n2. Please burn disc of study for Veteran and VHA\r\n3. Written reports to be returned to originating facility per VHA policy","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"RADIOLOGY DEXA SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"2085R0202X"}],"services":[{"id":3048,"description":"One DEXA Scan as deemed medically necessary to measure bone density and risk for fracture, as well as for diagnosing osteoporosis.","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4799,"precertRequired":false,"billingCode":"77080","codeType":"CPT"},{"id":4800,"precertRequired":false,"billingCode":"77081","codeType":"CPT"},{"id":4802,"precertRequired":false,"billingCode":"77085","codeType":"CPT"},{"id":4803,"precertRequired":false,"billingCode":"77086","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":287,"seocKey":46,"name":"DEXA Scan","seocId":"RAD_DEXA SCAN_1.0.2","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult","effectiveDate":"01-03-2019","endDate":"07-28-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. One DEXA Scan as deemed medically necessary to measure bone density and risk for fracture, as well as for diagnosing osteoporosis\r\n2. Please burn disc of study for Veteran and VHA\r\n3. Written reports to be returned to originating facility per VHA policy","maxAllowableVisits":null,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"RADIOLOGY DEXA SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"2085R0202X"}],"services":[{"id":1215,"description":"One DEXA Scan as deemed medically necessary to measure bone density and risk for fracture, as well as for diagnosing osteoporosis. ","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4799,"precertRequired":false,"billingCode":"77080","codeType":"CPT"},{"id":4800,"precertRequired":false,"billingCode":"77081","codeType":"CPT"},{"id":4802,"precertRequired":false,"billingCode":"77085","codeType":"CPT"},{"id":4803,"precertRequired":false,"billingCode":"77086","codeType":"CPT"},{"id":8265,"precertRequired":false,"billingCode":"G8399","codeType":"HCPCS"},{"id":8266,"precertRequired":false,"billingCode":"G8400","codeType":"HCPCS"},{"id":8269,"precertRequired":false,"billingCode":"G8861","codeType":"HCPCS"},{"id":8321,"precertRequired":false,"billingCode":"G9471","codeType":"HCPCS"},{"id":8322,"precertRequired":false,"billingCode":"G9472","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":145,"seocKey":46,"name":"DEXA Scan","seocId":"RAD_DEXA SCAN_1.0.1","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. One DEXA Scan as deemed medically necessary to measure bone density and risk for fracture, as well as for diagnosing osteoporosis\r\n2. Please burn disc of study for Veteran and VHA\r\n3. Written reports to be returned to originating facility per VHA policy","maxAllowableVisits":999,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"RADIOLOGY DEXA SCAN","serviceLine":"Radiology","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":502,"description":"One DEXA Scan as deemed medically necessary to measure bone density and risk for fracture, as well as for diagnosing osteoporosis. ","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4799,"precertRequired":false,"billingCode":"77080","codeType":"CPT"},{"id":4800,"precertRequired":false,"billingCode":"77081","codeType":"CPT"},{"id":4802,"precertRequired":false,"billingCode":"77085","codeType":"CPT"},{"id":4803,"precertRequired":false,"billingCode":"77086","codeType":"CPT"},{"id":8265,"precertRequired":false,"billingCode":"G8399","codeType":"HCPCS"},{"id":8266,"precertRequired":false,"billingCode":"G8400","codeType":"HCPCS"},{"id":8269,"precertRequired":false,"billingCode":"G8861","codeType":"HCPCS"},{"id":8321,"precertRequired":false,"billingCode":"G9471","codeType":"HCPCS"},{"id":8322,"precertRequired":false,"billingCode":"G9472","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":286,"seocKey":47,"name":"EBUS","seocId":"RAD_EBUS_1.2.2","versionNumber":"1.2.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-03-2019","endDate":"02-14-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Endobronchial ultrasound for the referred condition indicated on the consult","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only. \r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"RADIOLOGY ULTRASOUND","serviceLine":"Radiology","hptcs":[{"hptc":"207RP1001X"}],"services":[{"id":1214,"description":"Endobronchial ultrasound for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"29-Pulmonary disease"}],"billingCodes":[{"id":2025,"precertRequired":false,"billingCode":"31623","codeType":"CPT"},{"id":2027,"precertRequired":false,"billingCode":"31625","codeType":"CPT"},{"id":2030,"precertRequired":false,"billingCode":"31628","codeType":"CPT"},{"id":2031,"precertRequired":false,"billingCode":"31629","codeType":"CPT"},{"id":2034,"precertRequired":false,"billingCode":"31632","codeType":"CPT"},{"id":2035,"precertRequired":false,"billingCode":"31633","codeType":"CPT"},{"id":2050,"precertRequired":false,"billingCode":"31652","codeType":"CPT"},{"id":2051,"precertRequired":false,"billingCode":"31653","codeType":"CPT"},{"id":2052,"precertRequired":false,"billingCode":"31654","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RP1001X"}]}]}},{"Seoc":{"id":67,"seocKey":47,"name":"EBUS","seocId":"RAD_EBUS_1.2.1","versionNumber":"1.2.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"05-31-2018","endDate":"01-03-2019","duration":60,"REV":false,"PRCT":false,"proceduralOverview":"1. Endobronchial ultrasound for the referred condition indicated on the consult","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only. \r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"RADIOLOGY ULTRASOUND","serviceLine":"Radiology","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":501,"description":"Endobronchial ultrasound for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"29-Pulmonary disease"}],"billingCodes":[{"id":2025,"precertRequired":false,"billingCode":"31623","codeType":"CPT"},{"id":2027,"precertRequired":false,"billingCode":"31625","codeType":"CPT"},{"id":2030,"precertRequired":false,"billingCode":"31628","codeType":"CPT"},{"id":2031,"precertRequired":false,"billingCode":"31629","codeType":"CPT"},{"id":2034,"precertRequired":false,"billingCode":"31632","codeType":"CPT"},{"id":2035,"precertRequired":false,"billingCode":"31633","codeType":"CPT"},{"id":2050,"precertRequired":false,"billingCode":"31652","codeType":"CPT"},{"id":2051,"precertRequired":false,"billingCode":"31653","codeType":"CPT"},{"id":2052,"precertRequired":false,"billingCode":"31654","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RP1001X"}]}]}},{"Seoc":{"id":1747,"seocKey":48,"name":"ECT Initial_REV_PRCT","seocId":"MHC_ECT INITIAL_1.6.5_REV_PRCT","versionNumber":"1.6.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":120,"REV":true,"PRCT":true,"proceduralOverview":"1.  Evaluation and treatment for the referred condition indicated on the consult order\r\n2.  Diagnostic imaging relevant to the referred condition on the consult order\r\n3.  Labs and pathology relevant to the referred condition on the consult order\r\n4.  Diagnostic studies needed to assess other conditions that impact safety and efficacy of ECT, these could include but are not limited to echocardiogram.\r\n5.  Anesthesia consultation related to the procedure\r\n6.  No more than 24 electroconvulsive therapy (ECT) visits as medically necessary . If additional treatments are needed for continuation ECT, a separate request and justification would be needed.\r\n7.  EEG and ECG monitoring during treatment\r\n8.  Follow up visits for the referred condition\r\n9.  Inpatient or observation emergent admission if clinically necessary \r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"2084P0800X"},{"hptc":"261QM0801X"},{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":5192,"description":"Evaluation and treatment for the referred condition indicated on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6569,"precertRequired":false,"billingCode":"90785","codeType":"CPT"},{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"},{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":7173,"precertRequired":true,"billingCode":"96116","codeType":"CPT"},{"id":7178,"precertRequired":false,"billingCode":"96127","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"},{"id":13398,"precertRequired":false,"billingCode":"96156","codeType":"CPT"},{"id":13399,"precertRequired":false,"billingCode":"96158","codeType":"CPT"},{"id":13400,"precertRequired":false,"billingCode":"96159","codeType":"CPT"},{"id":13532,"precertRequired":false,"billingCode":"96164","codeType":"CPT"},{"id":13533,"precertRequired":false,"billingCode":"96165","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":5193,"description":"Diagnostic imaging relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4384,"precertRequired":false,"billingCode":"70250","codeType":"CPT"},{"id":4385,"precertRequired":false,"billingCode":"70260","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5194,"description":"Diagnostic studies needed to assess other conditions that impact safety and efficacy of ECT, these could include but are not limited to echocardiogram.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":6868,"precertRequired":false,"billingCode":"93303","codeType":"CPT"},{"id":6869,"precertRequired":false,"billingCode":"93304","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6880,"precertRequired":false,"billingCode":"93320","codeType":"CPT"},{"id":6881,"precertRequired":false,"billingCode":"93321","codeType":"CPT"},{"id":6882,"precertRequired":false,"billingCode":"93325","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5195,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"26-Psychiatry"}],"billingCodes":[{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2084P0301X"},{"HPTC":"2084P0800X"}]},{"id":5196,"description":"EG and ECG monitoring during treatment","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":7080,"precertRequired":false,"billingCode":"95812","codeType":"CPT"},{"id":7081,"precertRequired":false,"billingCode":"95813","codeType":"CPT"},{"id":7082,"precertRequired":false,"billingCode":"95816","codeType":"CPT"},{"id":7083,"precertRequired":false,"billingCode":"95819","codeType":"CPT"},{"id":7084,"precertRequired":false,"billingCode":"95822","codeType":"CPT"},{"id":7087,"precertRequired":false,"billingCode":"95830","codeType":"CPT"},{"id":7138,"precertRequired":false,"billingCode":"95954","codeType":"CPT"},{"id":7139,"precertRequired":false,"billingCode":"95955","codeType":"CPT"},{"id":7141,"precertRequired":false,"billingCode":"95957","codeType":"CPT"},{"id":7142,"precertRequired":false,"billingCode":"95958","codeType":"CPT"},{"id":7428,"precertRequired":false,"billingCode":"99360","codeType":"CPT"},{"id":13418,"precertRequired":false,"billingCode":"95700","codeType":"CPT"},{"id":13419,"precertRequired":false,"billingCode":"95705","codeType":"CPT"},{"id":13420,"precertRequired":false,"billingCode":"95706","codeType":"CPT"},{"id":13421,"precertRequired":false,"billingCode":"95707","codeType":"CPT"},{"id":13422,"precertRequired":false,"billingCode":"95708","codeType":"CPT"},{"id":13423,"precertRequired":false,"billingCode":"95709","codeType":"CPT"},{"id":13424,"precertRequired":false,"billingCode":"95710","codeType":"CPT"},{"id":13425,"precertRequired":false,"billingCode":"95711","codeType":"CPT"},{"id":13426,"precertRequired":false,"billingCode":"95712","codeType":"CPT"},{"id":13427,"precertRequired":false,"billingCode":"95713","codeType":"CPT"},{"id":13428,"precertRequired":false,"billingCode":"95714","codeType":"CPT"},{"id":13429,"precertRequired":false,"billingCode":"95715","codeType":"CPT"},{"id":13430,"precertRequired":false,"billingCode":"95716","codeType":"CPT"},{"id":13431,"precertRequired":false,"billingCode":"95717","codeType":"CPT"},{"id":13432,"precertRequired":false,"billingCode":"95718","codeType":"CPT"},{"id":13433,"precertRequired":false,"billingCode":"95719","codeType":"CPT"},{"id":13434,"precertRequired":false,"billingCode":"95720","codeType":"CPT"},{"id":13435,"precertRequired":false,"billingCode":"95721","codeType":"CPT"},{"id":13436,"precertRequired":false,"billingCode":"95722","codeType":"CPT"},{"id":13437,"precertRequired":false,"billingCode":"95723","codeType":"CPT"},{"id":13438,"precertRequired":false,"billingCode":"95724","codeType":"CPT"},{"id":13439,"precertRequired":false,"billingCode":"95725","codeType":"CPT"},{"id":13440,"precertRequired":false,"billingCode":"95726","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":5197,"description":"No more than 24 electroconvulsive therapy (ECT) visits as medically necessary . If additional treatments are needed for continuation ECT, a separate request and justification would be needed.","frequency":null,"frequencyType":"","visits":24,"codeRequired":"YES","clinicalServices":[{"clinicalService":"21-Cardiac electrophysiology"}],"billingCodes":[{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7655,"precertRequired":false,"billingCode":"4066F","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0001X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"207XS0117X"},{"HPTC":"207XX0004X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"}]},{"id":5198,"description":"Labs and pathology relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5199,"description":"Follow up visits for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"21-Cardiac electrophysiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RC0001X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"207XS0117X"},{"HPTC":"207XX0004X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"}]},{"id":5200,"description":"Inpatient or observation emergent admission if clinically necessary \r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":651,"seocKey":48,"name":"ECT Initial_REV_PRCT","seocId":"MHC_ECT INITIAL_1.6.4_REV_PRCT","versionNumber":"1.6.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"11-12-2019","endDate":"06-08-2020","duration":120,"REV":true,"PRCT":true,"proceduralOverview":"1.  Evaluation and treatment for the referred condition indicated on the consult\r\n2.  Diagnostic imaging relevant to the referred condition on the consult\r\n3.  Labs and pathology relevant to the referred condition on the consult \r\n4.  Diagnostic studies needed to assess other conditions that impact safety and efficacy of ECT, these could include but are not limited to echocardiogram.\r\n5. Anesthesia consultation related to the procedure\r\n6. No more than 24 electroconvulsive therapy (ECT) visits as medically necessary . If additional treatments are needed for continuation ECT, a separate request and justification would be needed.\r\n7. EEG and ECG monitoring during treatment\r\n8. Follow up visits for the referred condition\r\n9. Inpatient or observation emergent admission if clinically necessary \r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for urgent admission","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"2084P0800X"},{"hptc":"261QM0801X"},{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":3618,"description":"Evaluation for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6569,"precertRequired":false,"billingCode":"90785","codeType":"CPT"},{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"},{"id":6572,"precertRequired":false,"billingCode":"90832","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":6579,"precertRequired":false,"billingCode":"90839","codeType":"CPT"},{"id":6580,"precertRequired":false,"billingCode":"90840","codeType":"CPT"},{"id":6582,"precertRequired":false,"billingCode":"90846","codeType":"CPT"},{"id":6583,"precertRequired":false,"billingCode":"90847","codeType":"CPT"},{"id":6585,"precertRequired":false,"billingCode":"90853","codeType":"CPT"},{"id":7173,"precertRequired":true,"billingCode":"96116","codeType":"CPT"},{"id":7178,"precertRequired":false,"billingCode":"96127","codeType":"CPT"},{"id":7180,"precertRequired":false,"billingCode":"96151","codeType":"CPT"},{"id":7181,"precertRequired":false,"billingCode":"96152","codeType":"CPT"},{"id":7182,"precertRequired":false,"billingCode":"96153","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":3619,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4384,"precertRequired":false,"billingCode":"70250","codeType":"CPT"},{"id":4385,"precertRequired":false,"billingCode":"70260","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3620,"description":"Diagnostic studies needed to assess other conditions that impact safety and efficacy of ECT, these could include but are not limited to echocardiogram","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":6868,"precertRequired":false,"billingCode":"93303","codeType":"CPT"},{"id":6869,"precertRequired":false,"billingCode":"93304","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6874,"precertRequired":false,"billingCode":"93313","codeType":"CPT"},{"id":6875,"precertRequired":false,"billingCode":"93314","codeType":"CPT"},{"id":6876,"precertRequired":false,"billingCode":"93315","codeType":"CPT"},{"id":6877,"precertRequired":false,"billingCode":"93316","codeType":"CPT"},{"id":6878,"precertRequired":false,"billingCode":"93317","codeType":"CPT"},{"id":6879,"precertRequired":false,"billingCode":"93318","codeType":"CPT"},{"id":6880,"precertRequired":false,"billingCode":"93320","codeType":"CPT"},{"id":6881,"precertRequired":false,"billingCode":"93321","codeType":"CPT"},{"id":6882,"precertRequired":false,"billingCode":"93325","codeType":"CPT"},{"id":6883,"precertRequired":false,"billingCode":"93350","codeType":"CPT"},{"id":6884,"precertRequired":false,"billingCode":"93351","codeType":"CPT"},{"id":6885,"precertRequired":false,"billingCode":"93352","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3621,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"26-Psychiatry"}],"billingCodes":[{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2084P0301X"},{"HPTC":"2084P0800X"}]},{"id":3622,"description":"EEG and ECG monitoring if required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":7080,"precertRequired":false,"billingCode":"95812","codeType":"CPT"},{"id":7081,"precertRequired":false,"billingCode":"95813","codeType":"CPT"},{"id":7082,"precertRequired":false,"billingCode":"95816","codeType":"CPT"},{"id":7083,"precertRequired":false,"billingCode":"95819","codeType":"CPT"},{"id":7084,"precertRequired":false,"billingCode":"95822","codeType":"CPT"},{"id":7086,"precertRequired":false,"billingCode":"95827","codeType":"CPT"},{"id":7087,"precertRequired":false,"billingCode":"95830","codeType":"CPT"},{"id":7135,"precertRequired":false,"billingCode":"95950","codeType":"CPT"},{"id":7136,"precertRequired":false,"billingCode":"95951","codeType":"CPT"},{"id":7137,"precertRequired":false,"billingCode":"95953","codeType":"CPT"},{"id":7138,"precertRequired":false,"billingCode":"95954","codeType":"CPT"},{"id":7139,"precertRequired":false,"billingCode":"95955","codeType":"CPT"},{"id":7140,"precertRequired":false,"billingCode":"95956","codeType":"CPT"},{"id":7141,"precertRequired":false,"billingCode":"95957","codeType":"CPT"},{"id":7142,"precertRequired":false,"billingCode":"95958","codeType":"CPT"},{"id":7428,"precertRequired":false,"billingCode":"99360","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":3623,"description":"No more than 24 electroconvulsive therapy (ECT) visits as medically necessary . If additional treatments are needed for continuation ECT, a separate request and justifiation would be needed.","frequency":null,"frequencyType":"","visits":24,"codeRequired":"YES","clinicalServices":[{"clinicalService":"21-Cardiac electrophysiology"}],"billingCodes":[{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7655,"precertRequired":false,"billingCode":"4066F","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0001X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"207XS0117X"},{"HPTC":"207XX0004X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"}]},{"id":3624,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":3625,"description":"Follow up visits for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"21-Cardiac electrophysiology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RC0001X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"207XS0117X"},{"HPTC":"207XX0004X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"}]},{"id":3626,"description":"Inpatient or observation emergent admission if clinically necessary \r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for urgent admission","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]}]}},{"Seoc":{"id":490,"seocKey":48,"name":"Electroconvulsive Therapy Services-Initial_PRCT","seocId":"MHC_ELECTROCONVULSIVE THERAPY SERVICES-INITIAL_1.6.3_PRCT","versionNumber":"1.6.3","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"07-28-2019","endDate":"11-12-2019","duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Evaluation for the referred condition indicated on the consult\r\n2. Electroconvulsive therapy\r\n3. Diagnostic labs, x-rays, EKG, MRI, head CT and/or an echocardiogram as clinically required\r\n4. Anesthesia consultation related to the procedure\r\n5. EEG and ECG monitoring if required\r\n6. Follow up visits for the referred condition","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"261QM0801X"},{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":2832,"description":"Evaluation for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7461,"precertRequired":false,"billingCode":"99408","codeType":"CPT"},{"id":7462,"precertRequired":false,"billingCode":"99409","codeType":"CPT"},{"id":7467,"precertRequired":false,"billingCode":"99441","codeType":"CPT"},{"id":7468,"precertRequired":false,"billingCode":"99442","codeType":"CPT"},{"id":7469,"precertRequired":false,"billingCode":"99443","codeType":"CPT"},{"id":7470,"precertRequired":false,"billingCode":"99446","codeType":"CPT"},{"id":7471,"precertRequired":false,"billingCode":"99447","codeType":"CPT"},{"id":7472,"precertRequired":false,"billingCode":"99448","codeType":"CPT"},{"id":7473,"precertRequired":false,"billingCode":"99449","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":2833,"description":"Electroconvulsive therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7655,"precertRequired":false,"billingCode":"4066F","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":2834,"description":"Diagnostic labs, x-rays, EKG, MRI, head CT and/or an echocardiogram as clinically required","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2835,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"26-Psychiatry"}],"billingCodes":[{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2084P0301X"},{"HPTC":"2084P0800X"}]},{"id":2836,"description":"EEG and ECG monitoring if required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":7080,"precertRequired":false,"billingCode":"95812","codeType":"CPT"},{"id":7081,"precertRequired":false,"billingCode":"95813","codeType":"CPT"},{"id":7082,"precertRequired":false,"billingCode":"95816","codeType":"CPT"},{"id":7083,"precertRequired":false,"billingCode":"95819","codeType":"CPT"},{"id":7084,"precertRequired":false,"billingCode":"95822","codeType":"CPT"},{"id":7085,"precertRequired":false,"billingCode":"95824","codeType":"CPT"},{"id":7086,"precertRequired":false,"billingCode":"95827","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":2837,"description":"Follow up visits for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"26-Psychiatry"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2084P0301X"},{"HPTC":"2084P0800X"}]}]}},{"Seoc":{"id":285,"seocKey":48,"name":"Electroconvulsive Therapy Services-Initial_PRCT","seocId":"MHC_ELECTROCONVULSIVE THERAPY SERVICES-INITIAL_1.6.2_PRCT","versionNumber":"1.6.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Evaluation for the referred condition indicated on the consult\r\n2. Electroconvulsive therapy\r\n3. Diagnostic labs, x-rays, EKG, MRI, head CT and/or an echocardiogram as clinically required\r\n4. Anesthesia consultation related to the procedure\r\n5. EEG and ECG monitoring if required\r\n6. Follow up visits for the referred condition","maxAllowableVisits":null,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n* All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"261QM0801X"},{"hptc":"273R00000X"},{"hptc":"283Q00000X"}],"services":[{"id":1208,"description":"Evaluation for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6575,"precertRequired":false,"billingCode":"90835","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7461,"precertRequired":false,"billingCode":"99408","codeType":"CPT"},{"id":7462,"precertRequired":false,"billingCode":"99409","codeType":"CPT"},{"id":7467,"precertRequired":false,"billingCode":"99441","codeType":"CPT"},{"id":7468,"precertRequired":false,"billingCode":"99442","codeType":"CPT"},{"id":7469,"precertRequired":false,"billingCode":"99443","codeType":"CPT"},{"id":7470,"precertRequired":false,"billingCode":"99446","codeType":"CPT"},{"id":7471,"precertRequired":false,"billingCode":"99447","codeType":"CPT"},{"id":7472,"precertRequired":false,"billingCode":"99448","codeType":"CPT"},{"id":7473,"precertRequired":false,"billingCode":"99449","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":1209,"description":"Electroconvulsive therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7655,"precertRequired":false,"billingCode":"4066F","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":1210,"description":"Diagnostic labs, x-rays, EKG, MRI, head CT and/or an echocardiogram as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1211,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"26-Psychiatry"}],"billingCodes":[{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2084P0301X"},{"HPTC":"2084P0800X"}]},{"id":1212,"description":"EEG and ECG monitoring if required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":7080,"precertRequired":false,"billingCode":"95812","codeType":"CPT"},{"id":7081,"precertRequired":false,"billingCode":"95813","codeType":"CPT"},{"id":7082,"precertRequired":false,"billingCode":"95816","codeType":"CPT"},{"id":7083,"precertRequired":false,"billingCode":"95819","codeType":"CPT"},{"id":7084,"precertRequired":false,"billingCode":"95822","codeType":"CPT"},{"id":7085,"precertRequired":false,"billingCode":"95824","codeType":"CPT"},{"id":7086,"precertRequired":false,"billingCode":"95827","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":1213,"description":"Follow up visits for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"26-Psychiatry"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2084P0301X"},{"HPTC":"2084P0800X"}]}]}},{"Seoc":{"id":108,"seocKey":48,"name":"Electroconvulsive Therapy Services-Initial_PRCT","seocId":"MHC_ELECTROCONVULSIVE THERAPY SERVICES-INITIAL_1.6.1_PRCT","versionNumber":"1.6.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"09-21-2018","endDate":"01-02-2019","duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Evaluation for the referred condition indicated on the consult\r\n2. Electroconvulsive therapy\r\n3. Diagnostic labs, x-rays, EKG, MRI, head CT and/or an echocardiogram as clinically required\r\n4. Anesthesia consultation related to the procedure\r\n5. EEG and ECG monitoring if required\r\n6. Follow up visits for the referred condition","maxAllowableVisits":999,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n* All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MENTAL HEALTH","serviceLine":"Mental Health Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":285,"description":"Evaluation for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"},{"id":6573,"precertRequired":false,"billingCode":"90833","codeType":"CPT"},{"id":6574,"precertRequired":false,"billingCode":"90834","codeType":"CPT"},{"id":6575,"precertRequired":false,"billingCode":"90835","codeType":"CPT"},{"id":6576,"precertRequired":false,"billingCode":"90836","codeType":"CPT"},{"id":6577,"precertRequired":false,"billingCode":"90837","codeType":"CPT"},{"id":6578,"precertRequired":false,"billingCode":"90838","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7461,"precertRequired":false,"billingCode":"99408","codeType":"CPT"},{"id":7462,"precertRequired":false,"billingCode":"99409","codeType":"CPT"},{"id":7467,"precertRequired":false,"billingCode":"99441","codeType":"CPT"},{"id":7468,"precertRequired":false,"billingCode":"99442","codeType":"CPT"},{"id":7469,"precertRequired":false,"billingCode":"99443","codeType":"CPT"},{"id":7470,"precertRequired":false,"billingCode":"99446","codeType":"CPT"},{"id":7471,"precertRequired":false,"billingCode":"99447","codeType":"CPT"},{"id":7472,"precertRequired":false,"billingCode":"99448","codeType":"CPT"},{"id":7473,"precertRequired":false,"billingCode":"99449","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":286,"description":"Electroconvulsive therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6590,"precertRequired":false,"billingCode":"90870","codeType":"CPT"},{"id":7655,"precertRequired":false,"billingCode":"4066F","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":287,"description":"Diagnostic labs, x-rays, EKG, MRI, head CT and/or an echocardiogram as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":288,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"26-Psychiatry"}],"billingCodes":[{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2084P0301X"},{"HPTC":"2084P0800X"}]},{"id":289,"description":"EEG and ECG monitoring if required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A0-Hospital"}],"billingCodes":[{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6830,"precertRequired":false,"billingCode":"93040","codeType":"CPT"},{"id":6831,"precertRequired":false,"billingCode":"93041","codeType":"CPT"},{"id":6832,"precertRequired":false,"billingCode":"93042","codeType":"CPT"},{"id":7080,"precertRequired":false,"billingCode":"95812","codeType":"CPT"},{"id":7081,"precertRequired":false,"billingCode":"95813","codeType":"CPT"},{"id":7082,"precertRequired":false,"billingCode":"95816","codeType":"CPT"},{"id":7083,"precertRequired":false,"billingCode":"95819","codeType":"CPT"},{"id":7084,"precertRequired":false,"billingCode":"95822","codeType":"CPT"},{"id":7085,"precertRequired":false,"billingCode":"95824","codeType":"CPT"},{"id":7086,"precertRequired":false,"billingCode":"95827","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"284300000X"},{"HPTC":"283Q00000X"},{"HPTC":"273Y00000X"},{"HPTC":"275N00000X"},{"HPTC":"283X00000X"},{"HPTC":"282E00000X"},{"HPTC":"282NC0060X"},{"HPTC":"282N00000X"}]},{"id":290,"description":"Follow up visits for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"26-Psychiatry"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2084P0301X"},{"HPTC":"2084P0800X"}]}]}},{"Seoc":{"id":284,"seocKey":49,"name":"Emergency/Urgent Care_PRCT","seocId":"EUC_EMERGENCY/URGENT CARE_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-03-2019","endDate":"05-02-2019","duration":7,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic imaging relevant to the referred condition\r\n3. Diagnostic studies, labs and pathology relevant to the referred condition\r\n4. Emergent/urgent services If admission is required contact nearest VA medical facility to inform of status change and to initiate transfer request.","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ER VISIT/URGENT CARE","serviceLine":"Emergent-Urgent Care","hptcs":[{"hptc":"207P00000X"}],"services":[{"id":1204,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"93-Emergency medicine"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7395,"precertRequired":false,"billingCode":"99282","codeType":"CPT"},{"id":7396,"precertRequired":false,"billingCode":"99283","codeType":"CPT"},{"id":7397,"precertRequired":false,"billingCode":"99284","codeType":"CPT"},{"id":7398,"precertRequired":false,"billingCode":"99285","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207PS0010X"},{"HPTC":"207PH0002X"},{"HPTC":"207PP0204X"},{"HPTC":"207PT0002X"},{"HPTC":"207P00000X"},{"HPTC":"207PE0005X"},{"HPTC":"207PE0004X"}]},{"id":1205,"description":"Diagnostic imaging relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4429,"precertRequired":false,"billingCode":"71010","codeType":"CPT"},{"id":4430,"precertRequired":false,"billingCode":"71020","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1206,"description":"Diagnostic studies, labs and pathology relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2591,"precertRequired":false,"billingCode":"36600","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5522,"precertRequired":false,"billingCode":"82948","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1207,"description":"Emergent/urgent services If admission is required contact nearest VA medical facility to inform of status change and to initiate transfer request.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"93-Emergency medicine"}],"billingCodes":[{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":465,"precertRequired":false,"billingCode":"16000","codeType":"CPT"},{"id":570,"precertRequired":true,"billingCode":"20605","codeType":"CPT"},{"id":571,"precertRequired":true,"billingCode":"20606","codeType":"CPT"},{"id":572,"precertRequired":true,"billingCode":"20610","codeType":"CPT"},{"id":573,"precertRequired":true,"billingCode":"20611","codeType":"CPT"},{"id":872,"precertRequired":false,"billingCode":"23650","codeType":"CPT"},{"id":1156,"precertRequired":false,"billingCode":"26010","codeType":"CPT"},{"id":1282,"precertRequired":false,"billingCode":"26600","codeType":"CPT"},{"id":1283,"precertRequired":false,"billingCode":"26605","codeType":"CPT"},{"id":1896,"precertRequired":false,"billingCode":"29105","codeType":"CPT"},{"id":1897,"precertRequired":false,"billingCode":"29125","codeType":"CPT"},{"id":1899,"precertRequired":false,"billingCode":"29130","codeType":"CPT"},{"id":1903,"precertRequired":false,"billingCode":"29260","codeType":"CPT"},{"id":1904,"precertRequired":false,"billingCode":"29280","codeType":"CPT"},{"id":1917,"precertRequired":false,"billingCode":"29505","codeType":"CPT"},{"id":1918,"precertRequired":false,"billingCode":"29515","codeType":"CPT"},{"id":1920,"precertRequired":false,"billingCode":"29530","codeType":"CPT"},{"id":1921,"precertRequired":false,"billingCode":"29540","codeType":"CPT"},{"id":1922,"precertRequired":false,"billingCode":"29550","codeType":"CPT"},{"id":1923,"precertRequired":false,"billingCode":"29580","codeType":"CPT"},{"id":1926,"precertRequired":false,"billingCode":"29700","codeType":"CPT"},{"id":1927,"precertRequired":false,"billingCode":"29705","codeType":"CPT"},{"id":1983,"precertRequired":false,"billingCode":"30901","codeType":"CPT"},{"id":1994,"precertRequired":false,"billingCode":"31500","codeType":"CPT"},{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2597,"precertRequired":false,"billingCode":"36680","codeType":"CPT"},{"id":2738,"precertRequired":false,"billingCode":"42809","codeType":"CPT"},{"id":2899,"precertRequired":false,"billingCode":"43753","codeType":"CPT"},{"id":2904,"precertRequired":false,"billingCode":"43760","codeType":"CPT"},{"id":3150,"precertRequired":false,"billingCode":"45915","codeType":"CPT"},{"id":3156,"precertRequired":false,"billingCode":"46050","codeType":"CPT"},{"id":3176,"precertRequired":false,"billingCode":"46320","codeType":"CPT"},{"id":3417,"precertRequired":false,"billingCode":"51701","codeType":"CPT"},{"id":3418,"precertRequired":false,"billingCode":"51702","codeType":"CPT"},{"id":3435,"precertRequired":false,"billingCode":"51798","codeType":"CPT"},{"id":3550,"precertRequired":false,"billingCode":"56405","codeType":"CPT"},{"id":3551,"precertRequired":false,"billingCode":"56420","codeType":"CPT"},{"id":3682,"precertRequired":false,"billingCode":"58301","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4099,"precertRequired":false,"billingCode":"65210","codeType":"CPT"},{"id":4100,"precertRequired":false,"billingCode":"65220","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":6804,"precertRequired":false,"billingCode":"92960","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":8977,"precertRequired":false,"billingCode":"S9083","codeType":"HCPCS"},{"id":8978,"precertRequired":false,"billingCode":"S9088","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207PS0010X"},{"HPTC":"207PH0002X"},{"HPTC":"207PP0204X"},{"HPTC":"207PT0002X"},{"HPTC":"207P00000X"},{"HPTC":"207PE0005X"},{"HPTC":"207PE0004X"}]}]}},{"Seoc":{"id":33,"seocKey":49,"name":"Emergency/Urgent Care_PRCT","seocId":"MSC_EMERGENCY/URGENT CARE_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"01-03-2019","duration":7,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic imaging relevant to the referred condition\r\n3. Diagnostic studies, labs and pathology relevant to the referred condition\r\n4. Emergent/urgent services If admission is required contact nearest VA medical facility to inform of status change and to initiate transfer request.","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ER VISIT/URGENT CARE","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":142,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"93-Emergency medicine"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7395,"precertRequired":false,"billingCode":"99282","codeType":"CPT"},{"id":7396,"precertRequired":false,"billingCode":"99283","codeType":"CPT"},{"id":7397,"precertRequired":false,"billingCode":"99284","codeType":"CPT"},{"id":7398,"precertRequired":false,"billingCode":"99285","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207PS0010X"},{"HPTC":"207PH0002X"},{"HPTC":"207PP0204X"},{"HPTC":"207PT0002X"},{"HPTC":"207P00000X"},{"HPTC":"207PE0005X"},{"HPTC":"207PE0004X"}]},{"id":143,"description":"Diagnostic imaging relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4429,"precertRequired":false,"billingCode":"71010","codeType":"CPT"},{"id":4430,"precertRequired":false,"billingCode":"71020","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":144,"description":"Diagnostic studies, labs and pathology relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2591,"precertRequired":false,"billingCode":"36600","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5522,"precertRequired":false,"billingCode":"82948","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":145,"description":"Emergent/urgent services If admission is required contact nearest VA medical facility to inform of status change and to initiate transfer request.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"93-Emergency medicine"}],"billingCodes":[{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":465,"precertRequired":false,"billingCode":"16000","codeType":"CPT"},{"id":570,"precertRequired":true,"billingCode":"20605","codeType":"CPT"},{"id":571,"precertRequired":true,"billingCode":"20606","codeType":"CPT"},{"id":572,"precertRequired":true,"billingCode":"20610","codeType":"CPT"},{"id":573,"precertRequired":true,"billingCode":"20611","codeType":"CPT"},{"id":872,"precertRequired":false,"billingCode":"23650","codeType":"CPT"},{"id":1156,"precertRequired":false,"billingCode":"26010","codeType":"CPT"},{"id":1282,"precertRequired":false,"billingCode":"26600","codeType":"CPT"},{"id":1283,"precertRequired":false,"billingCode":"26605","codeType":"CPT"},{"id":1896,"precertRequired":false,"billingCode":"29105","codeType":"CPT"},{"id":1897,"precertRequired":false,"billingCode":"29125","codeType":"CPT"},{"id":1899,"precertRequired":false,"billingCode":"29130","codeType":"CPT"},{"id":1903,"precertRequired":false,"billingCode":"29260","codeType":"CPT"},{"id":1904,"precertRequired":false,"billingCode":"29280","codeType":"CPT"},{"id":1917,"precertRequired":false,"billingCode":"29505","codeType":"CPT"},{"id":1918,"precertRequired":false,"billingCode":"29515","codeType":"CPT"},{"id":1920,"precertRequired":false,"billingCode":"29530","codeType":"CPT"},{"id":1921,"precertRequired":false,"billingCode":"29540","codeType":"CPT"},{"id":1922,"precertRequired":false,"billingCode":"29550","codeType":"CPT"},{"id":1923,"precertRequired":false,"billingCode":"29580","codeType":"CPT"},{"id":1926,"precertRequired":false,"billingCode":"29700","codeType":"CPT"},{"id":1927,"precertRequired":false,"billingCode":"29705","codeType":"CPT"},{"id":1983,"precertRequired":false,"billingCode":"30901","codeType":"CPT"},{"id":1994,"precertRequired":false,"billingCode":"31500","codeType":"CPT"},{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2597,"precertRequired":false,"billingCode":"36680","codeType":"CPT"},{"id":2738,"precertRequired":false,"billingCode":"42809","codeType":"CPT"},{"id":2899,"precertRequired":false,"billingCode":"43753","codeType":"CPT"},{"id":2904,"precertRequired":false,"billingCode":"43760","codeType":"CPT"},{"id":3150,"precertRequired":false,"billingCode":"45915","codeType":"CPT"},{"id":3156,"precertRequired":false,"billingCode":"46050","codeType":"CPT"},{"id":3176,"precertRequired":false,"billingCode":"46320","codeType":"CPT"},{"id":3417,"precertRequired":false,"billingCode":"51701","codeType":"CPT"},{"id":3418,"precertRequired":false,"billingCode":"51702","codeType":"CPT"},{"id":3435,"precertRequired":false,"billingCode":"51798","codeType":"CPT"},{"id":3550,"precertRequired":false,"billingCode":"56405","codeType":"CPT"},{"id":3551,"precertRequired":false,"billingCode":"56420","codeType":"CPT"},{"id":3682,"precertRequired":false,"billingCode":"58301","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4099,"precertRequired":false,"billingCode":"65210","codeType":"CPT"},{"id":4100,"precertRequired":false,"billingCode":"65220","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":6804,"precertRequired":false,"billingCode":"92960","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":8977,"precertRequired":false,"billingCode":"S9083","codeType":"HCPCS"},{"id":8978,"precertRequired":false,"billingCode":"S9088","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207PS0010X"},{"HPTC":"207PH0002X"},{"HPTC":"207PP0204X"},{"HPTC":"207PT0002X"},{"HPTC":"207P00000X"},{"HPTC":"207PE0005X"},{"HPTC":"207PE0004X"}]}]}},{"Seoc":{"id":283,"seocKey":50,"name":"Endocrine Diabetes Management_PRCT","seocId":"MSC_ENDOCRINE DIABETES MANAGEMENT_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"01-02-2019","endDate":"03-12-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the patient complaint documented on the consult\r\n2. Diagnostic studies, labs and pathology services relevant to the patient complaint/condition\r\n3. Medication management\r\n4. Follow up visits to include diagnostic studies","maxAllowableVisits":null,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** All diabetic testing materials and routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ENDOCRINOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RE0101X"}],"services":[{"id":1200,"description":"Initial outpatient evaluation and treatment for the patient complaint documented on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":1201,"description":"Diagnostic studies, labs and pathology services relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":5374,"precertRequired":false,"billingCode":"82043","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5518,"precertRequired":false,"billingCode":"82943","codeType":"CPT"},{"id":5520,"precertRequired":false,"billingCode":"82946","codeType":"CPT"},{"id":5523,"precertRequired":false,"billingCode":"82950","codeType":"CPT"},{"id":5524,"precertRequired":false,"billingCode":"82951","codeType":"CPT"},{"id":5525,"precertRequired":false,"billingCode":"82952","codeType":"CPT"},{"id":5682,"precertRequired":false,"billingCode":"84206","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1202,"description":"Medication management","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"},{"id":7325,"precertRequired":false,"billingCode":"99078","codeType":"CPT"},{"id":7674,"precertRequired":false,"billingCode":"A4233","codeType":"HCPCS"},{"id":7675,"precertRequired":false,"billingCode":"A4234","codeType":"HCPCS"},{"id":7676,"precertRequired":false,"billingCode":"A4235","codeType":"HCPCS"},{"id":7677,"precertRequired":false,"billingCode":"A4236","codeType":"HCPCS"},{"id":7679,"precertRequired":false,"billingCode":"A4245","codeType":"HCPCS"},{"id":7683,"precertRequired":false,"billingCode":"A4250","codeType":"HCPCS"},{"id":7684,"precertRequired":false,"billingCode":"A4253","codeType":"HCPCS"},{"id":7685,"precertRequired":false,"billingCode":"A4258","codeType":"HCPCS"},{"id":7686,"precertRequired":false,"billingCode":"A4259","codeType":"HCPCS"},{"id":7832,"precertRequired":false,"billingCode":"A5500","codeType":"HCPCS"},{"id":7833,"precertRequired":false,"billingCode":"A5501","codeType":"HCPCS"},{"id":7834,"precertRequired":false,"billingCode":"A5503","codeType":"HCPCS"},{"id":7835,"precertRequired":false,"billingCode":"A5504","codeType":"HCPCS"},{"id":7836,"precertRequired":false,"billingCode":"A5505","codeType":"HCPCS"},{"id":7837,"precertRequired":false,"billingCode":"A5506","codeType":"HCPCS"},{"id":7838,"precertRequired":false,"billingCode":"A5507","codeType":"HCPCS"},{"id":7839,"precertRequired":false,"billingCode":"A5508","codeType":"HCPCS"},{"id":7840,"precertRequired":false,"billingCode":"A5510","codeType":"HCPCS"},{"id":7841,"precertRequired":false,"billingCode":"A5512","codeType":"HCPCS"},{"id":7842,"precertRequired":false,"billingCode":"A5513","codeType":"HCPCS"},{"id":8072,"precertRequired":true,"billingCode":"E0607","codeType":"HCPCS"},{"id":8102,"precertRequired":true,"billingCode":"E2101","codeType":"HCPCS"},{"id":8121,"precertRequired":false,"billingCode":"G0108","codeType":"HCPCS"},{"id":8122,"precertRequired":false,"billingCode":"G0109","codeType":"HCPCS"},{"id":8162,"precertRequired":false,"billingCode":"G0245","codeType":"HCPCS"},{"id":8164,"precertRequired":false,"billingCode":"G0247","codeType":"HCPCS"},{"id":8451,"precertRequired":false,"billingCode":"J1815","codeType":"HCPCS"},{"id":8452,"precertRequired":false,"billingCode":"J1817","codeType":"HCPCS"},{"id":8891,"precertRequired":false,"billingCode":"S0390","codeType":"HCPCS"},{"id":8989,"precertRequired":false,"billingCode":"S9140","codeType":"HCPCS"},{"id":8990,"precertRequired":false,"billingCode":"S9141","codeType":"HCPCS"},{"id":8991,"precertRequired":false,"billingCode":"S9145","codeType":"HCPCS"},{"id":9028,"precertRequired":false,"billingCode":"S9460","codeType":"HCPCS"},{"id":9029,"precertRequired":false,"billingCode":"S9465","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":1203,"description":"Follow up visits to include diagnostic studies","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]}]}},{"Seoc":{"id":69,"seocKey":50,"name":"Endocrine Diabetes Management_PRCT","seocId":"MSC_ENDOCRINE DIABETES MANAGEMENT_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below as clinically indicated.","effectiveDate":"05-31-2018","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the patient complaint documented on the consult\r\n2. Diagnostic studies, labs and pathology services relevant to the patient complaint/condition\r\n3. Medication management\r\n4. Follow up visits to include diagnostic studies","maxAllowableVisits":999,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** All diabetic testing materials and routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ENDOCRINOLOGY TESTS, PROCEDURES, STUDIES","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":146,"description":"Initial outpatient evaluation and treatment for the patient complaint documented on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":147,"description":"Diagnostic studies, labs and pathology services relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":5374,"precertRequired":false,"billingCode":"82043","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5518,"precertRequired":false,"billingCode":"82943","codeType":"CPT"},{"id":5520,"precertRequired":false,"billingCode":"82946","codeType":"CPT"},{"id":5523,"precertRequired":false,"billingCode":"82950","codeType":"CPT"},{"id":5524,"precertRequired":false,"billingCode":"82951","codeType":"CPT"},{"id":5525,"precertRequired":false,"billingCode":"82952","codeType":"CPT"},{"id":5682,"precertRequired":false,"billingCode":"84206","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":148,"description":"Medication management","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7296,"precertRequired":false,"billingCode":"97802","codeType":"CPT"},{"id":7297,"precertRequired":false,"billingCode":"97803","codeType":"CPT"},{"id":7298,"precertRequired":false,"billingCode":"97804","codeType":"CPT"},{"id":7325,"precertRequired":false,"billingCode":"99078","codeType":"CPT"},{"id":7674,"precertRequired":false,"billingCode":"A4233","codeType":"HCPCS"},{"id":7675,"precertRequired":false,"billingCode":"A4234","codeType":"HCPCS"},{"id":7676,"precertRequired":false,"billingCode":"A4235","codeType":"HCPCS"},{"id":7677,"precertRequired":false,"billingCode":"A4236","codeType":"HCPCS"},{"id":7679,"precertRequired":false,"billingCode":"A4245","codeType":"HCPCS"},{"id":7683,"precertRequired":false,"billingCode":"A4250","codeType":"HCPCS"},{"id":7684,"precertRequired":false,"billingCode":"A4253","codeType":"HCPCS"},{"id":7685,"precertRequired":false,"billingCode":"A4258","codeType":"HCPCS"},{"id":7686,"precertRequired":false,"billingCode":"A4259","codeType":"HCPCS"},{"id":7832,"precertRequired":false,"billingCode":"A5500","codeType":"HCPCS"},{"id":7833,"precertRequired":false,"billingCode":"A5501","codeType":"HCPCS"},{"id":7834,"precertRequired":false,"billingCode":"A5503","codeType":"HCPCS"},{"id":7835,"precertRequired":false,"billingCode":"A5504","codeType":"HCPCS"},{"id":7836,"precertRequired":false,"billingCode":"A5505","codeType":"HCPCS"},{"id":7837,"precertRequired":false,"billingCode":"A5506","codeType":"HCPCS"},{"id":7838,"precertRequired":false,"billingCode":"A5507","codeType":"HCPCS"},{"id":7839,"precertRequired":false,"billingCode":"A5508","codeType":"HCPCS"},{"id":7840,"precertRequired":false,"billingCode":"A5510","codeType":"HCPCS"},{"id":7841,"precertRequired":false,"billingCode":"A5512","codeType":"HCPCS"},{"id":7842,"precertRequired":false,"billingCode":"A5513","codeType":"HCPCS"},{"id":8072,"precertRequired":true,"billingCode":"E0607","codeType":"HCPCS"},{"id":8102,"precertRequired":true,"billingCode":"E2101","codeType":"HCPCS"},{"id":8121,"precertRequired":false,"billingCode":"G0108","codeType":"HCPCS"},{"id":8122,"precertRequired":false,"billingCode":"G0109","codeType":"HCPCS"},{"id":8162,"precertRequired":false,"billingCode":"G0245","codeType":"HCPCS"},{"id":8164,"precertRequired":false,"billingCode":"G0247","codeType":"HCPCS"},{"id":8451,"precertRequired":false,"billingCode":"J1815","codeType":"HCPCS"},{"id":8452,"precertRequired":false,"billingCode":"J1817","codeType":"HCPCS"},{"id":8891,"precertRequired":false,"billingCode":"S0390","codeType":"HCPCS"},{"id":8989,"precertRequired":false,"billingCode":"S9140","codeType":"HCPCS"},{"id":8990,"precertRequired":false,"billingCode":"S9141","codeType":"HCPCS"},{"id":8991,"precertRequired":false,"billingCode":"S9145","codeType":"HCPCS"},{"id":9028,"precertRequired":false,"billingCode":"S9460","codeType":"HCPCS"},{"id":9029,"precertRequired":false,"billingCode":"S9465","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":149,"description":"Follow up visits to include diagnostic studies","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]}]}},{"Seoc":{"id":1754,"seocKey":51,"name":"ENT_PRCT","seocId":"SSC_ENT_1.0.7_PRCT","versionNumber":"1.0.7","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation and treatment for the referred condition on the consult order \r\n2.   Diagnostic imaging relevant to the referred condition on the consult order\r\n3.   Labs and pathology relevant to the referred condition on the consult order\r\n4.   Diagnostic studies relevant to the referred condition on the consult order\r\n5.   Procedures, as clinically indicated, including but not limited to: Laryngoscopy, nasal endoscopy, biopsy, tracheostomy/tracheostomy management, Botox injections, etc. \r\n6.    Anesthesia consultation related to the procedure \r\n7.    Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR, echo)\r\n8.    Inpatient or observation admission for surgical procedure if indicated\r\n9.    Inpatient admission or observation status for complications related to the procedure or surgery\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n10.   Follow-up visits for this episode of care \r\n11.   Speech/Voice Therapy, if medically indicated, up to 15 visits; Notify VA to request additional visits with supporting medical documentation","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"ENT","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207Y00000X"}],"services":[{"id":5243,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5244,"description":"Diagnostic imaging relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":8249,"precertRequired":false,"billingCode":"G6002","codeType":"HCPCS"},{"id":9765,"precertRequired":false,"billingCode":"70355","codeType":"CPT"},{"id":13321,"precertRequired":true,"billingCode":"70490","codeType":"CPT"},{"id":13322,"precertRequired":true,"billingCode":"70491","codeType":"CPT"},{"id":13323,"precertRequired":true,"billingCode":"70492","codeType":"CPT"},{"id":13324,"precertRequired":true,"billingCode":"70496","codeType":"CPT"},{"id":13325,"precertRequired":true,"billingCode":"70498","codeType":"CPT"},{"id":13328,"precertRequired":true,"billingCode":"70547","codeType":"CPT"},{"id":13329,"precertRequired":true,"billingCode":"70548","codeType":"CPT"},{"id":13335,"precertRequired":true,"billingCode":"76000","codeType":"CPT"},{"id":13656,"precertRequired":true,"billingCode":"71260","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5245,"description":"Labs and pathology relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5374,"precertRequired":false,"billingCode":"82043","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5745,"precertRequired":false,"billingCode":"84560","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5246,"description":"Diagnostic studies relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":6623,"precertRequired":false,"billingCode":"91030","codeType":"CPT"},{"id":6624,"precertRequired":false,"billingCode":"91034","codeType":"CPT"},{"id":6625,"precertRequired":false,"billingCode":"91035","codeType":"CPT"},{"id":6626,"precertRequired":false,"billingCode":"91037","codeType":"CPT"},{"id":6627,"precertRequired":false,"billingCode":"91038","codeType":"CPT"},{"id":6628,"precertRequired":false,"billingCode":"91040","codeType":"CPT"},{"id":6701,"precertRequired":true,"billingCode":"92502","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"},{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6705,"precertRequired":true,"billingCode":"92508","codeType":"CPT"},{"id":6706,"precertRequired":false,"billingCode":"92511","codeType":"CPT"},{"id":6707,"precertRequired":false,"billingCode":"92512","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6712,"precertRequired":false,"billingCode":"92531","codeType":"CPT"},{"id":6713,"precertRequired":false,"billingCode":"92532","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6763,"precertRequired":true,"billingCode":"92597","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6769,"precertRequired":true,"billingCode":"92608","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7099,"precertRequired":false,"billingCode":"95865","codeType":"CPT"},{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"},{"id":7170,"precertRequired":true,"billingCode":"96105","codeType":"CPT"},{"id":7171,"precertRequired":true,"billingCode":"96110","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7283,"precertRequired":false,"billingCode":"97602","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":9782,"precertRequired":false,"billingCode":"96112","codeType":"CPT"},{"id":9783,"precertRequired":false,"billingCode":"96113","codeType":"CPT"},{"id":9862,"precertRequired":false,"billingCode":"92516","codeType":"CPT"},{"id":9863,"precertRequired":false,"billingCode":"92520","codeType":"CPT"},{"id":9864,"precertRequired":false,"billingCode":"92526","codeType":"CPT"},{"id":13326,"precertRequired":true,"billingCode":"70545","codeType":"CPT"},{"id":13327,"precertRequired":true,"billingCode":"70546","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5247,"description":"Procedures, as clinically indicated, including but not limited to: Laryngoscopy, nasal endoscopy, biopsy, tracheostomy/tracheostomy management, Botox injections, etc.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":268,"precertRequired":false,"billingCode":"11311","codeType":"CPT"},{"id":269,"precertRequired":false,"billingCode":"11312","codeType":"CPT"},{"id":270,"precertRequired":false,"billingCode":"11313","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":399,"precertRequired":false,"billingCode":"15155","codeType":"CPT"},{"id":400,"precertRequired":false,"billingCode":"15156","codeType":"CPT"},{"id":401,"precertRequired":false,"billingCode":"15157","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":645,"precertRequired":false,"billingCode":"21230","codeType":"CPT"},{"id":646,"precertRequired":false,"billingCode":"21235","codeType":"CPT"},{"id":669,"precertRequired":false,"billingCode":"21315","codeType":"CPT"},{"id":670,"precertRequired":false,"billingCode":"21320","codeType":"CPT"},{"id":671,"precertRequired":false,"billingCode":"21325","codeType":"CPT"},{"id":672,"precertRequired":false,"billingCode":"21330","codeType":"CPT"},{"id":673,"precertRequired":false,"billingCode":"21335","codeType":"CPT"},{"id":674,"precertRequired":false,"billingCode":"21336","codeType":"CPT"},{"id":675,"precertRequired":false,"billingCode":"21337","codeType":"CPT"},{"id":676,"precertRequired":false,"billingCode":"21338","codeType":"CPT"},{"id":677,"precertRequired":false,"billingCode":"21339","codeType":"CPT"},{"id":678,"precertRequired":false,"billingCode":"21340","codeType":"CPT"},{"id":679,"precertRequired":false,"billingCode":"21343","codeType":"CPT"},{"id":680,"precertRequired":false,"billingCode":"21344","codeType":"CPT"},{"id":681,"precertRequired":false,"billingCode":"21345","codeType":"CPT"},{"id":682,"precertRequired":false,"billingCode":"21346","codeType":"CPT"},{"id":683,"precertRequired":false,"billingCode":"21347","codeType":"CPT"},{"id":684,"precertRequired":false,"billingCode":"21348","codeType":"CPT"},{"id":1975,"precertRequired":false,"billingCode":"30100","codeType":"CPT"},{"id":1976,"precertRequired":false,"billingCode":"30110","codeType":"CPT"},{"id":1977,"precertRequired":false,"billingCode":"30115","codeType":"CPT"},{"id":1978,"precertRequired":false,"billingCode":"30200","codeType":"CPT"},{"id":1979,"precertRequired":false,"billingCode":"30300","codeType":"CPT"},{"id":1980,"precertRequired":false,"billingCode":"30560","codeType":"CPT"},{"id":1981,"precertRequired":false,"billingCode":"30801","codeType":"CPT"},{"id":1982,"precertRequired":false,"billingCode":"30802","codeType":"CPT"},{"id":1983,"precertRequired":false,"billingCode":"30901","codeType":"CPT"},{"id":1984,"precertRequired":false,"billingCode":"30903","codeType":"CPT"},{"id":1985,"precertRequired":false,"billingCode":"30905","codeType":"CPT"},{"id":1986,"precertRequired":false,"billingCode":"30906","codeType":"CPT"},{"id":1987,"precertRequired":false,"billingCode":"30930","codeType":"CPT"},{"id":1988,"precertRequired":false,"billingCode":"31000","codeType":"CPT"},{"id":1989,"precertRequired":false,"billingCode":"31002","codeType":"CPT"},{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1993,"precertRequired":false,"billingCode":"31237","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":1997,"precertRequired":false,"billingCode":"31512","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2000,"precertRequired":false,"billingCode":"31528","codeType":"CPT"},{"id":2001,"precertRequired":false,"billingCode":"31529","codeType":"CPT"},{"id":2002,"precertRequired":false,"billingCode":"31535","codeType":"CPT"},{"id":2003,"precertRequired":false,"billingCode":"31536","codeType":"CPT"},{"id":2004,"precertRequired":false,"billingCode":"31540","codeType":"CPT"},{"id":2005,"precertRequired":false,"billingCode":"31541","codeType":"CPT"},{"id":2006,"precertRequired":false,"billingCode":"31572","codeType":"CPT"},{"id":2007,"precertRequired":false,"billingCode":"31573","codeType":"CPT"},{"id":2008,"precertRequired":false,"billingCode":"31574","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2011,"precertRequired":false,"billingCode":"31577","codeType":"CPT"},{"id":2012,"precertRequired":false,"billingCode":"31578","codeType":"CPT"},{"id":2013,"precertRequired":true,"billingCode":"31579","codeType":"CPT"},{"id":2014,"precertRequired":false,"billingCode":"31600","codeType":"CPT"},{"id":2016,"precertRequired":false,"billingCode":"31603","codeType":"CPT"},{"id":2017,"precertRequired":false,"billingCode":"31605","codeType":"CPT"},{"id":2018,"precertRequired":false,"billingCode":"31610","codeType":"CPT"},{"id":2019,"precertRequired":false,"billingCode":"31611","codeType":"CPT"},{"id":2020,"precertRequired":false,"billingCode":"31612","codeType":"CPT"},{"id":2021,"precertRequired":false,"billingCode":"31613","codeType":"CPT"},{"id":2022,"precertRequired":false,"billingCode":"31614","codeType":"CPT"},{"id":2023,"precertRequired":false,"billingCode":"31615","codeType":"CPT"},{"id":2024,"precertRequired":false,"billingCode":"31622","codeType":"CPT"},{"id":2056,"precertRequired":false,"billingCode":"31720","codeType":"CPT"},{"id":2057,"precertRequired":false,"billingCode":"31725","codeType":"CPT"},{"id":2058,"precertRequired":false,"billingCode":"31730","codeType":"CPT"},{"id":2059,"precertRequired":false,"billingCode":"31750","codeType":"CPT"},{"id":2060,"precertRequired":false,"billingCode":"31755","codeType":"CPT"},{"id":2061,"precertRequired":false,"billingCode":"31760","codeType":"CPT"},{"id":2062,"precertRequired":false,"billingCode":"31766","codeType":"CPT"},{"id":2065,"precertRequired":false,"billingCode":"31780","codeType":"CPT"},{"id":2066,"precertRequired":false,"billingCode":"31781","codeType":"CPT"},{"id":2067,"precertRequired":false,"billingCode":"31785","codeType":"CPT"},{"id":2068,"precertRequired":false,"billingCode":"31786","codeType":"CPT"},{"id":2069,"precertRequired":false,"billingCode":"31800","codeType":"CPT"},{"id":2070,"precertRequired":false,"billingCode":"31805","codeType":"CPT"},{"id":2071,"precertRequired":false,"billingCode":"31820","codeType":"CPT"},{"id":2072,"precertRequired":false,"billingCode":"31825","codeType":"CPT"},{"id":2073,"precertRequired":false,"billingCode":"31830","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2724,"precertRequired":false,"billingCode":"41000","codeType":"CPT"},{"id":2725,"precertRequired":false,"billingCode":"41100","codeType":"CPT"},{"id":2726,"precertRequired":false,"billingCode":"41105","codeType":"CPT"},{"id":2727,"precertRequired":false,"billingCode":"41108","codeType":"CPT"},{"id":2728,"precertRequired":false,"billingCode":"41250","codeType":"CPT"},{"id":2730,"precertRequired":false,"billingCode":"42300","codeType":"CPT"},{"id":2731,"precertRequired":false,"billingCode":"42310","codeType":"CPT"},{"id":2732,"precertRequired":false,"billingCode":"42330","codeType":"CPT"},{"id":2733,"precertRequired":false,"billingCode":"42550","codeType":"CPT"},{"id":2734,"precertRequired":false,"billingCode":"42700","codeType":"CPT"},{"id":2735,"precertRequired":false,"billingCode":"42800","codeType":"CPT"},{"id":2736,"precertRequired":false,"billingCode":"42804","codeType":"CPT"},{"id":2737,"precertRequired":false,"billingCode":"42806","codeType":"CPT"},{"id":2738,"precertRequired":false,"billingCode":"42809","codeType":"CPT"},{"id":2757,"precertRequired":false,"billingCode":"43180","codeType":"CPT"},{"id":2758,"precertRequired":false,"billingCode":"43191","codeType":"CPT"},{"id":2759,"precertRequired":false,"billingCode":"43192","codeType":"CPT"},{"id":2760,"precertRequired":false,"billingCode":"43193","codeType":"CPT"},{"id":2761,"precertRequired":false,"billingCode":"43194","codeType":"CPT"},{"id":2762,"precertRequired":false,"billingCode":"43195","codeType":"CPT"},{"id":2763,"precertRequired":false,"billingCode":"43196","codeType":"CPT"},{"id":2764,"precertRequired":false,"billingCode":"43197","codeType":"CPT"},{"id":2765,"precertRequired":false,"billingCode":"43198","codeType":"CPT"},{"id":2766,"precertRequired":false,"billingCode":"43200","codeType":"CPT"},{"id":2767,"precertRequired":false,"billingCode":"43201","codeType":"CPT"},{"id":2768,"precertRequired":false,"billingCode":"43202","codeType":"CPT"},{"id":2769,"precertRequired":false,"billingCode":"43204","codeType":"CPT"},{"id":2770,"precertRequired":false,"billingCode":"43205","codeType":"CPT"},{"id":2771,"precertRequired":false,"billingCode":"43206","codeType":"CPT"},{"id":2772,"precertRequired":false,"billingCode":"43210","codeType":"CPT"},{"id":2773,"precertRequired":false,"billingCode":"43211","codeType":"CPT"},{"id":2774,"precertRequired":false,"billingCode":"43212","codeType":"CPT"},{"id":2775,"precertRequired":false,"billingCode":"43213","codeType":"CPT"},{"id":2776,"precertRequired":false,"billingCode":"43214","codeType":"CPT"},{"id":2777,"precertRequired":false,"billingCode":"43215","codeType":"CPT"},{"id":2778,"precertRequired":false,"billingCode":"43216","codeType":"CPT"},{"id":2779,"precertRequired":false,"billingCode":"43217","codeType":"CPT"},{"id":2781,"precertRequired":false,"billingCode":"43220","codeType":"CPT"},{"id":2782,"precertRequired":false,"billingCode":"43226","codeType":"CPT"},{"id":2783,"precertRequired":false,"billingCode":"43227","codeType":"CPT"},{"id":2784,"precertRequired":false,"billingCode":"43229","codeType":"CPT"},{"id":2785,"precertRequired":false,"billingCode":"43231","codeType":"CPT"},{"id":2786,"precertRequired":false,"billingCode":"43232","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2790,"precertRequired":false,"billingCode":"43237","codeType":"CPT"},{"id":2791,"precertRequired":false,"billingCode":"43238","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2795,"precertRequired":false,"billingCode":"43242","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2810,"precertRequired":false,"billingCode":"43259","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2825,"precertRequired":false,"billingCode":"43279","codeType":"CPT"},{"id":2826,"precertRequired":false,"billingCode":"43280","codeType":"CPT"},{"id":2827,"precertRequired":false,"billingCode":"43281","codeType":"CPT"},{"id":2828,"precertRequired":false,"billingCode":"43282","codeType":"CPT"},{"id":2829,"precertRequired":false,"billingCode":"43283","codeType":"CPT"},{"id":2830,"precertRequired":false,"billingCode":"43284","codeType":"CPT"},{"id":2831,"precertRequired":false,"billingCode":"43285","codeType":"CPT"},{"id":2832,"precertRequired":false,"billingCode":"43286","codeType":"CPT"},{"id":2833,"precertRequired":false,"billingCode":"43287","codeType":"CPT"},{"id":2834,"precertRequired":false,"billingCode":"43288","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3981,"precertRequired":true,"billingCode":"64617","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4348,"precertRequired":false,"billingCode":"69000","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":4350,"precertRequired":false,"billingCode":"69105","codeType":"CPT"},{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4356,"precertRequired":true,"billingCode":"69222","codeType":"CPT"},{"id":4357,"precertRequired":false,"billingCode":"69420","codeType":"CPT"},{"id":4358,"precertRequired":false,"billingCode":"69433","codeType":"CPT"},{"id":4359,"precertRequired":false,"billingCode":"69540","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":8168,"precertRequired":false,"billingCode":"G0268","codeType":"HCPCS"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9170,"precertRequired":true,"billingCode":"15115","codeType":"CPT"},{"id":9171,"precertRequired":true,"billingCode":"15116","codeType":"CPT"},{"id":9172,"precertRequired":true,"billingCode":"15120","codeType":"CPT"},{"id":9173,"precertRequired":true,"billingCode":"15121","codeType":"CPT"},{"id":9174,"precertRequired":true,"billingCode":"15135","codeType":"CPT"},{"id":9175,"precertRequired":true,"billingCode":"15136","codeType":"CPT"},{"id":9176,"precertRequired":true,"billingCode":"15277","codeType":"CPT"},{"id":9177,"precertRequired":true,"billingCode":"15278","codeType":"CPT"},{"id":9193,"precertRequired":false,"billingCode":"21086","codeType":"CPT"},{"id":9231,"precertRequired":true,"billingCode":"21310","codeType":"CPT"},{"id":9343,"precertRequired":true,"billingCode":"30130","codeType":"CPT"},{"id":9344,"precertRequired":true,"billingCode":"30140","codeType":"CPT"},{"id":9345,"precertRequired":true,"billingCode":"30310","codeType":"CPT"},{"id":9346,"precertRequired":true,"billingCode":"30460","codeType":"CPT"},{"id":9347,"precertRequired":true,"billingCode":"30462","codeType":"CPT"},{"id":9348,"precertRequired":true,"billingCode":"30465","codeType":"CPT"},{"id":9349,"precertRequired":true,"billingCode":"30520","codeType":"CPT"},{"id":9350,"precertRequired":true,"billingCode":"30540","codeType":"CPT"},{"id":9351,"precertRequired":true,"billingCode":"30545","codeType":"CPT"},{"id":9352,"precertRequired":true,"billingCode":"30580","codeType":"CPT"},{"id":9353,"precertRequired":true,"billingCode":"30600","codeType":"CPT"},{"id":9354,"precertRequired":true,"billingCode":"30620","codeType":"CPT"},{"id":9355,"precertRequired":true,"billingCode":"30630","codeType":"CPT"},{"id":9356,"precertRequired":true,"billingCode":"31020","codeType":"CPT"},{"id":9357,"precertRequired":true,"billingCode":"31030","codeType":"CPT"},{"id":9358,"precertRequired":true,"billingCode":"31032","codeType":"CPT"},{"id":9359,"precertRequired":true,"billingCode":"31050","codeType":"CPT"},{"id":9360,"precertRequired":true,"billingCode":"31051","codeType":"CPT"},{"id":9361,"precertRequired":true,"billingCode":"31070","codeType":"CPT"},{"id":9362,"precertRequired":true,"billingCode":"31075","codeType":"CPT"},{"id":9363,"precertRequired":true,"billingCode":"31080","codeType":"CPT"},{"id":9364,"precertRequired":true,"billingCode":"31081","codeType":"CPT"},{"id":9365,"precertRequired":true,"billingCode":"31084","codeType":"CPT"},{"id":9366,"precertRequired":true,"billingCode":"31085","codeType":"CPT"},{"id":9367,"precertRequired":true,"billingCode":"31086","codeType":"CPT"},{"id":9368,"precertRequired":true,"billingCode":"31087","codeType":"CPT"},{"id":9369,"precertRequired":true,"billingCode":"31090","codeType":"CPT"},{"id":9370,"precertRequired":true,"billingCode":"31200","codeType":"CPT"},{"id":9371,"precertRequired":true,"billingCode":"31201","codeType":"CPT"},{"id":9372,"precertRequired":true,"billingCode":"31205","codeType":"CPT"},{"id":9373,"precertRequired":true,"billingCode":"31238","codeType":"CPT"},{"id":9374,"precertRequired":true,"billingCode":"31239","codeType":"CPT"},{"id":9375,"precertRequired":true,"billingCode":"31240","codeType":"CPT"},{"id":9376,"precertRequired":true,"billingCode":"31241","codeType":"CPT"},{"id":9377,"precertRequired":true,"billingCode":"31253","codeType":"CPT"},{"id":9378,"precertRequired":true,"billingCode":"31254","codeType":"CPT"},{"id":9379,"precertRequired":true,"billingCode":"31255","codeType":"CPT"},{"id":9380,"precertRequired":true,"billingCode":"31256","codeType":"CPT"},{"id":9381,"precertRequired":true,"billingCode":"31257","codeType":"CPT"},{"id":9382,"precertRequired":true,"billingCode":"31259","codeType":"CPT"},{"id":9383,"precertRequired":true,"billingCode":"31267","codeType":"CPT"},{"id":9384,"precertRequired":true,"billingCode":"31276","codeType":"CPT"},{"id":9385,"precertRequired":true,"billingCode":"31287","codeType":"CPT"},{"id":9386,"precertRequired":true,"billingCode":"31288","codeType":"CPT"},{"id":9387,"precertRequired":true,"billingCode":"31290","codeType":"CPT"},{"id":9388,"precertRequired":true,"billingCode":"31291","codeType":"CPT"},{"id":9389,"precertRequired":true,"billingCode":"31292","codeType":"CPT"},{"id":9390,"precertRequired":true,"billingCode":"31293","codeType":"CPT"},{"id":9391,"precertRequired":true,"billingCode":"31294","codeType":"CPT"},{"id":9392,"precertRequired":true,"billingCode":"31295","codeType":"CPT"},{"id":9393,"precertRequired":true,"billingCode":"31296","codeType":"CPT"},{"id":9394,"precertRequired":true,"billingCode":"31297","codeType":"CPT"},{"id":9395,"precertRequired":true,"billingCode":"31298","codeType":"CPT"},{"id":9396,"precertRequired":true,"billingCode":"31300","codeType":"CPT"},{"id":9397,"precertRequired":true,"billingCode":"31360","codeType":"CPT"},{"id":9398,"precertRequired":true,"billingCode":"31365","codeType":"CPT"},{"id":9399,"precertRequired":true,"billingCode":"31367","codeType":"CPT"},{"id":9400,"precertRequired":true,"billingCode":"31368","codeType":"CPT"},{"id":9401,"precertRequired":true,"billingCode":"31370","codeType":"CPT"},{"id":9402,"precertRequired":true,"billingCode":"31375","codeType":"CPT"},{"id":9403,"precertRequired":true,"billingCode":"31380","codeType":"CPT"},{"id":9404,"precertRequired":true,"billingCode":"31382","codeType":"CPT"},{"id":9405,"precertRequired":true,"billingCode":"31390","codeType":"CPT"},{"id":9406,"precertRequired":true,"billingCode":"31395","codeType":"CPT"},{"id":9407,"precertRequired":true,"billingCode":"31515","codeType":"CPT"},{"id":9408,"precertRequired":true,"billingCode":"31527","codeType":"CPT"},{"id":9409,"precertRequired":true,"billingCode":"31530","codeType":"CPT"},{"id":9410,"precertRequired":true,"billingCode":"31531","codeType":"CPT"},{"id":9411,"precertRequired":true,"billingCode":"31545","codeType":"CPT"},{"id":9412,"precertRequired":true,"billingCode":"31546","codeType":"CPT"},{"id":9413,"precertRequired":true,"billingCode":"31552","codeType":"CPT"},{"id":9414,"precertRequired":true,"billingCode":"31554","codeType":"CPT"},{"id":9415,"precertRequired":true,"billingCode":"31560","codeType":"CPT"},{"id":9416,"precertRequired":true,"billingCode":"31561","codeType":"CPT"},{"id":9417,"precertRequired":true,"billingCode":"31570","codeType":"CPT"},{"id":9418,"precertRequired":true,"billingCode":"31571","codeType":"CPT"},{"id":9434,"precertRequired":true,"billingCode":"40810","codeType":"CPT"},{"id":9435,"precertRequired":true,"billingCode":"40812","codeType":"CPT"},{"id":9436,"precertRequired":true,"billingCode":"40814","codeType":"CPT"},{"id":9437,"precertRequired":true,"billingCode":"40816","codeType":"CPT"},{"id":9439,"precertRequired":true,"billingCode":"40820","codeType":"CPT"},{"id":9447,"precertRequired":false,"billingCode":"41005","codeType":"CPT"},{"id":9448,"precertRequired":false,"billingCode":"41006","codeType":"CPT"},{"id":9449,"precertRequired":false,"billingCode":"41007","codeType":"CPT"},{"id":9450,"precertRequired":false,"billingCode":"41008","codeType":"CPT"},{"id":9451,"precertRequired":false,"billingCode":"41009","codeType":"CPT"},{"id":9452,"precertRequired":true,"billingCode":"41010","codeType":"CPT"},{"id":9453,"precertRequired":false,"billingCode":"41015","codeType":"CPT"},{"id":9454,"precertRequired":false,"billingCode":"41016","codeType":"CPT"},{"id":9455,"precertRequired":false,"billingCode":"41017","codeType":"CPT"},{"id":9456,"precertRequired":false,"billingCode":"41018","codeType":"CPT"},{"id":9457,"precertRequired":false,"billingCode":"41110","codeType":"CPT"},{"id":9458,"precertRequired":false,"billingCode":"41112","codeType":"CPT"},{"id":9459,"precertRequired":false,"billingCode":"41113","codeType":"CPT"},{"id":9460,"precertRequired":false,"billingCode":"41114","codeType":"CPT"},{"id":9461,"precertRequired":false,"billingCode":"41115","codeType":"CPT"},{"id":9462,"precertRequired":false,"billingCode":"41116","codeType":"CPT"},{"id":9463,"precertRequired":true,"billingCode":"41120","codeType":"CPT"},{"id":9464,"precertRequired":true,"billingCode":"41130","codeType":"CPT"},{"id":9465,"precertRequired":true,"billingCode":"41135","codeType":"CPT"},{"id":9466,"precertRequired":true,"billingCode":"41140","codeType":"CPT"},{"id":9467,"precertRequired":true,"billingCode":"41145","codeType":"CPT"},{"id":9468,"precertRequired":true,"billingCode":"41150","codeType":"CPT"},{"id":9469,"precertRequired":true,"billingCode":"41153","codeType":"CPT"},{"id":9470,"precertRequired":true,"billingCode":"41155","codeType":"CPT"},{"id":9471,"precertRequired":false,"billingCode":"41251","codeType":"CPT"},{"id":9472,"precertRequired":false,"billingCode":"41252","codeType":"CPT"},{"id":9473,"precertRequired":false,"billingCode":"41510","codeType":"CPT"},{"id":9474,"precertRequired":true,"billingCode":"41512","codeType":"CPT"},{"id":9475,"precertRequired":true,"billingCode":"41520","codeType":"CPT"},{"id":9515,"precertRequired":true,"billingCode":"42408","codeType":"CPT"},{"id":9516,"precertRequired":true,"billingCode":"42415","codeType":"CPT"},{"id":9517,"precertRequired":true,"billingCode":"42440","codeType":"CPT"},{"id":9518,"precertRequired":true,"billingCode":"42810","codeType":"CPT"},{"id":9519,"precertRequired":true,"billingCode":"42815","codeType":"CPT"},{"id":9520,"precertRequired":true,"billingCode":"42821","codeType":"CPT"},{"id":9521,"precertRequired":true,"billingCode":"42826","codeType":"CPT"},{"id":9522,"precertRequired":true,"billingCode":"42831","codeType":"CPT"},{"id":9523,"precertRequired":true,"billingCode":"42836","codeType":"CPT"},{"id":9524,"precertRequired":true,"billingCode":"42842","codeType":"CPT"},{"id":9525,"precertRequired":true,"billingCode":"42844","codeType":"CPT"},{"id":9526,"precertRequired":true,"billingCode":"42845","codeType":"CPT"},{"id":9859,"precertRequired":false,"billingCode":"61782","codeType":"CPT"},{"id":9860,"precertRequired":false,"billingCode":"30915","codeType":"CPT"},{"id":9861,"precertRequired":false,"billingCode":"30920","codeType":"CPT"},{"id":9865,"precertRequired":false,"billingCode":"42808","codeType":"CPT"},{"id":9866,"precertRequired":false,"billingCode":"42860","codeType":"CPT"},{"id":9867,"precertRequired":false,"billingCode":"42870","codeType":"CPT"},{"id":9868,"precertRequired":false,"billingCode":"42890","codeType":"CPT"},{"id":9869,"precertRequired":false,"billingCode":"42892","codeType":"CPT"},{"id":9871,"precertRequired":false,"billingCode":"69005","codeType":"CPT"},{"id":9872,"precertRequired":false,"billingCode":"69020","codeType":"CPT"},{"id":9873,"precertRequired":false,"billingCode":"69110","codeType":"CPT"},{"id":9874,"precertRequired":false,"billingCode":"69120","codeType":"CPT"},{"id":9875,"precertRequired":false,"billingCode":"69140","codeType":"CPT"},{"id":9876,"precertRequired":false,"billingCode":"69145","codeType":"CPT"},{"id":9877,"precertRequired":false,"billingCode":"69150","codeType":"CPT"},{"id":9878,"precertRequired":false,"billingCode":"69155","codeType":"CPT"},{"id":9879,"precertRequired":false,"billingCode":"69300","codeType":"CPT"},{"id":9880,"precertRequired":false,"billingCode":"69310","codeType":"CPT"},{"id":9881,"precertRequired":false,"billingCode":"69320","codeType":"CPT"},{"id":9882,"precertRequired":false,"billingCode":"69421","codeType":"CPT"},{"id":9883,"precertRequired":false,"billingCode":"69424","codeType":"CPT"},{"id":9884,"precertRequired":false,"billingCode":"69436","codeType":"CPT"},{"id":9885,"precertRequired":false,"billingCode":"69440","codeType":"CPT"},{"id":9886,"precertRequired":false,"billingCode":"69450","codeType":"CPT"},{"id":9887,"precertRequired":false,"billingCode":"69501","codeType":"CPT"},{"id":9888,"precertRequired":false,"billingCode":"69502","codeType":"CPT"},{"id":9889,"precertRequired":false,"billingCode":"69505","codeType":"CPT"},{"id":9890,"precertRequired":false,"billingCode":"69511","codeType":"CPT"},{"id":9891,"precertRequired":false,"billingCode":"69530","codeType":"CPT"},{"id":9892,"precertRequired":false,"billingCode":"69535","codeType":"CPT"},{"id":9893,"precertRequired":false,"billingCode":"69550","codeType":"CPT"},{"id":9894,"precertRequired":false,"billingCode":"69554","codeType":"CPT"},{"id":9895,"precertRequired":false,"billingCode":"69610","codeType":"CPT"},{"id":9896,"precertRequired":false,"billingCode":"69620","codeType":"CPT"},{"id":9897,"precertRequired":false,"billingCode":"69631","codeType":"CPT"},{"id":9898,"precertRequired":false,"billingCode":"69632","codeType":"CPT"},{"id":9899,"precertRequired":false,"billingCode":"69633","codeType":"CPT"},{"id":9900,"precertRequired":false,"billingCode":"69635","codeType":"CPT"},{"id":9901,"precertRequired":false,"billingCode":"69636","codeType":"CPT"},{"id":9902,"precertRequired":false,"billingCode":"69637","codeType":"CPT"},{"id":9903,"precertRequired":false,"billingCode":"69641","codeType":"CPT"},{"id":9904,"precertRequired":false,"billingCode":"69642","codeType":"CPT"},{"id":9905,"precertRequired":false,"billingCode":"69644","codeType":"CPT"},{"id":9906,"precertRequired":false,"billingCode":"69643","codeType":"CPT"},{"id":9907,"precertRequired":false,"billingCode":"69645","codeType":"CPT"},{"id":9908,"precertRequired":false,"billingCode":"69646","codeType":"CPT"},{"id":9909,"precertRequired":false,"billingCode":"69650","codeType":"CPT"},{"id":9910,"precertRequired":false,"billingCode":"69660","codeType":"CPT"},{"id":9911,"precertRequired":false,"billingCode":"69661","codeType":"CPT"},{"id":9912,"precertRequired":false,"billingCode":"69662","codeType":"CPT"},{"id":9913,"precertRequired":false,"billingCode":"69666","codeType":"CPT"},{"id":9914,"precertRequired":false,"billingCode":"69667","codeType":"CPT"},{"id":9915,"precertRequired":false,"billingCode":"69720","codeType":"CPT"},{"id":9916,"precertRequired":false,"billingCode":"69725","codeType":"CPT"},{"id":9917,"precertRequired":false,"billingCode":"69740","codeType":"CPT"},{"id":9918,"precertRequired":false,"billingCode":"69745","codeType":"CPT"},{"id":9919,"precertRequired":false,"billingCode":"69801","codeType":"CPT"},{"id":9920,"precertRequired":false,"billingCode":"69915","codeType":"CPT"},{"id":9921,"precertRequired":false,"billingCode":"69950","codeType":"CPT"},{"id":9922,"precertRequired":false,"billingCode":"69955","codeType":"CPT"},{"id":9923,"precertRequired":false,"billingCode":"69960","codeType":"CPT"},{"id":9924,"precertRequired":false,"billingCode":"69970","codeType":"CPT"},{"id":9925,"precertRequired":false,"billingCode":"C9745","codeType":"HCPCS"},{"id":9926,"precertRequired":false,"billingCode":"42894","codeType":"CPT"},{"id":9927,"precertRequired":false,"billingCode":"69552","codeType":"CPT"},{"id":9943,"precertRequired":false,"billingCode":"69676","codeType":"CPT"},{"id":9982,"precertRequired":false,"billingCode":"42305","codeType":"CPT"},{"id":9983,"precertRequired":false,"billingCode":"42500","codeType":"CPT"},{"id":9984,"precertRequired":false,"billingCode":"42505","codeType":"CPT"},{"id":9985,"precertRequired":false,"billingCode":"42950","codeType":"CPT"},{"id":11377,"precertRequired":false,"billingCode":"30210","codeType":"CPT"},{"id":11378,"precertRequired":false,"billingCode":"30320","codeType":"CPT"},{"id":11379,"precertRequired":false,"billingCode":"31511","codeType":"CPT"},{"id":11380,"precertRequired":false,"billingCode":"31513","codeType":"CPT"},{"id":11381,"precertRequired":false,"billingCode":"42320","codeType":"CPT"},{"id":11382,"precertRequired":false,"billingCode":"42335","codeType":"CPT"},{"id":11383,"precertRequired":false,"billingCode":"42340","codeType":"CPT"},{"id":11384,"precertRequired":false,"billingCode":"42400","codeType":"CPT"},{"id":11385,"precertRequired":false,"billingCode":"42405","codeType":"CPT"},{"id":11386,"precertRequired":false,"billingCode":"42409","codeType":"CPT"},{"id":11387,"precertRequired":false,"billingCode":"42410","codeType":"CPT"},{"id":11388,"precertRequired":false,"billingCode":"42420","codeType":"CPT"},{"id":11389,"precertRequired":false,"billingCode":"42425","codeType":"CPT"},{"id":11390,"precertRequired":false,"billingCode":"42426","codeType":"CPT"},{"id":11391,"precertRequired":false,"billingCode":"42450","codeType":"CPT"},{"id":11392,"precertRequired":false,"billingCode":"42507","codeType":"CPT"},{"id":11393,"precertRequired":false,"billingCode":"42509","codeType":"CPT"},{"id":11394,"precertRequired":false,"billingCode":"42510","codeType":"CPT"},{"id":11395,"precertRequired":false,"billingCode":"42600","codeType":"CPT"},{"id":11396,"precertRequired":false,"billingCode":"42650","codeType":"CPT"},{"id":11397,"precertRequired":false,"billingCode":"42660","codeType":"CPT"},{"id":11398,"precertRequired":false,"billingCode":"42665","codeType":"CPT"},{"id":11399,"precertRequired":false,"billingCode":"42720","codeType":"CPT"},{"id":11400,"precertRequired":false,"billingCode":"42725","codeType":"CPT"},{"id":11401,"precertRequired":false,"billingCode":"42900","codeType":"CPT"},{"id":11402,"precertRequired":false,"billingCode":"42953","codeType":"CPT"},{"id":11403,"precertRequired":false,"billingCode":"42955","codeType":"CPT"},{"id":11404,"precertRequired":false,"billingCode":"42960","codeType":"CPT"},{"id":11405,"precertRequired":false,"billingCode":"42961","codeType":"CPT"},{"id":11406,"precertRequired":false,"billingCode":"42962","codeType":"CPT"},{"id":11407,"precertRequired":false,"billingCode":"42970","codeType":"CPT"},{"id":11408,"precertRequired":false,"billingCode":"42971","codeType":"CPT"},{"id":11409,"precertRequired":false,"billingCode":"42972","codeType":"CPT"},{"id":11410,"precertRequired":false,"billingCode":"69670","codeType":"CPT"},{"id":11411,"precertRequired":false,"billingCode":"69700","codeType":"CPT"},{"id":11412,"precertRequired":false,"billingCode":"69805","codeType":"CPT"},{"id":11413,"precertRequired":false,"billingCode":"69806","codeType":"CPT"},{"id":11414,"precertRequired":false,"billingCode":"69905","codeType":"CPT"},{"id":11415,"precertRequired":false,"billingCode":"69910","codeType":"CPT"},{"id":13514,"precertRequired":false,"billingCode":"30117","codeType":"CPT"},{"id":13515,"precertRequired":false,"billingCode":"30118","codeType":"CPT"},{"id":13516,"precertRequired":false,"billingCode":"30120","codeType":"CPT"},{"id":13517,"precertRequired":false,"billingCode":"30124","codeType":"CPT"},{"id":13518,"precertRequired":false,"billingCode":"30125","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5248,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":1,"precertRequired":false,"billingCode":"00100","codeType":"CPT"},{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":14,"precertRequired":false,"billingCode":"00160","codeType":"CPT"},{"id":15,"precertRequired":false,"billingCode":"00162","codeType":"CPT"},{"id":16,"precertRequired":false,"billingCode":"00164","codeType":"CPT"},{"id":19,"precertRequired":false,"billingCode":"00174","codeType":"CPT"},{"id":20,"precertRequired":false,"billingCode":"00176","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":33,"precertRequired":false,"billingCode":"00320","codeType":"CPT"},{"id":34,"precertRequired":false,"billingCode":"00322","codeType":"CPT"},{"id":55,"precertRequired":false,"billingCode":"00539","codeType":"CPT"},{"id":217,"precertRequired":false,"billingCode":"01991","codeType":"CPT"},{"id":218,"precertRequired":false,"billingCode":"01992","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":5033,"precertRequired":false,"billingCode":"80176","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":5249,"description":"Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR, echo)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5250,"description":"Inpatient or observation admission for surgical procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5251,"description":"Inpatient admission or observation status for complications related to the procedure or surgery\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5252,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":5253,"description":"Speech/Voice Therapy, if medically indicated, up to 15 visits; Notify VA to request additional visits with supporting medical documentation","frequency":null,"frequencyType":"","visits":15,"codeRequired":"YES","clinicalServices":[{"clinicalService":"15-Speech language pathologist "}],"billingCodes":[{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":6767,"precertRequired":false,"billingCode":"92606","codeType":"CPT"},{"id":6770,"precertRequired":true,"billingCode":"92609","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7342,"precertRequired":false,"billingCode":"99183","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"235Z00000X"}]}]}},{"Seoc":{"id":549,"seocKey":51,"name":"ENT_PRCT","seocId":"SSC_ENT_1.0.6_PRCT","versionNumber":"1.0.6","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation and treatment for the referred condition on the consult \r\n2.   Diagnostic imaging relevant to the referred condition on the consult \r\n3.   Labs and pathology relevant to the referred condition on the consult\r\n4.   Diagnostic studies relevant to the referred condition on the consult \r\n5.   Procedures, as clinically indicated, including but not limited to: Laryngoscopy, nasal endoscopy, biopsy, tracheostomy/tracheostomy management, Botox injections, etc. \r\n6.    Anesthesia consultation related to the procedure \r\n7.    Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR, echo)\r\n8.    Inpatient or observation admission for surgical procedure if indicated\r\n9.    Inpatient admission or observation status for complications related to the procedure or surgery\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure or surgery\r\n10.    Follow-up visits for this episode of care \r\n11. Post-op Speech/Voice Therapy, if medically indicated, up to 15 visits; Notify VA to request additional visits with supporting medical documentation","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"ENT","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207Y00000X"}],"services":[{"id":3149,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":3150,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":8249,"precertRequired":false,"billingCode":"G6002","codeType":"HCPCS"},{"id":9765,"precertRequired":false,"billingCode":"70355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3151,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5374,"precertRequired":false,"billingCode":"82043","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5745,"precertRequired":false,"billingCode":"84560","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":3152,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":6701,"precertRequired":true,"billingCode":"92502","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"},{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6705,"precertRequired":true,"billingCode":"92508","codeType":"CPT"},{"id":6706,"precertRequired":false,"billingCode":"92511","codeType":"CPT"},{"id":6707,"precertRequired":false,"billingCode":"92512","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6712,"precertRequired":false,"billingCode":"92531","codeType":"CPT"},{"id":6713,"precertRequired":false,"billingCode":"92532","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6763,"precertRequired":true,"billingCode":"92597","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6769,"precertRequired":true,"billingCode":"92608","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"},{"id":7170,"precertRequired":true,"billingCode":"96105","codeType":"CPT"},{"id":7171,"precertRequired":true,"billingCode":"96110","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7283,"precertRequired":false,"billingCode":"97602","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":9782,"precertRequired":false,"billingCode":"96112","codeType":"CPT"},{"id":9783,"precertRequired":false,"billingCode":"96113","codeType":"CPT"},{"id":9862,"precertRequired":false,"billingCode":"92516","codeType":"CPT"},{"id":9863,"precertRequired":false,"billingCode":"92520","codeType":"CPT"},{"id":9864,"precertRequired":false,"billingCode":"92526","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":3153,"description":"Procedures, as clinically indicated, including but not limited to: Laryngoscopy, nasal endoscopy, biopsy, tracheostomy/tracheostomy management, botox injections, etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":268,"precertRequired":false,"billingCode":"11311","codeType":"CPT"},{"id":269,"precertRequired":false,"billingCode":"11312","codeType":"CPT"},{"id":270,"precertRequired":false,"billingCode":"11313","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":598,"precertRequired":false,"billingCode":"20926","codeType":"CPT"},{"id":645,"precertRequired":false,"billingCode":"21230","codeType":"CPT"},{"id":646,"precertRequired":false,"billingCode":"21235","codeType":"CPT"},{"id":669,"precertRequired":false,"billingCode":"21315","codeType":"CPT"},{"id":670,"precertRequired":false,"billingCode":"21320","codeType":"CPT"},{"id":671,"precertRequired":false,"billingCode":"21325","codeType":"CPT"},{"id":672,"precertRequired":false,"billingCode":"21330","codeType":"CPT"},{"id":673,"precertRequired":false,"billingCode":"21335","codeType":"CPT"},{"id":674,"precertRequired":false,"billingCode":"21336","codeType":"CPT"},{"id":675,"precertRequired":false,"billingCode":"21337","codeType":"CPT"},{"id":676,"precertRequired":false,"billingCode":"21338","codeType":"CPT"},{"id":677,"precertRequired":false,"billingCode":"21339","codeType":"CPT"},{"id":678,"precertRequired":false,"billingCode":"21340","codeType":"CPT"},{"id":679,"precertRequired":false,"billingCode":"21343","codeType":"CPT"},{"id":680,"precertRequired":false,"billingCode":"21344","codeType":"CPT"},{"id":681,"precertRequired":false,"billingCode":"21345","codeType":"CPT"},{"id":682,"precertRequired":false,"billingCode":"21346","codeType":"CPT"},{"id":683,"precertRequired":false,"billingCode":"21347","codeType":"CPT"},{"id":684,"precertRequired":false,"billingCode":"21348","codeType":"CPT"},{"id":1975,"precertRequired":false,"billingCode":"30100","codeType":"CPT"},{"id":1976,"precertRequired":false,"billingCode":"30110","codeType":"CPT"},{"id":1977,"precertRequired":false,"billingCode":"30115","codeType":"CPT"},{"id":1978,"precertRequired":false,"billingCode":"30200","codeType":"CPT"},{"id":1979,"precertRequired":false,"billingCode":"30300","codeType":"CPT"},{"id":1980,"precertRequired":false,"billingCode":"30560","codeType":"CPT"},{"id":1981,"precertRequired":false,"billingCode":"30801","codeType":"CPT"},{"id":1982,"precertRequired":false,"billingCode":"30802","codeType":"CPT"},{"id":1983,"precertRequired":false,"billingCode":"30901","codeType":"CPT"},{"id":1984,"precertRequired":false,"billingCode":"30903","codeType":"CPT"},{"id":1985,"precertRequired":false,"billingCode":"30905","codeType":"CPT"},{"id":1986,"precertRequired":false,"billingCode":"30906","codeType":"CPT"},{"id":1987,"precertRequired":false,"billingCode":"30930","codeType":"CPT"},{"id":1988,"precertRequired":false,"billingCode":"31000","codeType":"CPT"},{"id":1989,"precertRequired":false,"billingCode":"31002","codeType":"CPT"},{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1993,"precertRequired":false,"billingCode":"31237","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":1997,"precertRequired":false,"billingCode":"31512","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2000,"precertRequired":false,"billingCode":"31528","codeType":"CPT"},{"id":2001,"precertRequired":false,"billingCode":"31529","codeType":"CPT"},{"id":2002,"precertRequired":false,"billingCode":"31535","codeType":"CPT"},{"id":2003,"precertRequired":false,"billingCode":"31536","codeType":"CPT"},{"id":2004,"precertRequired":false,"billingCode":"31540","codeType":"CPT"},{"id":2005,"precertRequired":false,"billingCode":"31541","codeType":"CPT"},{"id":2006,"precertRequired":false,"billingCode":"31572","codeType":"CPT"},{"id":2007,"precertRequired":false,"billingCode":"31573","codeType":"CPT"},{"id":2008,"precertRequired":false,"billingCode":"31574","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2011,"precertRequired":false,"billingCode":"31577","codeType":"CPT"},{"id":2012,"precertRequired":false,"billingCode":"31578","codeType":"CPT"},{"id":2013,"precertRequired":true,"billingCode":"31579","codeType":"CPT"},{"id":2014,"precertRequired":false,"billingCode":"31600","codeType":"CPT"},{"id":2016,"precertRequired":false,"billingCode":"31603","codeType":"CPT"},{"id":2017,"precertRequired":false,"billingCode":"31605","codeType":"CPT"},{"id":2018,"precertRequired":false,"billingCode":"31610","codeType":"CPT"},{"id":2019,"precertRequired":false,"billingCode":"31611","codeType":"CPT"},{"id":2020,"precertRequired":false,"billingCode":"31612","codeType":"CPT"},{"id":2021,"precertRequired":false,"billingCode":"31613","codeType":"CPT"},{"id":2022,"precertRequired":false,"billingCode":"31614","codeType":"CPT"},{"id":2023,"precertRequired":false,"billingCode":"31615","codeType":"CPT"},{"id":2024,"precertRequired":false,"billingCode":"31622","codeType":"CPT"},{"id":2056,"precertRequired":false,"billingCode":"31720","codeType":"CPT"},{"id":2057,"precertRequired":false,"billingCode":"31725","codeType":"CPT"},{"id":2058,"precertRequired":false,"billingCode":"31730","codeType":"CPT"},{"id":2059,"precertRequired":false,"billingCode":"31750","codeType":"CPT"},{"id":2060,"precertRequired":false,"billingCode":"31755","codeType":"CPT"},{"id":2061,"precertRequired":false,"billingCode":"31760","codeType":"CPT"},{"id":2062,"precertRequired":false,"billingCode":"31766","codeType":"CPT"},{"id":2065,"precertRequired":false,"billingCode":"31780","codeType":"CPT"},{"id":2066,"precertRequired":false,"billingCode":"31781","codeType":"CPT"},{"id":2067,"precertRequired":false,"billingCode":"31785","codeType":"CPT"},{"id":2068,"precertRequired":false,"billingCode":"31786","codeType":"CPT"},{"id":2069,"precertRequired":false,"billingCode":"31800","codeType":"CPT"},{"id":2070,"precertRequired":false,"billingCode":"31805","codeType":"CPT"},{"id":2071,"precertRequired":false,"billingCode":"31820","codeType":"CPT"},{"id":2072,"precertRequired":false,"billingCode":"31825","codeType":"CPT"},{"id":2073,"precertRequired":false,"billingCode":"31830","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2724,"precertRequired":false,"billingCode":"41000","codeType":"CPT"},{"id":2725,"precertRequired":false,"billingCode":"41100","codeType":"CPT"},{"id":2726,"precertRequired":false,"billingCode":"41105","codeType":"CPT"},{"id":2727,"precertRequired":false,"billingCode":"41108","codeType":"CPT"},{"id":2728,"precertRequired":false,"billingCode":"41250","codeType":"CPT"},{"id":2730,"precertRequired":false,"billingCode":"42300","codeType":"CPT"},{"id":2731,"precertRequired":false,"billingCode":"42310","codeType":"CPT"},{"id":2732,"precertRequired":false,"billingCode":"42330","codeType":"CPT"},{"id":2733,"precertRequired":false,"billingCode":"42550","codeType":"CPT"},{"id":2734,"precertRequired":false,"billingCode":"42700","codeType":"CPT"},{"id":2735,"precertRequired":false,"billingCode":"42800","codeType":"CPT"},{"id":2736,"precertRequired":false,"billingCode":"42804","codeType":"CPT"},{"id":2737,"precertRequired":false,"billingCode":"42806","codeType":"CPT"},{"id":2738,"precertRequired":false,"billingCode":"42809","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3981,"precertRequired":true,"billingCode":"64617","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4348,"precertRequired":false,"billingCode":"69000","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":4350,"precertRequired":false,"billingCode":"69105","codeType":"CPT"},{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4356,"precertRequired":true,"billingCode":"69222","codeType":"CPT"},{"id":4357,"precertRequired":false,"billingCode":"69420","codeType":"CPT"},{"id":4358,"precertRequired":false,"billingCode":"69433","codeType":"CPT"},{"id":4359,"precertRequired":false,"billingCode":"69540","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":8168,"precertRequired":false,"billingCode":"G0268","codeType":"HCPCS"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9176,"precertRequired":true,"billingCode":"15277","codeType":"CPT"},{"id":9177,"precertRequired":true,"billingCode":"15278","codeType":"CPT"},{"id":9193,"precertRequired":false,"billingCode":"21086","codeType":"CPT"},{"id":9231,"precertRequired":true,"billingCode":"21310","codeType":"CPT"},{"id":9343,"precertRequired":true,"billingCode":"30130","codeType":"CPT"},{"id":9344,"precertRequired":true,"billingCode":"30140","codeType":"CPT"},{"id":9345,"precertRequired":true,"billingCode":"30310","codeType":"CPT"},{"id":9346,"precertRequired":true,"billingCode":"30460","codeType":"CPT"},{"id":9347,"precertRequired":true,"billingCode":"30462","codeType":"CPT"},{"id":9348,"precertRequired":true,"billingCode":"30465","codeType":"CPT"},{"id":9349,"precertRequired":true,"billingCode":"30520","codeType":"CPT"},{"id":9350,"precertRequired":true,"billingCode":"30540","codeType":"CPT"},{"id":9351,"precertRequired":true,"billingCode":"30545","codeType":"CPT"},{"id":9352,"precertRequired":true,"billingCode":"30580","codeType":"CPT"},{"id":9353,"precertRequired":true,"billingCode":"30600","codeType":"CPT"},{"id":9354,"precertRequired":true,"billingCode":"30620","codeType":"CPT"},{"id":9355,"precertRequired":true,"billingCode":"30630","codeType":"CPT"},{"id":9356,"precertRequired":true,"billingCode":"31020","codeType":"CPT"},{"id":9357,"precertRequired":true,"billingCode":"31030","codeType":"CPT"},{"id":9358,"precertRequired":true,"billingCode":"31032","codeType":"CPT"},{"id":9359,"precertRequired":true,"billingCode":"31050","codeType":"CPT"},{"id":9360,"precertRequired":true,"billingCode":"31051","codeType":"CPT"},{"id":9361,"precertRequired":true,"billingCode":"31070","codeType":"CPT"},{"id":9362,"precertRequired":true,"billingCode":"31075","codeType":"CPT"},{"id":9363,"precertRequired":true,"billingCode":"31080","codeType":"CPT"},{"id":9364,"precertRequired":true,"billingCode":"31081","codeType":"CPT"},{"id":9365,"precertRequired":true,"billingCode":"31084","codeType":"CPT"},{"id":9366,"precertRequired":true,"billingCode":"31085","codeType":"CPT"},{"id":9367,"precertRequired":true,"billingCode":"31086","codeType":"CPT"},{"id":9368,"precertRequired":true,"billingCode":"31087","codeType":"CPT"},{"id":9369,"precertRequired":true,"billingCode":"31090","codeType":"CPT"},{"id":9370,"precertRequired":true,"billingCode":"31200","codeType":"CPT"},{"id":9371,"precertRequired":true,"billingCode":"31201","codeType":"CPT"},{"id":9372,"precertRequired":true,"billingCode":"31205","codeType":"CPT"},{"id":9373,"precertRequired":true,"billingCode":"31238","codeType":"CPT"},{"id":9374,"precertRequired":true,"billingCode":"31239","codeType":"CPT"},{"id":9375,"precertRequired":true,"billingCode":"31240","codeType":"CPT"},{"id":9376,"precertRequired":true,"billingCode":"31241","codeType":"CPT"},{"id":9377,"precertRequired":true,"billingCode":"31253","codeType":"CPT"},{"id":9378,"precertRequired":true,"billingCode":"31254","codeType":"CPT"},{"id":9379,"precertRequired":true,"billingCode":"31255","codeType":"CPT"},{"id":9380,"precertRequired":true,"billingCode":"31256","codeType":"CPT"},{"id":9381,"precertRequired":true,"billingCode":"31257","codeType":"CPT"},{"id":9382,"precertRequired":true,"billingCode":"31259","codeType":"CPT"},{"id":9383,"precertRequired":true,"billingCode":"31267","codeType":"CPT"},{"id":9384,"precertRequired":true,"billingCode":"31276","codeType":"CPT"},{"id":9385,"precertRequired":true,"billingCode":"31287","codeType":"CPT"},{"id":9386,"precertRequired":true,"billingCode":"31288","codeType":"CPT"},{"id":9387,"precertRequired":true,"billingCode":"31290","codeType":"CPT"},{"id":9388,"precertRequired":true,"billingCode":"31291","codeType":"CPT"},{"id":9389,"precertRequired":true,"billingCode":"31292","codeType":"CPT"},{"id":9390,"precertRequired":true,"billingCode":"31293","codeType":"CPT"},{"id":9391,"precertRequired":true,"billingCode":"31294","codeType":"CPT"},{"id":9392,"precertRequired":true,"billingCode":"31295","codeType":"CPT"},{"id":9393,"precertRequired":true,"billingCode":"31296","codeType":"CPT"},{"id":9394,"precertRequired":true,"billingCode":"31297","codeType":"CPT"},{"id":9395,"precertRequired":true,"billingCode":"31298","codeType":"CPT"},{"id":9396,"precertRequired":true,"billingCode":"31300","codeType":"CPT"},{"id":9397,"precertRequired":true,"billingCode":"31360","codeType":"CPT"},{"id":9398,"precertRequired":true,"billingCode":"31365","codeType":"CPT"},{"id":9399,"precertRequired":true,"billingCode":"31367","codeType":"CPT"},{"id":9400,"precertRequired":true,"billingCode":"31368","codeType":"CPT"},{"id":9401,"precertRequired":true,"billingCode":"31370","codeType":"CPT"},{"id":9402,"precertRequired":true,"billingCode":"31375","codeType":"CPT"},{"id":9403,"precertRequired":true,"billingCode":"31380","codeType":"CPT"},{"id":9404,"precertRequired":true,"billingCode":"31382","codeType":"CPT"},{"id":9405,"precertRequired":true,"billingCode":"31390","codeType":"CPT"},{"id":9406,"precertRequired":true,"billingCode":"31395","codeType":"CPT"},{"id":9407,"precertRequired":true,"billingCode":"31515","codeType":"CPT"},{"id":9408,"precertRequired":true,"billingCode":"31527","codeType":"CPT"},{"id":9409,"precertRequired":true,"billingCode":"31530","codeType":"CPT"},{"id":9410,"precertRequired":true,"billingCode":"31531","codeType":"CPT"},{"id":9411,"precertRequired":true,"billingCode":"31545","codeType":"CPT"},{"id":9412,"precertRequired":true,"billingCode":"31546","codeType":"CPT"},{"id":9413,"precertRequired":true,"billingCode":"31552","codeType":"CPT"},{"id":9414,"precertRequired":true,"billingCode":"31554","codeType":"CPT"},{"id":9415,"precertRequired":true,"billingCode":"31560","codeType":"CPT"},{"id":9416,"precertRequired":true,"billingCode":"31561","codeType":"CPT"},{"id":9417,"precertRequired":true,"billingCode":"31570","codeType":"CPT"},{"id":9418,"precertRequired":true,"billingCode":"31571","codeType":"CPT"},{"id":9434,"precertRequired":true,"billingCode":"40810","codeType":"CPT"},{"id":9435,"precertRequired":true,"billingCode":"40812","codeType":"CPT"},{"id":9436,"precertRequired":true,"billingCode":"40814","codeType":"CPT"},{"id":9437,"precertRequired":true,"billingCode":"40816","codeType":"CPT"},{"id":9439,"precertRequired":true,"billingCode":"40820","codeType":"CPT"},{"id":9447,"precertRequired":false,"billingCode":"41005","codeType":"CPT"},{"id":9448,"precertRequired":false,"billingCode":"41006","codeType":"CPT"},{"id":9449,"precertRequired":false,"billingCode":"41007","codeType":"CPT"},{"id":9450,"precertRequired":false,"billingCode":"41008","codeType":"CPT"},{"id":9451,"precertRequired":false,"billingCode":"41009","codeType":"CPT"},{"id":9452,"precertRequired":true,"billingCode":"41010","codeType":"CPT"},{"id":9453,"precertRequired":false,"billingCode":"41015","codeType":"CPT"},{"id":9454,"precertRequired":false,"billingCode":"41016","codeType":"CPT"},{"id":9455,"precertRequired":false,"billingCode":"41017","codeType":"CPT"},{"id":9456,"precertRequired":false,"billingCode":"41018","codeType":"CPT"},{"id":9457,"precertRequired":false,"billingCode":"41110","codeType":"CPT"},{"id":9458,"precertRequired":false,"billingCode":"41112","codeType":"CPT"},{"id":9459,"precertRequired":false,"billingCode":"41113","codeType":"CPT"},{"id":9460,"precertRequired":false,"billingCode":"41114","codeType":"CPT"},{"id":9461,"precertRequired":false,"billingCode":"41115","codeType":"CPT"},{"id":9462,"precertRequired":false,"billingCode":"41116","codeType":"CPT"},{"id":9463,"precertRequired":true,"billingCode":"41120","codeType":"CPT"},{"id":9464,"precertRequired":true,"billingCode":"41130","codeType":"CPT"},{"id":9465,"precertRequired":true,"billingCode":"41135","codeType":"CPT"},{"id":9466,"precertRequired":true,"billingCode":"41140","codeType":"CPT"},{"id":9467,"precertRequired":true,"billingCode":"41145","codeType":"CPT"},{"id":9468,"precertRequired":true,"billingCode":"41150","codeType":"CPT"},{"id":9469,"precertRequired":true,"billingCode":"41153","codeType":"CPT"},{"id":9470,"precertRequired":true,"billingCode":"41155","codeType":"CPT"},{"id":9471,"precertRequired":false,"billingCode":"41251","codeType":"CPT"},{"id":9472,"precertRequired":false,"billingCode":"41252","codeType":"CPT"},{"id":9473,"precertRequired":false,"billingCode":"41510","codeType":"CPT"},{"id":9474,"precertRequired":true,"billingCode":"41512","codeType":"CPT"},{"id":9475,"precertRequired":true,"billingCode":"41520","codeType":"CPT"},{"id":9515,"precertRequired":true,"billingCode":"42408","codeType":"CPT"},{"id":9516,"precertRequired":true,"billingCode":"42415","codeType":"CPT"},{"id":9517,"precertRequired":true,"billingCode":"42440","codeType":"CPT"},{"id":9518,"precertRequired":true,"billingCode":"42810","codeType":"CPT"},{"id":9519,"precertRequired":true,"billingCode":"42815","codeType":"CPT"},{"id":9520,"precertRequired":true,"billingCode":"42821","codeType":"CPT"},{"id":9521,"precertRequired":true,"billingCode":"42826","codeType":"CPT"},{"id":9522,"precertRequired":true,"billingCode":"42831","codeType":"CPT"},{"id":9523,"precertRequired":true,"billingCode":"42836","codeType":"CPT"},{"id":9524,"precertRequired":true,"billingCode":"42842","codeType":"CPT"},{"id":9525,"precertRequired":true,"billingCode":"42844","codeType":"CPT"},{"id":9526,"precertRequired":true,"billingCode":"42845","codeType":"CPT"},{"id":9859,"precertRequired":false,"billingCode":"61782","codeType":"CPT"},{"id":9860,"precertRequired":false,"billingCode":"30915","codeType":"CPT"},{"id":9861,"precertRequired":false,"billingCode":"30920","codeType":"CPT"},{"id":9865,"precertRequired":false,"billingCode":"42808","codeType":"CPT"},{"id":9866,"precertRequired":false,"billingCode":"42860","codeType":"CPT"},{"id":9867,"precertRequired":false,"billingCode":"42870","codeType":"CPT"},{"id":9868,"precertRequired":false,"billingCode":"42890","codeType":"CPT"},{"id":9869,"precertRequired":false,"billingCode":"42892","codeType":"CPT"},{"id":9871,"precertRequired":false,"billingCode":"69005","codeType":"CPT"},{"id":9872,"precertRequired":false,"billingCode":"69020","codeType":"CPT"},{"id":9873,"precertRequired":false,"billingCode":"69110","codeType":"CPT"},{"id":9874,"precertRequired":false,"billingCode":"69120","codeType":"CPT"},{"id":9875,"precertRequired":false,"billingCode":"69140","codeType":"CPT"},{"id":9876,"precertRequired":false,"billingCode":"69145","codeType":"CPT"},{"id":9877,"precertRequired":false,"billingCode":"69150","codeType":"CPT"},{"id":9878,"precertRequired":false,"billingCode":"69155","codeType":"CPT"},{"id":9879,"precertRequired":false,"billingCode":"69300","codeType":"CPT"},{"id":9880,"precertRequired":false,"billingCode":"69310","codeType":"CPT"},{"id":9881,"precertRequired":false,"billingCode":"69320","codeType":"CPT"},{"id":9882,"precertRequired":false,"billingCode":"69421","codeType":"CPT"},{"id":9883,"precertRequired":false,"billingCode":"69424","codeType":"CPT"},{"id":9884,"precertRequired":false,"billingCode":"69436","codeType":"CPT"},{"id":9885,"precertRequired":false,"billingCode":"69440","codeType":"CPT"},{"id":9886,"precertRequired":false,"billingCode":"69450","codeType":"CPT"},{"id":9887,"precertRequired":false,"billingCode":"69501","codeType":"CPT"},{"id":9888,"precertRequired":false,"billingCode":"69502","codeType":"CPT"},{"id":9889,"precertRequired":false,"billingCode":"69505","codeType":"CPT"},{"id":9890,"precertRequired":false,"billingCode":"69511","codeType":"CPT"},{"id":9891,"precertRequired":false,"billingCode":"69530","codeType":"CPT"},{"id":9892,"precertRequired":false,"billingCode":"69535","codeType":"CPT"},{"id":9893,"precertRequired":false,"billingCode":"69550","codeType":"CPT"},{"id":9894,"precertRequired":false,"billingCode":"69554","codeType":"CPT"},{"id":9895,"precertRequired":false,"billingCode":"69610","codeType":"CPT"},{"id":9896,"precertRequired":false,"billingCode":"69620","codeType":"CPT"},{"id":9897,"precertRequired":false,"billingCode":"69631","codeType":"CPT"},{"id":9898,"precertRequired":false,"billingCode":"69632","codeType":"CPT"},{"id":9899,"precertRequired":false,"billingCode":"69633","codeType":"CPT"},{"id":9900,"precertRequired":false,"billingCode":"69635","codeType":"CPT"},{"id":9901,"precertRequired":false,"billingCode":"69636","codeType":"CPT"},{"id":9902,"precertRequired":false,"billingCode":"69637","codeType":"CPT"},{"id":9903,"precertRequired":false,"billingCode":"69641","codeType":"CPT"},{"id":9904,"precertRequired":false,"billingCode":"69642","codeType":"CPT"},{"id":9905,"precertRequired":false,"billingCode":"69644","codeType":"CPT"},{"id":9906,"precertRequired":false,"billingCode":"69643","codeType":"CPT"},{"id":9907,"precertRequired":false,"billingCode":"69645","codeType":"CPT"},{"id":9908,"precertRequired":false,"billingCode":"69646","codeType":"CPT"},{"id":9909,"precertRequired":false,"billingCode":"69650","codeType":"CPT"},{"id":9910,"precertRequired":false,"billingCode":"69660","codeType":"CPT"},{"id":9911,"precertRequired":false,"billingCode":"69661","codeType":"CPT"},{"id":9912,"precertRequired":false,"billingCode":"69662","codeType":"CPT"},{"id":9913,"precertRequired":false,"billingCode":"69666","codeType":"CPT"},{"id":9914,"precertRequired":false,"billingCode":"69667","codeType":"CPT"},{"id":9915,"precertRequired":false,"billingCode":"69720","codeType":"CPT"},{"id":9916,"precertRequired":false,"billingCode":"69725","codeType":"CPT"},{"id":9917,"precertRequired":false,"billingCode":"69740","codeType":"CPT"},{"id":9918,"precertRequired":false,"billingCode":"69745","codeType":"CPT"},{"id":9919,"precertRequired":false,"billingCode":"69801","codeType":"CPT"},{"id":9920,"precertRequired":false,"billingCode":"69915","codeType":"CPT"},{"id":9921,"precertRequired":false,"billingCode":"69950","codeType":"CPT"},{"id":9922,"precertRequired":false,"billingCode":"69955","codeType":"CPT"},{"id":9923,"precertRequired":false,"billingCode":"69960","codeType":"CPT"},{"id":9924,"precertRequired":false,"billingCode":"69970","codeType":"CPT"},{"id":9925,"precertRequired":false,"billingCode":"C9745","codeType":"HCPCS"},{"id":9926,"precertRequired":false,"billingCode":"42894","codeType":"CPT"},{"id":9927,"precertRequired":false,"billingCode":"69552","codeType":"CPT"},{"id":9943,"precertRequired":false,"billingCode":"69676","codeType":"CPT"},{"id":9982,"precertRequired":false,"billingCode":"42305","codeType":"CPT"},{"id":9983,"precertRequired":false,"billingCode":"42500","codeType":"CPT"},{"id":9984,"precertRequired":false,"billingCode":"42505","codeType":"CPT"},{"id":9985,"precertRequired":false,"billingCode":"42950","codeType":"CPT"},{"id":11377,"precertRequired":false,"billingCode":"30210","codeType":"CPT"},{"id":11378,"precertRequired":false,"billingCode":"30320","codeType":"CPT"},{"id":11379,"precertRequired":false,"billingCode":"31511","codeType":"CPT"},{"id":11380,"precertRequired":false,"billingCode":"31513","codeType":"CPT"},{"id":11381,"precertRequired":false,"billingCode":"42320","codeType":"CPT"},{"id":11382,"precertRequired":false,"billingCode":"42335","codeType":"CPT"},{"id":11383,"precertRequired":false,"billingCode":"42340","codeType":"CPT"},{"id":11384,"precertRequired":false,"billingCode":"42400","codeType":"CPT"},{"id":11385,"precertRequired":false,"billingCode":"42405","codeType":"CPT"},{"id":11386,"precertRequired":false,"billingCode":"42409","codeType":"CPT"},{"id":11387,"precertRequired":false,"billingCode":"42410","codeType":"CPT"},{"id":11388,"precertRequired":false,"billingCode":"42420","codeType":"CPT"},{"id":11389,"precertRequired":false,"billingCode":"42425","codeType":"CPT"},{"id":11390,"precertRequired":false,"billingCode":"42426","codeType":"CPT"},{"id":11391,"precertRequired":false,"billingCode":"42450","codeType":"CPT"},{"id":11392,"precertRequired":false,"billingCode":"42507","codeType":"CPT"},{"id":11393,"precertRequired":false,"billingCode":"42509","codeType":"CPT"},{"id":11394,"precertRequired":false,"billingCode":"42510","codeType":"CPT"},{"id":11395,"precertRequired":false,"billingCode":"42600","codeType":"CPT"},{"id":11396,"precertRequired":false,"billingCode":"42650","codeType":"CPT"},{"id":11397,"precertRequired":false,"billingCode":"42660","codeType":"CPT"},{"id":11398,"precertRequired":false,"billingCode":"42665","codeType":"CPT"},{"id":11399,"precertRequired":false,"billingCode":"42720","codeType":"CPT"},{"id":11400,"precertRequired":false,"billingCode":"42725","codeType":"CPT"},{"id":11401,"precertRequired":false,"billingCode":"42900","codeType":"CPT"},{"id":11402,"precertRequired":false,"billingCode":"42953","codeType":"CPT"},{"id":11403,"precertRequired":false,"billingCode":"42955","codeType":"CPT"},{"id":11404,"precertRequired":false,"billingCode":"42960","codeType":"CPT"},{"id":11405,"precertRequired":false,"billingCode":"42961","codeType":"CPT"},{"id":11406,"precertRequired":false,"billingCode":"42962","codeType":"CPT"},{"id":11407,"precertRequired":false,"billingCode":"42970","codeType":"CPT"},{"id":11408,"precertRequired":false,"billingCode":"42971","codeType":"CPT"},{"id":11409,"precertRequired":false,"billingCode":"42972","codeType":"CPT"},{"id":11410,"precertRequired":false,"billingCode":"69670","codeType":"CPT"},{"id":11411,"precertRequired":false,"billingCode":"69700","codeType":"CPT"},{"id":11412,"precertRequired":false,"billingCode":"69805","codeType":"CPT"},{"id":11413,"precertRequired":false,"billingCode":"69806","codeType":"CPT"},{"id":11414,"precertRequired":false,"billingCode":"69905","codeType":"CPT"},{"id":11415,"precertRequired":false,"billingCode":"69910","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":3154,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":1,"precertRequired":false,"billingCode":"00100","codeType":"CPT"},{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":14,"precertRequired":false,"billingCode":"00160","codeType":"CPT"},{"id":15,"precertRequired":false,"billingCode":"00162","codeType":"CPT"},{"id":16,"precertRequired":false,"billingCode":"00164","codeType":"CPT"},{"id":19,"precertRequired":false,"billingCode":"00174","codeType":"CPT"},{"id":20,"precertRequired":false,"billingCode":"00176","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":33,"precertRequired":false,"billingCode":"00320","codeType":"CPT"},{"id":34,"precertRequired":false,"billingCode":"00322","codeType":"CPT"},{"id":55,"precertRequired":false,"billingCode":"00539","codeType":"CPT"},{"id":217,"precertRequired":false,"billingCode":"01991","codeType":"CPT"},{"id":218,"precertRequired":false,"billingCode":"01992","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":5033,"precertRequired":false,"billingCode":"80176","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":3155,"description":"Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR, echo)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":3156,"description":"Inpatient or observation admission for surgical procedure if indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":8189,"precertRequired":false,"billingCode":"G0378","codeType":"HCPCS"},{"id":8190,"precertRequired":false,"billingCode":"G0379","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":3157,"description":"Inpatient admission or observation status for complications related to the procedure or surgery\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure or surgery","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":8189,"precertRequired":false,"billingCode":"G0378","codeType":"HCPCS"},{"id":8190,"precertRequired":false,"billingCode":"G0379","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":3158,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":3159,"description":"Post-op Speech/Voice Therapy, if medically indicated, up to 15 visits; Notify VA to request additional visits with supporting medical documentation","frequency":null,"frequencyType":"week","visits":15,"codeRequired":"YES","clinicalServices":[{"clinicalService":"15-Speech language pathologist "}],"billingCodes":[{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":6767,"precertRequired":false,"billingCode":"92606","codeType":"CPT"},{"id":6770,"precertRequired":true,"billingCode":"92609","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7342,"precertRequired":false,"billingCode":"99183","codeType":"CPT"},{"id":8294,"precertRequired":true,"billingCode":"G8999","codeType":"HCPCS"},{"id":8299,"precertRequired":true,"billingCode":"G9158","codeType":"HCPCS"},{"id":8300,"precertRequired":true,"billingCode":"G9159","codeType":"HCPCS"},{"id":8301,"precertRequired":true,"billingCode":"G9160","codeType":"HCPCS"},{"id":8302,"precertRequired":true,"billingCode":"G9161","codeType":"HCPCS"},{"id":8303,"precertRequired":true,"billingCode":"G9162","codeType":"HCPCS"},{"id":8304,"precertRequired":true,"billingCode":"G9163","codeType":"HCPCS"},{"id":8305,"precertRequired":true,"billingCode":"G9164","codeType":"HCPCS"},{"id":8306,"precertRequired":true,"billingCode":"G9170","codeType":"HCPCS"},{"id":8307,"precertRequired":true,"billingCode":"G9171","codeType":"HCPCS"},{"id":8308,"precertRequired":false,"billingCode":"G9172","codeType":"HCPCS"},{"id":8309,"precertRequired":true,"billingCode":"G9173","codeType":"HCPCS"},{"id":8310,"precertRequired":true,"billingCode":"G9174","codeType":"HCPCS"},{"id":8311,"precertRequired":true,"billingCode":"G9175","codeType":"HCPCS"},{"id":8312,"precertRequired":true,"billingCode":"G9176","codeType":"HCPCS"},{"id":8313,"precertRequired":true,"billingCode":"G9186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"235Z00000X"}]}]}},{"Seoc":{"id":373,"seocKey":51,"name":"ENT_PRCT","seocId":"SSC_ENT_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"05-07-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation and treatment for the referred condition on the consult \r\n2.   Diagnostic imaging relevant to the referred condition on the consult \r\n3.   Labs and pathology relevant to the referred condition on the consult\r\n4.   Diagnostic studies relevant to the referred condition on the consult \r\n5.   Procedures, as clinically indicated, including but not limited to: Laryngoscopy, nasal endoscopy, biopsy, tracheostomy/tracheostomy management, Botox injections, etc. \r\n6.    Anesthesia consultation related to the procedure \r\n7.    Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR, echo)\r\n8.    Inpatient or observation admission for surgical procedure if indicated\r\n9.    Inpatient admission or observation status for complications related to the procedure or surgery\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure or surgery\r\n10.    Follow-up visits for this episode of care \r\n11. Post-op Speech/Voice Therapy, if medically indicated, up to 15 visits; Notify VA to request additional visits with supporting medical documentation","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be immediately faxed/provided to VA pharmacy to be dispensed timely by VA pharmacy. Non-formulary drug approval process may be required.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ENT","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207Y00000X"}],"services":[{"id":1963,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1964,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":8249,"precertRequired":false,"billingCode":"G6002","codeType":"HCPCS"},{"id":9765,"precertRequired":false,"billingCode":"70355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1965,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5374,"precertRequired":false,"billingCode":"82043","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5745,"precertRequired":false,"billingCode":"84560","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1966,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":6701,"precertRequired":true,"billingCode":"92502","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"},{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6705,"precertRequired":true,"billingCode":"92508","codeType":"CPT"},{"id":6706,"precertRequired":false,"billingCode":"92511","codeType":"CPT"},{"id":6707,"precertRequired":false,"billingCode":"92512","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6712,"precertRequired":false,"billingCode":"92531","codeType":"CPT"},{"id":6713,"precertRequired":false,"billingCode":"92532","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6728,"precertRequired":false,"billingCode":"92552","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6763,"precertRequired":true,"billingCode":"92597","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6769,"precertRequired":true,"billingCode":"92608","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"},{"id":7170,"precertRequired":true,"billingCode":"96105","codeType":"CPT"},{"id":7171,"precertRequired":true,"billingCode":"96110","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7283,"precertRequired":false,"billingCode":"97602","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":9782,"precertRequired":false,"billingCode":"96112","codeType":"CPT"},{"id":9783,"precertRequired":false,"billingCode":"96113","codeType":"CPT"},{"id":9862,"precertRequired":false,"billingCode":"92516","codeType":"CPT"},{"id":9863,"precertRequired":false,"billingCode":"92520","codeType":"CPT"},{"id":9864,"precertRequired":false,"billingCode":"92526","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1967,"description":"Procedures, as clinically indicated, including but not limited to: Laryngoscopy, nasal endoscopy, biopsy, tracheostomy/tracheostomy management, botox injections, etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":268,"precertRequired":false,"billingCode":"11311","codeType":"CPT"},{"id":269,"precertRequired":false,"billingCode":"11312","codeType":"CPT"},{"id":270,"precertRequired":false,"billingCode":"11313","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":598,"precertRequired":false,"billingCode":"20926","codeType":"CPT"},{"id":645,"precertRequired":false,"billingCode":"21230","codeType":"CPT"},{"id":646,"precertRequired":false,"billingCode":"21235","codeType":"CPT"},{"id":669,"precertRequired":false,"billingCode":"21315","codeType":"CPT"},{"id":670,"precertRequired":false,"billingCode":"21320","codeType":"CPT"},{"id":671,"precertRequired":false,"billingCode":"21325","codeType":"CPT"},{"id":672,"precertRequired":false,"billingCode":"21330","codeType":"CPT"},{"id":673,"precertRequired":false,"billingCode":"21335","codeType":"CPT"},{"id":674,"precertRequired":false,"billingCode":"21336","codeType":"CPT"},{"id":675,"precertRequired":false,"billingCode":"21337","codeType":"CPT"},{"id":676,"precertRequired":false,"billingCode":"21338","codeType":"CPT"},{"id":677,"precertRequired":false,"billingCode":"21339","codeType":"CPT"},{"id":678,"precertRequired":false,"billingCode":"21340","codeType":"CPT"},{"id":679,"precertRequired":false,"billingCode":"21343","codeType":"CPT"},{"id":680,"precertRequired":false,"billingCode":"21344","codeType":"CPT"},{"id":681,"precertRequired":false,"billingCode":"21345","codeType":"CPT"},{"id":682,"precertRequired":false,"billingCode":"21346","codeType":"CPT"},{"id":683,"precertRequired":false,"billingCode":"21347","codeType":"CPT"},{"id":684,"precertRequired":false,"billingCode":"21348","codeType":"CPT"},{"id":1975,"precertRequired":false,"billingCode":"30100","codeType":"CPT"},{"id":1976,"precertRequired":false,"billingCode":"30110","codeType":"CPT"},{"id":1977,"precertRequired":false,"billingCode":"30115","codeType":"CPT"},{"id":1978,"precertRequired":false,"billingCode":"30200","codeType":"CPT"},{"id":1979,"precertRequired":false,"billingCode":"30300","codeType":"CPT"},{"id":1980,"precertRequired":false,"billingCode":"30560","codeType":"CPT"},{"id":1981,"precertRequired":false,"billingCode":"30801","codeType":"CPT"},{"id":1982,"precertRequired":false,"billingCode":"30802","codeType":"CPT"},{"id":1983,"precertRequired":false,"billingCode":"30901","codeType":"CPT"},{"id":1984,"precertRequired":false,"billingCode":"30903","codeType":"CPT"},{"id":1985,"precertRequired":false,"billingCode":"30905","codeType":"CPT"},{"id":1986,"precertRequired":false,"billingCode":"30906","codeType":"CPT"},{"id":1987,"precertRequired":false,"billingCode":"30930","codeType":"CPT"},{"id":1988,"precertRequired":false,"billingCode":"31000","codeType":"CPT"},{"id":1989,"precertRequired":false,"billingCode":"31002","codeType":"CPT"},{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1993,"precertRequired":false,"billingCode":"31237","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":1997,"precertRequired":false,"billingCode":"31512","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2000,"precertRequired":false,"billingCode":"31528","codeType":"CPT"},{"id":2001,"precertRequired":false,"billingCode":"31529","codeType":"CPT"},{"id":2002,"precertRequired":false,"billingCode":"31535","codeType":"CPT"},{"id":2003,"precertRequired":false,"billingCode":"31536","codeType":"CPT"},{"id":2004,"precertRequired":false,"billingCode":"31540","codeType":"CPT"},{"id":2005,"precertRequired":false,"billingCode":"31541","codeType":"CPT"},{"id":2006,"precertRequired":false,"billingCode":"31572","codeType":"CPT"},{"id":2007,"precertRequired":false,"billingCode":"31573","codeType":"CPT"},{"id":2008,"precertRequired":false,"billingCode":"31574","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2011,"precertRequired":false,"billingCode":"31577","codeType":"CPT"},{"id":2012,"precertRequired":false,"billingCode":"31578","codeType":"CPT"},{"id":2013,"precertRequired":true,"billingCode":"31579","codeType":"CPT"},{"id":2014,"precertRequired":false,"billingCode":"31600","codeType":"CPT"},{"id":2016,"precertRequired":false,"billingCode":"31603","codeType":"CPT"},{"id":2017,"precertRequired":false,"billingCode":"31605","codeType":"CPT"},{"id":2018,"precertRequired":false,"billingCode":"31610","codeType":"CPT"},{"id":2019,"precertRequired":false,"billingCode":"31611","codeType":"CPT"},{"id":2020,"precertRequired":false,"billingCode":"31612","codeType":"CPT"},{"id":2021,"precertRequired":false,"billingCode":"31613","codeType":"CPT"},{"id":2022,"precertRequired":false,"billingCode":"31614","codeType":"CPT"},{"id":2023,"precertRequired":false,"billingCode":"31615","codeType":"CPT"},{"id":2024,"precertRequired":false,"billingCode":"31622","codeType":"CPT"},{"id":2056,"precertRequired":false,"billingCode":"31720","codeType":"CPT"},{"id":2057,"precertRequired":false,"billingCode":"31725","codeType":"CPT"},{"id":2058,"precertRequired":false,"billingCode":"31730","codeType":"CPT"},{"id":2059,"precertRequired":false,"billingCode":"31750","codeType":"CPT"},{"id":2060,"precertRequired":false,"billingCode":"31755","codeType":"CPT"},{"id":2061,"precertRequired":false,"billingCode":"31760","codeType":"CPT"},{"id":2062,"precertRequired":false,"billingCode":"31766","codeType":"CPT"},{"id":2065,"precertRequired":false,"billingCode":"31780","codeType":"CPT"},{"id":2066,"precertRequired":false,"billingCode":"31781","codeType":"CPT"},{"id":2067,"precertRequired":false,"billingCode":"31785","codeType":"CPT"},{"id":2068,"precertRequired":false,"billingCode":"31786","codeType":"CPT"},{"id":2069,"precertRequired":false,"billingCode":"31800","codeType":"CPT"},{"id":2070,"precertRequired":false,"billingCode":"31805","codeType":"CPT"},{"id":2071,"precertRequired":false,"billingCode":"31820","codeType":"CPT"},{"id":2072,"precertRequired":false,"billingCode":"31825","codeType":"CPT"},{"id":2073,"precertRequired":false,"billingCode":"31830","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2724,"precertRequired":false,"billingCode":"41000","codeType":"CPT"},{"id":2725,"precertRequired":false,"billingCode":"41100","codeType":"CPT"},{"id":2726,"precertRequired":false,"billingCode":"41105","codeType":"CPT"},{"id":2727,"precertRequired":false,"billingCode":"41108","codeType":"CPT"},{"id":2728,"precertRequired":false,"billingCode":"41250","codeType":"CPT"},{"id":2730,"precertRequired":false,"billingCode":"42300","codeType":"CPT"},{"id":2731,"precertRequired":false,"billingCode":"42310","codeType":"CPT"},{"id":2732,"precertRequired":false,"billingCode":"42330","codeType":"CPT"},{"id":2733,"precertRequired":false,"billingCode":"42550","codeType":"CPT"},{"id":2734,"precertRequired":false,"billingCode":"42700","codeType":"CPT"},{"id":2735,"precertRequired":false,"billingCode":"42800","codeType":"CPT"},{"id":2736,"precertRequired":false,"billingCode":"42804","codeType":"CPT"},{"id":2737,"precertRequired":false,"billingCode":"42806","codeType":"CPT"},{"id":2738,"precertRequired":false,"billingCode":"42809","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3981,"precertRequired":true,"billingCode":"64617","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4348,"precertRequired":false,"billingCode":"69000","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":4350,"precertRequired":false,"billingCode":"69105","codeType":"CPT"},{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4356,"precertRequired":true,"billingCode":"69222","codeType":"CPT"},{"id":4357,"precertRequired":false,"billingCode":"69420","codeType":"CPT"},{"id":4358,"precertRequired":false,"billingCode":"69433","codeType":"CPT"},{"id":4359,"precertRequired":false,"billingCode":"69540","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":8168,"precertRequired":false,"billingCode":"G0268","codeType":"HCPCS"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9176,"precertRequired":true,"billingCode":"15277","codeType":"CPT"},{"id":9177,"precertRequired":true,"billingCode":"15278","codeType":"CPT"},{"id":9193,"precertRequired":false,"billingCode":"21086","codeType":"CPT"},{"id":9231,"precertRequired":true,"billingCode":"21310","codeType":"CPT"},{"id":9343,"precertRequired":true,"billingCode":"30130","codeType":"CPT"},{"id":9344,"precertRequired":true,"billingCode":"30140","codeType":"CPT"},{"id":9345,"precertRequired":true,"billingCode":"30310","codeType":"CPT"},{"id":9346,"precertRequired":true,"billingCode":"30460","codeType":"CPT"},{"id":9347,"precertRequired":true,"billingCode":"30462","codeType":"CPT"},{"id":9348,"precertRequired":true,"billingCode":"30465","codeType":"CPT"},{"id":9349,"precertRequired":true,"billingCode":"30520","codeType":"CPT"},{"id":9350,"precertRequired":true,"billingCode":"30540","codeType":"CPT"},{"id":9351,"precertRequired":true,"billingCode":"30545","codeType":"CPT"},{"id":9352,"precertRequired":true,"billingCode":"30580","codeType":"CPT"},{"id":9353,"precertRequired":true,"billingCode":"30600","codeType":"CPT"},{"id":9354,"precertRequired":true,"billingCode":"30620","codeType":"CPT"},{"id":9355,"precertRequired":true,"billingCode":"30630","codeType":"CPT"},{"id":9356,"precertRequired":true,"billingCode":"31020","codeType":"CPT"},{"id":9357,"precertRequired":true,"billingCode":"31030","codeType":"CPT"},{"id":9358,"precertRequired":true,"billingCode":"31032","codeType":"CPT"},{"id":9359,"precertRequired":true,"billingCode":"31050","codeType":"CPT"},{"id":9360,"precertRequired":true,"billingCode":"31051","codeType":"CPT"},{"id":9361,"precertRequired":true,"billingCode":"31070","codeType":"CPT"},{"id":9362,"precertRequired":true,"billingCode":"31075","codeType":"CPT"},{"id":9363,"precertRequired":true,"billingCode":"31080","codeType":"CPT"},{"id":9364,"precertRequired":true,"billingCode":"31081","codeType":"CPT"},{"id":9365,"precertRequired":true,"billingCode":"31084","codeType":"CPT"},{"id":9366,"precertRequired":true,"billingCode":"31085","codeType":"CPT"},{"id":9367,"precertRequired":true,"billingCode":"31086","codeType":"CPT"},{"id":9368,"precertRequired":true,"billingCode":"31087","codeType":"CPT"},{"id":9369,"precertRequired":true,"billingCode":"31090","codeType":"CPT"},{"id":9370,"precertRequired":true,"billingCode":"31200","codeType":"CPT"},{"id":9371,"precertRequired":true,"billingCode":"31201","codeType":"CPT"},{"id":9372,"precertRequired":true,"billingCode":"31205","codeType":"CPT"},{"id":9373,"precertRequired":true,"billingCode":"31238","codeType":"CPT"},{"id":9374,"precertRequired":true,"billingCode":"31239","codeType":"CPT"},{"id":9375,"precertRequired":true,"billingCode":"31240","codeType":"CPT"},{"id":9376,"precertRequired":true,"billingCode":"31241","codeType":"CPT"},{"id":9377,"precertRequired":true,"billingCode":"31253","codeType":"CPT"},{"id":9378,"precertRequired":true,"billingCode":"31254","codeType":"CPT"},{"id":9379,"precertRequired":true,"billingCode":"31255","codeType":"CPT"},{"id":9380,"precertRequired":true,"billingCode":"31256","codeType":"CPT"},{"id":9381,"precertRequired":true,"billingCode":"31257","codeType":"CPT"},{"id":9382,"precertRequired":true,"billingCode":"31259","codeType":"CPT"},{"id":9383,"precertRequired":true,"billingCode":"31267","codeType":"CPT"},{"id":9384,"precertRequired":true,"billingCode":"31276","codeType":"CPT"},{"id":9385,"precertRequired":true,"billingCode":"31287","codeType":"CPT"},{"id":9386,"precertRequired":true,"billingCode":"31288","codeType":"CPT"},{"id":9387,"precertRequired":true,"billingCode":"31290","codeType":"CPT"},{"id":9388,"precertRequired":true,"billingCode":"31291","codeType":"CPT"},{"id":9389,"precertRequired":true,"billingCode":"31292","codeType":"CPT"},{"id":9390,"precertRequired":true,"billingCode":"31293","codeType":"CPT"},{"id":9391,"precertRequired":true,"billingCode":"31294","codeType":"CPT"},{"id":9392,"precertRequired":true,"billingCode":"31295","codeType":"CPT"},{"id":9393,"precertRequired":true,"billingCode":"31296","codeType":"CPT"},{"id":9394,"precertRequired":true,"billingCode":"31297","codeType":"CPT"},{"id":9395,"precertRequired":true,"billingCode":"31298","codeType":"CPT"},{"id":9396,"precertRequired":true,"billingCode":"31300","codeType":"CPT"},{"id":9397,"precertRequired":true,"billingCode":"31360","codeType":"CPT"},{"id":9398,"precertRequired":true,"billingCode":"31365","codeType":"CPT"},{"id":9399,"precertRequired":true,"billingCode":"31367","codeType":"CPT"},{"id":9400,"precertRequired":true,"billingCode":"31368","codeType":"CPT"},{"id":9401,"precertRequired":true,"billingCode":"31370","codeType":"CPT"},{"id":9402,"precertRequired":true,"billingCode":"31375","codeType":"CPT"},{"id":9403,"precertRequired":true,"billingCode":"31380","codeType":"CPT"},{"id":9404,"precertRequired":true,"billingCode":"31382","codeType":"CPT"},{"id":9405,"precertRequired":true,"billingCode":"31390","codeType":"CPT"},{"id":9406,"precertRequired":true,"billingCode":"31395","codeType":"CPT"},{"id":9407,"precertRequired":true,"billingCode":"31515","codeType":"CPT"},{"id":9408,"precertRequired":true,"billingCode":"31527","codeType":"CPT"},{"id":9409,"precertRequired":true,"billingCode":"31530","codeType":"CPT"},{"id":9410,"precertRequired":true,"billingCode":"31531","codeType":"CPT"},{"id":9411,"precertRequired":true,"billingCode":"31545","codeType":"CPT"},{"id":9412,"precertRequired":true,"billingCode":"31546","codeType":"CPT"},{"id":9413,"precertRequired":true,"billingCode":"31552","codeType":"CPT"},{"id":9414,"precertRequired":true,"billingCode":"31554","codeType":"CPT"},{"id":9415,"precertRequired":true,"billingCode":"31560","codeType":"CPT"},{"id":9416,"precertRequired":true,"billingCode":"31561","codeType":"CPT"},{"id":9417,"precertRequired":true,"billingCode":"31570","codeType":"CPT"},{"id":9418,"precertRequired":true,"billingCode":"31571","codeType":"CPT"},{"id":9434,"precertRequired":true,"billingCode":"40810","codeType":"CPT"},{"id":9435,"precertRequired":true,"billingCode":"40812","codeType":"CPT"},{"id":9436,"precertRequired":true,"billingCode":"40814","codeType":"CPT"},{"id":9437,"precertRequired":true,"billingCode":"40816","codeType":"CPT"},{"id":9439,"precertRequired":true,"billingCode":"40820","codeType":"CPT"},{"id":9447,"precertRequired":false,"billingCode":"41005","codeType":"CPT"},{"id":9448,"precertRequired":false,"billingCode":"41006","codeType":"CPT"},{"id":9449,"precertRequired":false,"billingCode":"41007","codeType":"CPT"},{"id":9450,"precertRequired":false,"billingCode":"41008","codeType":"CPT"},{"id":9451,"precertRequired":false,"billingCode":"41009","codeType":"CPT"},{"id":9452,"precertRequired":true,"billingCode":"41010","codeType":"CPT"},{"id":9453,"precertRequired":false,"billingCode":"41015","codeType":"CPT"},{"id":9454,"precertRequired":false,"billingCode":"41016","codeType":"CPT"},{"id":9455,"precertRequired":false,"billingCode":"41017","codeType":"CPT"},{"id":9456,"precertRequired":false,"billingCode":"41018","codeType":"CPT"},{"id":9457,"precertRequired":false,"billingCode":"41110","codeType":"CPT"},{"id":9458,"precertRequired":false,"billingCode":"41112","codeType":"CPT"},{"id":9459,"precertRequired":false,"billingCode":"41113","codeType":"CPT"},{"id":9460,"precertRequired":false,"billingCode":"41114","codeType":"CPT"},{"id":9461,"precertRequired":false,"billingCode":"41115","codeType":"CPT"},{"id":9462,"precertRequired":false,"billingCode":"41116","codeType":"CPT"},{"id":9463,"precertRequired":true,"billingCode":"41120","codeType":"CPT"},{"id":9464,"precertRequired":true,"billingCode":"41130","codeType":"CPT"},{"id":9465,"precertRequired":true,"billingCode":"41135","codeType":"CPT"},{"id":9466,"precertRequired":true,"billingCode":"41140","codeType":"CPT"},{"id":9467,"precertRequired":true,"billingCode":"41145","codeType":"CPT"},{"id":9468,"precertRequired":true,"billingCode":"41150","codeType":"CPT"},{"id":9469,"precertRequired":true,"billingCode":"41153","codeType":"CPT"},{"id":9470,"precertRequired":true,"billingCode":"41155","codeType":"CPT"},{"id":9471,"precertRequired":false,"billingCode":"41251","codeType":"CPT"},{"id":9472,"precertRequired":false,"billingCode":"41252","codeType":"CPT"},{"id":9473,"precertRequired":false,"billingCode":"41510","codeType":"CPT"},{"id":9474,"precertRequired":true,"billingCode":"41512","codeType":"CPT"},{"id":9475,"precertRequired":true,"billingCode":"41520","codeType":"CPT"},{"id":9515,"precertRequired":true,"billingCode":"42408","codeType":"CPT"},{"id":9516,"precertRequired":true,"billingCode":"42415","codeType":"CPT"},{"id":9517,"precertRequired":true,"billingCode":"42440","codeType":"CPT"},{"id":9518,"precertRequired":true,"billingCode":"42810","codeType":"CPT"},{"id":9519,"precertRequired":true,"billingCode":"42815","codeType":"CPT"},{"id":9520,"precertRequired":true,"billingCode":"42821","codeType":"CPT"},{"id":9521,"precertRequired":true,"billingCode":"42826","codeType":"CPT"},{"id":9522,"precertRequired":true,"billingCode":"42831","codeType":"CPT"},{"id":9523,"precertRequired":true,"billingCode":"42836","codeType":"CPT"},{"id":9524,"precertRequired":true,"billingCode":"42842","codeType":"CPT"},{"id":9525,"precertRequired":true,"billingCode":"42844","codeType":"CPT"},{"id":9526,"precertRequired":true,"billingCode":"42845","codeType":"CPT"},{"id":9859,"precertRequired":false,"billingCode":"61782","codeType":"CPT"},{"id":9860,"precertRequired":false,"billingCode":"30915","codeType":"CPT"},{"id":9861,"precertRequired":false,"billingCode":"30920","codeType":"CPT"},{"id":9865,"precertRequired":false,"billingCode":"42808","codeType":"CPT"},{"id":9866,"precertRequired":false,"billingCode":"42860","codeType":"CPT"},{"id":9867,"precertRequired":false,"billingCode":"42870","codeType":"CPT"},{"id":9868,"precertRequired":false,"billingCode":"42890","codeType":"CPT"},{"id":9869,"precertRequired":false,"billingCode":"42892","codeType":"CPT"},{"id":9871,"precertRequired":false,"billingCode":"69005","codeType":"CPT"},{"id":9872,"precertRequired":false,"billingCode":"69020","codeType":"CPT"},{"id":9873,"precertRequired":false,"billingCode":"69110","codeType":"CPT"},{"id":9874,"precertRequired":false,"billingCode":"69120","codeType":"CPT"},{"id":9875,"precertRequired":false,"billingCode":"69140","codeType":"CPT"},{"id":9876,"precertRequired":false,"billingCode":"69145","codeType":"CPT"},{"id":9877,"precertRequired":false,"billingCode":"69150","codeType":"CPT"},{"id":9878,"precertRequired":false,"billingCode":"69155","codeType":"CPT"},{"id":9879,"precertRequired":false,"billingCode":"69300","codeType":"CPT"},{"id":9880,"precertRequired":false,"billingCode":"69310","codeType":"CPT"},{"id":9881,"precertRequired":false,"billingCode":"69320","codeType":"CPT"},{"id":9882,"precertRequired":false,"billingCode":"69421","codeType":"CPT"},{"id":9883,"precertRequired":false,"billingCode":"69424","codeType":"CPT"},{"id":9884,"precertRequired":false,"billingCode":"69436","codeType":"CPT"},{"id":9885,"precertRequired":false,"billingCode":"69440","codeType":"CPT"},{"id":9886,"precertRequired":false,"billingCode":"69450","codeType":"CPT"},{"id":9887,"precertRequired":false,"billingCode":"69501","codeType":"CPT"},{"id":9888,"precertRequired":false,"billingCode":"69502","codeType":"CPT"},{"id":9889,"precertRequired":false,"billingCode":"69505","codeType":"CPT"},{"id":9890,"precertRequired":false,"billingCode":"69511","codeType":"CPT"},{"id":9891,"precertRequired":false,"billingCode":"69530","codeType":"CPT"},{"id":9892,"precertRequired":false,"billingCode":"69535","codeType":"CPT"},{"id":9893,"precertRequired":false,"billingCode":"69550","codeType":"CPT"},{"id":9894,"precertRequired":false,"billingCode":"69554","codeType":"CPT"},{"id":9895,"precertRequired":false,"billingCode":"69610","codeType":"CPT"},{"id":9896,"precertRequired":false,"billingCode":"69620","codeType":"CPT"},{"id":9897,"precertRequired":false,"billingCode":"69631","codeType":"CPT"},{"id":9898,"precertRequired":false,"billingCode":"69632","codeType":"CPT"},{"id":9899,"precertRequired":false,"billingCode":"69633","codeType":"CPT"},{"id":9900,"precertRequired":false,"billingCode":"69635","codeType":"CPT"},{"id":9901,"precertRequired":false,"billingCode":"69636","codeType":"CPT"},{"id":9902,"precertRequired":false,"billingCode":"69637","codeType":"CPT"},{"id":9903,"precertRequired":false,"billingCode":"69641","codeType":"CPT"},{"id":9904,"precertRequired":false,"billingCode":"69642","codeType":"CPT"},{"id":9905,"precertRequired":false,"billingCode":"69644","codeType":"CPT"},{"id":9906,"precertRequired":false,"billingCode":"69643","codeType":"CPT"},{"id":9907,"precertRequired":false,"billingCode":"69645","codeType":"CPT"},{"id":9908,"precertRequired":false,"billingCode":"69646","codeType":"CPT"},{"id":9909,"precertRequired":false,"billingCode":"69650","codeType":"CPT"},{"id":9910,"precertRequired":false,"billingCode":"69660","codeType":"CPT"},{"id":9911,"precertRequired":false,"billingCode":"69661","codeType":"CPT"},{"id":9912,"precertRequired":false,"billingCode":"69662","codeType":"CPT"},{"id":9913,"precertRequired":false,"billingCode":"69666","codeType":"CPT"},{"id":9914,"precertRequired":false,"billingCode":"69667","codeType":"CPT"},{"id":9915,"precertRequired":false,"billingCode":"69720","codeType":"CPT"},{"id":9916,"precertRequired":false,"billingCode":"69725","codeType":"CPT"},{"id":9917,"precertRequired":false,"billingCode":"69740","codeType":"CPT"},{"id":9918,"precertRequired":false,"billingCode":"69745","codeType":"CPT"},{"id":9919,"precertRequired":false,"billingCode":"69801","codeType":"CPT"},{"id":9920,"precertRequired":false,"billingCode":"69915","codeType":"CPT"},{"id":9921,"precertRequired":false,"billingCode":"69950","codeType":"CPT"},{"id":9922,"precertRequired":false,"billingCode":"69955","codeType":"CPT"},{"id":9923,"precertRequired":false,"billingCode":"69960","codeType":"CPT"},{"id":9924,"precertRequired":false,"billingCode":"69970","codeType":"CPT"},{"id":9925,"precertRequired":false,"billingCode":"C9745","codeType":"HCPCS"},{"id":9926,"precertRequired":false,"billingCode":"42894","codeType":"CPT"},{"id":9927,"precertRequired":false,"billingCode":"69552","codeType":"CPT"},{"id":9943,"precertRequired":false,"billingCode":"69676","codeType":"CPT"},{"id":9982,"precertRequired":false,"billingCode":"42305","codeType":"CPT"},{"id":9983,"precertRequired":false,"billingCode":"42500","codeType":"CPT"},{"id":9984,"precertRequired":false,"billingCode":"42505","codeType":"CPT"},{"id":9985,"precertRequired":false,"billingCode":"42950","codeType":"CPT"},{"id":11377,"precertRequired":false,"billingCode":"30210","codeType":"CPT"},{"id":11378,"precertRequired":false,"billingCode":"30320","codeType":"CPT"},{"id":11379,"precertRequired":false,"billingCode":"31511","codeType":"CPT"},{"id":11380,"precertRequired":false,"billingCode":"31513","codeType":"CPT"},{"id":11381,"precertRequired":false,"billingCode":"42320","codeType":"CPT"},{"id":11382,"precertRequired":false,"billingCode":"42335","codeType":"CPT"},{"id":11383,"precertRequired":false,"billingCode":"42340","codeType":"CPT"},{"id":11384,"precertRequired":false,"billingCode":"42400","codeType":"CPT"},{"id":11385,"precertRequired":false,"billingCode":"42405","codeType":"CPT"},{"id":11386,"precertRequired":false,"billingCode":"42409","codeType":"CPT"},{"id":11387,"precertRequired":false,"billingCode":"42410","codeType":"CPT"},{"id":11388,"precertRequired":false,"billingCode":"42420","codeType":"CPT"},{"id":11389,"precertRequired":false,"billingCode":"42425","codeType":"CPT"},{"id":11390,"precertRequired":false,"billingCode":"42426","codeType":"CPT"},{"id":11391,"precertRequired":false,"billingCode":"42450","codeType":"CPT"},{"id":11392,"precertRequired":false,"billingCode":"42507","codeType":"CPT"},{"id":11393,"precertRequired":false,"billingCode":"42509","codeType":"CPT"},{"id":11394,"precertRequired":false,"billingCode":"42510","codeType":"CPT"},{"id":11395,"precertRequired":false,"billingCode":"42600","codeType":"CPT"},{"id":11396,"precertRequired":false,"billingCode":"42650","codeType":"CPT"},{"id":11397,"precertRequired":false,"billingCode":"42660","codeType":"CPT"},{"id":11398,"precertRequired":false,"billingCode":"42665","codeType":"CPT"},{"id":11399,"precertRequired":false,"billingCode":"42720","codeType":"CPT"},{"id":11400,"precertRequired":false,"billingCode":"42725","codeType":"CPT"},{"id":11401,"precertRequired":false,"billingCode":"42900","codeType":"CPT"},{"id":11402,"precertRequired":false,"billingCode":"42953","codeType":"CPT"},{"id":11403,"precertRequired":false,"billingCode":"42955","codeType":"CPT"},{"id":11404,"precertRequired":false,"billingCode":"42960","codeType":"CPT"},{"id":11405,"precertRequired":false,"billingCode":"42961","codeType":"CPT"},{"id":11406,"precertRequired":false,"billingCode":"42962","codeType":"CPT"},{"id":11407,"precertRequired":false,"billingCode":"42970","codeType":"CPT"},{"id":11408,"precertRequired":false,"billingCode":"42971","codeType":"CPT"},{"id":11409,"precertRequired":false,"billingCode":"42972","codeType":"CPT"},{"id":11410,"precertRequired":false,"billingCode":"69670","codeType":"CPT"},{"id":11411,"precertRequired":false,"billingCode":"69700","codeType":"CPT"},{"id":11412,"precertRequired":false,"billingCode":"69805","codeType":"CPT"},{"id":11413,"precertRequired":false,"billingCode":"69806","codeType":"CPT"},{"id":11414,"precertRequired":false,"billingCode":"69905","codeType":"CPT"},{"id":11415,"precertRequired":false,"billingCode":"69910","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1968,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":1,"precertRequired":false,"billingCode":"00100","codeType":"CPT"},{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":14,"precertRequired":false,"billingCode":"00160","codeType":"CPT"},{"id":15,"precertRequired":false,"billingCode":"00162","codeType":"CPT"},{"id":16,"precertRequired":false,"billingCode":"00164","codeType":"CPT"},{"id":19,"precertRequired":false,"billingCode":"00174","codeType":"CPT"},{"id":20,"precertRequired":false,"billingCode":"00176","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":33,"precertRequired":false,"billingCode":"00320","codeType":"CPT"},{"id":34,"precertRequired":false,"billingCode":"00322","codeType":"CPT"},{"id":55,"precertRequired":false,"billingCode":"00539","codeType":"CPT"},{"id":217,"precertRequired":false,"billingCode":"01991","codeType":"CPT"},{"id":218,"precertRequired":false,"billingCode":"01992","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":5033,"precertRequired":false,"billingCode":"80176","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1969,"description":"Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR, echo)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1970,"description":"Inpatient or observation admission for surgical procedure if indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":8189,"precertRequired":false,"billingCode":"G0378","codeType":"HCPCS"},{"id":8190,"precertRequired":false,"billingCode":"G0379","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1971,"description":"Inpatient admission or observation status for complications related to the procedure or surgery\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure or surgery","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":8189,"precertRequired":false,"billingCode":"G0378","codeType":"HCPCS"},{"id":8190,"precertRequired":false,"billingCode":"G0379","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1972,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1977,"description":"Post-op Speech/Voice Therapy, if medically indicated, up to 15 visits; Notify VA to request additional visits with supporting medical documentation","frequency":null,"frequencyType":"week","visits":15,"codeRequired":"YES","clinicalServices":[{"clinicalService":"15-Speech language pathologist "}],"billingCodes":[{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":6767,"precertRequired":false,"billingCode":"92606","codeType":"CPT"},{"id":6770,"precertRequired":true,"billingCode":"92609","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7342,"precertRequired":false,"billingCode":"99183","codeType":"CPT"},{"id":8294,"precertRequired":true,"billingCode":"G8999","codeType":"HCPCS"},{"id":8299,"precertRequired":true,"billingCode":"G9158","codeType":"HCPCS"},{"id":8300,"precertRequired":true,"billingCode":"G9159","codeType":"HCPCS"},{"id":8301,"precertRequired":true,"billingCode":"G9160","codeType":"HCPCS"},{"id":8302,"precertRequired":true,"billingCode":"G9161","codeType":"HCPCS"},{"id":8303,"precertRequired":true,"billingCode":"G9162","codeType":"HCPCS"},{"id":8304,"precertRequired":true,"billingCode":"G9163","codeType":"HCPCS"},{"id":8305,"precertRequired":true,"billingCode":"G9164","codeType":"HCPCS"},{"id":8306,"precertRequired":true,"billingCode":"G9170","codeType":"HCPCS"},{"id":8307,"precertRequired":true,"billingCode":"G9171","codeType":"HCPCS"},{"id":8308,"precertRequired":false,"billingCode":"G9172","codeType":"HCPCS"},{"id":8309,"precertRequired":true,"billingCode":"G9173","codeType":"HCPCS"},{"id":8310,"precertRequired":true,"billingCode":"G9174","codeType":"HCPCS"},{"id":8311,"precertRequired":true,"billingCode":"G9175","codeType":"HCPCS"},{"id":8312,"precertRequired":true,"billingCode":"G9176","codeType":"HCPCS"},{"id":8313,"precertRequired":true,"billingCode":"G9186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"235Z00000X"}]}]}},{"Seoc":{"id":336,"seocKey":51,"name":"ENT_PRCT","seocId":"SSC_ENT_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"03-15-2019","endDate":"05-07-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation and treatment for the referred condition on the consult \r\n2.   Diagnostic imaging relevant to the referred condition on the consult \r\n3.   Labs and pathology relevant to the referred condition on the consult\r\n4.   Diagnostic studies relevant to the referred condition on the consult \r\n5.   Procedures, as clinically indicated, including but not limited to: Laryngoscopy, nasal endoscopy, biopsy, tracheostomy/tracheostomy management, Botox injections, etc. \r\n6.    Anesthesia consultation related to the procedure \r\n7.    Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR \r\n8.    Inpatient or observation admission for surgical procedure if indicated\r\n9.    Inpatient admission or observation status for complications related to the procedure or surgery\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure or surgery\r\n10.    Follow-up visits for this episode of care \r\n11.   Follow-up imaging as clinically necessary relevant to the referred condition on the consult \r\n12.   Follow-up studies as clinically necessary relevant to the referred condition on the consult \r\n13.  Speech/Voice Therapy as indicated; up to three (3) visits per week x 5 weeks (15 visits); Notify VA to request additional visits with supporting medical documentation\r\n14.  Post-Op Speech/Voice Therapy as indicated; up to three (3) visits per week x 8 weeks (24 visits); Notify VA to request additional visits with supporting medical documentation","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and \r\ncan submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ENT","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207Y00000X"}],"services":[{"id":1593,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1594,"description":"Diagnostic imaging relevant to the referred condition","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4832,"precertRequired":false,"billingCode":"77386","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":8249,"precertRequired":false,"billingCode":"G6002","codeType":"HCPCS"},{"id":9765,"precertRequired":false,"billingCode":"70355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1595,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5374,"precertRequired":false,"billingCode":"82043","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5745,"precertRequired":false,"billingCode":"84560","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1596,"description":" Diagnostic studies relevant to the referred condition on the consult ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":6701,"precertRequired":true,"billingCode":"92502","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"},{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6705,"precertRequired":true,"billingCode":"92508","codeType":"CPT"},{"id":6706,"precertRequired":false,"billingCode":"92511","codeType":"CPT"},{"id":6707,"precertRequired":false,"billingCode":"92512","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6712,"precertRequired":false,"billingCode":"92531","codeType":"CPT"},{"id":6713,"precertRequired":false,"billingCode":"92532","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6763,"precertRequired":true,"billingCode":"92597","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6769,"precertRequired":true,"billingCode":"92608","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6964,"precertRequired":false,"billingCode":"93799","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"},{"id":7170,"precertRequired":true,"billingCode":"96105","codeType":"CPT"},{"id":7171,"precertRequired":true,"billingCode":"96110","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7283,"precertRequired":false,"billingCode":"97602","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":9782,"precertRequired":false,"billingCode":"96112","codeType":"CPT"},{"id":9783,"precertRequired":false,"billingCode":"96113","codeType":"CPT"},{"id":9862,"precertRequired":false,"billingCode":"92516","codeType":"CPT"},{"id":9863,"precertRequired":false,"billingCode":"92520","codeType":"CPT"},{"id":9864,"precertRequired":false,"billingCode":"92526","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1597,"description":"Procedures, as clinically indicated, including but not limited to: Laryngoscopy, nasal endoscopy, biopsy, tracheostomy/tracheostomy management, botox injections, etc. ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":598,"precertRequired":false,"billingCode":"20926","codeType":"CPT"},{"id":645,"precertRequired":false,"billingCode":"21230","codeType":"CPT"},{"id":646,"precertRequired":false,"billingCode":"21235","codeType":"CPT"},{"id":669,"precertRequired":false,"billingCode":"21315","codeType":"CPT"},{"id":670,"precertRequired":false,"billingCode":"21320","codeType":"CPT"},{"id":671,"precertRequired":false,"billingCode":"21325","codeType":"CPT"},{"id":672,"precertRequired":false,"billingCode":"21330","codeType":"CPT"},{"id":673,"precertRequired":false,"billingCode":"21335","codeType":"CPT"},{"id":674,"precertRequired":false,"billingCode":"21336","codeType":"CPT"},{"id":675,"precertRequired":false,"billingCode":"21337","codeType":"CPT"},{"id":676,"precertRequired":false,"billingCode":"21338","codeType":"CPT"},{"id":677,"precertRequired":false,"billingCode":"21339","codeType":"CPT"},{"id":678,"precertRequired":false,"billingCode":"21340","codeType":"CPT"},{"id":679,"precertRequired":false,"billingCode":"21343","codeType":"CPT"},{"id":680,"precertRequired":false,"billingCode":"21344","codeType":"CPT"},{"id":681,"precertRequired":false,"billingCode":"21345","codeType":"CPT"},{"id":682,"precertRequired":false,"billingCode":"21346","codeType":"CPT"},{"id":683,"precertRequired":false,"billingCode":"21347","codeType":"CPT"},{"id":684,"precertRequired":false,"billingCode":"21348","codeType":"CPT"},{"id":1975,"precertRequired":false,"billingCode":"30100","codeType":"CPT"},{"id":1976,"precertRequired":false,"billingCode":"30110","codeType":"CPT"},{"id":1977,"precertRequired":false,"billingCode":"30115","codeType":"CPT"},{"id":1978,"precertRequired":false,"billingCode":"30200","codeType":"CPT"},{"id":1979,"precertRequired":false,"billingCode":"30300","codeType":"CPT"},{"id":1980,"precertRequired":false,"billingCode":"30560","codeType":"CPT"},{"id":1981,"precertRequired":false,"billingCode":"30801","codeType":"CPT"},{"id":1982,"precertRequired":false,"billingCode":"30802","codeType":"CPT"},{"id":1983,"precertRequired":false,"billingCode":"30901","codeType":"CPT"},{"id":1984,"precertRequired":false,"billingCode":"30903","codeType":"CPT"},{"id":1985,"precertRequired":false,"billingCode":"30905","codeType":"CPT"},{"id":1986,"precertRequired":false,"billingCode":"30906","codeType":"CPT"},{"id":1987,"precertRequired":false,"billingCode":"30930","codeType":"CPT"},{"id":1988,"precertRequired":false,"billingCode":"31000","codeType":"CPT"},{"id":1989,"precertRequired":false,"billingCode":"31002","codeType":"CPT"},{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1993,"precertRequired":false,"billingCode":"31237","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2000,"precertRequired":false,"billingCode":"31528","codeType":"CPT"},{"id":2001,"precertRequired":false,"billingCode":"31529","codeType":"CPT"},{"id":2002,"precertRequired":false,"billingCode":"31535","codeType":"CPT"},{"id":2003,"precertRequired":false,"billingCode":"31536","codeType":"CPT"},{"id":2004,"precertRequired":false,"billingCode":"31540","codeType":"CPT"},{"id":2005,"precertRequired":false,"billingCode":"31541","codeType":"CPT"},{"id":2006,"precertRequired":false,"billingCode":"31572","codeType":"CPT"},{"id":2007,"precertRequired":false,"billingCode":"31573","codeType":"CPT"},{"id":2008,"precertRequired":false,"billingCode":"31574","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2011,"precertRequired":false,"billingCode":"31577","codeType":"CPT"},{"id":2012,"precertRequired":false,"billingCode":"31578","codeType":"CPT"},{"id":2013,"precertRequired":true,"billingCode":"31579","codeType":"CPT"},{"id":2014,"precertRequired":false,"billingCode":"31600","codeType":"CPT"},{"id":2016,"precertRequired":false,"billingCode":"31603","codeType":"CPT"},{"id":2017,"precertRequired":false,"billingCode":"31605","codeType":"CPT"},{"id":2018,"precertRequired":false,"billingCode":"31610","codeType":"CPT"},{"id":2019,"precertRequired":false,"billingCode":"31611","codeType":"CPT"},{"id":2020,"precertRequired":false,"billingCode":"31612","codeType":"CPT"},{"id":2021,"precertRequired":false,"billingCode":"31613","codeType":"CPT"},{"id":2022,"precertRequired":false,"billingCode":"31614","codeType":"CPT"},{"id":2023,"precertRequired":false,"billingCode":"31615","codeType":"CPT"},{"id":2024,"precertRequired":false,"billingCode":"31622","codeType":"CPT"},{"id":2056,"precertRequired":false,"billingCode":"31720","codeType":"CPT"},{"id":2057,"precertRequired":false,"billingCode":"31725","codeType":"CPT"},{"id":2058,"precertRequired":false,"billingCode":"31730","codeType":"CPT"},{"id":2059,"precertRequired":false,"billingCode":"31750","codeType":"CPT"},{"id":2060,"precertRequired":false,"billingCode":"31755","codeType":"CPT"},{"id":2061,"precertRequired":false,"billingCode":"31760","codeType":"CPT"},{"id":2062,"precertRequired":false,"billingCode":"31766","codeType":"CPT"},{"id":2065,"precertRequired":false,"billingCode":"31780","codeType":"CPT"},{"id":2066,"precertRequired":false,"billingCode":"31781","codeType":"CPT"},{"id":2067,"precertRequired":false,"billingCode":"31785","codeType":"CPT"},{"id":2068,"precertRequired":false,"billingCode":"31786","codeType":"CPT"},{"id":2069,"precertRequired":false,"billingCode":"31800","codeType":"CPT"},{"id":2070,"precertRequired":false,"billingCode":"31805","codeType":"CPT"},{"id":2071,"precertRequired":false,"billingCode":"31820","codeType":"CPT"},{"id":2072,"precertRequired":false,"billingCode":"31825","codeType":"CPT"},{"id":2073,"precertRequired":false,"billingCode":"31830","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2724,"precertRequired":false,"billingCode":"41000","codeType":"CPT"},{"id":2725,"precertRequired":false,"billingCode":"41100","codeType":"CPT"},{"id":2727,"precertRequired":false,"billingCode":"41108","codeType":"CPT"},{"id":2728,"precertRequired":false,"billingCode":"41250","codeType":"CPT"},{"id":2730,"precertRequired":false,"billingCode":"42300","codeType":"CPT"},{"id":2731,"precertRequired":false,"billingCode":"42310","codeType":"CPT"},{"id":2732,"precertRequired":false,"billingCode":"42330","codeType":"CPT"},{"id":2733,"precertRequired":false,"billingCode":"42550","codeType":"CPT"},{"id":2734,"precertRequired":false,"billingCode":"42700","codeType":"CPT"},{"id":2735,"precertRequired":false,"billingCode":"42800","codeType":"CPT"},{"id":2736,"precertRequired":false,"billingCode":"42804","codeType":"CPT"},{"id":2737,"precertRequired":false,"billingCode":"42806","codeType":"CPT"},{"id":2738,"precertRequired":false,"billingCode":"42809","codeType":"CPT"},{"id":3763,"precertRequired":false,"billingCode":"58999","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3981,"precertRequired":true,"billingCode":"64617","codeType":"CPT"},{"id":4060,"precertRequired":false,"billingCode":"64864","codeType":"CPT"},{"id":4083,"precertRequired":false,"billingCode":"64999","codeType":"CPT"},{"id":4348,"precertRequired":false,"billingCode":"69000","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":4350,"precertRequired":false,"billingCode":"69105","codeType":"CPT"},{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4356,"precertRequired":true,"billingCode":"69222","codeType":"CPT"},{"id":4357,"precertRequired":false,"billingCode":"69420","codeType":"CPT"},{"id":4358,"precertRequired":false,"billingCode":"69433","codeType":"CPT"},{"id":4359,"precertRequired":false,"billingCode":"69540","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7459,"precertRequired":false,"billingCode":"99406","codeType":"CPT"},{"id":7579,"precertRequired":false,"billingCode":"0485T","codeType":"CPT"},{"id":7580,"precertRequired":false,"billingCode":"0486T","codeType":"CPT"},{"id":8168,"precertRequired":false,"billingCode":"G0268","codeType":"HCPCS"},{"id":8378,"precertRequired":false,"billingCode":"J0585","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9193,"precertRequired":false,"billingCode":"21086","codeType":"CPT"},{"id":9231,"precertRequired":true,"billingCode":"21310","codeType":"CPT"},{"id":9343,"precertRequired":true,"billingCode":"30130","codeType":"CPT"},{"id":9344,"precertRequired":true,"billingCode":"30140","codeType":"CPT"},{"id":9345,"precertRequired":true,"billingCode":"30310","codeType":"CPT"},{"id":9348,"precertRequired":true,"billingCode":"30465","codeType":"CPT"},{"id":9349,"precertRequired":true,"billingCode":"30520","codeType":"CPT"},{"id":9350,"precertRequired":true,"billingCode":"30540","codeType":"CPT"},{"id":9351,"precertRequired":true,"billingCode":"30545","codeType":"CPT"},{"id":9352,"precertRequired":true,"billingCode":"30580","codeType":"CPT"},{"id":9353,"precertRequired":true,"billingCode":"30600","codeType":"CPT"},{"id":9354,"precertRequired":true,"billingCode":"30620","codeType":"CPT"},{"id":9355,"precertRequired":true,"billingCode":"30630","codeType":"CPT"},{"id":9356,"precertRequired":true,"billingCode":"31020","codeType":"CPT"},{"id":9357,"precertRequired":true,"billingCode":"31030","codeType":"CPT"},{"id":9358,"precertRequired":true,"billingCode":"31032","codeType":"CPT"},{"id":9359,"precertRequired":true,"billingCode":"31050","codeType":"CPT"},{"id":9360,"precertRequired":true,"billingCode":"31051","codeType":"CPT"},{"id":9361,"precertRequired":true,"billingCode":"31070","codeType":"CPT"},{"id":9362,"precertRequired":true,"billingCode":"31075","codeType":"CPT"},{"id":9363,"precertRequired":true,"billingCode":"31080","codeType":"CPT"},{"id":9364,"precertRequired":true,"billingCode":"31081","codeType":"CPT"},{"id":9365,"precertRequired":true,"billingCode":"31084","codeType":"CPT"},{"id":9366,"precertRequired":true,"billingCode":"31085","codeType":"CPT"},{"id":9367,"precertRequired":true,"billingCode":"31086","codeType":"CPT"},{"id":9368,"precertRequired":true,"billingCode":"31087","codeType":"CPT"},{"id":9369,"precertRequired":true,"billingCode":"31090","codeType":"CPT"},{"id":9370,"precertRequired":true,"billingCode":"31200","codeType":"CPT"},{"id":9371,"precertRequired":true,"billingCode":"31201","codeType":"CPT"},{"id":9372,"precertRequired":true,"billingCode":"31205","codeType":"CPT"},{"id":9373,"precertRequired":true,"billingCode":"31238","codeType":"CPT"},{"id":9374,"precertRequired":true,"billingCode":"31239","codeType":"CPT"},{"id":9375,"precertRequired":true,"billingCode":"31240","codeType":"CPT"},{"id":9376,"precertRequired":true,"billingCode":"31241","codeType":"CPT"},{"id":9377,"precertRequired":true,"billingCode":"31253","codeType":"CPT"},{"id":9378,"precertRequired":true,"billingCode":"31254","codeType":"CPT"},{"id":9379,"precertRequired":true,"billingCode":"31255","codeType":"CPT"},{"id":9380,"precertRequired":true,"billingCode":"31256","codeType":"CPT"},{"id":9381,"precertRequired":true,"billingCode":"31257","codeType":"CPT"},{"id":9382,"precertRequired":true,"billingCode":"31259","codeType":"CPT"},{"id":9383,"precertRequired":true,"billingCode":"31267","codeType":"CPT"},{"id":9384,"precertRequired":true,"billingCode":"31276","codeType":"CPT"},{"id":9385,"precertRequired":true,"billingCode":"31287","codeType":"CPT"},{"id":9386,"precertRequired":true,"billingCode":"31288","codeType":"CPT"},{"id":9387,"precertRequired":true,"billingCode":"31290","codeType":"CPT"},{"id":9388,"precertRequired":true,"billingCode":"31291","codeType":"CPT"},{"id":9389,"precertRequired":true,"billingCode":"31292","codeType":"CPT"},{"id":9390,"precertRequired":true,"billingCode":"31293","codeType":"CPT"},{"id":9391,"precertRequired":true,"billingCode":"31294","codeType":"CPT"},{"id":9392,"precertRequired":true,"billingCode":"31295","codeType":"CPT"},{"id":9393,"precertRequired":true,"billingCode":"31296","codeType":"CPT"},{"id":9394,"precertRequired":true,"billingCode":"31297","codeType":"CPT"},{"id":9395,"precertRequired":true,"billingCode":"31298","codeType":"CPT"},{"id":9396,"precertRequired":true,"billingCode":"31300","codeType":"CPT"},{"id":9397,"precertRequired":true,"billingCode":"31360","codeType":"CPT"},{"id":9398,"precertRequired":true,"billingCode":"31365","codeType":"CPT"},{"id":9399,"precertRequired":true,"billingCode":"31367","codeType":"CPT"},{"id":9400,"precertRequired":true,"billingCode":"31368","codeType":"CPT"},{"id":9401,"precertRequired":true,"billingCode":"31370","codeType":"CPT"},{"id":9402,"precertRequired":true,"billingCode":"31375","codeType":"CPT"},{"id":9403,"precertRequired":true,"billingCode":"31380","codeType":"CPT"},{"id":9404,"precertRequired":true,"billingCode":"31382","codeType":"CPT"},{"id":9405,"precertRequired":true,"billingCode":"31390","codeType":"CPT"},{"id":9406,"precertRequired":true,"billingCode":"31395","codeType":"CPT"},{"id":9407,"precertRequired":true,"billingCode":"31515","codeType":"CPT"},{"id":9408,"precertRequired":true,"billingCode":"31527","codeType":"CPT"},{"id":9409,"precertRequired":true,"billingCode":"31530","codeType":"CPT"},{"id":9410,"precertRequired":true,"billingCode":"31531","codeType":"CPT"},{"id":9411,"precertRequired":true,"billingCode":"31545","codeType":"CPT"},{"id":9412,"precertRequired":true,"billingCode":"31546","codeType":"CPT"},{"id":9413,"precertRequired":true,"billingCode":"31552","codeType":"CPT"},{"id":9414,"precertRequired":true,"billingCode":"31554","codeType":"CPT"},{"id":9415,"precertRequired":true,"billingCode":"31560","codeType":"CPT"},{"id":9416,"precertRequired":true,"billingCode":"31561","codeType":"CPT"},{"id":9417,"precertRequired":true,"billingCode":"31570","codeType":"CPT"},{"id":9418,"precertRequired":true,"billingCode":"31571","codeType":"CPT"},{"id":9434,"precertRequired":true,"billingCode":"40810","codeType":"CPT"},{"id":9437,"precertRequired":true,"billingCode":"40816","codeType":"CPT"},{"id":9439,"precertRequired":true,"billingCode":"40820","codeType":"CPT"},{"id":9457,"precertRequired":false,"billingCode":"41110","codeType":"CPT"},{"id":9458,"precertRequired":false,"billingCode":"41112","codeType":"CPT"},{"id":9459,"precertRequired":false,"billingCode":"41113","codeType":"CPT"},{"id":9460,"precertRequired":false,"billingCode":"41114","codeType":"CPT"},{"id":9461,"precertRequired":false,"billingCode":"41115","codeType":"CPT"},{"id":9462,"precertRequired":false,"billingCode":"41116","codeType":"CPT"},{"id":9463,"precertRequired":true,"billingCode":"41120","codeType":"CPT"},{"id":9464,"precertRequired":true,"billingCode":"41130","codeType":"CPT"},{"id":9465,"precertRequired":true,"billingCode":"41135","codeType":"CPT"},{"id":9466,"precertRequired":true,"billingCode":"41140","codeType":"CPT"},{"id":9467,"precertRequired":true,"billingCode":"41145","codeType":"CPT"},{"id":9468,"precertRequired":true,"billingCode":"41150","codeType":"CPT"},{"id":9469,"precertRequired":true,"billingCode":"41153","codeType":"CPT"},{"id":9470,"precertRequired":true,"billingCode":"41155","codeType":"CPT"},{"id":9471,"precertRequired":false,"billingCode":"41251","codeType":"CPT"},{"id":9472,"precertRequired":false,"billingCode":"41252","codeType":"CPT"},{"id":9515,"precertRequired":true,"billingCode":"42408","codeType":"CPT"},{"id":9516,"precertRequired":true,"billingCode":"42415","codeType":"CPT"},{"id":9517,"precertRequired":true,"billingCode":"42440","codeType":"CPT"},{"id":9518,"precertRequired":true,"billingCode":"42810","codeType":"CPT"},{"id":9519,"precertRequired":true,"billingCode":"42815","codeType":"CPT"},{"id":9520,"precertRequired":true,"billingCode":"42821","codeType":"CPT"},{"id":9521,"precertRequired":true,"billingCode":"42826","codeType":"CPT"},{"id":9522,"precertRequired":true,"billingCode":"42831","codeType":"CPT"},{"id":9523,"precertRequired":true,"billingCode":"42836","codeType":"CPT"},{"id":9524,"precertRequired":true,"billingCode":"42842","codeType":"CPT"},{"id":9525,"precertRequired":true,"billingCode":"42844","codeType":"CPT"},{"id":9526,"precertRequired":true,"billingCode":"42845","codeType":"CPT"},{"id":9859,"precertRequired":false,"billingCode":"61782","codeType":"CPT"},{"id":9860,"precertRequired":false,"billingCode":"30915","codeType":"CPT"},{"id":9861,"precertRequired":false,"billingCode":"30920","codeType":"CPT"},{"id":9865,"precertRequired":false,"billingCode":"42808","codeType":"CPT"},{"id":9866,"precertRequired":false,"billingCode":"42860","codeType":"CPT"},{"id":9867,"precertRequired":false,"billingCode":"42870","codeType":"CPT"},{"id":9868,"precertRequired":false,"billingCode":"42890","codeType":"CPT"},{"id":9869,"precertRequired":false,"billingCode":"42892","codeType":"CPT"},{"id":9871,"precertRequired":false,"billingCode":"69005","codeType":"CPT"},{"id":9872,"precertRequired":false,"billingCode":"69020","codeType":"CPT"},{"id":9873,"precertRequired":false,"billingCode":"69110","codeType":"CPT"},{"id":9874,"precertRequired":false,"billingCode":"69120","codeType":"CPT"},{"id":9875,"precertRequired":false,"billingCode":"69140","codeType":"CPT"},{"id":9876,"precertRequired":false,"billingCode":"69145","codeType":"CPT"},{"id":9877,"precertRequired":false,"billingCode":"69150","codeType":"CPT"},{"id":9878,"precertRequired":false,"billingCode":"69155","codeType":"CPT"},{"id":9879,"precertRequired":false,"billingCode":"69300","codeType":"CPT"},{"id":9880,"precertRequired":false,"billingCode":"69310","codeType":"CPT"},{"id":9881,"precertRequired":false,"billingCode":"69320","codeType":"CPT"},{"id":9882,"precertRequired":false,"billingCode":"69421","codeType":"CPT"},{"id":9883,"precertRequired":false,"billingCode":"69424","codeType":"CPT"},{"id":9884,"precertRequired":false,"billingCode":"69436","codeType":"CPT"},{"id":9885,"precertRequired":false,"billingCode":"69440","codeType":"CPT"},{"id":9886,"precertRequired":false,"billingCode":"69450","codeType":"CPT"},{"id":9887,"precertRequired":false,"billingCode":"69501","codeType":"CPT"},{"id":9888,"precertRequired":false,"billingCode":"69502","codeType":"CPT"},{"id":9889,"precertRequired":false,"billingCode":"69505","codeType":"CPT"},{"id":9890,"precertRequired":false,"billingCode":"69511","codeType":"CPT"},{"id":9891,"precertRequired":false,"billingCode":"69530","codeType":"CPT"},{"id":9892,"precertRequired":false,"billingCode":"69535","codeType":"CPT"},{"id":9893,"precertRequired":false,"billingCode":"69550","codeType":"CPT"},{"id":9894,"precertRequired":false,"billingCode":"69554","codeType":"CPT"},{"id":9895,"precertRequired":false,"billingCode":"69610","codeType":"CPT"},{"id":9896,"precertRequired":false,"billingCode":"69620","codeType":"CPT"},{"id":9897,"precertRequired":false,"billingCode":"69631","codeType":"CPT"},{"id":9898,"precertRequired":false,"billingCode":"69632","codeType":"CPT"},{"id":9899,"precertRequired":false,"billingCode":"69633","codeType":"CPT"},{"id":9900,"precertRequired":false,"billingCode":"69635","codeType":"CPT"},{"id":9901,"precertRequired":false,"billingCode":"69636","codeType":"CPT"},{"id":9902,"precertRequired":false,"billingCode":"69637","codeType":"CPT"},{"id":9903,"precertRequired":false,"billingCode":"69641","codeType":"CPT"},{"id":9904,"precertRequired":false,"billingCode":"69642","codeType":"CPT"},{"id":9905,"precertRequired":false,"billingCode":"69644","codeType":"CPT"},{"id":9906,"precertRequired":false,"billingCode":"69643","codeType":"CPT"},{"id":9907,"precertRequired":false,"billingCode":"69645","codeType":"CPT"},{"id":9908,"precertRequired":false,"billingCode":"69646","codeType":"CPT"},{"id":9909,"precertRequired":false,"billingCode":"69650","codeType":"CPT"},{"id":9910,"precertRequired":false,"billingCode":"69660","codeType":"CPT"},{"id":9911,"precertRequired":false,"billingCode":"69661","codeType":"CPT"},{"id":9912,"precertRequired":false,"billingCode":"69662","codeType":"CPT"},{"id":9913,"precertRequired":false,"billingCode":"69666","codeType":"CPT"},{"id":9914,"precertRequired":false,"billingCode":"69667","codeType":"CPT"},{"id":9915,"precertRequired":false,"billingCode":"69720","codeType":"CPT"},{"id":9916,"precertRequired":false,"billingCode":"69725","codeType":"CPT"},{"id":9917,"precertRequired":false,"billingCode":"69740","codeType":"CPT"},{"id":9918,"precertRequired":false,"billingCode":"69745","codeType":"CPT"},{"id":9919,"precertRequired":false,"billingCode":"69801","codeType":"CPT"},{"id":9920,"precertRequired":false,"billingCode":"69915","codeType":"CPT"},{"id":9921,"precertRequired":false,"billingCode":"69950","codeType":"CPT"},{"id":9922,"precertRequired":false,"billingCode":"69955","codeType":"CPT"},{"id":9923,"precertRequired":false,"billingCode":"69960","codeType":"CPT"},{"id":9924,"precertRequired":false,"billingCode":"69970","codeType":"CPT"},{"id":9926,"precertRequired":false,"billingCode":"42894","codeType":"CPT"},{"id":9927,"precertRequired":false,"billingCode":"69552","codeType":"CPT"},{"id":9943,"precertRequired":false,"billingCode":"69676","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1598,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":1,"precertRequired":false,"billingCode":"00100","codeType":"CPT"},{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":14,"precertRequired":false,"billingCode":"00160","codeType":"CPT"},{"id":15,"precertRequired":false,"billingCode":"00162","codeType":"CPT"},{"id":16,"precertRequired":false,"billingCode":"00164","codeType":"CPT"},{"id":17,"precertRequired":false,"billingCode":"00170","codeType":"CPT"},{"id":18,"precertRequired":false,"billingCode":"00172","codeType":"CPT"},{"id":21,"precertRequired":false,"billingCode":"00190","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":33,"precertRequired":false,"billingCode":"00320","codeType":"CPT"},{"id":34,"precertRequired":false,"billingCode":"00322","codeType":"CPT"},{"id":55,"precertRequired":false,"billingCode":"00539","codeType":"CPT"},{"id":217,"precertRequired":false,"billingCode":"01991","codeType":"CPT"},{"id":218,"precertRequired":false,"billingCode":"01992","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":5033,"precertRequired":false,"billingCode":"80176","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1599,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1600,"description":"Inpatient or observation admission for surgical procedure if indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7379,"precertRequired":true,"billingCode":"99241","codeType":"CPT"},{"id":7380,"precertRequired":true,"billingCode":"99242","codeType":"CPT"},{"id":7381,"precertRequired":true,"billingCode":"99243","codeType":"CPT"},{"id":7382,"precertRequired":true,"billingCode":"99244","codeType":"CPT"},{"id":7383,"precertRequired":true,"billingCode":"99245","codeType":"CPT"},{"id":7389,"precertRequired":false,"billingCode":"99251","codeType":"CPT"},{"id":7390,"precertRequired":false,"billingCode":"99252","codeType":"CPT"},{"id":7391,"precertRequired":false,"billingCode":"99253","codeType":"CPT"},{"id":7392,"precertRequired":false,"billingCode":"99254","codeType":"CPT"},{"id":7393,"precertRequired":false,"billingCode":"99255","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7488,"precertRequired":false,"billingCode":"99483","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1601,"description":"  Inpatient admission or observation status for complications related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7379,"precertRequired":true,"billingCode":"99241","codeType":"CPT"},{"id":7380,"precertRequired":true,"billingCode":"99242","codeType":"CPT"},{"id":7381,"precertRequired":true,"billingCode":"99243","codeType":"CPT"},{"id":7382,"precertRequired":true,"billingCode":"99244","codeType":"CPT"},{"id":7383,"precertRequired":true,"billingCode":"99245","codeType":"CPT"},{"id":7389,"precertRequired":false,"billingCode":"99251","codeType":"CPT"},{"id":7390,"precertRequired":false,"billingCode":"99252","codeType":"CPT"},{"id":7391,"precertRequired":false,"billingCode":"99253","codeType":"CPT"},{"id":7392,"precertRequired":false,"billingCode":"99254","codeType":"CPT"},{"id":7393,"precertRequired":false,"billingCode":"99255","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7488,"precertRequired":false,"billingCode":"99483","codeType":"CPT"},{"id":8189,"precertRequired":false,"billingCode":"G0378","codeType":"HCPCS"},{"id":8190,"precertRequired":false,"billingCode":"G0379","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1602,"description":"  Follow-up visits for this episode of care ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1603,"description":"Follow-up imaging as clinically necessary relevant to the referred condition on the consult ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4832,"precertRequired":false,"billingCode":"77386","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":9765,"precertRequired":false,"billingCode":"70355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1604,"description":"Follow-up studies as clinically necessary relevant to the referred condition on the consult ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":6701,"precertRequired":true,"billingCode":"92502","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"},{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6705,"precertRequired":true,"billingCode":"92508","codeType":"CPT"},{"id":6706,"precertRequired":false,"billingCode":"92511","codeType":"CPT"},{"id":6707,"precertRequired":false,"billingCode":"92512","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6712,"precertRequired":false,"billingCode":"92531","codeType":"CPT"},{"id":6713,"precertRequired":false,"billingCode":"92532","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6763,"precertRequired":true,"billingCode":"92597","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6769,"precertRequired":true,"billingCode":"92608","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6964,"precertRequired":false,"billingCode":"93799","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"},{"id":7170,"precertRequired":true,"billingCode":"96105","codeType":"CPT"},{"id":7171,"precertRequired":true,"billingCode":"96110","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7283,"precertRequired":false,"billingCode":"97602","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":8249,"precertRequired":false,"billingCode":"G6002","codeType":"HCPCS"},{"id":9782,"precertRequired":false,"billingCode":"96112","codeType":"CPT"},{"id":9783,"precertRequired":false,"billingCode":"96113","codeType":"CPT"},{"id":9862,"precertRequired":false,"billingCode":"92516","codeType":"CPT"},{"id":9863,"precertRequired":false,"billingCode":"92520","codeType":"CPT"},{"id":9864,"precertRequired":false,"billingCode":"92526","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1605,"description":"Speech/Voice Therapy as indicated; up to three (3) visits per week x 5 weeks (15 visits); Notify VA to request additional visits with supporting medical documentation","frequency":3,"frequencyType":"week","visits":15,"codeRequired":"YES","clinicalServices":[{"clinicalService":"15-Speech language pathologist "}],"billingCodes":[{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":6767,"precertRequired":false,"billingCode":"92606","codeType":"CPT"},{"id":6770,"precertRequired":true,"billingCode":"92609","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":8294,"precertRequired":true,"billingCode":"G8999","codeType":"HCPCS"},{"id":8299,"precertRequired":true,"billingCode":"G9158","codeType":"HCPCS"},{"id":8300,"precertRequired":true,"billingCode":"G9159","codeType":"HCPCS"},{"id":8301,"precertRequired":true,"billingCode":"G9160","codeType":"HCPCS"},{"id":8302,"precertRequired":true,"billingCode":"G9161","codeType":"HCPCS"},{"id":8303,"precertRequired":true,"billingCode":"G9162","codeType":"HCPCS"},{"id":8304,"precertRequired":true,"billingCode":"G9163","codeType":"HCPCS"},{"id":8305,"precertRequired":true,"billingCode":"G9164","codeType":"HCPCS"},{"id":8306,"precertRequired":true,"billingCode":"G9170","codeType":"HCPCS"},{"id":8307,"precertRequired":true,"billingCode":"G9171","codeType":"HCPCS"},{"id":8308,"precertRequired":false,"billingCode":"G9172","codeType":"HCPCS"},{"id":8309,"precertRequired":true,"billingCode":"G9173","codeType":"HCPCS"},{"id":8310,"precertRequired":true,"billingCode":"G9174","codeType":"HCPCS"},{"id":8311,"precertRequired":true,"billingCode":"G9175","codeType":"HCPCS"},{"id":8312,"precertRequired":true,"billingCode":"G9176","codeType":"HCPCS"},{"id":8313,"precertRequired":true,"billingCode":"G9186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"235Z00000X"}]},{"id":1606,"description":"Post-Op Speech/Voice Therapy as indicated; up to three (3) visits per week x 8 weeks (24 visits); Notify VA to request additional visits with supporting medical documentation","frequency":3,"frequencyType":"week","visits":24,"codeRequired":"YES","clinicalServices":[{"clinicalService":"15-Speech language pathologist "}],"billingCodes":[{"id":6767,"precertRequired":false,"billingCode":"92606","codeType":"CPT"},{"id":6770,"precertRequired":true,"billingCode":"92609","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7342,"precertRequired":false,"billingCode":"99183","codeType":"CPT"},{"id":8243,"precertRequired":false,"billingCode":"G0515","codeType":"HCPCS"},{"id":8294,"precertRequired":true,"billingCode":"G8999","codeType":"HCPCS"},{"id":8299,"precertRequired":true,"billingCode":"G9158","codeType":"HCPCS"},{"id":8300,"precertRequired":true,"billingCode":"G9159","codeType":"HCPCS"},{"id":8301,"precertRequired":true,"billingCode":"G9160","codeType":"HCPCS"},{"id":8302,"precertRequired":true,"billingCode":"G9161","codeType":"HCPCS"},{"id":8303,"precertRequired":true,"billingCode":"G9162","codeType":"HCPCS"},{"id":8304,"precertRequired":true,"billingCode":"G9163","codeType":"HCPCS"},{"id":8305,"precertRequired":true,"billingCode":"G9164","codeType":"HCPCS"},{"id":8307,"precertRequired":true,"billingCode":"G9171","codeType":"HCPCS"},{"id":8308,"precertRequired":false,"billingCode":"G9172","codeType":"HCPCS"},{"id":8309,"precertRequired":true,"billingCode":"G9173","codeType":"HCPCS"},{"id":8310,"precertRequired":true,"billingCode":"G9174","codeType":"HCPCS"},{"id":8311,"precertRequired":true,"billingCode":"G9175","codeType":"HCPCS"},{"id":8312,"precertRequired":true,"billingCode":"G9176","codeType":"HCPCS"},{"id":8313,"precertRequired":true,"billingCode":"G9186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"235Z00000X"}]}]}},{"Seoc":{"id":317,"seocKey":51,"name":"ENT_PRCT","seocId":"SSC_ENT_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"03-12-2019","endDate":"03-15-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation and treatment for the referred condition on the consult \r\n2.   Diagnostic imaging relevant to the referred condition on the consult \r\n3.   Labs and pathology relevant to the referred condition on the consult\r\n4.   Diagnostic studies relevant to the referred condition on the consult \r\n5.   Procedures, as clinically indicated, including but not limited to: Laryngoscopy, nasal endoscopy, biopsy, tracheostomy/tracheostomy management, Botox injections, etc. \r\n6.    Anesthesia consultation related to the procedure \r\n7.    Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR \r\n8.    Inpatient or observation admission for surgical procedure if indicated\r\n9.    Inpatient admission or observation status for complications related to the procedure or surgery\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure or surgery\r\n10.    Follow-up visits for this episode of care \r\n11.   Follow-up imaging as clinically necessary relevant to the referred condition on the consult \r\n12.   Follow-up studies as clinically necessary relevant to the referred condition on the consult \r\n13.  Speech/Voice Therapy as indicated; up to three (3) visits per week x 5 weeks (15 visits); Notify VA to request additional visits with supporting medical documentation\r\n14.  Post-Op Speech/Voice Therapy as indicated; up to three (3) visits per week x 8 weeks (24 visits); Notify VA to request additional visits with supporting medical documentation","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n*Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n*The Veteran will be required to pay out of pocket for any urgent/emergent medications and \r\ncan submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ENT","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207Y00000X"}],"services":[{"id":1398,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1399,"description":"Diagnostic imaging relevant to the referred condition","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4832,"precertRequired":false,"billingCode":"77386","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":8249,"precertRequired":false,"billingCode":"G6002","codeType":"HCPCS"},{"id":9765,"precertRequired":false,"billingCode":"70355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1462,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5374,"precertRequired":false,"billingCode":"82043","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5745,"precertRequired":false,"billingCode":"84560","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1463,"description":" Diagnostic studies relevant to the referred condition on the consult ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":6701,"precertRequired":true,"billingCode":"92502","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"},{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6705,"precertRequired":true,"billingCode":"92508","codeType":"CPT"},{"id":6706,"precertRequired":false,"billingCode":"92511","codeType":"CPT"},{"id":6707,"precertRequired":false,"billingCode":"92512","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6712,"precertRequired":false,"billingCode":"92531","codeType":"CPT"},{"id":6713,"precertRequired":false,"billingCode":"92532","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6763,"precertRequired":true,"billingCode":"92597","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6769,"precertRequired":true,"billingCode":"92608","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6964,"precertRequired":false,"billingCode":"93799","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"},{"id":7170,"precertRequired":true,"billingCode":"96105","codeType":"CPT"},{"id":7171,"precertRequired":true,"billingCode":"96110","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7283,"precertRequired":false,"billingCode":"97602","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":9782,"precertRequired":false,"billingCode":"96112","codeType":"CPT"},{"id":9783,"precertRequired":false,"billingCode":"96113","codeType":"CPT"},{"id":9862,"precertRequired":false,"billingCode":"92516","codeType":"CPT"},{"id":9863,"precertRequired":false,"billingCode":"92520","codeType":"CPT"},{"id":9864,"precertRequired":false,"billingCode":"92526","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1464,"description":"Procedures, as clinically indicated, including but not limited to: Laryngoscopy, nasal endoscopy, biopsy, tracheostomy/tracheostomy management, botox injections, etc. ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":267,"precertRequired":false,"billingCode":"11310","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":598,"precertRequired":false,"billingCode":"20926","codeType":"CPT"},{"id":645,"precertRequired":false,"billingCode":"21230","codeType":"CPT"},{"id":646,"precertRequired":false,"billingCode":"21235","codeType":"CPT"},{"id":669,"precertRequired":false,"billingCode":"21315","codeType":"CPT"},{"id":670,"precertRequired":false,"billingCode":"21320","codeType":"CPT"},{"id":671,"precertRequired":false,"billingCode":"21325","codeType":"CPT"},{"id":672,"precertRequired":false,"billingCode":"21330","codeType":"CPT"},{"id":673,"precertRequired":false,"billingCode":"21335","codeType":"CPT"},{"id":674,"precertRequired":false,"billingCode":"21336","codeType":"CPT"},{"id":675,"precertRequired":false,"billingCode":"21337","codeType":"CPT"},{"id":676,"precertRequired":false,"billingCode":"21338","codeType":"CPT"},{"id":677,"precertRequired":false,"billingCode":"21339","codeType":"CPT"},{"id":678,"precertRequired":false,"billingCode":"21340","codeType":"CPT"},{"id":679,"precertRequired":false,"billingCode":"21343","codeType":"CPT"},{"id":680,"precertRequired":false,"billingCode":"21344","codeType":"CPT"},{"id":681,"precertRequired":false,"billingCode":"21345","codeType":"CPT"},{"id":682,"precertRequired":false,"billingCode":"21346","codeType":"CPT"},{"id":683,"precertRequired":false,"billingCode":"21347","codeType":"CPT"},{"id":684,"precertRequired":false,"billingCode":"21348","codeType":"CPT"},{"id":1975,"precertRequired":false,"billingCode":"30100","codeType":"CPT"},{"id":1976,"precertRequired":false,"billingCode":"30110","codeType":"CPT"},{"id":1977,"precertRequired":false,"billingCode":"30115","codeType":"CPT"},{"id":1978,"precertRequired":false,"billingCode":"30200","codeType":"CPT"},{"id":1979,"precertRequired":false,"billingCode":"30300","codeType":"CPT"},{"id":1980,"precertRequired":false,"billingCode":"30560","codeType":"CPT"},{"id":1981,"precertRequired":false,"billingCode":"30801","codeType":"CPT"},{"id":1982,"precertRequired":false,"billingCode":"30802","codeType":"CPT"},{"id":1983,"precertRequired":false,"billingCode":"30901","codeType":"CPT"},{"id":1984,"precertRequired":false,"billingCode":"30903","codeType":"CPT"},{"id":1985,"precertRequired":false,"billingCode":"30905","codeType":"CPT"},{"id":1986,"precertRequired":false,"billingCode":"30906","codeType":"CPT"},{"id":1987,"precertRequired":false,"billingCode":"30930","codeType":"CPT"},{"id":1988,"precertRequired":false,"billingCode":"31000","codeType":"CPT"},{"id":1989,"precertRequired":false,"billingCode":"31002","codeType":"CPT"},{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1993,"precertRequired":false,"billingCode":"31237","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2000,"precertRequired":false,"billingCode":"31528","codeType":"CPT"},{"id":2001,"precertRequired":false,"billingCode":"31529","codeType":"CPT"},{"id":2002,"precertRequired":false,"billingCode":"31535","codeType":"CPT"},{"id":2003,"precertRequired":false,"billingCode":"31536","codeType":"CPT"},{"id":2004,"precertRequired":false,"billingCode":"31540","codeType":"CPT"},{"id":2005,"precertRequired":false,"billingCode":"31541","codeType":"CPT"},{"id":2006,"precertRequired":false,"billingCode":"31572","codeType":"CPT"},{"id":2007,"precertRequired":false,"billingCode":"31573","codeType":"CPT"},{"id":2008,"precertRequired":false,"billingCode":"31574","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2011,"precertRequired":false,"billingCode":"31577","codeType":"CPT"},{"id":2012,"precertRequired":false,"billingCode":"31578","codeType":"CPT"},{"id":2013,"precertRequired":true,"billingCode":"31579","codeType":"CPT"},{"id":2014,"precertRequired":false,"billingCode":"31600","codeType":"CPT"},{"id":2016,"precertRequired":false,"billingCode":"31603","codeType":"CPT"},{"id":2017,"precertRequired":false,"billingCode":"31605","codeType":"CPT"},{"id":2018,"precertRequired":false,"billingCode":"31610","codeType":"CPT"},{"id":2019,"precertRequired":false,"billingCode":"31611","codeType":"CPT"},{"id":2020,"precertRequired":false,"billingCode":"31612","codeType":"CPT"},{"id":2021,"precertRequired":false,"billingCode":"31613","codeType":"CPT"},{"id":2022,"precertRequired":false,"billingCode":"31614","codeType":"CPT"},{"id":2023,"precertRequired":false,"billingCode":"31615","codeType":"CPT"},{"id":2024,"precertRequired":false,"billingCode":"31622","codeType":"CPT"},{"id":2056,"precertRequired":false,"billingCode":"31720","codeType":"CPT"},{"id":2057,"precertRequired":false,"billingCode":"31725","codeType":"CPT"},{"id":2058,"precertRequired":false,"billingCode":"31730","codeType":"CPT"},{"id":2059,"precertRequired":false,"billingCode":"31750","codeType":"CPT"},{"id":2060,"precertRequired":false,"billingCode":"31755","codeType":"CPT"},{"id":2061,"precertRequired":false,"billingCode":"31760","codeType":"CPT"},{"id":2062,"precertRequired":false,"billingCode":"31766","codeType":"CPT"},{"id":2065,"precertRequired":false,"billingCode":"31780","codeType":"CPT"},{"id":2066,"precertRequired":false,"billingCode":"31781","codeType":"CPT"},{"id":2067,"precertRequired":false,"billingCode":"31785","codeType":"CPT"},{"id":2068,"precertRequired":false,"billingCode":"31786","codeType":"CPT"},{"id":2069,"precertRequired":false,"billingCode":"31800","codeType":"CPT"},{"id":2070,"precertRequired":false,"billingCode":"31805","codeType":"CPT"},{"id":2071,"precertRequired":false,"billingCode":"31820","codeType":"CPT"},{"id":2072,"precertRequired":false,"billingCode":"31825","codeType":"CPT"},{"id":2073,"precertRequired":false,"billingCode":"31830","codeType":"CPT"},{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2724,"precertRequired":false,"billingCode":"41000","codeType":"CPT"},{"id":2725,"precertRequired":false,"billingCode":"41100","codeType":"CPT"},{"id":2727,"precertRequired":false,"billingCode":"41108","codeType":"CPT"},{"id":2728,"precertRequired":false,"billingCode":"41250","codeType":"CPT"},{"id":2730,"precertRequired":false,"billingCode":"42300","codeType":"CPT"},{"id":2731,"precertRequired":false,"billingCode":"42310","codeType":"CPT"},{"id":2732,"precertRequired":false,"billingCode":"42330","codeType":"CPT"},{"id":2733,"precertRequired":false,"billingCode":"42550","codeType":"CPT"},{"id":2734,"precertRequired":false,"billingCode":"42700","codeType":"CPT"},{"id":2735,"precertRequired":false,"billingCode":"42800","codeType":"CPT"},{"id":2736,"precertRequired":false,"billingCode":"42804","codeType":"CPT"},{"id":2737,"precertRequired":false,"billingCode":"42806","codeType":"CPT"},{"id":2738,"precertRequired":false,"billingCode":"42809","codeType":"CPT"},{"id":3763,"precertRequired":false,"billingCode":"58999","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3981,"precertRequired":true,"billingCode":"64617","codeType":"CPT"},{"id":4060,"precertRequired":false,"billingCode":"64864","codeType":"CPT"},{"id":4083,"precertRequired":false,"billingCode":"64999","codeType":"CPT"},{"id":4348,"precertRequired":false,"billingCode":"69000","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":4350,"precertRequired":false,"billingCode":"69105","codeType":"CPT"},{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4352,"precertRequired":true,"billingCode":"69205","codeType":"CPT"},{"id":4353,"precertRequired":false,"billingCode":"69209","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4356,"precertRequired":true,"billingCode":"69222","codeType":"CPT"},{"id":4357,"precertRequired":false,"billingCode":"69420","codeType":"CPT"},{"id":4358,"precertRequired":false,"billingCode":"69433","codeType":"CPT"},{"id":4359,"precertRequired":false,"billingCode":"69540","codeType":"CPT"},{"id":5056,"precertRequired":false,"billingCode":"80305","codeType":"CPT"},{"id":5057,"precertRequired":false,"billingCode":"80306","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5930,"precertRequired":false,"billingCode":"86353","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5948,"precertRequired":false,"billingCode":"86485","codeType":"CPT"},{"id":5949,"precertRequired":false,"billingCode":"86486","codeType":"CPT"},{"id":5950,"precertRequired":false,"billingCode":"86490","codeType":"CPT"},{"id":5951,"precertRequired":false,"billingCode":"86510","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6463,"precertRequired":false,"billingCode":"89190","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7001,"precertRequired":false,"billingCode":"94200","codeType":"CPT"},{"id":7003,"precertRequired":false,"billingCode":"94375","codeType":"CPT"},{"id":7009,"precertRequired":false,"billingCode":"94617","codeType":"CPT"},{"id":7013,"precertRequired":false,"billingCode":"94640","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7028,"precertRequired":false,"billingCode":"94728","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7030,"precertRequired":false,"billingCode":"94750","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7032,"precertRequired":false,"billingCode":"94761","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7037,"precertRequired":false,"billingCode":"95012","codeType":"CPT"},{"id":7039,"precertRequired":false,"billingCode":"95017","codeType":"CPT"},{"id":7040,"precertRequired":false,"billingCode":"95018","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7042,"precertRequired":false,"billingCode":"95027","codeType":"CPT"},{"id":7043,"precertRequired":false,"billingCode":"95028","codeType":"CPT"},{"id":7044,"precertRequired":false,"billingCode":"95044","codeType":"CPT"},{"id":7045,"precertRequired":false,"billingCode":"95052","codeType":"CPT"},{"id":7046,"precertRequired":false,"billingCode":"95056","codeType":"CPT"},{"id":7047,"precertRequired":false,"billingCode":"95060","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7049,"precertRequired":false,"billingCode":"95070","codeType":"CPT"},{"id":7050,"precertRequired":false,"billingCode":"95071","codeType":"CPT"},{"id":7051,"precertRequired":false,"billingCode":"95076","codeType":"CPT"},{"id":7052,"precertRequired":false,"billingCode":"95079","codeType":"CPT"},{"id":7070,"precertRequired":false,"billingCode":"95180","codeType":"CPT"},{"id":7459,"precertRequired":false,"billingCode":"99406","codeType":"CPT"},{"id":7579,"precertRequired":false,"billingCode":"0485T","codeType":"CPT"},{"id":7580,"precertRequired":false,"billingCode":"0486T","codeType":"CPT"},{"id":8168,"precertRequired":false,"billingCode":"G0268","codeType":"HCPCS"},{"id":8378,"precertRequired":false,"billingCode":"J0585","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9193,"precertRequired":false,"billingCode":"21086","codeType":"CPT"},{"id":9231,"precertRequired":true,"billingCode":"21310","codeType":"CPT"},{"id":9343,"precertRequired":true,"billingCode":"30130","codeType":"CPT"},{"id":9344,"precertRequired":true,"billingCode":"30140","codeType":"CPT"},{"id":9345,"precertRequired":true,"billingCode":"30310","codeType":"CPT"},{"id":9348,"precertRequired":true,"billingCode":"30465","codeType":"CPT"},{"id":9349,"precertRequired":true,"billingCode":"30520","codeType":"CPT"},{"id":9350,"precertRequired":true,"billingCode":"30540","codeType":"CPT"},{"id":9351,"precertRequired":true,"billingCode":"30545","codeType":"CPT"},{"id":9352,"precertRequired":true,"billingCode":"30580","codeType":"CPT"},{"id":9353,"precertRequired":true,"billingCode":"30600","codeType":"CPT"},{"id":9354,"precertRequired":true,"billingCode":"30620","codeType":"CPT"},{"id":9355,"precertRequired":true,"billingCode":"30630","codeType":"CPT"},{"id":9356,"precertRequired":true,"billingCode":"31020","codeType":"CPT"},{"id":9357,"precertRequired":true,"billingCode":"31030","codeType":"CPT"},{"id":9358,"precertRequired":true,"billingCode":"31032","codeType":"CPT"},{"id":9359,"precertRequired":true,"billingCode":"31050","codeType":"CPT"},{"id":9360,"precertRequired":true,"billingCode":"31051","codeType":"CPT"},{"id":9361,"precertRequired":true,"billingCode":"31070","codeType":"CPT"},{"id":9362,"precertRequired":true,"billingCode":"31075","codeType":"CPT"},{"id":9363,"precertRequired":true,"billingCode":"31080","codeType":"CPT"},{"id":9364,"precertRequired":true,"billingCode":"31081","codeType":"CPT"},{"id":9365,"precertRequired":true,"billingCode":"31084","codeType":"CPT"},{"id":9366,"precertRequired":true,"billingCode":"31085","codeType":"CPT"},{"id":9367,"precertRequired":true,"billingCode":"31086","codeType":"CPT"},{"id":9368,"precertRequired":true,"billingCode":"31087","codeType":"CPT"},{"id":9369,"precertRequired":true,"billingCode":"31090","codeType":"CPT"},{"id":9370,"precertRequired":true,"billingCode":"31200","codeType":"CPT"},{"id":9371,"precertRequired":true,"billingCode":"31201","codeType":"CPT"},{"id":9372,"precertRequired":true,"billingCode":"31205","codeType":"CPT"},{"id":9373,"precertRequired":true,"billingCode":"31238","codeType":"CPT"},{"id":9374,"precertRequired":true,"billingCode":"31239","codeType":"CPT"},{"id":9375,"precertRequired":true,"billingCode":"31240","codeType":"CPT"},{"id":9376,"precertRequired":true,"billingCode":"31241","codeType":"CPT"},{"id":9377,"precertRequired":true,"billingCode":"31253","codeType":"CPT"},{"id":9378,"precertRequired":true,"billingCode":"31254","codeType":"CPT"},{"id":9379,"precertRequired":true,"billingCode":"31255","codeType":"CPT"},{"id":9380,"precertRequired":true,"billingCode":"31256","codeType":"CPT"},{"id":9381,"precertRequired":true,"billingCode":"31257","codeType":"CPT"},{"id":9382,"precertRequired":true,"billingCode":"31259","codeType":"CPT"},{"id":9383,"precertRequired":true,"billingCode":"31267","codeType":"CPT"},{"id":9384,"precertRequired":true,"billingCode":"31276","codeType":"CPT"},{"id":9385,"precertRequired":true,"billingCode":"31287","codeType":"CPT"},{"id":9386,"precertRequired":true,"billingCode":"31288","codeType":"CPT"},{"id":9387,"precertRequired":true,"billingCode":"31290","codeType":"CPT"},{"id":9388,"precertRequired":true,"billingCode":"31291","codeType":"CPT"},{"id":9389,"precertRequired":true,"billingCode":"31292","codeType":"CPT"},{"id":9390,"precertRequired":true,"billingCode":"31293","codeType":"CPT"},{"id":9391,"precertRequired":true,"billingCode":"31294","codeType":"CPT"},{"id":9392,"precertRequired":true,"billingCode":"31295","codeType":"CPT"},{"id":9393,"precertRequired":true,"billingCode":"31296","codeType":"CPT"},{"id":9394,"precertRequired":true,"billingCode":"31297","codeType":"CPT"},{"id":9395,"precertRequired":true,"billingCode":"31298","codeType":"CPT"},{"id":9396,"precertRequired":true,"billingCode":"31300","codeType":"CPT"},{"id":9397,"precertRequired":true,"billingCode":"31360","codeType":"CPT"},{"id":9398,"precertRequired":true,"billingCode":"31365","codeType":"CPT"},{"id":9399,"precertRequired":true,"billingCode":"31367","codeType":"CPT"},{"id":9400,"precertRequired":true,"billingCode":"31368","codeType":"CPT"},{"id":9401,"precertRequired":true,"billingCode":"31370","codeType":"CPT"},{"id":9402,"precertRequired":true,"billingCode":"31375","codeType":"CPT"},{"id":9403,"precertRequired":true,"billingCode":"31380","codeType":"CPT"},{"id":9404,"precertRequired":true,"billingCode":"31382","codeType":"CPT"},{"id":9405,"precertRequired":true,"billingCode":"31390","codeType":"CPT"},{"id":9406,"precertRequired":true,"billingCode":"31395","codeType":"CPT"},{"id":9407,"precertRequired":true,"billingCode":"31515","codeType":"CPT"},{"id":9408,"precertRequired":true,"billingCode":"31527","codeType":"CPT"},{"id":9409,"precertRequired":true,"billingCode":"31530","codeType":"CPT"},{"id":9410,"precertRequired":true,"billingCode":"31531","codeType":"CPT"},{"id":9411,"precertRequired":true,"billingCode":"31545","codeType":"CPT"},{"id":9412,"precertRequired":true,"billingCode":"31546","codeType":"CPT"},{"id":9413,"precertRequired":true,"billingCode":"31552","codeType":"CPT"},{"id":9414,"precertRequired":true,"billingCode":"31554","codeType":"CPT"},{"id":9415,"precertRequired":true,"billingCode":"31560","codeType":"CPT"},{"id":9416,"precertRequired":true,"billingCode":"31561","codeType":"CPT"},{"id":9417,"precertRequired":true,"billingCode":"31570","codeType":"CPT"},{"id":9418,"precertRequired":true,"billingCode":"31571","codeType":"CPT"},{"id":9434,"precertRequired":true,"billingCode":"40810","codeType":"CPT"},{"id":9437,"precertRequired":true,"billingCode":"40816","codeType":"CPT"},{"id":9439,"precertRequired":true,"billingCode":"40820","codeType":"CPT"},{"id":9457,"precertRequired":false,"billingCode":"41110","codeType":"CPT"},{"id":9458,"precertRequired":false,"billingCode":"41112","codeType":"CPT"},{"id":9459,"precertRequired":false,"billingCode":"41113","codeType":"CPT"},{"id":9460,"precertRequired":false,"billingCode":"41114","codeType":"CPT"},{"id":9461,"precertRequired":false,"billingCode":"41115","codeType":"CPT"},{"id":9462,"precertRequired":false,"billingCode":"41116","codeType":"CPT"},{"id":9463,"precertRequired":true,"billingCode":"41120","codeType":"CPT"},{"id":9464,"precertRequired":true,"billingCode":"41130","codeType":"CPT"},{"id":9465,"precertRequired":true,"billingCode":"41135","codeType":"CPT"},{"id":9466,"precertRequired":true,"billingCode":"41140","codeType":"CPT"},{"id":9467,"precertRequired":true,"billingCode":"41145","codeType":"CPT"},{"id":9468,"precertRequired":true,"billingCode":"41150","codeType":"CPT"},{"id":9469,"precertRequired":true,"billingCode":"41153","codeType":"CPT"},{"id":9470,"precertRequired":true,"billingCode":"41155","codeType":"CPT"},{"id":9471,"precertRequired":false,"billingCode":"41251","codeType":"CPT"},{"id":9472,"precertRequired":false,"billingCode":"41252","codeType":"CPT"},{"id":9515,"precertRequired":true,"billingCode":"42408","codeType":"CPT"},{"id":9516,"precertRequired":true,"billingCode":"42415","codeType":"CPT"},{"id":9517,"precertRequired":true,"billingCode":"42440","codeType":"CPT"},{"id":9518,"precertRequired":true,"billingCode":"42810","codeType":"CPT"},{"id":9519,"precertRequired":true,"billingCode":"42815","codeType":"CPT"},{"id":9520,"precertRequired":true,"billingCode":"42821","codeType":"CPT"},{"id":9521,"precertRequired":true,"billingCode":"42826","codeType":"CPT"},{"id":9522,"precertRequired":true,"billingCode":"42831","codeType":"CPT"},{"id":9523,"precertRequired":true,"billingCode":"42836","codeType":"CPT"},{"id":9524,"precertRequired":true,"billingCode":"42842","codeType":"CPT"},{"id":9525,"precertRequired":true,"billingCode":"42844","codeType":"CPT"},{"id":9526,"precertRequired":true,"billingCode":"42845","codeType":"CPT"},{"id":9859,"precertRequired":false,"billingCode":"61782","codeType":"CPT"},{"id":9860,"precertRequired":false,"billingCode":"30915","codeType":"CPT"},{"id":9861,"precertRequired":false,"billingCode":"30920","codeType":"CPT"},{"id":9865,"precertRequired":false,"billingCode":"42808","codeType":"CPT"},{"id":9866,"precertRequired":false,"billingCode":"42860","codeType":"CPT"},{"id":9867,"precertRequired":false,"billingCode":"42870","codeType":"CPT"},{"id":9868,"precertRequired":false,"billingCode":"42890","codeType":"CPT"},{"id":9869,"precertRequired":false,"billingCode":"42892","codeType":"CPT"},{"id":9870,"precertRequired":false,"billingCode":"67676","codeType":"CPT"},{"id":9871,"precertRequired":false,"billingCode":"69005","codeType":"CPT"},{"id":9872,"precertRequired":false,"billingCode":"69020","codeType":"CPT"},{"id":9873,"precertRequired":false,"billingCode":"69110","codeType":"CPT"},{"id":9874,"precertRequired":false,"billingCode":"69120","codeType":"CPT"},{"id":9875,"precertRequired":false,"billingCode":"69140","codeType":"CPT"},{"id":9876,"precertRequired":false,"billingCode":"69145","codeType":"CPT"},{"id":9877,"precertRequired":false,"billingCode":"69150","codeType":"CPT"},{"id":9878,"precertRequired":false,"billingCode":"69155","codeType":"CPT"},{"id":9879,"precertRequired":false,"billingCode":"69300","codeType":"CPT"},{"id":9880,"precertRequired":false,"billingCode":"69310","codeType":"CPT"},{"id":9881,"precertRequired":false,"billingCode":"69320","codeType":"CPT"},{"id":9882,"precertRequired":false,"billingCode":"69421","codeType":"CPT"},{"id":9883,"precertRequired":false,"billingCode":"69424","codeType":"CPT"},{"id":9884,"precertRequired":false,"billingCode":"69436","codeType":"CPT"},{"id":9885,"precertRequired":false,"billingCode":"69440","codeType":"CPT"},{"id":9886,"precertRequired":false,"billingCode":"69450","codeType":"CPT"},{"id":9887,"precertRequired":false,"billingCode":"69501","codeType":"CPT"},{"id":9888,"precertRequired":false,"billingCode":"69502","codeType":"CPT"},{"id":9889,"precertRequired":false,"billingCode":"69505","codeType":"CPT"},{"id":9890,"precertRequired":false,"billingCode":"69511","codeType":"CPT"},{"id":9891,"precertRequired":false,"billingCode":"69530","codeType":"CPT"},{"id":9892,"precertRequired":false,"billingCode":"69535","codeType":"CPT"},{"id":9893,"precertRequired":false,"billingCode":"69550","codeType":"CPT"},{"id":9894,"precertRequired":false,"billingCode":"69554","codeType":"CPT"},{"id":9895,"precertRequired":false,"billingCode":"69610","codeType":"CPT"},{"id":9896,"precertRequired":false,"billingCode":"69620","codeType":"CPT"},{"id":9897,"precertRequired":false,"billingCode":"69631","codeType":"CPT"},{"id":9898,"precertRequired":false,"billingCode":"69632","codeType":"CPT"},{"id":9899,"precertRequired":false,"billingCode":"69633","codeType":"CPT"},{"id":9900,"precertRequired":false,"billingCode":"69635","codeType":"CPT"},{"id":9901,"precertRequired":false,"billingCode":"69636","codeType":"CPT"},{"id":9902,"precertRequired":false,"billingCode":"69637","codeType":"CPT"},{"id":9903,"precertRequired":false,"billingCode":"69641","codeType":"CPT"},{"id":9904,"precertRequired":false,"billingCode":"69642","codeType":"CPT"},{"id":9905,"precertRequired":false,"billingCode":"69644","codeType":"CPT"},{"id":9906,"precertRequired":false,"billingCode":"69643","codeType":"CPT"},{"id":9907,"precertRequired":false,"billingCode":"69645","codeType":"CPT"},{"id":9908,"precertRequired":false,"billingCode":"69646","codeType":"CPT"},{"id":9909,"precertRequired":false,"billingCode":"69650","codeType":"CPT"},{"id":9910,"precertRequired":false,"billingCode":"69660","codeType":"CPT"},{"id":9911,"precertRequired":false,"billingCode":"69661","codeType":"CPT"},{"id":9912,"precertRequired":false,"billingCode":"69662","codeType":"CPT"},{"id":9913,"precertRequired":false,"billingCode":"69666","codeType":"CPT"},{"id":9914,"precertRequired":false,"billingCode":"69667","codeType":"CPT"},{"id":9915,"precertRequired":false,"billingCode":"69720","codeType":"CPT"},{"id":9916,"precertRequired":false,"billingCode":"69725","codeType":"CPT"},{"id":9917,"precertRequired":false,"billingCode":"69740","codeType":"CPT"},{"id":9918,"precertRequired":false,"billingCode":"69745","codeType":"CPT"},{"id":9919,"precertRequired":false,"billingCode":"69801","codeType":"CPT"},{"id":9920,"precertRequired":false,"billingCode":"69915","codeType":"CPT"},{"id":9921,"precertRequired":false,"billingCode":"69950","codeType":"CPT"},{"id":9922,"precertRequired":false,"billingCode":"69955","codeType":"CPT"},{"id":9923,"precertRequired":false,"billingCode":"69960","codeType":"CPT"},{"id":9924,"precertRequired":false,"billingCode":"69970","codeType":"CPT"},{"id":9926,"precertRequired":false,"billingCode":"42894","codeType":"CPT"},{"id":9927,"precertRequired":false,"billingCode":"69552","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1500,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":1,"precertRequired":false,"billingCode":"00100","codeType":"CPT"},{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":14,"precertRequired":false,"billingCode":"00160","codeType":"CPT"},{"id":15,"precertRequired":false,"billingCode":"00162","codeType":"CPT"},{"id":16,"precertRequired":false,"billingCode":"00164","codeType":"CPT"},{"id":17,"precertRequired":false,"billingCode":"00170","codeType":"CPT"},{"id":18,"precertRequired":false,"billingCode":"00172","codeType":"CPT"},{"id":21,"precertRequired":false,"billingCode":"00190","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":33,"precertRequired":false,"billingCode":"00320","codeType":"CPT"},{"id":34,"precertRequired":false,"billingCode":"00322","codeType":"CPT"},{"id":55,"precertRequired":false,"billingCode":"00539","codeType":"CPT"},{"id":217,"precertRequired":false,"billingCode":"01991","codeType":"CPT"},{"id":218,"precertRequired":false,"billingCode":"01992","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":5033,"precertRequired":false,"billingCode":"80176","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1506,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1509,"description":"Inpatient or observation admission for surgical procedure if indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7379,"precertRequired":true,"billingCode":"99241","codeType":"CPT"},{"id":7380,"precertRequired":true,"billingCode":"99242","codeType":"CPT"},{"id":7381,"precertRequired":true,"billingCode":"99243","codeType":"CPT"},{"id":7382,"precertRequired":true,"billingCode":"99244","codeType":"CPT"},{"id":7383,"precertRequired":true,"billingCode":"99245","codeType":"CPT"},{"id":7389,"precertRequired":false,"billingCode":"99251","codeType":"CPT"},{"id":7390,"precertRequired":false,"billingCode":"99252","codeType":"CPT"},{"id":7391,"precertRequired":false,"billingCode":"99253","codeType":"CPT"},{"id":7392,"precertRequired":false,"billingCode":"99254","codeType":"CPT"},{"id":7393,"precertRequired":false,"billingCode":"99255","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7488,"precertRequired":false,"billingCode":"99483","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1510,"description":"  Inpatient admission or observation status for complications related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7379,"precertRequired":true,"billingCode":"99241","codeType":"CPT"},{"id":7380,"precertRequired":true,"billingCode":"99242","codeType":"CPT"},{"id":7381,"precertRequired":true,"billingCode":"99243","codeType":"CPT"},{"id":7382,"precertRequired":true,"billingCode":"99244","codeType":"CPT"},{"id":7383,"precertRequired":true,"billingCode":"99245","codeType":"CPT"},{"id":7389,"precertRequired":false,"billingCode":"99251","codeType":"CPT"},{"id":7390,"precertRequired":false,"billingCode":"99252","codeType":"CPT"},{"id":7391,"precertRequired":false,"billingCode":"99253","codeType":"CPT"},{"id":7392,"precertRequired":false,"billingCode":"99254","codeType":"CPT"},{"id":7393,"precertRequired":false,"billingCode":"99255","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7488,"precertRequired":false,"billingCode":"99483","codeType":"CPT"},{"id":8189,"precertRequired":false,"billingCode":"G0378","codeType":"HCPCS"},{"id":8190,"precertRequired":false,"billingCode":"G0379","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1511,"description":"  Follow-up visits for this episode of care ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1512,"description":"Follow-up imaging as clinically necessary relevant to the referred condition on the consult ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4401,"precertRequired":true,"billingCode":"70480","codeType":"CPT"},{"id":4402,"precertRequired":true,"billingCode":"70481","codeType":"CPT"},{"id":4403,"precertRequired":true,"billingCode":"70482","codeType":"CPT"},{"id":4404,"precertRequired":true,"billingCode":"70486","codeType":"CPT"},{"id":4405,"precertRequired":true,"billingCode":"70487","codeType":"CPT"},{"id":4406,"precertRequired":true,"billingCode":"70488","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4832,"precertRequired":false,"billingCode":"77386","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":9765,"precertRequired":false,"billingCode":"70355","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1513,"description":"Follow-up studies as clinically necessary relevant to the referred condition on the consult ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":1999,"precertRequired":false,"billingCode":"31526","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":6701,"precertRequired":true,"billingCode":"92502","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"},{"id":6704,"precertRequired":true,"billingCode":"92507","codeType":"CPT"},{"id":6705,"precertRequired":true,"billingCode":"92508","codeType":"CPT"},{"id":6706,"precertRequired":false,"billingCode":"92511","codeType":"CPT"},{"id":6707,"precertRequired":false,"billingCode":"92512","codeType":"CPT"},{"id":6711,"precertRequired":true,"billingCode":"92524","codeType":"CPT"},{"id":6712,"precertRequired":false,"billingCode":"92531","codeType":"CPT"},{"id":6713,"precertRequired":false,"billingCode":"92532","codeType":"CPT"},{"id":6716,"precertRequired":false,"billingCode":"92537","codeType":"CPT"},{"id":6717,"precertRequired":false,"billingCode":"92538","codeType":"CPT"},{"id":6718,"precertRequired":false,"billingCode":"92540","codeType":"CPT"},{"id":6719,"precertRequired":false,"billingCode":"92541","codeType":"CPT"},{"id":6720,"precertRequired":false,"billingCode":"92542","codeType":"CPT"},{"id":6723,"precertRequired":false,"billingCode":"92546","codeType":"CPT"},{"id":6726,"precertRequired":false,"billingCode":"92550","codeType":"CPT"},{"id":6729,"precertRequired":false,"billingCode":"92553","codeType":"CPT"},{"id":6730,"precertRequired":true,"billingCode":"92555","codeType":"CPT"},{"id":6731,"precertRequired":true,"billingCode":"92556","codeType":"CPT"},{"id":6732,"precertRequired":true,"billingCode":"92557","codeType":"CPT"},{"id":6734,"precertRequired":false,"billingCode":"92560","codeType":"CPT"},{"id":6735,"precertRequired":false,"billingCode":"92561","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":6741,"precertRequired":false,"billingCode":"92568","codeType":"CPT"},{"id":6742,"precertRequired":false,"billingCode":"92570","codeType":"CPT"},{"id":6743,"precertRequired":true,"billingCode":"92571","codeType":"CPT"},{"id":6747,"precertRequired":true,"billingCode":"92577","codeType":"CPT"},{"id":6748,"precertRequired":false,"billingCode":"92579","codeType":"CPT"},{"id":6763,"precertRequired":true,"billingCode":"92597","codeType":"CPT"},{"id":6765,"precertRequired":false,"billingCode":"92604","codeType":"CPT"},{"id":6769,"precertRequired":true,"billingCode":"92608","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":6783,"precertRequired":false,"billingCode":"92626","codeType":"CPT"},{"id":6784,"precertRequired":false,"billingCode":"92627","codeType":"CPT"},{"id":6964,"precertRequired":false,"billingCode":"93799","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":7035,"precertRequired":false,"billingCode":"95004","codeType":"CPT"},{"id":7041,"precertRequired":false,"billingCode":"95024","codeType":"CPT"},{"id":7048,"precertRequired":false,"billingCode":"95065","codeType":"CPT"},{"id":7160,"precertRequired":false,"billingCode":"95992","codeType":"CPT"},{"id":7170,"precertRequired":true,"billingCode":"96105","codeType":"CPT"},{"id":7171,"precertRequired":true,"billingCode":"96110","codeType":"CPT"},{"id":7177,"precertRequired":true,"billingCode":"96125","codeType":"CPT"},{"id":7283,"precertRequired":false,"billingCode":"97602","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":8249,"precertRequired":false,"billingCode":"G6002","codeType":"HCPCS"},{"id":9782,"precertRequired":false,"billingCode":"96112","codeType":"CPT"},{"id":9783,"precertRequired":false,"billingCode":"96113","codeType":"CPT"},{"id":9862,"precertRequired":false,"billingCode":"92516","codeType":"CPT"},{"id":9863,"precertRequired":false,"billingCode":"92520","codeType":"CPT"},{"id":9864,"precertRequired":false,"billingCode":"92526","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1514,"description":"Speech/Voice Therapy as indicated; up to three (3) visits per week x 5 weeks (15 visits); Notify VA to request additional visits with supporting medical documentation","frequency":3,"frequencyType":"week","visits":15,"codeRequired":"YES","clinicalServices":[{"clinicalService":"15-Speech language pathologist "}],"billingCodes":[{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4395,"precertRequired":true,"billingCode":"70371","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":6767,"precertRequired":false,"billingCode":"92606","codeType":"CPT"},{"id":6770,"precertRequired":true,"billingCode":"92609","codeType":"CPT"},{"id":6771,"precertRequired":true,"billingCode":"92610","codeType":"CPT"},{"id":6772,"precertRequired":true,"billingCode":"92611","codeType":"CPT"},{"id":6773,"precertRequired":true,"billingCode":"92612","codeType":"CPT"},{"id":6774,"precertRequired":true,"billingCode":"92613","codeType":"CPT"},{"id":6776,"precertRequired":true,"billingCode":"92615","codeType":"CPT"},{"id":6777,"precertRequired":true,"billingCode":"92616","codeType":"CPT"},{"id":6778,"precertRequired":true,"billingCode":"92617","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":8294,"precertRequired":true,"billingCode":"G8999","codeType":"HCPCS"},{"id":8299,"precertRequired":true,"billingCode":"G9158","codeType":"HCPCS"},{"id":8300,"precertRequired":true,"billingCode":"G9159","codeType":"HCPCS"},{"id":8301,"precertRequired":true,"billingCode":"G9160","codeType":"HCPCS"},{"id":8302,"precertRequired":true,"billingCode":"G9161","codeType":"HCPCS"},{"id":8303,"precertRequired":true,"billingCode":"G9162","codeType":"HCPCS"},{"id":8304,"precertRequired":true,"billingCode":"G9163","codeType":"HCPCS"},{"id":8305,"precertRequired":true,"billingCode":"G9164","codeType":"HCPCS"},{"id":8306,"precertRequired":true,"billingCode":"G9170","codeType":"HCPCS"},{"id":8307,"precertRequired":true,"billingCode":"G9171","codeType":"HCPCS"},{"id":8308,"precertRequired":false,"billingCode":"G9172","codeType":"HCPCS"},{"id":8309,"precertRequired":true,"billingCode":"G9173","codeType":"HCPCS"},{"id":8310,"precertRequired":true,"billingCode":"G9174","codeType":"HCPCS"},{"id":8311,"precertRequired":true,"billingCode":"G9175","codeType":"HCPCS"},{"id":8312,"precertRequired":true,"billingCode":"G9176","codeType":"HCPCS"},{"id":8313,"precertRequired":true,"billingCode":"G9186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"235Z00000X"}]},{"id":1515,"description":"Post-Op Speech/Voice Therapy as indicated; up to three (3) visits per week x 8 weeks (24 visits); Notify VA to request additional visits with supporting medical documentation","frequency":3,"frequencyType":"week","visits":24,"codeRequired":"YES","clinicalServices":[{"clinicalService":"15-Speech language pathologist "}],"billingCodes":[{"id":6767,"precertRequired":false,"billingCode":"92606","codeType":"CPT"},{"id":6770,"precertRequired":true,"billingCode":"92609","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7342,"precertRequired":false,"billingCode":"99183","codeType":"CPT"},{"id":8243,"precertRequired":false,"billingCode":"G0515","codeType":"HCPCS"},{"id":8294,"precertRequired":true,"billingCode":"G8999","codeType":"HCPCS"},{"id":8299,"precertRequired":true,"billingCode":"G9158","codeType":"HCPCS"},{"id":8300,"precertRequired":true,"billingCode":"G9159","codeType":"HCPCS"},{"id":8301,"precertRequired":true,"billingCode":"G9160","codeType":"HCPCS"},{"id":8302,"precertRequired":true,"billingCode":"G9161","codeType":"HCPCS"},{"id":8303,"precertRequired":true,"billingCode":"G9162","codeType":"HCPCS"},{"id":8304,"precertRequired":true,"billingCode":"G9163","codeType":"HCPCS"},{"id":8305,"precertRequired":true,"billingCode":"G9164","codeType":"HCPCS"},{"id":8307,"precertRequired":true,"billingCode":"G9171","codeType":"HCPCS"},{"id":8308,"precertRequired":false,"billingCode":"G9172","codeType":"HCPCS"},{"id":8309,"precertRequired":true,"billingCode":"G9173","codeType":"HCPCS"},{"id":8310,"precertRequired":true,"billingCode":"G9174","codeType":"HCPCS"},{"id":8311,"precertRequired":true,"billingCode":"G9175","codeType":"HCPCS"},{"id":8312,"precertRequired":true,"billingCode":"G9176","codeType":"HCPCS"},{"id":8313,"precertRequired":true,"billingCode":"G9186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"235Z00000X"}]}]}},{"Seoc":{"id":282,"seocKey":51,"name":"ENT_PRCT","seocId":"SSC_ENT_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-03-2019","endDate":"03-12-2019","duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Diagnostic imaging relevant to the referred condition\r\n3. Diagnostic studies, labs and pathology relevant to the referred condition\r\n4. Procedures to include any of the following as clinically indicated: Direct laryngoscopy with biopsy, sinoscopy and sinus surgery, palliative tracheostomy or PEG tube placement\r\n5. Follow up visits as clinically required","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ENT","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207Y00000X"}],"services":[{"id":1195,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1196,"description":"Diagnostic imaging relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":2006,"precertRequired":false,"billingCode":"31572","codeType":"CPT"},{"id":2007,"precertRequired":false,"billingCode":"31573","codeType":"CPT"},{"id":2008,"precertRequired":false,"billingCode":"31574","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2011,"precertRequired":false,"billingCode":"31577","codeType":"CPT"},{"id":2012,"precertRequired":false,"billingCode":"31578","codeType":"CPT"},{"id":2013,"precertRequired":true,"billingCode":"31579","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1197,"description":"Diagnostic studies, labs and pathology relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":2006,"precertRequired":false,"billingCode":"31572","codeType":"CPT"},{"id":2007,"precertRequired":false,"billingCode":"31573","codeType":"CPT"},{"id":2008,"precertRequired":false,"billingCode":"31574","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2011,"precertRequired":false,"billingCode":"31577","codeType":"CPT"},{"id":2012,"precertRequired":false,"billingCode":"31578","codeType":"CPT"},{"id":2013,"precertRequired":true,"billingCode":"31579","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1198,"description":"Procedures to include any of the following as clinically indicated: Direct laryngoscopy with biopsy, sinoscopy and sinus surgery, palliative tracheostomy or PEG tube placement.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":255,"precertRequired":false,"billingCode":"11100","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":1975,"precertRequired":false,"billingCode":"30100","codeType":"CPT"},{"id":1978,"precertRequired":false,"billingCode":"30200","codeType":"CPT"},{"id":1980,"precertRequired":false,"billingCode":"30560","codeType":"CPT"},{"id":1981,"precertRequired":false,"billingCode":"30801","codeType":"CPT"},{"id":1982,"precertRequired":false,"billingCode":"30802","codeType":"CPT"},{"id":1983,"precertRequired":false,"billingCode":"30901","codeType":"CPT"},{"id":1984,"precertRequired":false,"billingCode":"30903","codeType":"CPT"},{"id":1985,"precertRequired":false,"billingCode":"30905","codeType":"CPT"},{"id":1987,"precertRequired":false,"billingCode":"30930","codeType":"CPT"},{"id":1988,"precertRequired":false,"billingCode":"31000","codeType":"CPT"},{"id":1989,"precertRequired":false,"billingCode":"31002","codeType":"CPT"},{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":2724,"precertRequired":false,"billingCode":"41000","codeType":"CPT"},{"id":2725,"precertRequired":false,"billingCode":"41100","codeType":"CPT"},{"id":2727,"precertRequired":false,"billingCode":"41108","codeType":"CPT"},{"id":2728,"precertRequired":false,"billingCode":"41250","codeType":"CPT"},{"id":2730,"precertRequired":false,"billingCode":"42300","codeType":"CPT"},{"id":2731,"precertRequired":false,"billingCode":"42310","codeType":"CPT"},{"id":2732,"precertRequired":false,"billingCode":"42330","codeType":"CPT"},{"id":2733,"precertRequired":false,"billingCode":"42550","codeType":"CPT"},{"id":2734,"precertRequired":false,"billingCode":"42700","codeType":"CPT"},{"id":2735,"precertRequired":false,"billingCode":"42800","codeType":"CPT"},{"id":2736,"precertRequired":false,"billingCode":"42804","codeType":"CPT"},{"id":2737,"precertRequired":false,"billingCode":"42806","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":4348,"precertRequired":false,"billingCode":"69000","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":4350,"precertRequired":false,"billingCode":"69105","codeType":"CPT"},{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4357,"precertRequired":false,"billingCode":"69420","codeType":"CPT"},{"id":4358,"precertRequired":false,"billingCode":"69433","codeType":"CPT"},{"id":4359,"precertRequired":false,"billingCode":"69540","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"},{"id":6706,"precertRequired":false,"billingCode":"92511","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":8395,"precertRequired":false,"billingCode":"J0800","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":1199,"description":"Follow up visits as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]}]}},{"Seoc":{"id":34,"seocKey":51,"name":"ENT_PRCT","seocId":"SSC_ENT_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"01-03-2019","duration":120,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on the consult\r\n2. Diagnostic imaging relevant to the referred condition\r\n3. Diagnostic studies, labs and pathology relevant to the referred condition\r\n4. Procedures to include any of the following as clinically indicated: Direct laryngoscopy with biopsy, sinoscopy and sinus surgery, palliative tracheostomy or PEG tube placement\r\n5. Follow up visits as clinically required","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"ENT","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":150,"description":"Initial outpatient evaluation and treatment for the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":151,"description":"Diagnostic imaging relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":2006,"precertRequired":false,"billingCode":"31572","codeType":"CPT"},{"id":2007,"precertRequired":false,"billingCode":"31573","codeType":"CPT"},{"id":2008,"precertRequired":false,"billingCode":"31574","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2011,"precertRequired":false,"billingCode":"31577","codeType":"CPT"},{"id":2012,"precertRequired":false,"billingCode":"31578","codeType":"CPT"},{"id":2013,"precertRequired":true,"billingCode":"31579","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":152,"description":"Diagnostic studies, labs and pathology relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":1998,"precertRequired":false,"billingCode":"31525","codeType":"CPT"},{"id":2006,"precertRequired":false,"billingCode":"31572","codeType":"CPT"},{"id":2007,"precertRequired":false,"billingCode":"31573","codeType":"CPT"},{"id":2008,"precertRequired":false,"billingCode":"31574","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2011,"precertRequired":false,"billingCode":"31577","codeType":"CPT"},{"id":2012,"precertRequired":false,"billingCode":"31578","codeType":"CPT"},{"id":2013,"precertRequired":true,"billingCode":"31579","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":153,"description":"Procedures to include any of the following as clinically indicated: Direct laryngoscopy with biopsy, sinoscopy and sinus surgery, palliative tracheostomy or PEG tube placement.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":255,"precertRequired":false,"billingCode":"11100","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":1975,"precertRequired":false,"billingCode":"30100","codeType":"CPT"},{"id":1978,"precertRequired":false,"billingCode":"30200","codeType":"CPT"},{"id":1980,"precertRequired":false,"billingCode":"30560","codeType":"CPT"},{"id":1981,"precertRequired":false,"billingCode":"30801","codeType":"CPT"},{"id":1982,"precertRequired":false,"billingCode":"30802","codeType":"CPT"},{"id":1983,"precertRequired":false,"billingCode":"30901","codeType":"CPT"},{"id":1984,"precertRequired":false,"billingCode":"30903","codeType":"CPT"},{"id":1985,"precertRequired":false,"billingCode":"30905","codeType":"CPT"},{"id":1987,"precertRequired":false,"billingCode":"30930","codeType":"CPT"},{"id":1988,"precertRequired":false,"billingCode":"31000","codeType":"CPT"},{"id":1989,"precertRequired":false,"billingCode":"31002","codeType":"CPT"},{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1991,"precertRequired":false,"billingCode":"31233","codeType":"CPT"},{"id":1992,"precertRequired":false,"billingCode":"31235","codeType":"CPT"},{"id":2724,"precertRequired":false,"billingCode":"41000","codeType":"CPT"},{"id":2725,"precertRequired":false,"billingCode":"41100","codeType":"CPT"},{"id":2727,"precertRequired":false,"billingCode":"41108","codeType":"CPT"},{"id":2728,"precertRequired":false,"billingCode":"41250","codeType":"CPT"},{"id":2730,"precertRequired":false,"billingCode":"42300","codeType":"CPT"},{"id":2731,"precertRequired":false,"billingCode":"42310","codeType":"CPT"},{"id":2732,"precertRequired":false,"billingCode":"42330","codeType":"CPT"},{"id":2733,"precertRequired":false,"billingCode":"42550","codeType":"CPT"},{"id":2734,"precertRequired":false,"billingCode":"42700","codeType":"CPT"},{"id":2735,"precertRequired":false,"billingCode":"42800","codeType":"CPT"},{"id":2736,"precertRequired":false,"billingCode":"42804","codeType":"CPT"},{"id":2737,"precertRequired":false,"billingCode":"42806","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":4348,"precertRequired":false,"billingCode":"69000","codeType":"CPT"},{"id":4349,"precertRequired":false,"billingCode":"69100","codeType":"CPT"},{"id":4350,"precertRequired":false,"billingCode":"69105","codeType":"CPT"},{"id":4351,"precertRequired":false,"billingCode":"69200","codeType":"CPT"},{"id":4354,"precertRequired":false,"billingCode":"69210","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4357,"precertRequired":false,"billingCode":"69420","codeType":"CPT"},{"id":4358,"precertRequired":false,"billingCode":"69433","codeType":"CPT"},{"id":4359,"precertRequired":false,"billingCode":"69540","codeType":"CPT"},{"id":6702,"precertRequired":false,"billingCode":"92504","codeType":"CPT"},{"id":6706,"precertRequired":false,"billingCode":"92511","codeType":"CPT"},{"id":6740,"precertRequired":false,"billingCode":"92567","codeType":"CPT"},{"id":8395,"precertRequired":false,"billingCode":"J0800","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]},{"id":154,"description":"Follow up visits as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"04-Otolaryngology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"207YS0012X"},{"HPTC":"207Y00000X"},{"HPTC":"207YX0905X"},{"HPTC":"207YX0007X"},{"HPTC":"207YS0123X"},{"HPTC":"207YP0228X"},{"HPTC":"207YX0901X"},{"HPTC":"207YX0602X"}]}]}},{"Seoc":{"id":1786,"seocKey":52,"name":"Eye Care Comprehensive 1 Year_PRCT","seocId":"SSC_EYE CARE COMPREHENSIVE 1 YEAR_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.  These services may be provided by an Optometrist or Ophthalmologist in some cases. Only ophthalmologists can perform invasive procedures, including injections, lasers, and eye surgery. VA authorization excludes coverage of premium IOLs ( toric, multifocal, accommodating), and refractive and cosmetic surgery that does not correct a functional disability.","effectiveDate":"06-08-2020","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition order\r\n2.    Diagnostic images/laboratories/studies relevant to the referred condition order\r\n3.    Procedures and pathology services relevant to the referred condition order.  Note:  VA authorization excludes coverage of premium IOLs ( toric, multifocal, accommodating), and refractive and cosmetic surgery that does not correct a functional disability.   \r\n4.    Anesthesia consultation related to the procedure\r\n5.    Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n6.   Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website. \r\n7.   Intravitreal anti-VEGF injections according to VA protocol (see below)\r\n7a. VA Protocol: The following initial treatment is recommended and approved - A series of 3 monthly bevacizumab injections per eye with re-evaluation. At the end of the series if there is measurable improvement, patient will continue on this treatment for up to 8 total injections per eye for this episode of care. If patient shows no measurable improvement to the initial series of injections, additional request for services is needed with accompanying medical justification must be submitted to request other medications or procedures to treat the condition indicated on the consult, including ranibizumab, aflibercept, intraocular steroid implants, laser, or vitrectomy.\r\n8.    Inpatient or observation admission for surgical procedure, if medically necessary\r\n9.    Inpatient admission or observation status for complications related to the procedure\r\nNote: Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n10.  Follow-up visits for this episode of care","maxAllowableVisits":null,"disclaimer":"* VA (and Veterans) will not pay extra for laser assisted cataract surgery with conventional intraocular lens implant in accordance with Medicare policy and CMS rulings.\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","QASP":"General Care","categoryOfCare":"OPHTHALMOLOGY","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207W00000X"}],"services":[{"id":5513,"description":"Initial outpatient evaluation and treatment for the referred condition order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5514,"description":"Diagnostic images/laboratories/studies relevant to the referred condition order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4716,"precertRequired":false,"billingCode":"76514","codeType":"CPT"},{"id":4717,"precertRequired":false,"billingCode":"76516","codeType":"CPT"},{"id":4718,"precertRequired":false,"billingCode":"76519","codeType":"CPT"},{"id":4719,"precertRequired":false,"billingCode":"76529","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6656,"precertRequired":false,"billingCode":"92100","codeType":"CPT"},{"id":6657,"precertRequired":false,"billingCode":"92132","codeType":"CPT"},{"id":6658,"precertRequired":false,"billingCode":"92133","codeType":"CPT"},{"id":6659,"precertRequired":false,"billingCode":"92134","codeType":"CPT"},{"id":6660,"precertRequired":false,"billingCode":"92136","codeType":"CPT"},{"id":6661,"precertRequired":false,"billingCode":"92145","codeType":"CPT"},{"id":6664,"precertRequired":false,"billingCode":"92227","codeType":"CPT"},{"id":6665,"precertRequired":false,"billingCode":"92228","codeType":"CPT"},{"id":6666,"precertRequired":false,"billingCode":"92230","codeType":"CPT"},{"id":6667,"precertRequired":false,"billingCode":"92235","codeType":"CPT"},{"id":6668,"precertRequired":false,"billingCode":"92240","codeType":"CPT"},{"id":6669,"precertRequired":false,"billingCode":"92242","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":6671,"precertRequired":false,"billingCode":"92260","codeType":"CPT"},{"id":6672,"precertRequired":false,"billingCode":"92265","codeType":"CPT"},{"id":6673,"precertRequired":false,"billingCode":"92270","codeType":"CPT"},{"id":6675,"precertRequired":false,"billingCode":"92283","codeType":"CPT"},{"id":6676,"precertRequired":false,"billingCode":"92284","codeType":"CPT"},{"id":6677,"precertRequired":false,"billingCode":"92285","codeType":"CPT"},{"id":6678,"precertRequired":false,"billingCode":"92286","codeType":"CPT"},{"id":6679,"precertRequired":false,"billingCode":"92287","codeType":"CPT"},{"id":7536,"precertRequired":false,"billingCode":"0329T","codeType":"CPT"},{"id":7537,"precertRequired":false,"billingCode":"0330T","codeType":"CPT"},{"id":7554,"precertRequired":false,"billingCode":"0378T","codeType":"CPT"},{"id":7555,"precertRequired":false,"billingCode":"0379T","codeType":"CPT"},{"id":11591,"precertRequired":false,"billingCode":"92273","codeType":"CPT"},{"id":11592,"precertRequired":false,"billingCode":"92274","codeType":"CPT"},{"id":11593,"precertRequired":false,"billingCode":"0509T","codeType":"CPT"},{"id":13441,"precertRequired":false,"billingCode":"92201","codeType":"CPT"},{"id":13442,"precertRequired":false,"billingCode":"92202","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5515,"description":"Procedures and pathology services relevant to the referred condition order.  Note:  VA authorization excludes coverage of premium IOLs ( toric, multifocal, accommodating), and refractive and cosmetic surgery that does not correct a functional disability.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":399,"precertRequired":false,"billingCode":"15155","codeType":"CPT"},{"id":400,"precertRequired":false,"billingCode":"15156","codeType":"CPT"},{"id":401,"precertRequired":false,"billingCode":"15157","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":4084,"precertRequired":false,"billingCode":"65091","codeType":"CPT"},{"id":4085,"precertRequired":false,"billingCode":"65093","codeType":"CPT"},{"id":4086,"precertRequired":false,"billingCode":"65101","codeType":"CPT"},{"id":4087,"precertRequired":false,"billingCode":"65103","codeType":"CPT"},{"id":4088,"precertRequired":false,"billingCode":"65105","codeType":"CPT"},{"id":4089,"precertRequired":false,"billingCode":"65110","codeType":"CPT"},{"id":4090,"precertRequired":false,"billingCode":"65112","codeType":"CPT"},{"id":4091,"precertRequired":false,"billingCode":"65114","codeType":"CPT"},{"id":4092,"precertRequired":false,"billingCode":"65130","codeType":"CPT"},{"id":4093,"precertRequired":false,"billingCode":"65135","codeType":"CPT"},{"id":4094,"precertRequired":false,"billingCode":"65140","codeType":"CPT"},{"id":4095,"precertRequired":false,"billingCode":"65150","codeType":"CPT"},{"id":4096,"precertRequired":false,"billingCode":"65155","codeType":"CPT"},{"id":4097,"precertRequired":false,"billingCode":"65175","codeType":"CPT"},{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4099,"precertRequired":false,"billingCode":"65210","codeType":"CPT"},{"id":4100,"precertRequired":false,"billingCode":"65220","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4104,"precertRequired":false,"billingCode":"65260","codeType":"CPT"},{"id":4105,"precertRequired":false,"billingCode":"65270","codeType":"CPT"},{"id":4106,"precertRequired":false,"billingCode":"65272","codeType":"CPT"},{"id":4107,"precertRequired":false,"billingCode":"65273","codeType":"CPT"},{"id":4108,"precertRequired":false,"billingCode":"65275","codeType":"CPT"},{"id":4109,"precertRequired":false,"billingCode":"65280","codeType":"CPT"},{"id":4110,"precertRequired":false,"billingCode":"65285","codeType":"CPT"},{"id":4111,"precertRequired":false,"billingCode":"65286","codeType":"CPT"},{"id":4112,"precertRequired":false,"billingCode":"65290","codeType":"CPT"},{"id":4113,"precertRequired":false,"billingCode":"65400","codeType":"CPT"},{"id":4114,"precertRequired":false,"billingCode":"65410","codeType":"CPT"},{"id":4115,"precertRequired":false,"billingCode":"65420","codeType":"CPT"},{"id":4116,"precertRequired":false,"billingCode":"65426","codeType":"CPT"},{"id":4117,"precertRequired":false,"billingCode":"65430","codeType":"CPT"},{"id":4118,"precertRequired":false,"billingCode":"65435","codeType":"CPT"},{"id":4119,"precertRequired":false,"billingCode":"65436","codeType":"CPT"},{"id":4120,"precertRequired":false,"billingCode":"65450","codeType":"CPT"},{"id":4121,"precertRequired":false,"billingCode":"65600","codeType":"CPT"},{"id":4122,"precertRequired":false,"billingCode":"65710","codeType":"CPT"},{"id":4123,"precertRequired":false,"billingCode":"65730","codeType":"CPT"},{"id":4124,"precertRequired":false,"billingCode":"65750","codeType":"CPT"},{"id":4125,"precertRequired":false,"billingCode":"65755","codeType":"CPT"},{"id":4126,"precertRequired":false,"billingCode":"65756","codeType":"CPT"},{"id":4127,"precertRequired":false,"billingCode":"65757","codeType":"CPT"},{"id":4128,"precertRequired":false,"billingCode":"65760","codeType":"CPT"},{"id":4129,"precertRequired":false,"billingCode":"65765","codeType":"CPT"},{"id":4130,"precertRequired":false,"billingCode":"65767","codeType":"CPT"},{"id":4131,"precertRequired":false,"billingCode":"65770","codeType":"CPT"},{"id":4132,"precertRequired":false,"billingCode":"65771","codeType":"CPT"},{"id":4133,"precertRequired":false,"billingCode":"65772","codeType":"CPT"},{"id":4134,"precertRequired":false,"billingCode":"65775","codeType":"CPT"},{"id":4135,"precertRequired":false,"billingCode":"65778","codeType":"CPT"},{"id":4136,"precertRequired":false,"billingCode":"65779","codeType":"CPT"},{"id":4137,"precertRequired":false,"billingCode":"65780","codeType":"CPT"},{"id":4138,"precertRequired":false,"billingCode":"65781","codeType":"CPT"},{"id":4139,"precertRequired":false,"billingCode":"65782","codeType":"CPT"},{"id":4141,"precertRequired":false,"billingCode":"65800","codeType":"CPT"},{"id":4142,"precertRequired":false,"billingCode":"65810","codeType":"CPT"},{"id":4143,"precertRequired":false,"billingCode":"65815","codeType":"CPT"},{"id":4144,"precertRequired":false,"billingCode":"65820","codeType":"CPT"},{"id":4145,"precertRequired":false,"billingCode":"65850","codeType":"CPT"},{"id":4146,"precertRequired":false,"billingCode":"65855","codeType":"CPT"},{"id":4147,"precertRequired":false,"billingCode":"65860","codeType":"CPT"},{"id":4148,"precertRequired":false,"billingCode":"65865","codeType":"CPT"},{"id":4149,"precertRequired":false,"billingCode":"65870","codeType":"CPT"},{"id":4150,"precertRequired":false,"billingCode":"65875","codeType":"CPT"},{"id":4151,"precertRequired":false,"billingCode":"65880","codeType":"CPT"},{"id":4152,"precertRequired":false,"billingCode":"65900","codeType":"CPT"},{"id":4153,"precertRequired":false,"billingCode":"65920","codeType":"CPT"},{"id":4154,"precertRequired":false,"billingCode":"65930","codeType":"CPT"},{"id":4157,"precertRequired":false,"billingCode":"66130","codeType":"CPT"},{"id":4158,"precertRequired":false,"billingCode":"66150","codeType":"CPT"},{"id":4159,"precertRequired":false,"billingCode":"66155","codeType":"CPT"},{"id":4160,"precertRequired":false,"billingCode":"66160","codeType":"CPT"},{"id":4161,"precertRequired":false,"billingCode":"66170","codeType":"CPT"},{"id":4162,"precertRequired":false,"billingCode":"66172","codeType":"CPT"},{"id":4163,"precertRequired":false,"billingCode":"66174","codeType":"CPT"},{"id":4164,"precertRequired":false,"billingCode":"66179","codeType":"CPT"},{"id":4165,"precertRequired":false,"billingCode":"66180","codeType":"CPT"},{"id":4166,"precertRequired":false,"billingCode":"66183","codeType":"CPT"},{"id":4167,"precertRequired":false,"billingCode":"66184","codeType":"CPT"},{"id":4168,"precertRequired":false,"billingCode":"66185","codeType":"CPT"},{"id":4170,"precertRequired":false,"billingCode":"66225","codeType":"CPT"},{"id":4171,"precertRequired":false,"billingCode":"66250","codeType":"CPT"},{"id":4172,"precertRequired":false,"billingCode":"66500","codeType":"CPT"},{"id":4173,"precertRequired":false,"billingCode":"66505","codeType":"CPT"},{"id":4174,"precertRequired":false,"billingCode":"66600","codeType":"CPT"},{"id":4175,"precertRequired":false,"billingCode":"66605","codeType":"CPT"},{"id":4176,"precertRequired":false,"billingCode":"66625","codeType":"CPT"},{"id":4177,"precertRequired":false,"billingCode":"66630","codeType":"CPT"},{"id":4178,"precertRequired":false,"billingCode":"66635","codeType":"CPT"},{"id":4179,"precertRequired":false,"billingCode":"66680","codeType":"CPT"},{"id":4180,"precertRequired":false,"billingCode":"66682","codeType":"CPT"},{"id":4181,"precertRequired":false,"billingCode":"66700","codeType":"CPT"},{"id":4182,"precertRequired":false,"billingCode":"66710","codeType":"CPT"},{"id":4183,"precertRequired":false,"billingCode":"66711","codeType":"CPT"},{"id":4184,"precertRequired":false,"billingCode":"66720","codeType":"CPT"},{"id":4185,"precertRequired":false,"billingCode":"66740","codeType":"CPT"},{"id":4186,"precertRequired":false,"billingCode":"66761","codeType":"CPT"},{"id":4187,"precertRequired":false,"billingCode":"66762","codeType":"CPT"},{"id":4188,"precertRequired":false,"billingCode":"66770","codeType":"CPT"},{"id":4189,"precertRequired":false,"billingCode":"66820","codeType":"CPT"},{"id":4190,"precertRequired":false,"billingCode":"66821","codeType":"CPT"},{"id":4191,"precertRequired":false,"billingCode":"66825","codeType":"CPT"},{"id":4192,"precertRequired":false,"billingCode":"66830","codeType":"CPT"},{"id":4193,"precertRequired":false,"billingCode":"66840","codeType":"CPT"},{"id":4194,"precertRequired":false,"billingCode":"66850","codeType":"CPT"},{"id":4195,"precertRequired":false,"billingCode":"66852","codeType":"CPT"},{"id":4196,"precertRequired":false,"billingCode":"66920","codeType":"CPT"},{"id":4197,"precertRequired":false,"billingCode":"66930","codeType":"CPT"},{"id":4198,"precertRequired":false,"billingCode":"66940","codeType":"CPT"},{"id":4199,"precertRequired":false,"billingCode":"66982","codeType":"CPT"},{"id":4200,"precertRequired":false,"billingCode":"66983","codeType":"CPT"},{"id":4201,"precertRequired":false,"billingCode":"66984","codeType":"CPT"},{"id":4202,"precertRequired":false,"billingCode":"66985","codeType":"CPT"},{"id":4203,"precertRequired":false,"billingCode":"66986","codeType":"CPT"},{"id":4204,"precertRequired":false,"billingCode":"66990","codeType":"CPT"},{"id":4205,"precertRequired":false,"billingCode":"67005","codeType":"CPT"},{"id":4206,"precertRequired":false,"billingCode":"67010","codeType":"CPT"},{"id":4207,"precertRequired":false,"billingCode":"67015","codeType":"CPT"},{"id":4211,"precertRequired":false,"billingCode":"67030","codeType":"CPT"},{"id":4212,"precertRequired":false,"billingCode":"67031","codeType":"CPT"},{"id":4213,"precertRequired":false,"billingCode":"67036","codeType":"CPT"},{"id":4214,"precertRequired":false,"billingCode":"67039","codeType":"CPT"},{"id":4215,"precertRequired":false,"billingCode":"67040","codeType":"CPT"},{"id":4216,"precertRequired":false,"billingCode":"67041","codeType":"CPT"},{"id":4217,"precertRequired":false,"billingCode":"67042","codeType":"CPT"},{"id":4218,"precertRequired":false,"billingCode":"67043","codeType":"CPT"},{"id":4220,"precertRequired":false,"billingCode":"67101","codeType":"CPT"},{"id":4221,"precertRequired":false,"billingCode":"67105","codeType":"CPT"},{"id":4222,"precertRequired":false,"billingCode":"67107","codeType":"CPT"},{"id":4223,"precertRequired":false,"billingCode":"67108","codeType":"CPT"},{"id":4224,"precertRequired":false,"billingCode":"67110","codeType":"CPT"},{"id":4225,"precertRequired":false,"billingCode":"67113","codeType":"CPT"},{"id":4226,"precertRequired":false,"billingCode":"67115","codeType":"CPT"},{"id":4227,"precertRequired":false,"billingCode":"67120","codeType":"CPT"},{"id":4228,"precertRequired":false,"billingCode":"67121","codeType":"CPT"},{"id":4229,"precertRequired":false,"billingCode":"67141","codeType":"CPT"},{"id":4230,"precertRequired":false,"billingCode":"67145","codeType":"CPT"},{"id":4231,"precertRequired":false,"billingCode":"67208","codeType":"CPT"},{"id":4232,"precertRequired":false,"billingCode":"67210","codeType":"CPT"},{"id":4233,"precertRequired":false,"billingCode":"67218","codeType":"CPT"},{"id":4234,"precertRequired":false,"billingCode":"67220","codeType":"CPT"},{"id":4235,"precertRequired":false,"billingCode":"67221","codeType":"CPT"},{"id":4236,"precertRequired":false,"billingCode":"67225","codeType":"CPT"},{"id":4237,"precertRequired":false,"billingCode":"67227","codeType":"CPT"},{"id":4238,"precertRequired":false,"billingCode":"67228","codeType":"CPT"},{"id":4239,"precertRequired":false,"billingCode":"67250","codeType":"CPT"},{"id":4240,"precertRequired":false,"billingCode":"67255","codeType":"CPT"},{"id":4242,"precertRequired":false,"billingCode":"67311","codeType":"CPT"},{"id":4243,"precertRequired":false,"billingCode":"67312","codeType":"CPT"},{"id":4244,"precertRequired":false,"billingCode":"67314","codeType":"CPT"},{"id":4245,"precertRequired":false,"billingCode":"67316","codeType":"CPT"},{"id":4246,"precertRequired":false,"billingCode":"67318","codeType":"CPT"},{"id":4247,"precertRequired":false,"billingCode":"67320","codeType":"CPT"},{"id":4248,"precertRequired":false,"billingCode":"67331","codeType":"CPT"},{"id":4249,"precertRequired":false,"billingCode":"67332","codeType":"CPT"},{"id":4250,"precertRequired":false,"billingCode":"67334","codeType":"CPT"},{"id":4251,"precertRequired":false,"billingCode":"67335","codeType":"CPT"},{"id":4252,"precertRequired":false,"billingCode":"67340","codeType":"CPT"},{"id":4253,"precertRequired":false,"billingCode":"67343","codeType":"CPT"},{"id":4254,"precertRequired":false,"billingCode":"67345","codeType":"CPT"},{"id":4255,"precertRequired":false,"billingCode":"67346","codeType":"CPT"},{"id":4257,"precertRequired":false,"billingCode":"67400","codeType":"CPT"},{"id":4258,"precertRequired":false,"billingCode":"67405","codeType":"CPT"},{"id":4259,"precertRequired":false,"billingCode":"67412","codeType":"CPT"},{"id":4260,"precertRequired":false,"billingCode":"67413","codeType":"CPT"},{"id":4261,"precertRequired":false,"billingCode":"67414","codeType":"CPT"},{"id":4262,"precertRequired":false,"billingCode":"67415","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4268,"precertRequired":false,"billingCode":"67500","codeType":"CPT"},{"id":4269,"precertRequired":false,"billingCode":"67505","codeType":"CPT"},{"id":4270,"precertRequired":false,"billingCode":"67515","codeType":"CPT"},{"id":4271,"precertRequired":false,"billingCode":"67550","codeType":"CPT"},{"id":4272,"precertRequired":false,"billingCode":"67560","codeType":"CPT"},{"id":4273,"precertRequired":false,"billingCode":"67570","codeType":"CPT"},{"id":4275,"precertRequired":false,"billingCode":"67700","codeType":"CPT"},{"id":4276,"precertRequired":false,"billingCode":"67710","codeType":"CPT"},{"id":4277,"precertRequired":false,"billingCode":"67715","codeType":"CPT"},{"id":4278,"precertRequired":false,"billingCode":"67800","codeType":"CPT"},{"id":4279,"precertRequired":false,"billingCode":"67801","codeType":"CPT"},{"id":4280,"precertRequired":false,"billingCode":"67805","codeType":"CPT"},{"id":4281,"precertRequired":false,"billingCode":"67808","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4283,"precertRequired":false,"billingCode":"67820","codeType":"CPT"},{"id":4284,"precertRequired":false,"billingCode":"67825","codeType":"CPT"},{"id":4285,"precertRequired":false,"billingCode":"67830","codeType":"CPT"},{"id":4286,"precertRequired":false,"billingCode":"67835","codeType":"CPT"},{"id":4287,"precertRequired":false,"billingCode":"67840","codeType":"CPT"},{"id":4288,"precertRequired":false,"billingCode":"67850","codeType":"CPT"},{"id":4289,"precertRequired":false,"billingCode":"67875","codeType":"CPT"},{"id":4290,"precertRequired":false,"billingCode":"67880","codeType":"CPT"},{"id":4291,"precertRequired":false,"billingCode":"67882","codeType":"CPT"},{"id":4292,"precertRequired":false,"billingCode":"67900","codeType":"CPT"},{"id":4293,"precertRequired":false,"billingCode":"67901","codeType":"CPT"},{"id":4294,"precertRequired":false,"billingCode":"67902","codeType":"CPT"},{"id":4295,"precertRequired":false,"billingCode":"67903","codeType":"CPT"},{"id":4296,"precertRequired":false,"billingCode":"67904","codeType":"CPT"},{"id":4297,"precertRequired":false,"billingCode":"67906","codeType":"CPT"},{"id":4298,"precertRequired":false,"billingCode":"67908","codeType":"CPT"},{"id":4299,"precertRequired":false,"billingCode":"67909","codeType":"CPT"},{"id":4300,"precertRequired":false,"billingCode":"67911","codeType":"CPT"},{"id":4301,"precertRequired":false,"billingCode":"67912","codeType":"CPT"},{"id":4302,"precertRequired":false,"billingCode":"67916","codeType":"CPT"},{"id":4303,"precertRequired":false,"billingCode":"67917","codeType":"CPT"},{"id":4304,"precertRequired":false,"billingCode":"67921","codeType":"CPT"},{"id":4305,"precertRequired":false,"billingCode":"67922","codeType":"CPT"},{"id":4306,"precertRequired":false,"billingCode":"67923","codeType":"CPT"},{"id":4307,"precertRequired":false,"billingCode":"67924","codeType":"CPT"},{"id":4308,"precertRequired":false,"billingCode":"67930","codeType":"CPT"},{"id":4309,"precertRequired":false,"billingCode":"67935","codeType":"CPT"},{"id":4310,"precertRequired":false,"billingCode":"67950","codeType":"CPT"},{"id":4311,"precertRequired":false,"billingCode":"67961","codeType":"CPT"},{"id":4312,"precertRequired":false,"billingCode":"67966","codeType":"CPT"},{"id":4313,"precertRequired":false,"billingCode":"67971","codeType":"CPT"},{"id":4314,"precertRequired":false,"billingCode":"67973","codeType":"CPT"},{"id":4315,"precertRequired":false,"billingCode":"67974","codeType":"CPT"},{"id":4316,"precertRequired":false,"billingCode":"67975","codeType":"CPT"},{"id":4318,"precertRequired":false,"billingCode":"68020","codeType":"CPT"},{"id":4319,"precertRequired":false,"billingCode":"68040","codeType":"CPT"},{"id":4320,"precertRequired":false,"billingCode":"68100","codeType":"CPT"},{"id":4321,"precertRequired":false,"billingCode":"68110","codeType":"CPT"},{"id":4322,"precertRequired":false,"billingCode":"68115","codeType":"CPT"},{"id":4323,"precertRequired":false,"billingCode":"68130","codeType":"CPT"},{"id":4324,"precertRequired":false,"billingCode":"68135","codeType":"CPT"},{"id":4325,"precertRequired":false,"billingCode":"68200","codeType":"CPT"},{"id":4326,"precertRequired":false,"billingCode":"68320","codeType":"CPT"},{"id":4327,"precertRequired":false,"billingCode":"68325","codeType":"CPT"},{"id":4328,"precertRequired":false,"billingCode":"68326","codeType":"CPT"},{"id":4329,"precertRequired":false,"billingCode":"68328","codeType":"CPT"},{"id":4330,"precertRequired":false,"billingCode":"68330","codeType":"CPT"},{"id":4331,"precertRequired":false,"billingCode":"68335","codeType":"CPT"},{"id":4332,"precertRequired":false,"billingCode":"68340","codeType":"CPT"},{"id":4333,"precertRequired":false,"billingCode":"68360","codeType":"CPT"},{"id":4334,"precertRequired":false,"billingCode":"68362","codeType":"CPT"},{"id":4335,"precertRequired":false,"billingCode":"68371","codeType":"CPT"},{"id":4337,"precertRequired":false,"billingCode":"68400","codeType":"CPT"},{"id":4338,"precertRequired":false,"billingCode":"68420","codeType":"CPT"},{"id":4339,"precertRequired":false,"billingCode":"68440","codeType":"CPT"},{"id":4340,"precertRequired":false,"billingCode":"68500","codeType":"CPT"},{"id":4341,"precertRequired":false,"billingCode":"68505","codeType":"CPT"},{"id":4342,"precertRequired":false,"billingCode":"68510","codeType":"CPT"},{"id":4344,"precertRequired":false,"billingCode":"68720","codeType":"CPT"},{"id":4345,"precertRequired":false,"billingCode":"68801","codeType":"CPT"},{"id":4346,"precertRequired":false,"billingCode":"68850","codeType":"CPT"},{"id":5614,"precertRequired":false,"billingCode":"83861","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6651,"precertRequired":false,"billingCode":"92071","codeType":"CPT"},{"id":6652,"precertRequired":false,"billingCode":"92072","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6688,"precertRequired":false,"billingCode":"92325","codeType":"CPT"},{"id":6689,"precertRequired":false,"billingCode":"92326","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6697,"precertRequired":false,"billingCode":"92358","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7338,"precertRequired":false,"billingCode":"99172","codeType":"CPT"},{"id":7339,"precertRequired":false,"billingCode":"99173","codeType":"CPT"},{"id":7340,"precertRequired":false,"billingCode":"99174","codeType":"CPT"},{"id":7341,"precertRequired":false,"billingCode":"99177","codeType":"CPT"},{"id":7624,"precertRequired":false,"billingCode":"2022F","codeType":"CPT"},{"id":7846,"precertRequired":false,"billingCode":"A6410","codeType":"HCPCS"},{"id":7847,"precertRequired":false,"billingCode":"A6411","codeType":"HCPCS"},{"id":7848,"precertRequired":false,"billingCode":"A6412","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8156,"precertRequired":false,"billingCode":"G0186","codeType":"HCPCS"},{"id":9170,"precertRequired":true,"billingCode":"15115","codeType":"CPT"},{"id":9171,"precertRequired":true,"billingCode":"15116","codeType":"CPT"},{"id":9172,"precertRequired":true,"billingCode":"15120","codeType":"CPT"},{"id":9173,"precertRequired":true,"billingCode":"15121","codeType":"CPT"},{"id":9174,"precertRequired":true,"billingCode":"15135","codeType":"CPT"},{"id":9175,"precertRequired":true,"billingCode":"15136","codeType":"CPT"},{"id":9958,"precertRequired":false,"billingCode":"15823","codeType":"CPT"},{"id":11595,"precertRequired":false,"billingCode":"65265","codeType":"CPT"},{"id":11597,"precertRequired":false,"billingCode":"66175","codeType":"CPT"},{"id":11606,"precertRequired":false,"billingCode":"68745","codeType":"CPT"},{"id":11607,"precertRequired":false,"billingCode":"68750","codeType":"CPT"},{"id":11608,"precertRequired":false,"billingCode":"68760","codeType":"CPT"},{"id":11609,"precertRequired":false,"billingCode":"68761","codeType":"CPT"},{"id":11610,"precertRequired":false,"billingCode":"68770","codeType":"CPT"},{"id":11611,"precertRequired":false,"billingCode":"68810","codeType":"CPT"},{"id":11612,"precertRequired":false,"billingCode":"68811","codeType":"CPT"},{"id":11613,"precertRequired":false,"billingCode":"68815","codeType":"CPT"},{"id":11614,"precertRequired":false,"billingCode":"68816","codeType":"CPT"},{"id":11615,"precertRequired":false,"billingCode":"68840","codeType":"CPT"},{"id":11616,"precertRequired":false,"billingCode":"0191T","codeType":"CPT"},{"id":11618,"precertRequired":false,"billingCode":"0376T","codeType":"CPT"},{"id":11619,"precertRequired":false,"billingCode":"0402T","codeType":"CPT"},{"id":11620,"precertRequired":false,"billingCode":"0449T","codeType":"CPT"},{"id":11622,"precertRequired":false,"billingCode":"0474T","codeType":"CPT"},{"id":11624,"precertRequired":false,"billingCode":"2019F","codeType":"CPT"},{"id":11625,"precertRequired":false,"billingCode":"2021F","codeType":"CPT"},{"id":11626,"precertRequired":false,"billingCode":"2027F","codeType":"CPT"},{"id":13477,"precertRequired":false,"billingCode":"15820","codeType":"CPT"},{"id":13478,"precertRequired":false,"billingCode":"15821","codeType":"CPT"},{"id":13479,"precertRequired":false,"billingCode":"15822","codeType":"CPT"},{"id":13480,"precertRequired":false,"billingCode":"66987","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5516,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":8,"precertRequired":false,"billingCode":"00140","codeType":"CPT"},{"id":9,"precertRequired":false,"billingCode":"00142","codeType":"CPT"},{"id":11,"precertRequired":false,"billingCode":"00145","codeType":"CPT"},{"id":12,"precertRequired":false,"billingCode":"00147","codeType":"CPT"},{"id":13,"precertRequired":false,"billingCode":"00148","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":5517,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5518,"description":"Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4155,"precertRequired":false,"billingCode":"66020","codeType":"CPT"},{"id":4156,"precertRequired":false,"billingCode":"66030","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5519,"description":"Intravitreal anti-VEGF injections according to VA protocol (see below)\r\n7a. VA Protocol: The following initial treatment is recommended and approved - A series of 3 monthly bevacizumab injections per eye with re-evaluation. At the end of the series if there is measurable improvement, patient will continue on this treatment for up to 8 total injections per eye for this episode of care. If patient shows no measurable improvement to the initial series of injections, additional request for services is needed with accompanying medical justification must be submitted to request other medications or procedures to treat the condition indicated on the consult, including ranibizumab, aflibercept, intraocular steroid implants, laser, or vitrectomy.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4208,"precertRequired":false,"billingCode":"67025","codeType":"CPT"},{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5520,"description":"Inpatient or observation admission for surgical procedure, if medically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5521,"description":"Inpatient admission or observation status for complications related to the procedure\r\nNote: Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5522,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]}]}},{"Seoc":{"id":484,"seocKey":52,"name":"Eye Care Comprehensive 1 Year_PRCT","seocId":"SSC_EYE CARE COMPREHENSIVE 1 YEAR_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below as clinically necessary. These services can be provided by an Optometrist or Ophthalmologist.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic images/laboratories/studies relevant to the referred condition\r\n3. Procedures and pathology services relevant to the referred condition\r\n4. Anesthesia consultation related to the procedure\r\n5. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n6. Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website\r\n7. Intravitreal anti-VEGF injections according to VA protocol (see below)             \r\na.  VA Protocol: The following initial treatment is recommended and approved - A series of 3 monthly bevacizumab injections per eye with re-evaluation. At the end of the series if there is measurable improvement, patient will continue on this treatment for up to 8 total injections per eye for this episode of care. If patient shows no measurable improvement to the initial series of injections, additional request for services is needed with accompanying medical justification must be submitted to request other medications or procedures to treat the condition indicated on the consult, including ranibizumab, aflibercept, intraocular steroid implants, laser, or vitrectomy\r\n8. Inpatient or observation admission for surgical procedure, if medically necessary\r\n9. Inpatient admission or observation status for complications related to the procedure       \r\n** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n10. Follow-up visits for this episode of care  \r\na.    Follow-up images/studies/laboratories as indicated.","maxAllowableVisits":null,"disclaimer":"*VA authorization excludes coverage of premium IOLs (toric, multifocal, accommodating), and refractive and cosmetic surgery that does not correct a functional disability\r\n* VA (and Veterans) will not pay extra for laser assisted cataract surgery with conventional intraocular lens implant in accordance with Medicare policy and CMS rulings.\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","QASP":"General Care","categoryOfCare":"OPHTHALMOLOGY","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207W00000X"}],"services":[{"id":2765,"description":"Initial outpatient evaluation and treatment for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2766,"description":"Diagnostic images/laboratories/studies relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4716,"precertRequired":false,"billingCode":"76514","codeType":"CPT"},{"id":4717,"precertRequired":false,"billingCode":"76516","codeType":"CPT"},{"id":4718,"precertRequired":false,"billingCode":"76519","codeType":"CPT"},{"id":4719,"precertRequired":false,"billingCode":"76529","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6656,"precertRequired":false,"billingCode":"92100","codeType":"CPT"},{"id":6657,"precertRequired":false,"billingCode":"92132","codeType":"CPT"},{"id":6658,"precertRequired":false,"billingCode":"92133","codeType":"CPT"},{"id":6659,"precertRequired":false,"billingCode":"92134","codeType":"CPT"},{"id":6660,"precertRequired":false,"billingCode":"92136","codeType":"CPT"},{"id":6661,"precertRequired":false,"billingCode":"92145","codeType":"CPT"},{"id":6662,"precertRequired":false,"billingCode":"92225","codeType":"CPT"},{"id":6663,"precertRequired":false,"billingCode":"92226","codeType":"CPT"},{"id":6664,"precertRequired":false,"billingCode":"92227","codeType":"CPT"},{"id":6665,"precertRequired":false,"billingCode":"92228","codeType":"CPT"},{"id":6666,"precertRequired":false,"billingCode":"92230","codeType":"CPT"},{"id":6667,"precertRequired":false,"billingCode":"92235","codeType":"CPT"},{"id":6668,"precertRequired":false,"billingCode":"92240","codeType":"CPT"},{"id":6669,"precertRequired":false,"billingCode":"92242","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":6671,"precertRequired":false,"billingCode":"92260","codeType":"CPT"},{"id":6672,"precertRequired":false,"billingCode":"92265","codeType":"CPT"},{"id":6673,"precertRequired":false,"billingCode":"92270","codeType":"CPT"},{"id":6675,"precertRequired":false,"billingCode":"92283","codeType":"CPT"},{"id":6676,"precertRequired":false,"billingCode":"92284","codeType":"CPT"},{"id":6677,"precertRequired":false,"billingCode":"92285","codeType":"CPT"},{"id":6678,"precertRequired":false,"billingCode":"92286","codeType":"CPT"},{"id":7536,"precertRequired":false,"billingCode":"0329T","codeType":"CPT"},{"id":7537,"precertRequired":false,"billingCode":"0330T","codeType":"CPT"},{"id":7554,"precertRequired":false,"billingCode":"0378T","codeType":"CPT"},{"id":7555,"precertRequired":false,"billingCode":"0379T","codeType":"CPT"},{"id":7556,"precertRequired":false,"billingCode":"0380T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2767,"description":"Procedures and pathology services relevant to the referred condition","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4084,"precertRequired":false,"billingCode":"65091","codeType":"CPT"},{"id":4085,"precertRequired":false,"billingCode":"65093","codeType":"CPT"},{"id":4086,"precertRequired":false,"billingCode":"65101","codeType":"CPT"},{"id":4087,"precertRequired":false,"billingCode":"65103","codeType":"CPT"},{"id":4088,"precertRequired":false,"billingCode":"65105","codeType":"CPT"},{"id":4089,"precertRequired":false,"billingCode":"65110","codeType":"CPT"},{"id":4090,"precertRequired":false,"billingCode":"65112","codeType":"CPT"},{"id":4091,"precertRequired":false,"billingCode":"65114","codeType":"CPT"},{"id":4092,"precertRequired":false,"billingCode":"65130","codeType":"CPT"},{"id":4093,"precertRequired":false,"billingCode":"65135","codeType":"CPT"},{"id":4094,"precertRequired":false,"billingCode":"65140","codeType":"CPT"},{"id":4095,"precertRequired":false,"billingCode":"65150","codeType":"CPT"},{"id":4096,"precertRequired":false,"billingCode":"65155","codeType":"CPT"},{"id":4097,"precertRequired":false,"billingCode":"65175","codeType":"CPT"},{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4099,"precertRequired":false,"billingCode":"65210","codeType":"CPT"},{"id":4100,"precertRequired":false,"billingCode":"65220","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4104,"precertRequired":false,"billingCode":"65260","codeType":"CPT"},{"id":4105,"precertRequired":false,"billingCode":"65270","codeType":"CPT"},{"id":4106,"precertRequired":false,"billingCode":"65272","codeType":"CPT"},{"id":4107,"precertRequired":false,"billingCode":"65273","codeType":"CPT"},{"id":4108,"precertRequired":false,"billingCode":"65275","codeType":"CPT"},{"id":4109,"precertRequired":false,"billingCode":"65280","codeType":"CPT"},{"id":4110,"precertRequired":false,"billingCode":"65285","codeType":"CPT"},{"id":4111,"precertRequired":false,"billingCode":"65286","codeType":"CPT"},{"id":4112,"precertRequired":false,"billingCode":"65290","codeType":"CPT"},{"id":4113,"precertRequired":false,"billingCode":"65400","codeType":"CPT"},{"id":4114,"precertRequired":false,"billingCode":"65410","codeType":"CPT"},{"id":4115,"precertRequired":false,"billingCode":"65420","codeType":"CPT"},{"id":4116,"precertRequired":false,"billingCode":"65426","codeType":"CPT"},{"id":4117,"precertRequired":false,"billingCode":"65430","codeType":"CPT"},{"id":4118,"precertRequired":false,"billingCode":"65435","codeType":"CPT"},{"id":4119,"precertRequired":false,"billingCode":"65436","codeType":"CPT"},{"id":4120,"precertRequired":false,"billingCode":"65450","codeType":"CPT"},{"id":4121,"precertRequired":false,"billingCode":"65600","codeType":"CPT"},{"id":4122,"precertRequired":false,"billingCode":"65710","codeType":"CPT"},{"id":4123,"precertRequired":false,"billingCode":"65730","codeType":"CPT"},{"id":4124,"precertRequired":false,"billingCode":"65750","codeType":"CPT"},{"id":4125,"precertRequired":false,"billingCode":"65755","codeType":"CPT"},{"id":4126,"precertRequired":false,"billingCode":"65756","codeType":"CPT"},{"id":4127,"precertRequired":false,"billingCode":"65757","codeType":"CPT"},{"id":4128,"precertRequired":false,"billingCode":"65760","codeType":"CPT"},{"id":4129,"precertRequired":false,"billingCode":"65765","codeType":"CPT"},{"id":4130,"precertRequired":false,"billingCode":"65767","codeType":"CPT"},{"id":4131,"precertRequired":false,"billingCode":"65770","codeType":"CPT"},{"id":4132,"precertRequired":false,"billingCode":"65771","codeType":"CPT"},{"id":4133,"precertRequired":false,"billingCode":"65772","codeType":"CPT"},{"id":4134,"precertRequired":false,"billingCode":"65775","codeType":"CPT"},{"id":4135,"precertRequired":false,"billingCode":"65778","codeType":"CPT"},{"id":4136,"precertRequired":false,"billingCode":"65779","codeType":"CPT"},{"id":4137,"precertRequired":false,"billingCode":"65780","codeType":"CPT"},{"id":4138,"precertRequired":false,"billingCode":"65781","codeType":"CPT"},{"id":4139,"precertRequired":false,"billingCode":"65782","codeType":"CPT"},{"id":4141,"precertRequired":false,"billingCode":"65800","codeType":"CPT"},{"id":4142,"precertRequired":false,"billingCode":"65810","codeType":"CPT"},{"id":4143,"precertRequired":false,"billingCode":"65815","codeType":"CPT"},{"id":4144,"precertRequired":false,"billingCode":"65820","codeType":"CPT"},{"id":4145,"precertRequired":false,"billingCode":"65850","codeType":"CPT"},{"id":4146,"precertRequired":false,"billingCode":"65855","codeType":"CPT"},{"id":4147,"precertRequired":false,"billingCode":"65860","codeType":"CPT"},{"id":4148,"precertRequired":false,"billingCode":"65865","codeType":"CPT"},{"id":4149,"precertRequired":false,"billingCode":"65870","codeType":"CPT"},{"id":4150,"precertRequired":false,"billingCode":"65875","codeType":"CPT"},{"id":4151,"precertRequired":false,"billingCode":"65880","codeType":"CPT"},{"id":4152,"precertRequired":false,"billingCode":"65900","codeType":"CPT"},{"id":4153,"precertRequired":false,"billingCode":"65920","codeType":"CPT"},{"id":4154,"precertRequired":false,"billingCode":"65930","codeType":"CPT"},{"id":4155,"precertRequired":false,"billingCode":"66020","codeType":"CPT"},{"id":4157,"precertRequired":false,"billingCode":"66130","codeType":"CPT"},{"id":4158,"precertRequired":false,"billingCode":"66150","codeType":"CPT"},{"id":4159,"precertRequired":false,"billingCode":"66155","codeType":"CPT"},{"id":4160,"precertRequired":false,"billingCode":"66160","codeType":"CPT"},{"id":4161,"precertRequired":false,"billingCode":"66170","codeType":"CPT"},{"id":4162,"precertRequired":false,"billingCode":"66172","codeType":"CPT"},{"id":4163,"precertRequired":false,"billingCode":"66174","codeType":"CPT"},{"id":4164,"precertRequired":false,"billingCode":"66179","codeType":"CPT"},{"id":4165,"precertRequired":false,"billingCode":"66180","codeType":"CPT"},{"id":4166,"precertRequired":false,"billingCode":"66183","codeType":"CPT"},{"id":4167,"precertRequired":false,"billingCode":"66184","codeType":"CPT"},{"id":4168,"precertRequired":false,"billingCode":"66185","codeType":"CPT"},{"id":4170,"precertRequired":false,"billingCode":"66225","codeType":"CPT"},{"id":4171,"precertRequired":false,"billingCode":"66250","codeType":"CPT"},{"id":4172,"precertRequired":false,"billingCode":"66500","codeType":"CPT"},{"id":4174,"precertRequired":false,"billingCode":"66600","codeType":"CPT"},{"id":4175,"precertRequired":false,"billingCode":"66605","codeType":"CPT"},{"id":4176,"precertRequired":false,"billingCode":"66625","codeType":"CPT"},{"id":4177,"precertRequired":false,"billingCode":"66630","codeType":"CPT"},{"id":4178,"precertRequired":false,"billingCode":"66635","codeType":"CPT"},{"id":4179,"precertRequired":false,"billingCode":"66680","codeType":"CPT"},{"id":4180,"precertRequired":false,"billingCode":"66682","codeType":"CPT"},{"id":4181,"precertRequired":false,"billingCode":"66700","codeType":"CPT"},{"id":4182,"precertRequired":false,"billingCode":"66710","codeType":"CPT"},{"id":4183,"precertRequired":false,"billingCode":"66711","codeType":"CPT"},{"id":4184,"precertRequired":false,"billingCode":"66720","codeType":"CPT"},{"id":4185,"precertRequired":false,"billingCode":"66740","codeType":"CPT"},{"id":4186,"precertRequired":false,"billingCode":"66761","codeType":"CPT"},{"id":4187,"precertRequired":false,"billingCode":"66762","codeType":"CPT"},{"id":4188,"precertRequired":false,"billingCode":"66770","codeType":"CPT"},{"id":4189,"precertRequired":false,"billingCode":"66820","codeType":"CPT"},{"id":4190,"precertRequired":false,"billingCode":"66821","codeType":"CPT"},{"id":4191,"precertRequired":false,"billingCode":"66825","codeType":"CPT"},{"id":4192,"precertRequired":false,"billingCode":"66830","codeType":"CPT"},{"id":4193,"precertRequired":false,"billingCode":"66840","codeType":"CPT"},{"id":4194,"precertRequired":false,"billingCode":"66850","codeType":"CPT"},{"id":4195,"precertRequired":false,"billingCode":"66852","codeType":"CPT"},{"id":4196,"precertRequired":false,"billingCode":"66920","codeType":"CPT"},{"id":4197,"precertRequired":false,"billingCode":"66930","codeType":"CPT"},{"id":4198,"precertRequired":false,"billingCode":"66940","codeType":"CPT"},{"id":4199,"precertRequired":false,"billingCode":"66982","codeType":"CPT"},{"id":4200,"precertRequired":false,"billingCode":"66983","codeType":"CPT"},{"id":4201,"precertRequired":false,"billingCode":"66984","codeType":"CPT"},{"id":4202,"precertRequired":false,"billingCode":"66985","codeType":"CPT"},{"id":4203,"precertRequired":false,"billingCode":"66986","codeType":"CPT"},{"id":4204,"precertRequired":false,"billingCode":"66990","codeType":"CPT"},{"id":4205,"precertRequired":false,"billingCode":"67005","codeType":"CPT"},{"id":4206,"precertRequired":false,"billingCode":"67010","codeType":"CPT"},{"id":4207,"precertRequired":false,"billingCode":"67015","codeType":"CPT"},{"id":4208,"precertRequired":false,"billingCode":"67025","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":4211,"precertRequired":false,"billingCode":"67030","codeType":"CPT"},{"id":4212,"precertRequired":false,"billingCode":"67031","codeType":"CPT"},{"id":4213,"precertRequired":false,"billingCode":"67036","codeType":"CPT"},{"id":4214,"precertRequired":false,"billingCode":"67039","codeType":"CPT"},{"id":4215,"precertRequired":false,"billingCode":"67040","codeType":"CPT"},{"id":4216,"precertRequired":false,"billingCode":"67041","codeType":"CPT"},{"id":4217,"precertRequired":false,"billingCode":"67042","codeType":"CPT"},{"id":4218,"precertRequired":false,"billingCode":"67043","codeType":"CPT"},{"id":4220,"precertRequired":false,"billingCode":"67101","codeType":"CPT"},{"id":4221,"precertRequired":false,"billingCode":"67105","codeType":"CPT"},{"id":4222,"precertRequired":false,"billingCode":"67107","codeType":"CPT"},{"id":4223,"precertRequired":false,"billingCode":"67108","codeType":"CPT"},{"id":4224,"precertRequired":false,"billingCode":"67110","codeType":"CPT"},{"id":4225,"precertRequired":false,"billingCode":"67113","codeType":"CPT"},{"id":4226,"precertRequired":false,"billingCode":"67115","codeType":"CPT"},{"id":4227,"precertRequired":false,"billingCode":"67120","codeType":"CPT"},{"id":4228,"precertRequired":false,"billingCode":"67121","codeType":"CPT"},{"id":4229,"precertRequired":false,"billingCode":"67141","codeType":"CPT"},{"id":4230,"precertRequired":false,"billingCode":"67145","codeType":"CPT"},{"id":4231,"precertRequired":false,"billingCode":"67208","codeType":"CPT"},{"id":4232,"precertRequired":false,"billingCode":"67210","codeType":"CPT"},{"id":4233,"precertRequired":false,"billingCode":"67218","codeType":"CPT"},{"id":4234,"precertRequired":false,"billingCode":"67220","codeType":"CPT"},{"id":4235,"precertRequired":false,"billingCode":"67221","codeType":"CPT"},{"id":4236,"precertRequired":false,"billingCode":"67225","codeType":"CPT"},{"id":4237,"precertRequired":false,"billingCode":"67227","codeType":"CPT"},{"id":4238,"precertRequired":false,"billingCode":"67228","codeType":"CPT"},{"id":4239,"precertRequired":false,"billingCode":"67250","codeType":"CPT"},{"id":4240,"precertRequired":false,"billingCode":"67255","codeType":"CPT"},{"id":4241,"precertRequired":false,"billingCode":"67299","codeType":"CPT"},{"id":4242,"precertRequired":false,"billingCode":"67311","codeType":"CPT"},{"id":4243,"precertRequired":false,"billingCode":"67312","codeType":"CPT"},{"id":4244,"precertRequired":false,"billingCode":"67314","codeType":"CPT"},{"id":4245,"precertRequired":false,"billingCode":"67316","codeType":"CPT"},{"id":4246,"precertRequired":false,"billingCode":"67318","codeType":"CPT"},{"id":4247,"precertRequired":false,"billingCode":"67320","codeType":"CPT"},{"id":4248,"precertRequired":false,"billingCode":"67331","codeType":"CPT"},{"id":4249,"precertRequired":false,"billingCode":"67332","codeType":"CPT"},{"id":4250,"precertRequired":false,"billingCode":"67334","codeType":"CPT"},{"id":4251,"precertRequired":false,"billingCode":"67335","codeType":"CPT"},{"id":4252,"precertRequired":false,"billingCode":"67340","codeType":"CPT"},{"id":4253,"precertRequired":false,"billingCode":"67343","codeType":"CPT"},{"id":4254,"precertRequired":false,"billingCode":"67345","codeType":"CPT"},{"id":4255,"precertRequired":false,"billingCode":"67346","codeType":"CPT"},{"id":4256,"precertRequired":false,"billingCode":"67399","codeType":"CPT"},{"id":4257,"precertRequired":false,"billingCode":"67400","codeType":"CPT"},{"id":4258,"precertRequired":false,"billingCode":"67405","codeType":"CPT"},{"id":4259,"precertRequired":false,"billingCode":"67412","codeType":"CPT"},{"id":4260,"precertRequired":false,"billingCode":"67413","codeType":"CPT"},{"id":4261,"precertRequired":false,"billingCode":"67414","codeType":"CPT"},{"id":4262,"precertRequired":false,"billingCode":"67415","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4268,"precertRequired":false,"billingCode":"67500","codeType":"CPT"},{"id":4269,"precertRequired":false,"billingCode":"67505","codeType":"CPT"},{"id":4270,"precertRequired":false,"billingCode":"67515","codeType":"CPT"},{"id":4271,"precertRequired":false,"billingCode":"67550","codeType":"CPT"},{"id":4272,"precertRequired":false,"billingCode":"67560","codeType":"CPT"},{"id":4273,"precertRequired":false,"billingCode":"67570","codeType":"CPT"},{"id":4274,"precertRequired":false,"billingCode":"67599","codeType":"CPT"},{"id":4275,"precertRequired":false,"billingCode":"67700","codeType":"CPT"},{"id":4276,"precertRequired":false,"billingCode":"67710","codeType":"CPT"},{"id":4277,"precertRequired":false,"billingCode":"67715","codeType":"CPT"},{"id":4278,"precertRequired":false,"billingCode":"67800","codeType":"CPT"},{"id":4279,"precertRequired":false,"billingCode":"67801","codeType":"CPT"},{"id":4280,"precertRequired":false,"billingCode":"67805","codeType":"CPT"},{"id":4281,"precertRequired":false,"billingCode":"67808","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4284,"precertRequired":false,"billingCode":"67825","codeType":"CPT"},{"id":4285,"precertRequired":false,"billingCode":"67830","codeType":"CPT"},{"id":4286,"precertRequired":false,"billingCode":"67835","codeType":"CPT"},{"id":4287,"precertRequired":false,"billingCode":"67840","codeType":"CPT"},{"id":4288,"precertRequired":false,"billingCode":"67850","codeType":"CPT"},{"id":4289,"precertRequired":false,"billingCode":"67875","codeType":"CPT"},{"id":4290,"precertRequired":false,"billingCode":"67880","codeType":"CPT"},{"id":4291,"precertRequired":false,"billingCode":"67882","codeType":"CPT"},{"id":4292,"precertRequired":false,"billingCode":"67900","codeType":"CPT"},{"id":4293,"precertRequired":false,"billingCode":"67901","codeType":"CPT"},{"id":4294,"precertRequired":false,"billingCode":"67902","codeType":"CPT"},{"id":4295,"precertRequired":false,"billingCode":"67903","codeType":"CPT"},{"id":4296,"precertRequired":false,"billingCode":"67904","codeType":"CPT"},{"id":4297,"precertRequired":false,"billingCode":"67906","codeType":"CPT"},{"id":4298,"precertRequired":false,"billingCode":"67908","codeType":"CPT"},{"id":4299,"precertRequired":false,"billingCode":"67909","codeType":"CPT"},{"id":4300,"precertRequired":false,"billingCode":"67911","codeType":"CPT"},{"id":4301,"precertRequired":false,"billingCode":"67912","codeType":"CPT"},{"id":4302,"precertRequired":false,"billingCode":"67916","codeType":"CPT"},{"id":4303,"precertRequired":false,"billingCode":"67917","codeType":"CPT"},{"id":4304,"precertRequired":false,"billingCode":"67921","codeType":"CPT"},{"id":4305,"precertRequired":false,"billingCode":"67922","codeType":"CPT"},{"id":4306,"precertRequired":false,"billingCode":"67923","codeType":"CPT"},{"id":4307,"precertRequired":false,"billingCode":"67924","codeType":"CPT"},{"id":4308,"precertRequired":false,"billingCode":"67930","codeType":"CPT"},{"id":4309,"precertRequired":false,"billingCode":"67935","codeType":"CPT"},{"id":4310,"precertRequired":false,"billingCode":"67950","codeType":"CPT"},{"id":4311,"precertRequired":false,"billingCode":"67961","codeType":"CPT"},{"id":4312,"precertRequired":false,"billingCode":"67966","codeType":"CPT"},{"id":4313,"precertRequired":false,"billingCode":"67971","codeType":"CPT"},{"id":4314,"precertRequired":false,"billingCode":"67973","codeType":"CPT"},{"id":4315,"precertRequired":false,"billingCode":"67974","codeType":"CPT"},{"id":4316,"precertRequired":false,"billingCode":"67975","codeType":"CPT"},{"id":4317,"precertRequired":false,"billingCode":"67999","codeType":"CPT"},{"id":4318,"precertRequired":false,"billingCode":"68020","codeType":"CPT"},{"id":4319,"precertRequired":false,"billingCode":"68040","codeType":"CPT"},{"id":4321,"precertRequired":false,"billingCode":"68110","codeType":"CPT"},{"id":4322,"precertRequired":false,"billingCode":"68115","codeType":"CPT"},{"id":4323,"precertRequired":false,"billingCode":"68130","codeType":"CPT"},{"id":4324,"precertRequired":false,"billingCode":"68135","codeType":"CPT"},{"id":4325,"precertRequired":false,"billingCode":"68200","codeType":"CPT"},{"id":4326,"precertRequired":false,"billingCode":"68320","codeType":"CPT"},{"id":4327,"precertRequired":false,"billingCode":"68325","codeType":"CPT"},{"id":4328,"precertRequired":false,"billingCode":"68326","codeType":"CPT"},{"id":4329,"precertRequired":false,"billingCode":"68328","codeType":"CPT"},{"id":4330,"precertRequired":false,"billingCode":"68330","codeType":"CPT"},{"id":4331,"precertRequired":false,"billingCode":"68335","codeType":"CPT"},{"id":4332,"precertRequired":false,"billingCode":"68340","codeType":"CPT"},{"id":4333,"precertRequired":false,"billingCode":"68360","codeType":"CPT"},{"id":4334,"precertRequired":false,"billingCode":"68362","codeType":"CPT"},{"id":4335,"precertRequired":false,"billingCode":"68371","codeType":"CPT"},{"id":4336,"precertRequired":false,"billingCode":"68399","codeType":"CPT"},{"id":4337,"precertRequired":false,"billingCode":"68400","codeType":"CPT"},{"id":4338,"precertRequired":false,"billingCode":"68420","codeType":"CPT"},{"id":4339,"precertRequired":false,"billingCode":"68440","codeType":"CPT"},{"id":4340,"precertRequired":false,"billingCode":"68500","codeType":"CPT"},{"id":4341,"precertRequired":false,"billingCode":"68505","codeType":"CPT"},{"id":4342,"precertRequired":false,"billingCode":"68510","codeType":"CPT"},{"id":4343,"precertRequired":false,"billingCode":"68550","codeType":"CPT"},{"id":4344,"precertRequired":false,"billingCode":"68720","codeType":"CPT"},{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6651,"precertRequired":false,"billingCode":"92071","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6688,"precertRequired":false,"billingCode":"92325","codeType":"CPT"},{"id":6689,"precertRequired":false,"billingCode":"92326","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6697,"precertRequired":false,"billingCode":"92358","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"},{"id":6700,"precertRequired":false,"billingCode":"92499","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7338,"precertRequired":false,"billingCode":"99172","codeType":"CPT"},{"id":7339,"precertRequired":false,"billingCode":"99173","codeType":"CPT"},{"id":7340,"precertRequired":false,"billingCode":"99174","codeType":"CPT"},{"id":7341,"precertRequired":false,"billingCode":"99177","codeType":"CPT"},{"id":7846,"precertRequired":false,"billingCode":"A6410","codeType":"HCPCS"},{"id":7848,"precertRequired":false,"billingCode":"A6412","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8156,"precertRequired":false,"billingCode":"G0186","codeType":"HCPCS"},{"id":11591,"precertRequired":false,"billingCode":"92273","codeType":"CPT"},{"id":11592,"precertRequired":false,"billingCode":"92274","codeType":"CPT"},{"id":11593,"precertRequired":false,"billingCode":"0509T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2768,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":9,"precertRequired":false,"billingCode":"00142","codeType":"CPT"},{"id":11,"precertRequired":false,"billingCode":"00145","codeType":"CPT"},{"id":12,"precertRequired":false,"billingCode":"00147","codeType":"CPT"},{"id":13,"precertRequired":false,"billingCode":"00148","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":2769,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5121,"precertRequired":false,"billingCode":"80410","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2770,"description":"Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2771,"description":"Intravitreal anti-VEGF injections according to VA protocol (see Procedural Overview no.7 for specific information about VA protocol)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2772,"description":"Inpatient or observation admission for surgical procedure, if medically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2773,"description":"Inpatient admission or observation status for complications related to the procedure ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2774,"description":"Follow-up visits for this episode of care a.Follow-up images/studies/laboratories as indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]}]}},{"Seoc":{"id":281,"seocKey":52,"name":"Eye Care Comprehensive 1 Year_PRCT","seocId":"SSC_EYE CARE COMPREHENSIVE 1 YEAR_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below as clinically necessary. These services can be provided by an Optometrist or Ophthalmologist.","effectiveDate":"01-03-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic images/laboratories/studies relevant to the referred condition\r\n3. Procedures and pathology services relevant to the referred condition\r\n4. Anesthesia consultation related to the procedure\r\n5. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n6. Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website\r\n7. Intravitreal anti-VEGF injections according to VA protocol (see below)             \r\na.  VA Protocol: The following initial treatment is recommended and approved - A series of 3 monthly bevacizumab injections per eye with re-evaluation. At the end of the series if there is measurable improvement, patient will continue on this treatment for up to 8 total injections per eye for this episode of care. If patient shows no measurable improvement to the initial series of injections, additional request for services is needed with accompanying medical justification must be submitted to request other medications or procedures to treat the condition indicated on the consult, including ranibizumab, aflibercept, intraocular steroid implants, laser, or vitrectomy\r\n8. Inpatient or observation admission for surgical procedure, if medically necessary\r\n9. Inpatient admission or observation status for complications related to the procedure       \r\n** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n10. Follow-up visits for this episode of care  \r\na.    Follow-up images/studies/laboratories as indicated. ","maxAllowableVisits":null,"disclaimer":"* Additional consultations related to the referred condition require VA review and approval.\r\n* Community Provider must follow VA Protocol and non-formulary medication approval process for intravitreal anti-VEGF injections as well as intraocular steroid injections and steroid implants\r\n* VA (and Veterans) will not pay extra for laser assisted cataract surgery with conventional intraocular lens implant in accordance with Medicare policy and CMS rulings.\r\n* Durable Medical Equipment [DME], prosthetics and orthotics must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the Va to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"OPHTHALMOLOGY","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207W00000X"}],"services":[{"id":1185,"description":"Initial outpatient evaluation and treatment for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1186,"description":"Diagnostic images/laboratories/studies relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4716,"precertRequired":false,"billingCode":"76514","codeType":"CPT"},{"id":4717,"precertRequired":false,"billingCode":"76516","codeType":"CPT"},{"id":4718,"precertRequired":false,"billingCode":"76519","codeType":"CPT"},{"id":4719,"precertRequired":false,"billingCode":"76529","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6656,"precertRequired":false,"billingCode":"92100","codeType":"CPT"},{"id":6657,"precertRequired":false,"billingCode":"92132","codeType":"CPT"},{"id":6658,"precertRequired":false,"billingCode":"92133","codeType":"CPT"},{"id":6659,"precertRequired":false,"billingCode":"92134","codeType":"CPT"},{"id":6660,"precertRequired":false,"billingCode":"92136","codeType":"CPT"},{"id":6661,"precertRequired":false,"billingCode":"92145","codeType":"CPT"},{"id":6662,"precertRequired":false,"billingCode":"92225","codeType":"CPT"},{"id":6663,"precertRequired":false,"billingCode":"92226","codeType":"CPT"},{"id":6664,"precertRequired":false,"billingCode":"92227","codeType":"CPT"},{"id":6665,"precertRequired":false,"billingCode":"92228","codeType":"CPT"},{"id":6666,"precertRequired":false,"billingCode":"92230","codeType":"CPT"},{"id":6667,"precertRequired":false,"billingCode":"92235","codeType":"CPT"},{"id":6668,"precertRequired":false,"billingCode":"92240","codeType":"CPT"},{"id":6669,"precertRequired":false,"billingCode":"92242","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":6671,"precertRequired":false,"billingCode":"92260","codeType":"CPT"},{"id":6672,"precertRequired":false,"billingCode":"92265","codeType":"CPT"},{"id":6673,"precertRequired":false,"billingCode":"92270","codeType":"CPT"},{"id":6674,"precertRequired":false,"billingCode":"92275","codeType":"CPT"},{"id":6675,"precertRequired":false,"billingCode":"92283","codeType":"CPT"},{"id":6676,"precertRequired":false,"billingCode":"92284","codeType":"CPT"},{"id":6677,"precertRequired":false,"billingCode":"92285","codeType":"CPT"},{"id":6678,"precertRequired":false,"billingCode":"92286","codeType":"CPT"},{"id":7536,"precertRequired":false,"billingCode":"0329T","codeType":"CPT"},{"id":7537,"precertRequired":false,"billingCode":"0330T","codeType":"CPT"},{"id":7554,"precertRequired":false,"billingCode":"0378T","codeType":"CPT"},{"id":7555,"precertRequired":false,"billingCode":"0379T","codeType":"CPT"},{"id":7556,"precertRequired":false,"billingCode":"0380T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1187,"description":"Procedures and pathology services relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4084,"precertRequired":false,"billingCode":"65091","codeType":"CPT"},{"id":4085,"precertRequired":false,"billingCode":"65093","codeType":"CPT"},{"id":4086,"precertRequired":false,"billingCode":"65101","codeType":"CPT"},{"id":4087,"precertRequired":false,"billingCode":"65103","codeType":"CPT"},{"id":4088,"precertRequired":false,"billingCode":"65105","codeType":"CPT"},{"id":4089,"precertRequired":false,"billingCode":"65110","codeType":"CPT"},{"id":4090,"precertRequired":false,"billingCode":"65112","codeType":"CPT"},{"id":4091,"precertRequired":false,"billingCode":"65114","codeType":"CPT"},{"id":4092,"precertRequired":false,"billingCode":"65130","codeType":"CPT"},{"id":4093,"precertRequired":false,"billingCode":"65135","codeType":"CPT"},{"id":4094,"precertRequired":false,"billingCode":"65140","codeType":"CPT"},{"id":4095,"precertRequired":false,"billingCode":"65150","codeType":"CPT"},{"id":4096,"precertRequired":false,"billingCode":"65155","codeType":"CPT"},{"id":4097,"precertRequired":false,"billingCode":"65175","codeType":"CPT"},{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4099,"precertRequired":false,"billingCode":"65210","codeType":"CPT"},{"id":4100,"precertRequired":false,"billingCode":"65220","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4102,"precertRequired":false,"billingCode":"65225","codeType":"CPT"},{"id":4104,"precertRequired":false,"billingCode":"65260","codeType":"CPT"},{"id":4105,"precertRequired":false,"billingCode":"65270","codeType":"CPT"},{"id":4106,"precertRequired":false,"billingCode":"65272","codeType":"CPT"},{"id":4107,"precertRequired":false,"billingCode":"65273","codeType":"CPT"},{"id":4108,"precertRequired":false,"billingCode":"65275","codeType":"CPT"},{"id":4109,"precertRequired":false,"billingCode":"65280","codeType":"CPT"},{"id":4110,"precertRequired":false,"billingCode":"65285","codeType":"CPT"},{"id":4111,"precertRequired":false,"billingCode":"65286","codeType":"CPT"},{"id":4112,"precertRequired":false,"billingCode":"65290","codeType":"CPT"},{"id":4113,"precertRequired":false,"billingCode":"65400","codeType":"CPT"},{"id":4114,"precertRequired":false,"billingCode":"65410","codeType":"CPT"},{"id":4115,"precertRequired":false,"billingCode":"65420","codeType":"CPT"},{"id":4116,"precertRequired":false,"billingCode":"65426","codeType":"CPT"},{"id":4117,"precertRequired":false,"billingCode":"65430","codeType":"CPT"},{"id":4118,"precertRequired":false,"billingCode":"65435","codeType":"CPT"},{"id":4119,"precertRequired":false,"billingCode":"65436","codeType":"CPT"},{"id":4120,"precertRequired":false,"billingCode":"65450","codeType":"CPT"},{"id":4121,"precertRequired":false,"billingCode":"65600","codeType":"CPT"},{"id":4122,"precertRequired":false,"billingCode":"65710","codeType":"CPT"},{"id":4123,"precertRequired":false,"billingCode":"65730","codeType":"CPT"},{"id":4124,"precertRequired":false,"billingCode":"65750","codeType":"CPT"},{"id":4125,"precertRequired":false,"billingCode":"65755","codeType":"CPT"},{"id":4126,"precertRequired":false,"billingCode":"65756","codeType":"CPT"},{"id":4127,"precertRequired":false,"billingCode":"65757","codeType":"CPT"},{"id":4128,"precertRequired":false,"billingCode":"65760","codeType":"CPT"},{"id":4129,"precertRequired":false,"billingCode":"65765","codeType":"CPT"},{"id":4130,"precertRequired":false,"billingCode":"65767","codeType":"CPT"},{"id":4131,"precertRequired":false,"billingCode":"65770","codeType":"CPT"},{"id":4132,"precertRequired":false,"billingCode":"65771","codeType":"CPT"},{"id":4133,"precertRequired":false,"billingCode":"65772","codeType":"CPT"},{"id":4134,"precertRequired":false,"billingCode":"65775","codeType":"CPT"},{"id":4135,"precertRequired":false,"billingCode":"65778","codeType":"CPT"},{"id":4136,"precertRequired":false,"billingCode":"65779","codeType":"CPT"},{"id":4137,"precertRequired":false,"billingCode":"65780","codeType":"CPT"},{"id":4138,"precertRequired":false,"billingCode":"65781","codeType":"CPT"},{"id":4139,"precertRequired":false,"billingCode":"65782","codeType":"CPT"},{"id":4140,"precertRequired":false,"billingCode":"65783","codeType":"CPT"},{"id":4141,"precertRequired":false,"billingCode":"65800","codeType":"CPT"},{"id":4142,"precertRequired":false,"billingCode":"65810","codeType":"CPT"},{"id":4143,"precertRequired":false,"billingCode":"65815","codeType":"CPT"},{"id":4144,"precertRequired":false,"billingCode":"65820","codeType":"CPT"},{"id":4145,"precertRequired":false,"billingCode":"65850","codeType":"CPT"},{"id":4146,"precertRequired":false,"billingCode":"65855","codeType":"CPT"},{"id":4147,"precertRequired":false,"billingCode":"65860","codeType":"CPT"},{"id":4148,"precertRequired":false,"billingCode":"65865","codeType":"CPT"},{"id":4149,"precertRequired":false,"billingCode":"65870","codeType":"CPT"},{"id":4150,"precertRequired":false,"billingCode":"65875","codeType":"CPT"},{"id":4151,"precertRequired":false,"billingCode":"65880","codeType":"CPT"},{"id":4152,"precertRequired":false,"billingCode":"65900","codeType":"CPT"},{"id":4153,"precertRequired":false,"billingCode":"65920","codeType":"CPT"},{"id":4154,"precertRequired":false,"billingCode":"65930","codeType":"CPT"},{"id":4155,"precertRequired":false,"billingCode":"66020","codeType":"CPT"},{"id":4157,"precertRequired":false,"billingCode":"66130","codeType":"CPT"},{"id":4158,"precertRequired":false,"billingCode":"66150","codeType":"CPT"},{"id":4159,"precertRequired":false,"billingCode":"66155","codeType":"CPT"},{"id":4160,"precertRequired":false,"billingCode":"66160","codeType":"CPT"},{"id":4161,"precertRequired":false,"billingCode":"66170","codeType":"CPT"},{"id":4162,"precertRequired":false,"billingCode":"66172","codeType":"CPT"},{"id":4163,"precertRequired":false,"billingCode":"66174","codeType":"CPT"},{"id":4164,"precertRequired":false,"billingCode":"66179","codeType":"CPT"},{"id":4165,"precertRequired":false,"billingCode":"66180","codeType":"CPT"},{"id":4166,"precertRequired":false,"billingCode":"66183","codeType":"CPT"},{"id":4167,"precertRequired":false,"billingCode":"66184","codeType":"CPT"},{"id":4168,"precertRequired":false,"billingCode":"66185","codeType":"CPT"},{"id":4169,"precertRequired":false,"billingCode":"66220","codeType":"CPT"},{"id":4170,"precertRequired":false,"billingCode":"66225","codeType":"CPT"},{"id":4171,"precertRequired":false,"billingCode":"66250","codeType":"CPT"},{"id":4172,"precertRequired":false,"billingCode":"66500","codeType":"CPT"},{"id":4174,"precertRequired":false,"billingCode":"66600","codeType":"CPT"},{"id":4175,"precertRequired":false,"billingCode":"66605","codeType":"CPT"},{"id":4176,"precertRequired":false,"billingCode":"66625","codeType":"CPT"},{"id":4177,"precertRequired":false,"billingCode":"66630","codeType":"CPT"},{"id":4178,"precertRequired":false,"billingCode":"66635","codeType":"CPT"},{"id":4179,"precertRequired":false,"billingCode":"66680","codeType":"CPT"},{"id":4180,"precertRequired":false,"billingCode":"66682","codeType":"CPT"},{"id":4181,"precertRequired":false,"billingCode":"66700","codeType":"CPT"},{"id":4182,"precertRequired":false,"billingCode":"66710","codeType":"CPT"},{"id":4183,"precertRequired":false,"billingCode":"66711","codeType":"CPT"},{"id":4184,"precertRequired":false,"billingCode":"66720","codeType":"CPT"},{"id":4185,"precertRequired":false,"billingCode":"66740","codeType":"CPT"},{"id":4186,"precertRequired":false,"billingCode":"66761","codeType":"CPT"},{"id":4187,"precertRequired":false,"billingCode":"66762","codeType":"CPT"},{"id":4188,"precertRequired":false,"billingCode":"66770","codeType":"CPT"},{"id":4189,"precertRequired":false,"billingCode":"66820","codeType":"CPT"},{"id":4190,"precertRequired":false,"billingCode":"66821","codeType":"CPT"},{"id":4191,"precertRequired":false,"billingCode":"66825","codeType":"CPT"},{"id":4192,"precertRequired":false,"billingCode":"66830","codeType":"CPT"},{"id":4193,"precertRequired":false,"billingCode":"66840","codeType":"CPT"},{"id":4194,"precertRequired":false,"billingCode":"66850","codeType":"CPT"},{"id":4195,"precertRequired":false,"billingCode":"66852","codeType":"CPT"},{"id":4196,"precertRequired":false,"billingCode":"66920","codeType":"CPT"},{"id":4197,"precertRequired":false,"billingCode":"66930","codeType":"CPT"},{"id":4198,"precertRequired":false,"billingCode":"66940","codeType":"CPT"},{"id":4199,"precertRequired":false,"billingCode":"66982","codeType":"CPT"},{"id":4200,"precertRequired":false,"billingCode":"66983","codeType":"CPT"},{"id":4201,"precertRequired":false,"billingCode":"66984","codeType":"CPT"},{"id":4202,"precertRequired":false,"billingCode":"66985","codeType":"CPT"},{"id":4203,"precertRequired":false,"billingCode":"66986","codeType":"CPT"},{"id":4204,"precertRequired":false,"billingCode":"66990","codeType":"CPT"},{"id":4205,"precertRequired":false,"billingCode":"67005","codeType":"CPT"},{"id":4206,"precertRequired":false,"billingCode":"67010","codeType":"CPT"},{"id":4207,"precertRequired":false,"billingCode":"67015","codeType":"CPT"},{"id":4208,"precertRequired":false,"billingCode":"67025","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":4211,"precertRequired":false,"billingCode":"67030","codeType":"CPT"},{"id":4212,"precertRequired":false,"billingCode":"67031","codeType":"CPT"},{"id":4213,"precertRequired":false,"billingCode":"67036","codeType":"CPT"},{"id":4214,"precertRequired":false,"billingCode":"67039","codeType":"CPT"},{"id":4215,"precertRequired":false,"billingCode":"67040","codeType":"CPT"},{"id":4216,"precertRequired":false,"billingCode":"67041","codeType":"CPT"},{"id":4217,"precertRequired":false,"billingCode":"67042","codeType":"CPT"},{"id":4218,"precertRequired":false,"billingCode":"67043","codeType":"CPT"},{"id":4219,"precertRequired":false,"billingCode":"67075","codeType":"CPT"},{"id":4220,"precertRequired":false,"billingCode":"67101","codeType":"CPT"},{"id":4221,"precertRequired":false,"billingCode":"67105","codeType":"CPT"},{"id":4222,"precertRequired":false,"billingCode":"67107","codeType":"CPT"},{"id":4223,"precertRequired":false,"billingCode":"67108","codeType":"CPT"},{"id":4224,"precertRequired":false,"billingCode":"67110","codeType":"CPT"},{"id":4225,"precertRequired":false,"billingCode":"67113","codeType":"CPT"},{"id":4226,"precertRequired":false,"billingCode":"67115","codeType":"CPT"},{"id":4227,"precertRequired":false,"billingCode":"67120","codeType":"CPT"},{"id":4228,"precertRequired":false,"billingCode":"67121","codeType":"CPT"},{"id":4229,"precertRequired":false,"billingCode":"67141","codeType":"CPT"},{"id":4230,"precertRequired":false,"billingCode":"67145","codeType":"CPT"},{"id":4231,"precertRequired":false,"billingCode":"67208","codeType":"CPT"},{"id":4232,"precertRequired":false,"billingCode":"67210","codeType":"CPT"},{"id":4233,"precertRequired":false,"billingCode":"67218","codeType":"CPT"},{"id":4234,"precertRequired":false,"billingCode":"67220","codeType":"CPT"},{"id":4235,"precertRequired":false,"billingCode":"67221","codeType":"CPT"},{"id":4236,"precertRequired":false,"billingCode":"67225","codeType":"CPT"},{"id":4237,"precertRequired":false,"billingCode":"67227","codeType":"CPT"},{"id":4238,"precertRequired":false,"billingCode":"67228","codeType":"CPT"},{"id":4239,"precertRequired":false,"billingCode":"67250","codeType":"CPT"},{"id":4240,"precertRequired":false,"billingCode":"67255","codeType":"CPT"},{"id":4241,"precertRequired":false,"billingCode":"67299","codeType":"CPT"},{"id":4242,"precertRequired":false,"billingCode":"67311","codeType":"CPT"},{"id":4243,"precertRequired":false,"billingCode":"67312","codeType":"CPT"},{"id":4244,"precertRequired":false,"billingCode":"67314","codeType":"CPT"},{"id":4245,"precertRequired":false,"billingCode":"67316","codeType":"CPT"},{"id":4246,"precertRequired":false,"billingCode":"67318","codeType":"CPT"},{"id":4247,"precertRequired":false,"billingCode":"67320","codeType":"CPT"},{"id":4248,"precertRequired":false,"billingCode":"67331","codeType":"CPT"},{"id":4249,"precertRequired":false,"billingCode":"67332","codeType":"CPT"},{"id":4250,"precertRequired":false,"billingCode":"67334","codeType":"CPT"},{"id":4251,"precertRequired":false,"billingCode":"67335","codeType":"CPT"},{"id":4252,"precertRequired":false,"billingCode":"67340","codeType":"CPT"},{"id":4253,"precertRequired":false,"billingCode":"67343","codeType":"CPT"},{"id":4254,"precertRequired":false,"billingCode":"67345","codeType":"CPT"},{"id":4255,"precertRequired":false,"billingCode":"67346","codeType":"CPT"},{"id":4256,"precertRequired":false,"billingCode":"67399","codeType":"CPT"},{"id":4257,"precertRequired":false,"billingCode":"67400","codeType":"CPT"},{"id":4258,"precertRequired":false,"billingCode":"67405","codeType":"CPT"},{"id":4259,"precertRequired":false,"billingCode":"67412","codeType":"CPT"},{"id":4260,"precertRequired":false,"billingCode":"67413","codeType":"CPT"},{"id":4261,"precertRequired":false,"billingCode":"67414","codeType":"CPT"},{"id":4262,"precertRequired":false,"billingCode":"67415","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4268,"precertRequired":false,"billingCode":"67500","codeType":"CPT"},{"id":4269,"precertRequired":false,"billingCode":"67505","codeType":"CPT"},{"id":4270,"precertRequired":false,"billingCode":"67515","codeType":"CPT"},{"id":4271,"precertRequired":false,"billingCode":"67550","codeType":"CPT"},{"id":4272,"precertRequired":false,"billingCode":"67560","codeType":"CPT"},{"id":4273,"precertRequired":false,"billingCode":"67570","codeType":"CPT"},{"id":4274,"precertRequired":false,"billingCode":"67599","codeType":"CPT"},{"id":4275,"precertRequired":false,"billingCode":"67700","codeType":"CPT"},{"id":4276,"precertRequired":false,"billingCode":"67710","codeType":"CPT"},{"id":4277,"precertRequired":false,"billingCode":"67715","codeType":"CPT"},{"id":4278,"precertRequired":false,"billingCode":"67800","codeType":"CPT"},{"id":4279,"precertRequired":false,"billingCode":"67801","codeType":"CPT"},{"id":4280,"precertRequired":false,"billingCode":"67805","codeType":"CPT"},{"id":4281,"precertRequired":false,"billingCode":"67808","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4284,"precertRequired":false,"billingCode":"67825","codeType":"CPT"},{"id":4285,"precertRequired":false,"billingCode":"67830","codeType":"CPT"},{"id":4286,"precertRequired":false,"billingCode":"67835","codeType":"CPT"},{"id":4287,"precertRequired":false,"billingCode":"67840","codeType":"CPT"},{"id":4288,"precertRequired":false,"billingCode":"67850","codeType":"CPT"},{"id":4289,"precertRequired":false,"billingCode":"67875","codeType":"CPT"},{"id":4290,"precertRequired":false,"billingCode":"67880","codeType":"CPT"},{"id":4291,"precertRequired":false,"billingCode":"67882","codeType":"CPT"},{"id":4292,"precertRequired":false,"billingCode":"67900","codeType":"CPT"},{"id":4293,"precertRequired":false,"billingCode":"67901","codeType":"CPT"},{"id":4294,"precertRequired":false,"billingCode":"67902","codeType":"CPT"},{"id":4295,"precertRequired":false,"billingCode":"67903","codeType":"CPT"},{"id":4296,"precertRequired":false,"billingCode":"67904","codeType":"CPT"},{"id":4297,"precertRequired":false,"billingCode":"67906","codeType":"CPT"},{"id":4298,"precertRequired":false,"billingCode":"67908","codeType":"CPT"},{"id":4299,"precertRequired":false,"billingCode":"67909","codeType":"CPT"},{"id":4300,"precertRequired":false,"billingCode":"67911","codeType":"CPT"},{"id":4301,"precertRequired":false,"billingCode":"67912","codeType":"CPT"},{"id":4302,"precertRequired":false,"billingCode":"67916","codeType":"CPT"},{"id":4303,"precertRequired":false,"billingCode":"67917","codeType":"CPT"},{"id":4304,"precertRequired":false,"billingCode":"67921","codeType":"CPT"},{"id":4305,"precertRequired":false,"billingCode":"67922","codeType":"CPT"},{"id":4306,"precertRequired":false,"billingCode":"67923","codeType":"CPT"},{"id":4307,"precertRequired":false,"billingCode":"67924","codeType":"CPT"},{"id":4308,"precertRequired":false,"billingCode":"67930","codeType":"CPT"},{"id":4309,"precertRequired":false,"billingCode":"67935","codeType":"CPT"},{"id":4310,"precertRequired":false,"billingCode":"67950","codeType":"CPT"},{"id":4311,"precertRequired":false,"billingCode":"67961","codeType":"CPT"},{"id":4312,"precertRequired":false,"billingCode":"67966","codeType":"CPT"},{"id":4313,"precertRequired":false,"billingCode":"67971","codeType":"CPT"},{"id":4314,"precertRequired":false,"billingCode":"67973","codeType":"CPT"},{"id":4315,"precertRequired":false,"billingCode":"67974","codeType":"CPT"},{"id":4316,"precertRequired":false,"billingCode":"67975","codeType":"CPT"},{"id":4317,"precertRequired":false,"billingCode":"67999","codeType":"CPT"},{"id":4318,"precertRequired":false,"billingCode":"68020","codeType":"CPT"},{"id":4319,"precertRequired":false,"billingCode":"68040","codeType":"CPT"},{"id":4321,"precertRequired":false,"billingCode":"68110","codeType":"CPT"},{"id":4322,"precertRequired":false,"billingCode":"68115","codeType":"CPT"},{"id":4323,"precertRequired":false,"billingCode":"68130","codeType":"CPT"},{"id":4324,"precertRequired":false,"billingCode":"68135","codeType":"CPT"},{"id":4325,"precertRequired":false,"billingCode":"68200","codeType":"CPT"},{"id":4326,"precertRequired":false,"billingCode":"68320","codeType":"CPT"},{"id":4327,"precertRequired":false,"billingCode":"68325","codeType":"CPT"},{"id":4328,"precertRequired":false,"billingCode":"68326","codeType":"CPT"},{"id":4329,"precertRequired":false,"billingCode":"68328","codeType":"CPT"},{"id":4330,"precertRequired":false,"billingCode":"68330","codeType":"CPT"},{"id":4331,"precertRequired":false,"billingCode":"68335","codeType":"CPT"},{"id":4332,"precertRequired":false,"billingCode":"68340","codeType":"CPT"},{"id":4333,"precertRequired":false,"billingCode":"68360","codeType":"CPT"},{"id":4334,"precertRequired":false,"billingCode":"68362","codeType":"CPT"},{"id":4335,"precertRequired":false,"billingCode":"68371","codeType":"CPT"},{"id":4336,"precertRequired":false,"billingCode":"68399","codeType":"CPT"},{"id":4337,"precertRequired":false,"billingCode":"68400","codeType":"CPT"},{"id":4338,"precertRequired":false,"billingCode":"68420","codeType":"CPT"},{"id":4339,"precertRequired":false,"billingCode":"68440","codeType":"CPT"},{"id":4340,"precertRequired":false,"billingCode":"68500","codeType":"CPT"},{"id":4341,"precertRequired":false,"billingCode":"68505","codeType":"CPT"},{"id":4342,"precertRequired":false,"billingCode":"68510","codeType":"CPT"},{"id":4343,"precertRequired":false,"billingCode":"68550","codeType":"CPT"},{"id":4344,"precertRequired":false,"billingCode":"68720","codeType":"CPT"},{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6651,"precertRequired":false,"billingCode":"92071","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6688,"precertRequired":false,"billingCode":"92325","codeType":"CPT"},{"id":6689,"precertRequired":false,"billingCode":"92326","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6697,"precertRequired":false,"billingCode":"92358","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"},{"id":6700,"precertRequired":false,"billingCode":"92499","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7338,"precertRequired":false,"billingCode":"99172","codeType":"CPT"},{"id":7339,"precertRequired":false,"billingCode":"99173","codeType":"CPT"},{"id":7340,"precertRequired":false,"billingCode":"99174","codeType":"CPT"},{"id":7341,"precertRequired":false,"billingCode":"99177","codeType":"CPT"},{"id":7846,"precertRequired":false,"billingCode":"A6410","codeType":"HCPCS"},{"id":7848,"precertRequired":false,"billingCode":"A6412","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8156,"precertRequired":false,"billingCode":"G0186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1188,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":9,"precertRequired":false,"billingCode":"00142","codeType":"CPT"},{"id":11,"precertRequired":false,"billingCode":"00145","codeType":"CPT"},{"id":12,"precertRequired":false,"billingCode":"00147","codeType":"CPT"},{"id":13,"precertRequired":false,"billingCode":"00148","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1189,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5121,"precertRequired":false,"billingCode":"80410","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1190,"description":"Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1191,"description":"Intravitreal anti-VEGF injections according to VA protocol (see Procedural Overview no.7 for specific information about VA protocol)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1192,"description":"Inpatient or observation admission for surgical procedure, if medically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1193,"description":"Inpatient admission or observation status for complications related to the procedure ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1194,"description":"Follow-up visits for this episode of care a.Follow-up images/studies/laboratories as indicated. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]}]}},{"Seoc":{"id":146,"seocKey":52,"name":"Eye Care Comprehensive 1 Year_PRCT","seocId":"SSC_EYE CARE COMPREHENSIVE 1 YEAR_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below as clinically necessary. These services can be provided by an Optometrist or Ophthalmologist.","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic images/laboratories/studies relevant to the referred condition\r\n3. Procedures and pathology services relevant to the referred condition\r\n4. Anesthesia consultation related to the procedure\r\n5. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n6. Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website\r\n7. Intravitreal anti-VEGF injections according to VA protocol (see below)             \r\na.  VA Protocol: The following initial treatment is recommended and approved - A series of 3 monthly bevacizumab injections per eye with re-evaluation. At the end of the series if there is measurable improvement, patient will continue on this treatment for up to 8 total injections per eye for this episode of care. If patient shows no measurable improvement to the initial series of injections, additional request for services is needed with accompanying medical justification must be submitted to request other medications or procedures to treat the condition indicated on the consult, including ranibizumab, aflibercept, intraocular steroid implants, laser, or vitrectomy\r\n8. Inpatient or observation admission for surgical procedure, if medically necessary\r\n9. Inpatient admission or observation status for complications related to the procedure       \r\n** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n10. Follow-up visits for this episode of care  \r\na.    Follow-up images/studies/laboratories as indicated. ","maxAllowableVisits":999,"disclaimer":"* Additional consultations related to the referred condition require VA review and approval.\r\n* Community Provider must follow VA Protocol and non-formulary medication approval process for intravitreal anti-VEGF injections as well as intraocular steroid injections and steroid implants\r\n* VA (and Veterans) will not pay extra for laser assisted cataract surgery with conventional intraocular lens implant in accordance with Medicare policy and CMS rulings.\r\n* Durable Medical Equipment [DME], prosthetics and orthotics must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the Va to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"OPHTHALMOLOGY","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":155,"description":"Initial outpatient evaluation and treatment for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":156,"description":"Diagnostic images/laboratories/studies relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4716,"precertRequired":false,"billingCode":"76514","codeType":"CPT"},{"id":4717,"precertRequired":false,"billingCode":"76516","codeType":"CPT"},{"id":4718,"precertRequired":false,"billingCode":"76519","codeType":"CPT"},{"id":4719,"precertRequired":false,"billingCode":"76529","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6656,"precertRequired":false,"billingCode":"92100","codeType":"CPT"},{"id":6657,"precertRequired":false,"billingCode":"92132","codeType":"CPT"},{"id":6658,"precertRequired":false,"billingCode":"92133","codeType":"CPT"},{"id":6659,"precertRequired":false,"billingCode":"92134","codeType":"CPT"},{"id":6660,"precertRequired":false,"billingCode":"92136","codeType":"CPT"},{"id":6661,"precertRequired":false,"billingCode":"92145","codeType":"CPT"},{"id":6662,"precertRequired":false,"billingCode":"92225","codeType":"CPT"},{"id":6663,"precertRequired":false,"billingCode":"92226","codeType":"CPT"},{"id":6664,"precertRequired":false,"billingCode":"92227","codeType":"CPT"},{"id":6665,"precertRequired":false,"billingCode":"92228","codeType":"CPT"},{"id":6666,"precertRequired":false,"billingCode":"92230","codeType":"CPT"},{"id":6667,"precertRequired":false,"billingCode":"92235","codeType":"CPT"},{"id":6668,"precertRequired":false,"billingCode":"92240","codeType":"CPT"},{"id":6669,"precertRequired":false,"billingCode":"92242","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":6671,"precertRequired":false,"billingCode":"92260","codeType":"CPT"},{"id":6672,"precertRequired":false,"billingCode":"92265","codeType":"CPT"},{"id":6673,"precertRequired":false,"billingCode":"92270","codeType":"CPT"},{"id":6674,"precertRequired":false,"billingCode":"92275","codeType":"CPT"},{"id":6675,"precertRequired":false,"billingCode":"92283","codeType":"CPT"},{"id":6676,"precertRequired":false,"billingCode":"92284","codeType":"CPT"},{"id":6677,"precertRequired":false,"billingCode":"92285","codeType":"CPT"},{"id":6678,"precertRequired":false,"billingCode":"92286","codeType":"CPT"},{"id":7536,"precertRequired":false,"billingCode":"0329T","codeType":"CPT"},{"id":7537,"precertRequired":false,"billingCode":"0330T","codeType":"CPT"},{"id":7554,"precertRequired":false,"billingCode":"0378T","codeType":"CPT"},{"id":7555,"precertRequired":false,"billingCode":"0379T","codeType":"CPT"},{"id":7556,"precertRequired":false,"billingCode":"0380T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":157,"description":"Procedures and pathology services relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4084,"precertRequired":false,"billingCode":"65091","codeType":"CPT"},{"id":4085,"precertRequired":false,"billingCode":"65093","codeType":"CPT"},{"id":4086,"precertRequired":false,"billingCode":"65101","codeType":"CPT"},{"id":4087,"precertRequired":false,"billingCode":"65103","codeType":"CPT"},{"id":4088,"precertRequired":false,"billingCode":"65105","codeType":"CPT"},{"id":4089,"precertRequired":false,"billingCode":"65110","codeType":"CPT"},{"id":4090,"precertRequired":false,"billingCode":"65112","codeType":"CPT"},{"id":4091,"precertRequired":false,"billingCode":"65114","codeType":"CPT"},{"id":4092,"precertRequired":false,"billingCode":"65130","codeType":"CPT"},{"id":4093,"precertRequired":false,"billingCode":"65135","codeType":"CPT"},{"id":4094,"precertRequired":false,"billingCode":"65140","codeType":"CPT"},{"id":4095,"precertRequired":false,"billingCode":"65150","codeType":"CPT"},{"id":4096,"precertRequired":false,"billingCode":"65155","codeType":"CPT"},{"id":4097,"precertRequired":false,"billingCode":"65175","codeType":"CPT"},{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4099,"precertRequired":false,"billingCode":"65210","codeType":"CPT"},{"id":4100,"precertRequired":false,"billingCode":"65220","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4102,"precertRequired":false,"billingCode":"65225","codeType":"CPT"},{"id":4104,"precertRequired":false,"billingCode":"65260","codeType":"CPT"},{"id":4105,"precertRequired":false,"billingCode":"65270","codeType":"CPT"},{"id":4106,"precertRequired":false,"billingCode":"65272","codeType":"CPT"},{"id":4107,"precertRequired":false,"billingCode":"65273","codeType":"CPT"},{"id":4108,"precertRequired":false,"billingCode":"65275","codeType":"CPT"},{"id":4109,"precertRequired":false,"billingCode":"65280","codeType":"CPT"},{"id":4110,"precertRequired":false,"billingCode":"65285","codeType":"CPT"},{"id":4111,"precertRequired":false,"billingCode":"65286","codeType":"CPT"},{"id":4112,"precertRequired":false,"billingCode":"65290","codeType":"CPT"},{"id":4113,"precertRequired":false,"billingCode":"65400","codeType":"CPT"},{"id":4114,"precertRequired":false,"billingCode":"65410","codeType":"CPT"},{"id":4115,"precertRequired":false,"billingCode":"65420","codeType":"CPT"},{"id":4116,"precertRequired":false,"billingCode":"65426","codeType":"CPT"},{"id":4117,"precertRequired":false,"billingCode":"65430","codeType":"CPT"},{"id":4118,"precertRequired":false,"billingCode":"65435","codeType":"CPT"},{"id":4119,"precertRequired":false,"billingCode":"65436","codeType":"CPT"},{"id":4120,"precertRequired":false,"billingCode":"65450","codeType":"CPT"},{"id":4121,"precertRequired":false,"billingCode":"65600","codeType":"CPT"},{"id":4122,"precertRequired":false,"billingCode":"65710","codeType":"CPT"},{"id":4123,"precertRequired":false,"billingCode":"65730","codeType":"CPT"},{"id":4124,"precertRequired":false,"billingCode":"65750","codeType":"CPT"},{"id":4125,"precertRequired":false,"billingCode":"65755","codeType":"CPT"},{"id":4126,"precertRequired":false,"billingCode":"65756","codeType":"CPT"},{"id":4127,"precertRequired":false,"billingCode":"65757","codeType":"CPT"},{"id":4128,"precertRequired":false,"billingCode":"65760","codeType":"CPT"},{"id":4129,"precertRequired":false,"billingCode":"65765","codeType":"CPT"},{"id":4130,"precertRequired":false,"billingCode":"65767","codeType":"CPT"},{"id":4131,"precertRequired":false,"billingCode":"65770","codeType":"CPT"},{"id":4132,"precertRequired":false,"billingCode":"65771","codeType":"CPT"},{"id":4133,"precertRequired":false,"billingCode":"65772","codeType":"CPT"},{"id":4134,"precertRequired":false,"billingCode":"65775","codeType":"CPT"},{"id":4135,"precertRequired":false,"billingCode":"65778","codeType":"CPT"},{"id":4136,"precertRequired":false,"billingCode":"65779","codeType":"CPT"},{"id":4137,"precertRequired":false,"billingCode":"65780","codeType":"CPT"},{"id":4138,"precertRequired":false,"billingCode":"65781","codeType":"CPT"},{"id":4139,"precertRequired":false,"billingCode":"65782","codeType":"CPT"},{"id":4140,"precertRequired":false,"billingCode":"65783","codeType":"CPT"},{"id":4141,"precertRequired":false,"billingCode":"65800","codeType":"CPT"},{"id":4142,"precertRequired":false,"billingCode":"65810","codeType":"CPT"},{"id":4143,"precertRequired":false,"billingCode":"65815","codeType":"CPT"},{"id":4144,"precertRequired":false,"billingCode":"65820","codeType":"CPT"},{"id":4145,"precertRequired":false,"billingCode":"65850","codeType":"CPT"},{"id":4146,"precertRequired":false,"billingCode":"65855","codeType":"CPT"},{"id":4147,"precertRequired":false,"billingCode":"65860","codeType":"CPT"},{"id":4148,"precertRequired":false,"billingCode":"65865","codeType":"CPT"},{"id":4149,"precertRequired":false,"billingCode":"65870","codeType":"CPT"},{"id":4150,"precertRequired":false,"billingCode":"65875","codeType":"CPT"},{"id":4151,"precertRequired":false,"billingCode":"65880","codeType":"CPT"},{"id":4152,"precertRequired":false,"billingCode":"65900","codeType":"CPT"},{"id":4153,"precertRequired":false,"billingCode":"65920","codeType":"CPT"},{"id":4154,"precertRequired":false,"billingCode":"65930","codeType":"CPT"},{"id":4155,"precertRequired":false,"billingCode":"66020","codeType":"CPT"},{"id":4157,"precertRequired":false,"billingCode":"66130","codeType":"CPT"},{"id":4158,"precertRequired":false,"billingCode":"66150","codeType":"CPT"},{"id":4159,"precertRequired":false,"billingCode":"66155","codeType":"CPT"},{"id":4160,"precertRequired":false,"billingCode":"66160","codeType":"CPT"},{"id":4161,"precertRequired":false,"billingCode":"66170","codeType":"CPT"},{"id":4162,"precertRequired":false,"billingCode":"66172","codeType":"CPT"},{"id":4163,"precertRequired":false,"billingCode":"66174","codeType":"CPT"},{"id":4164,"precertRequired":false,"billingCode":"66179","codeType":"CPT"},{"id":4165,"precertRequired":false,"billingCode":"66180","codeType":"CPT"},{"id":4166,"precertRequired":false,"billingCode":"66183","codeType":"CPT"},{"id":4167,"precertRequired":false,"billingCode":"66184","codeType":"CPT"},{"id":4168,"precertRequired":false,"billingCode":"66185","codeType":"CPT"},{"id":4169,"precertRequired":false,"billingCode":"66220","codeType":"CPT"},{"id":4170,"precertRequired":false,"billingCode":"66225","codeType":"CPT"},{"id":4171,"precertRequired":false,"billingCode":"66250","codeType":"CPT"},{"id":4172,"precertRequired":false,"billingCode":"66500","codeType":"CPT"},{"id":4174,"precertRequired":false,"billingCode":"66600","codeType":"CPT"},{"id":4175,"precertRequired":false,"billingCode":"66605","codeType":"CPT"},{"id":4176,"precertRequired":false,"billingCode":"66625","codeType":"CPT"},{"id":4177,"precertRequired":false,"billingCode":"66630","codeType":"CPT"},{"id":4178,"precertRequired":false,"billingCode":"66635","codeType":"CPT"},{"id":4179,"precertRequired":false,"billingCode":"66680","codeType":"CPT"},{"id":4180,"precertRequired":false,"billingCode":"66682","codeType":"CPT"},{"id":4181,"precertRequired":false,"billingCode":"66700","codeType":"CPT"},{"id":4182,"precertRequired":false,"billingCode":"66710","codeType":"CPT"},{"id":4183,"precertRequired":false,"billingCode":"66711","codeType":"CPT"},{"id":4184,"precertRequired":false,"billingCode":"66720","codeType":"CPT"},{"id":4185,"precertRequired":false,"billingCode":"66740","codeType":"CPT"},{"id":4186,"precertRequired":false,"billingCode":"66761","codeType":"CPT"},{"id":4187,"precertRequired":false,"billingCode":"66762","codeType":"CPT"},{"id":4188,"precertRequired":false,"billingCode":"66770","codeType":"CPT"},{"id":4189,"precertRequired":false,"billingCode":"66820","codeType":"CPT"},{"id":4190,"precertRequired":false,"billingCode":"66821","codeType":"CPT"},{"id":4191,"precertRequired":false,"billingCode":"66825","codeType":"CPT"},{"id":4192,"precertRequired":false,"billingCode":"66830","codeType":"CPT"},{"id":4193,"precertRequired":false,"billingCode":"66840","codeType":"CPT"},{"id":4194,"precertRequired":false,"billingCode":"66850","codeType":"CPT"},{"id":4195,"precertRequired":false,"billingCode":"66852","codeType":"CPT"},{"id":4196,"precertRequired":false,"billingCode":"66920","codeType":"CPT"},{"id":4197,"precertRequired":false,"billingCode":"66930","codeType":"CPT"},{"id":4198,"precertRequired":false,"billingCode":"66940","codeType":"CPT"},{"id":4199,"precertRequired":false,"billingCode":"66982","codeType":"CPT"},{"id":4200,"precertRequired":false,"billingCode":"66983","codeType":"CPT"},{"id":4201,"precertRequired":false,"billingCode":"66984","codeType":"CPT"},{"id":4202,"precertRequired":false,"billingCode":"66985","codeType":"CPT"},{"id":4203,"precertRequired":false,"billingCode":"66986","codeType":"CPT"},{"id":4204,"precertRequired":false,"billingCode":"66990","codeType":"CPT"},{"id":4205,"precertRequired":false,"billingCode":"67005","codeType":"CPT"},{"id":4206,"precertRequired":false,"billingCode":"67010","codeType":"CPT"},{"id":4207,"precertRequired":false,"billingCode":"67015","codeType":"CPT"},{"id":4208,"precertRequired":false,"billingCode":"67025","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":4211,"precertRequired":false,"billingCode":"67030","codeType":"CPT"},{"id":4212,"precertRequired":false,"billingCode":"67031","codeType":"CPT"},{"id":4213,"precertRequired":false,"billingCode":"67036","codeType":"CPT"},{"id":4214,"precertRequired":false,"billingCode":"67039","codeType":"CPT"},{"id":4215,"precertRequired":false,"billingCode":"67040","codeType":"CPT"},{"id":4216,"precertRequired":false,"billingCode":"67041","codeType":"CPT"},{"id":4217,"precertRequired":false,"billingCode":"67042","codeType":"CPT"},{"id":4218,"precertRequired":false,"billingCode":"67043","codeType":"CPT"},{"id":4219,"precertRequired":false,"billingCode":"67075","codeType":"CPT"},{"id":4220,"precertRequired":false,"billingCode":"67101","codeType":"CPT"},{"id":4221,"precertRequired":false,"billingCode":"67105","codeType":"CPT"},{"id":4222,"precertRequired":false,"billingCode":"67107","codeType":"CPT"},{"id":4223,"precertRequired":false,"billingCode":"67108","codeType":"CPT"},{"id":4224,"precertRequired":false,"billingCode":"67110","codeType":"CPT"},{"id":4225,"precertRequired":false,"billingCode":"67113","codeType":"CPT"},{"id":4226,"precertRequired":false,"billingCode":"67115","codeType":"CPT"},{"id":4227,"precertRequired":false,"billingCode":"67120","codeType":"CPT"},{"id":4228,"precertRequired":false,"billingCode":"67121","codeType":"CPT"},{"id":4229,"precertRequired":false,"billingCode":"67141","codeType":"CPT"},{"id":4230,"precertRequired":false,"billingCode":"67145","codeType":"CPT"},{"id":4231,"precertRequired":false,"billingCode":"67208","codeType":"CPT"},{"id":4232,"precertRequired":false,"billingCode":"67210","codeType":"CPT"},{"id":4233,"precertRequired":false,"billingCode":"67218","codeType":"CPT"},{"id":4234,"precertRequired":false,"billingCode":"67220","codeType":"CPT"},{"id":4235,"precertRequired":false,"billingCode":"67221","codeType":"CPT"},{"id":4236,"precertRequired":false,"billingCode":"67225","codeType":"CPT"},{"id":4237,"precertRequired":false,"billingCode":"67227","codeType":"CPT"},{"id":4238,"precertRequired":false,"billingCode":"67228","codeType":"CPT"},{"id":4239,"precertRequired":false,"billingCode":"67250","codeType":"CPT"},{"id":4240,"precertRequired":false,"billingCode":"67255","codeType":"CPT"},{"id":4241,"precertRequired":false,"billingCode":"67299","codeType":"CPT"},{"id":4242,"precertRequired":false,"billingCode":"67311","codeType":"CPT"},{"id":4243,"precertRequired":false,"billingCode":"67312","codeType":"CPT"},{"id":4244,"precertRequired":false,"billingCode":"67314","codeType":"CPT"},{"id":4245,"precertRequired":false,"billingCode":"67316","codeType":"CPT"},{"id":4246,"precertRequired":false,"billingCode":"67318","codeType":"CPT"},{"id":4247,"precertRequired":false,"billingCode":"67320","codeType":"CPT"},{"id":4248,"precertRequired":false,"billingCode":"67331","codeType":"CPT"},{"id":4249,"precertRequired":false,"billingCode":"67332","codeType":"CPT"},{"id":4250,"precertRequired":false,"billingCode":"67334","codeType":"CPT"},{"id":4251,"precertRequired":false,"billingCode":"67335","codeType":"CPT"},{"id":4252,"precertRequired":false,"billingCode":"67340","codeType":"CPT"},{"id":4253,"precertRequired":false,"billingCode":"67343","codeType":"CPT"},{"id":4254,"precertRequired":false,"billingCode":"67345","codeType":"CPT"},{"id":4255,"precertRequired":false,"billingCode":"67346","codeType":"CPT"},{"id":4256,"precertRequired":false,"billingCode":"67399","codeType":"CPT"},{"id":4257,"precertRequired":false,"billingCode":"67400","codeType":"CPT"},{"id":4258,"precertRequired":false,"billingCode":"67405","codeType":"CPT"},{"id":4259,"precertRequired":false,"billingCode":"67412","codeType":"CPT"},{"id":4260,"precertRequired":false,"billingCode":"67413","codeType":"CPT"},{"id":4261,"precertRequired":false,"billingCode":"67414","codeType":"CPT"},{"id":4262,"precertRequired":false,"billingCode":"67415","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4268,"precertRequired":false,"billingCode":"67500","codeType":"CPT"},{"id":4269,"precertRequired":false,"billingCode":"67505","codeType":"CPT"},{"id":4270,"precertRequired":false,"billingCode":"67515","codeType":"CPT"},{"id":4271,"precertRequired":false,"billingCode":"67550","codeType":"CPT"},{"id":4272,"precertRequired":false,"billingCode":"67560","codeType":"CPT"},{"id":4273,"precertRequired":false,"billingCode":"67570","codeType":"CPT"},{"id":4274,"precertRequired":false,"billingCode":"67599","codeType":"CPT"},{"id":4275,"precertRequired":false,"billingCode":"67700","codeType":"CPT"},{"id":4276,"precertRequired":false,"billingCode":"67710","codeType":"CPT"},{"id":4277,"precertRequired":false,"billingCode":"67715","codeType":"CPT"},{"id":4278,"precertRequired":false,"billingCode":"67800","codeType":"CPT"},{"id":4279,"precertRequired":false,"billingCode":"67801","codeType":"CPT"},{"id":4280,"precertRequired":false,"billingCode":"67805","codeType":"CPT"},{"id":4281,"precertRequired":false,"billingCode":"67808","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4284,"precertRequired":false,"billingCode":"67825","codeType":"CPT"},{"id":4285,"precertRequired":false,"billingCode":"67830","codeType":"CPT"},{"id":4286,"precertRequired":false,"billingCode":"67835","codeType":"CPT"},{"id":4287,"precertRequired":false,"billingCode":"67840","codeType":"CPT"},{"id":4288,"precertRequired":false,"billingCode":"67850","codeType":"CPT"},{"id":4289,"precertRequired":false,"billingCode":"67875","codeType":"CPT"},{"id":4290,"precertRequired":false,"billingCode":"67880","codeType":"CPT"},{"id":4291,"precertRequired":false,"billingCode":"67882","codeType":"CPT"},{"id":4292,"precertRequired":false,"billingCode":"67900","codeType":"CPT"},{"id":4293,"precertRequired":false,"billingCode":"67901","codeType":"CPT"},{"id":4294,"precertRequired":false,"billingCode":"67902","codeType":"CPT"},{"id":4295,"precertRequired":false,"billingCode":"67903","codeType":"CPT"},{"id":4296,"precertRequired":false,"billingCode":"67904","codeType":"CPT"},{"id":4297,"precertRequired":false,"billingCode":"67906","codeType":"CPT"},{"id":4298,"precertRequired":false,"billingCode":"67908","codeType":"CPT"},{"id":4299,"precertRequired":false,"billingCode":"67909","codeType":"CPT"},{"id":4300,"precertRequired":false,"billingCode":"67911","codeType":"CPT"},{"id":4301,"precertRequired":false,"billingCode":"67912","codeType":"CPT"},{"id":4302,"precertRequired":false,"billingCode":"67916","codeType":"CPT"},{"id":4303,"precertRequired":false,"billingCode":"67917","codeType":"CPT"},{"id":4304,"precertRequired":false,"billingCode":"67921","codeType":"CPT"},{"id":4305,"precertRequired":false,"billingCode":"67922","codeType":"CPT"},{"id":4306,"precertRequired":false,"billingCode":"67923","codeType":"CPT"},{"id":4307,"precertRequired":false,"billingCode":"67924","codeType":"CPT"},{"id":4308,"precertRequired":false,"billingCode":"67930","codeType":"CPT"},{"id":4309,"precertRequired":false,"billingCode":"67935","codeType":"CPT"},{"id":4310,"precertRequired":false,"billingCode":"67950","codeType":"CPT"},{"id":4311,"precertRequired":false,"billingCode":"67961","codeType":"CPT"},{"id":4312,"precertRequired":false,"billingCode":"67966","codeType":"CPT"},{"id":4313,"precertRequired":false,"billingCode":"67971","codeType":"CPT"},{"id":4314,"precertRequired":false,"billingCode":"67973","codeType":"CPT"},{"id":4315,"precertRequired":false,"billingCode":"67974","codeType":"CPT"},{"id":4316,"precertRequired":false,"billingCode":"67975","codeType":"CPT"},{"id":4317,"precertRequired":false,"billingCode":"67999","codeType":"CPT"},{"id":4318,"precertRequired":false,"billingCode":"68020","codeType":"CPT"},{"id":4319,"precertRequired":false,"billingCode":"68040","codeType":"CPT"},{"id":4321,"precertRequired":false,"billingCode":"68110","codeType":"CPT"},{"id":4322,"precertRequired":false,"billingCode":"68115","codeType":"CPT"},{"id":4323,"precertRequired":false,"billingCode":"68130","codeType":"CPT"},{"id":4324,"precertRequired":false,"billingCode":"68135","codeType":"CPT"},{"id":4325,"precertRequired":false,"billingCode":"68200","codeType":"CPT"},{"id":4326,"precertRequired":false,"billingCode":"68320","codeType":"CPT"},{"id":4327,"precertRequired":false,"billingCode":"68325","codeType":"CPT"},{"id":4328,"precertRequired":false,"billingCode":"68326","codeType":"CPT"},{"id":4329,"precertRequired":false,"billingCode":"68328","codeType":"CPT"},{"id":4330,"precertRequired":false,"billingCode":"68330","codeType":"CPT"},{"id":4331,"precertRequired":false,"billingCode":"68335","codeType":"CPT"},{"id":4332,"precertRequired":false,"billingCode":"68340","codeType":"CPT"},{"id":4333,"precertRequired":false,"billingCode":"68360","codeType":"CPT"},{"id":4334,"precertRequired":false,"billingCode":"68362","codeType":"CPT"},{"id":4335,"precertRequired":false,"billingCode":"68371","codeType":"CPT"},{"id":4336,"precertRequired":false,"billingCode":"68399","codeType":"CPT"},{"id":4337,"precertRequired":false,"billingCode":"68400","codeType":"CPT"},{"id":4338,"precertRequired":false,"billingCode":"68420","codeType":"CPT"},{"id":4339,"precertRequired":false,"billingCode":"68440","codeType":"CPT"},{"id":4340,"precertRequired":false,"billingCode":"68500","codeType":"CPT"},{"id":4341,"precertRequired":false,"billingCode":"68505","codeType":"CPT"},{"id":4342,"precertRequired":false,"billingCode":"68510","codeType":"CPT"},{"id":4343,"precertRequired":false,"billingCode":"68550","codeType":"CPT"},{"id":4344,"precertRequired":false,"billingCode":"68720","codeType":"CPT"},{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6651,"precertRequired":false,"billingCode":"92071","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6688,"precertRequired":false,"billingCode":"92325","codeType":"CPT"},{"id":6689,"precertRequired":false,"billingCode":"92326","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6697,"precertRequired":false,"billingCode":"92358","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"},{"id":6700,"precertRequired":false,"billingCode":"92499","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7338,"precertRequired":false,"billingCode":"99172","codeType":"CPT"},{"id":7339,"precertRequired":false,"billingCode":"99173","codeType":"CPT"},{"id":7340,"precertRequired":false,"billingCode":"99174","codeType":"CPT"},{"id":7341,"precertRequired":false,"billingCode":"99177","codeType":"CPT"},{"id":7846,"precertRequired":false,"billingCode":"A6410","codeType":"HCPCS"},{"id":7848,"precertRequired":false,"billingCode":"A6412","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8156,"precertRequired":false,"billingCode":"G0186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":158,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":9,"precertRequired":false,"billingCode":"00142","codeType":"CPT"},{"id":11,"precertRequired":false,"billingCode":"00145","codeType":"CPT"},{"id":12,"precertRequired":false,"billingCode":"00147","codeType":"CPT"},{"id":13,"precertRequired":false,"billingCode":"00148","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":159,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5121,"precertRequired":false,"billingCode":"80410","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":160,"description":"Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":161,"description":"Intravitreal anti-VEGF injections according to VA protocol (see Procedural Overview no.7 for specific information about VA protocol)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":162,"description":"Inpatient or observation admission for surgical procedure, if medically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":163,"description":"Inpatient admission or observation status for complications related to the procedure ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":164,"description":"Follow-up visits for this episode of care a.Follow-up images/studies/laboratories as indicated. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]}]}},{"Seoc":{"id":1788,"seocKey":53,"name":"Eye Care Comprehensive 6 months_PRCT","seocId":"SSC_EYE CARE COMPREHENSIVE 6 MONTHS_1.1.4_PRCT","versionNumber":"1.1.4","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order. These services may be provided by an Optometrist or Ophthalmologist in some cases. Only ophthalmologists can perform invasive procedures, including injections, lasers, and eye surgery. VA authorization excludes coverage of premium IOLs ( toric, multifocal, accommodating), and refractive and cosmetic surgery that does not correct a functional disability.","effectiveDate":"06-08-2020","endDate":null,"duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for the referred condition\r\n2.  Diagnostic images/laboratories/studies relevant to the referred condition\r\n3.  Procedures and pathology services relevant to the referred condition.  Note:  VA authorization excludes coverage of premium IOLs (toric, multifocal, accommodating), and refractive and cosmetic surgery that does not correct a functional disability.   \r\n4.  Anesthesia consultation related to the procedure\r\n5.  Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n6.  Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website. \r\n7.  Intravitreal anti-VEGF injections according to VA protocol (see below)\r\n7a. VA Protocol: The following initial treatment is recommended and approved - A series of 3 monthly bevacizumab injections per eye with re-evaluation. At the end of the series if there is measurable improvement, patient will continue on this treatment for up to 8 total injections per eye for this episode of care. If patient shows no measurable improvement to the initial series of injections, additional request for services is needed with accompanying medical justification must be submitted to request other medications or procedures to treat the condition indicated on the consult, including ranibizumab, aflibercept, intraocular steroid implants, laser, or vitrectomy.\r\n8.  Inpatient or observation admission for surgical procedure, if medically necessary\r\n9.  Inpatient admission or observation status for complications related to the procedure\r\nNote: Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n10. Follow-up visits for this episode of care","maxAllowableVisits":null,"disclaimer":"* VA (and Veterans) will not pay extra for laser assisted cataract surgery with conventional intraocular lens implant in accordance with Medicare policy and CMS rulings.\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","QASP":"General Care","categoryOfCare":"OPHTHALMOLOGY","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207W00000X"}],"services":[{"id":5533,"description":"Initial outpatient evaluation and treatment for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5534,"description":"Diagnostic images/laboratories/studies relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4716,"precertRequired":false,"billingCode":"76514","codeType":"CPT"},{"id":4717,"precertRequired":false,"billingCode":"76516","codeType":"CPT"},{"id":4718,"precertRequired":false,"billingCode":"76519","codeType":"CPT"},{"id":4719,"precertRequired":false,"billingCode":"76529","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6656,"precertRequired":false,"billingCode":"92100","codeType":"CPT"},{"id":6657,"precertRequired":false,"billingCode":"92132","codeType":"CPT"},{"id":6658,"precertRequired":false,"billingCode":"92133","codeType":"CPT"},{"id":6659,"precertRequired":false,"billingCode":"92134","codeType":"CPT"},{"id":6660,"precertRequired":false,"billingCode":"92136","codeType":"CPT"},{"id":6661,"precertRequired":false,"billingCode":"92145","codeType":"CPT"},{"id":6664,"precertRequired":false,"billingCode":"92227","codeType":"CPT"},{"id":6665,"precertRequired":false,"billingCode":"92228","codeType":"CPT"},{"id":6666,"precertRequired":false,"billingCode":"92230","codeType":"CPT"},{"id":6667,"precertRequired":false,"billingCode":"92235","codeType":"CPT"},{"id":6668,"precertRequired":false,"billingCode":"92240","codeType":"CPT"},{"id":6669,"precertRequired":false,"billingCode":"92242","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":6671,"precertRequired":false,"billingCode":"92260","codeType":"CPT"},{"id":6672,"precertRequired":false,"billingCode":"92265","codeType":"CPT"},{"id":6673,"precertRequired":false,"billingCode":"92270","codeType":"CPT"},{"id":6675,"precertRequired":false,"billingCode":"92283","codeType":"CPT"},{"id":6676,"precertRequired":false,"billingCode":"92284","codeType":"CPT"},{"id":6677,"precertRequired":false,"billingCode":"92285","codeType":"CPT"},{"id":6678,"precertRequired":false,"billingCode":"92286","codeType":"CPT"},{"id":6679,"precertRequired":false,"billingCode":"92287","codeType":"CPT"},{"id":7536,"precertRequired":false,"billingCode":"0329T","codeType":"CPT"},{"id":7537,"precertRequired":false,"billingCode":"0330T","codeType":"CPT"},{"id":7554,"precertRequired":false,"billingCode":"0378T","codeType":"CPT"},{"id":7555,"precertRequired":false,"billingCode":"0379T","codeType":"CPT"},{"id":11591,"precertRequired":false,"billingCode":"92273","codeType":"CPT"},{"id":11592,"precertRequired":false,"billingCode":"92274","codeType":"CPT"},{"id":11593,"precertRequired":false,"billingCode":"0509T","codeType":"CPT"},{"id":13441,"precertRequired":false,"billingCode":"92201","codeType":"CPT"},{"id":13442,"precertRequired":false,"billingCode":"92202","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5535,"description":"Procedures and pathology services relevant to the referred condition.  Note:  VA authorization excludes coverage of premium IOLs (toric, multifocal, accommodating), and refractive and cosmetic surgery that does not correct a functional disability.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":399,"precertRequired":false,"billingCode":"15155","codeType":"CPT"},{"id":400,"precertRequired":false,"billingCode":"15156","codeType":"CPT"},{"id":401,"precertRequired":false,"billingCode":"15157","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":4084,"precertRequired":false,"billingCode":"65091","codeType":"CPT"},{"id":4085,"precertRequired":false,"billingCode":"65093","codeType":"CPT"},{"id":4086,"precertRequired":false,"billingCode":"65101","codeType":"CPT"},{"id":4087,"precertRequired":false,"billingCode":"65103","codeType":"CPT"},{"id":4088,"precertRequired":false,"billingCode":"65105","codeType":"CPT"},{"id":4089,"precertRequired":false,"billingCode":"65110","codeType":"CPT"},{"id":4090,"precertRequired":false,"billingCode":"65112","codeType":"CPT"},{"id":4091,"precertRequired":false,"billingCode":"65114","codeType":"CPT"},{"id":4092,"precertRequired":false,"billingCode":"65130","codeType":"CPT"},{"id":4093,"precertRequired":false,"billingCode":"65135","codeType":"CPT"},{"id":4094,"precertRequired":false,"billingCode":"65140","codeType":"CPT"},{"id":4095,"precertRequired":false,"billingCode":"65150","codeType":"CPT"},{"id":4096,"precertRequired":false,"billingCode":"65155","codeType":"CPT"},{"id":4097,"precertRequired":false,"billingCode":"65175","codeType":"CPT"},{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4099,"precertRequired":false,"billingCode":"65210","codeType":"CPT"},{"id":4100,"precertRequired":false,"billingCode":"65220","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4104,"precertRequired":false,"billingCode":"65260","codeType":"CPT"},{"id":4105,"precertRequired":false,"billingCode":"65270","codeType":"CPT"},{"id":4106,"precertRequired":false,"billingCode":"65272","codeType":"CPT"},{"id":4107,"precertRequired":false,"billingCode":"65273","codeType":"CPT"},{"id":4108,"precertRequired":false,"billingCode":"65275","codeType":"CPT"},{"id":4109,"precertRequired":false,"billingCode":"65280","codeType":"CPT"},{"id":4110,"precertRequired":false,"billingCode":"65285","codeType":"CPT"},{"id":4111,"precertRequired":false,"billingCode":"65286","codeType":"CPT"},{"id":4112,"precertRequired":false,"billingCode":"65290","codeType":"CPT"},{"id":4113,"precertRequired":false,"billingCode":"65400","codeType":"CPT"},{"id":4114,"precertRequired":false,"billingCode":"65410","codeType":"CPT"},{"id":4115,"precertRequired":false,"billingCode":"65420","codeType":"CPT"},{"id":4116,"precertRequired":false,"billingCode":"65426","codeType":"CPT"},{"id":4117,"precertRequired":false,"billingCode":"65430","codeType":"CPT"},{"id":4118,"precertRequired":false,"billingCode":"65435","codeType":"CPT"},{"id":4119,"precertRequired":false,"billingCode":"65436","codeType":"CPT"},{"id":4120,"precertRequired":false,"billingCode":"65450","codeType":"CPT"},{"id":4121,"precertRequired":false,"billingCode":"65600","codeType":"CPT"},{"id":4122,"precertRequired":false,"billingCode":"65710","codeType":"CPT"},{"id":4123,"precertRequired":false,"billingCode":"65730","codeType":"CPT"},{"id":4124,"precertRequired":false,"billingCode":"65750","codeType":"CPT"},{"id":4125,"precertRequired":false,"billingCode":"65755","codeType":"CPT"},{"id":4126,"precertRequired":false,"billingCode":"65756","codeType":"CPT"},{"id":4127,"precertRequired":false,"billingCode":"65757","codeType":"CPT"},{"id":4128,"precertRequired":false,"billingCode":"65760","codeType":"CPT"},{"id":4129,"precertRequired":false,"billingCode":"65765","codeType":"CPT"},{"id":4130,"precertRequired":false,"billingCode":"65767","codeType":"CPT"},{"id":4131,"precertRequired":false,"billingCode":"65770","codeType":"CPT"},{"id":4132,"precertRequired":false,"billingCode":"65771","codeType":"CPT"},{"id":4133,"precertRequired":false,"billingCode":"65772","codeType":"CPT"},{"id":4134,"precertRequired":false,"billingCode":"65775","codeType":"CPT"},{"id":4135,"precertRequired":false,"billingCode":"65778","codeType":"CPT"},{"id":4136,"precertRequired":false,"billingCode":"65779","codeType":"CPT"},{"id":4137,"precertRequired":false,"billingCode":"65780","codeType":"CPT"},{"id":4138,"precertRequired":false,"billingCode":"65781","codeType":"CPT"},{"id":4139,"precertRequired":false,"billingCode":"65782","codeType":"CPT"},{"id":4141,"precertRequired":false,"billingCode":"65800","codeType":"CPT"},{"id":4142,"precertRequired":false,"billingCode":"65810","codeType":"CPT"},{"id":4143,"precertRequired":false,"billingCode":"65815","codeType":"CPT"},{"id":4144,"precertRequired":false,"billingCode":"65820","codeType":"CPT"},{"id":4145,"precertRequired":false,"billingCode":"65850","codeType":"CPT"},{"id":4146,"precertRequired":false,"billingCode":"65855","codeType":"CPT"},{"id":4147,"precertRequired":false,"billingCode":"65860","codeType":"CPT"},{"id":4148,"precertRequired":false,"billingCode":"65865","codeType":"CPT"},{"id":4149,"precertRequired":false,"billingCode":"65870","codeType":"CPT"},{"id":4150,"precertRequired":false,"billingCode":"65875","codeType":"CPT"},{"id":4151,"precertRequired":false,"billingCode":"65880","codeType":"CPT"},{"id":4152,"precertRequired":false,"billingCode":"65900","codeType":"CPT"},{"id":4153,"precertRequired":false,"billingCode":"65920","codeType":"CPT"},{"id":4154,"precertRequired":false,"billingCode":"65930","codeType":"CPT"},{"id":4157,"precertRequired":false,"billingCode":"66130","codeType":"CPT"},{"id":4158,"precertRequired":false,"billingCode":"66150","codeType":"CPT"},{"id":4159,"precertRequired":false,"billingCode":"66155","codeType":"CPT"},{"id":4160,"precertRequired":false,"billingCode":"66160","codeType":"CPT"},{"id":4161,"precertRequired":false,"billingCode":"66170","codeType":"CPT"},{"id":4162,"precertRequired":false,"billingCode":"66172","codeType":"CPT"},{"id":4163,"precertRequired":false,"billingCode":"66174","codeType":"CPT"},{"id":4164,"precertRequired":false,"billingCode":"66179","codeType":"CPT"},{"id":4165,"precertRequired":false,"billingCode":"66180","codeType":"CPT"},{"id":4166,"precertRequired":false,"billingCode":"66183","codeType":"CPT"},{"id":4167,"precertRequired":false,"billingCode":"66184","codeType":"CPT"},{"id":4168,"precertRequired":false,"billingCode":"66185","codeType":"CPT"},{"id":4170,"precertRequired":false,"billingCode":"66225","codeType":"CPT"},{"id":4171,"precertRequired":false,"billingCode":"66250","codeType":"CPT"},{"id":4172,"precertRequired":false,"billingCode":"66500","codeType":"CPT"},{"id":4173,"precertRequired":false,"billingCode":"66505","codeType":"CPT"},{"id":4174,"precertRequired":false,"billingCode":"66600","codeType":"CPT"},{"id":4175,"precertRequired":false,"billingCode":"66605","codeType":"CPT"},{"id":4176,"precertRequired":false,"billingCode":"66625","codeType":"CPT"},{"id":4177,"precertRequired":false,"billingCode":"66630","codeType":"CPT"},{"id":4178,"precertRequired":false,"billingCode":"66635","codeType":"CPT"},{"id":4179,"precertRequired":false,"billingCode":"66680","codeType":"CPT"},{"id":4180,"precertRequired":false,"billingCode":"66682","codeType":"CPT"},{"id":4181,"precertRequired":false,"billingCode":"66700","codeType":"CPT"},{"id":4182,"precertRequired":false,"billingCode":"66710","codeType":"CPT"},{"id":4183,"precertRequired":false,"billingCode":"66711","codeType":"CPT"},{"id":4184,"precertRequired":false,"billingCode":"66720","codeType":"CPT"},{"id":4185,"precertRequired":false,"billingCode":"66740","codeType":"CPT"},{"id":4186,"precertRequired":false,"billingCode":"66761","codeType":"CPT"},{"id":4187,"precertRequired":false,"billingCode":"66762","codeType":"CPT"},{"id":4188,"precertRequired":false,"billingCode":"66770","codeType":"CPT"},{"id":4189,"precertRequired":false,"billingCode":"66820","codeType":"CPT"},{"id":4190,"precertRequired":false,"billingCode":"66821","codeType":"CPT"},{"id":4191,"precertRequired":false,"billingCode":"66825","codeType":"CPT"},{"id":4192,"precertRequired":false,"billingCode":"66830","codeType":"CPT"},{"id":4193,"precertRequired":false,"billingCode":"66840","codeType":"CPT"},{"id":4194,"precertRequired":false,"billingCode":"66850","codeType":"CPT"},{"id":4195,"precertRequired":false,"billingCode":"66852","codeType":"CPT"},{"id":4196,"precertRequired":false,"billingCode":"66920","codeType":"CPT"},{"id":4197,"precertRequired":false,"billingCode":"66930","codeType":"CPT"},{"id":4198,"precertRequired":false,"billingCode":"66940","codeType":"CPT"},{"id":4199,"precertRequired":false,"billingCode":"66982","codeType":"CPT"},{"id":4200,"precertRequired":false,"billingCode":"66983","codeType":"CPT"},{"id":4201,"precertRequired":false,"billingCode":"66984","codeType":"CPT"},{"id":4202,"precertRequired":false,"billingCode":"66985","codeType":"CPT"},{"id":4203,"precertRequired":false,"billingCode":"66986","codeType":"CPT"},{"id":4204,"precertRequired":false,"billingCode":"66990","codeType":"CPT"},{"id":4205,"precertRequired":false,"billingCode":"67005","codeType":"CPT"},{"id":4206,"precertRequired":false,"billingCode":"67010","codeType":"CPT"},{"id":4207,"precertRequired":false,"billingCode":"67015","codeType":"CPT"},{"id":4211,"precertRequired":false,"billingCode":"67030","codeType":"CPT"},{"id":4212,"precertRequired":false,"billingCode":"67031","codeType":"CPT"},{"id":4213,"precertRequired":false,"billingCode":"67036","codeType":"CPT"},{"id":4214,"precertRequired":false,"billingCode":"67039","codeType":"CPT"},{"id":4215,"precertRequired":false,"billingCode":"67040","codeType":"CPT"},{"id":4216,"precertRequired":false,"billingCode":"67041","codeType":"CPT"},{"id":4217,"precertRequired":false,"billingCode":"67042","codeType":"CPT"},{"id":4218,"precertRequired":false,"billingCode":"67043","codeType":"CPT"},{"id":4220,"precertRequired":false,"billingCode":"67101","codeType":"CPT"},{"id":4221,"precertRequired":false,"billingCode":"67105","codeType":"CPT"},{"id":4222,"precertRequired":false,"billingCode":"67107","codeType":"CPT"},{"id":4223,"precertRequired":false,"billingCode":"67108","codeType":"CPT"},{"id":4224,"precertRequired":false,"billingCode":"67110","codeType":"CPT"},{"id":4225,"precertRequired":false,"billingCode":"67113","codeType":"CPT"},{"id":4226,"precertRequired":false,"billingCode":"67115","codeType":"CPT"},{"id":4227,"precertRequired":false,"billingCode":"67120","codeType":"CPT"},{"id":4228,"precertRequired":false,"billingCode":"67121","codeType":"CPT"},{"id":4229,"precertRequired":false,"billingCode":"67141","codeType":"CPT"},{"id":4230,"precertRequired":false,"billingCode":"67145","codeType":"CPT"},{"id":4231,"precertRequired":false,"billingCode":"67208","codeType":"CPT"},{"id":4232,"precertRequired":false,"billingCode":"67210","codeType":"CPT"},{"id":4233,"precertRequired":false,"billingCode":"67218","codeType":"CPT"},{"id":4234,"precertRequired":false,"billingCode":"67220","codeType":"CPT"},{"id":4235,"precertRequired":false,"billingCode":"67221","codeType":"CPT"},{"id":4236,"precertRequired":false,"billingCode":"67225","codeType":"CPT"},{"id":4237,"precertRequired":false,"billingCode":"67227","codeType":"CPT"},{"id":4238,"precertRequired":false,"billingCode":"67228","codeType":"CPT"},{"id":4239,"precertRequired":false,"billingCode":"67250","codeType":"CPT"},{"id":4240,"precertRequired":false,"billingCode":"67255","codeType":"CPT"},{"id":4242,"precertRequired":false,"billingCode":"67311","codeType":"CPT"},{"id":4243,"precertRequired":false,"billingCode":"67312","codeType":"CPT"},{"id":4244,"precertRequired":false,"billingCode":"67314","codeType":"CPT"},{"id":4245,"precertRequired":false,"billingCode":"67316","codeType":"CPT"},{"id":4246,"precertRequired":false,"billingCode":"67318","codeType":"CPT"},{"id":4247,"precertRequired":false,"billingCode":"67320","codeType":"CPT"},{"id":4248,"precertRequired":false,"billingCode":"67331","codeType":"CPT"},{"id":4249,"precertRequired":false,"billingCode":"67332","codeType":"CPT"},{"id":4250,"precertRequired":false,"billingCode":"67334","codeType":"CPT"},{"id":4251,"precertRequired":false,"billingCode":"67335","codeType":"CPT"},{"id":4252,"precertRequired":false,"billingCode":"67340","codeType":"CPT"},{"id":4253,"precertRequired":false,"billingCode":"67343","codeType":"CPT"},{"id":4254,"precertRequired":false,"billingCode":"67345","codeType":"CPT"},{"id":4255,"precertRequired":false,"billingCode":"67346","codeType":"CPT"},{"id":4257,"precertRequired":false,"billingCode":"67400","codeType":"CPT"},{"id":4258,"precertRequired":false,"billingCode":"67405","codeType":"CPT"},{"id":4259,"precertRequired":false,"billingCode":"67412","codeType":"CPT"},{"id":4260,"precertRequired":false,"billingCode":"67413","codeType":"CPT"},{"id":4261,"precertRequired":false,"billingCode":"67414","codeType":"CPT"},{"id":4262,"precertRequired":false,"billingCode":"67415","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4268,"precertRequired":false,"billingCode":"67500","codeType":"CPT"},{"id":4269,"precertRequired":false,"billingCode":"67505","codeType":"CPT"},{"id":4270,"precertRequired":false,"billingCode":"67515","codeType":"CPT"},{"id":4271,"precertRequired":false,"billingCode":"67550","codeType":"CPT"},{"id":4272,"precertRequired":false,"billingCode":"67560","codeType":"CPT"},{"id":4273,"precertRequired":false,"billingCode":"67570","codeType":"CPT"},{"id":4275,"precertRequired":false,"billingCode":"67700","codeType":"CPT"},{"id":4276,"precertRequired":false,"billingCode":"67710","codeType":"CPT"},{"id":4277,"precertRequired":false,"billingCode":"67715","codeType":"CPT"},{"id":4278,"precertRequired":false,"billingCode":"67800","codeType":"CPT"},{"id":4279,"precertRequired":false,"billingCode":"67801","codeType":"CPT"},{"id":4280,"precertRequired":false,"billingCode":"67805","codeType":"CPT"},{"id":4281,"precertRequired":false,"billingCode":"67808","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4283,"precertRequired":false,"billingCode":"67820","codeType":"CPT"},{"id":4284,"precertRequired":false,"billingCode":"67825","codeType":"CPT"},{"id":4285,"precertRequired":false,"billingCode":"67830","codeType":"CPT"},{"id":4286,"precertRequired":false,"billingCode":"67835","codeType":"CPT"},{"id":4287,"precertRequired":false,"billingCode":"67840","codeType":"CPT"},{"id":4288,"precertRequired":false,"billingCode":"67850","codeType":"CPT"},{"id":4289,"precertRequired":false,"billingCode":"67875","codeType":"CPT"},{"id":4290,"precertRequired":false,"billingCode":"67880","codeType":"CPT"},{"id":4291,"precertRequired":false,"billingCode":"67882","codeType":"CPT"},{"id":4292,"precertRequired":false,"billingCode":"67900","codeType":"CPT"},{"id":4293,"precertRequired":false,"billingCode":"67901","codeType":"CPT"},{"id":4294,"precertRequired":false,"billingCode":"67902","codeType":"CPT"},{"id":4295,"precertRequired":false,"billingCode":"67903","codeType":"CPT"},{"id":4296,"precertRequired":false,"billingCode":"67904","codeType":"CPT"},{"id":4297,"precertRequired":false,"billingCode":"67906","codeType":"CPT"},{"id":4298,"precertRequired":false,"billingCode":"67908","codeType":"CPT"},{"id":4299,"precertRequired":false,"billingCode":"67909","codeType":"CPT"},{"id":4300,"precertRequired":false,"billingCode":"67911","codeType":"CPT"},{"id":4301,"precertRequired":false,"billingCode":"67912","codeType":"CPT"},{"id":4302,"precertRequired":false,"billingCode":"67916","codeType":"CPT"},{"id":4303,"precertRequired":false,"billingCode":"67917","codeType":"CPT"},{"id":4304,"precertRequired":false,"billingCode":"67921","codeType":"CPT"},{"id":4305,"precertRequired":false,"billingCode":"67922","codeType":"CPT"},{"id":4306,"precertRequired":false,"billingCode":"67923","codeType":"CPT"},{"id":4307,"precertRequired":false,"billingCode":"67924","codeType":"CPT"},{"id":4308,"precertRequired":false,"billingCode":"67930","codeType":"CPT"},{"id":4309,"precertRequired":false,"billingCode":"67935","codeType":"CPT"},{"id":4310,"precertRequired":false,"billingCode":"67950","codeType":"CPT"},{"id":4311,"precertRequired":false,"billingCode":"67961","codeType":"CPT"},{"id":4312,"precertRequired":false,"billingCode":"67966","codeType":"CPT"},{"id":4313,"precertRequired":false,"billingCode":"67971","codeType":"CPT"},{"id":4314,"precertRequired":false,"billingCode":"67973","codeType":"CPT"},{"id":4315,"precertRequired":false,"billingCode":"67974","codeType":"CPT"},{"id":4316,"precertRequired":false,"billingCode":"67975","codeType":"CPT"},{"id":4318,"precertRequired":false,"billingCode":"68020","codeType":"CPT"},{"id":4319,"precertRequired":false,"billingCode":"68040","codeType":"CPT"},{"id":4320,"precertRequired":false,"billingCode":"68100","codeType":"CPT"},{"id":4321,"precertRequired":false,"billingCode":"68110","codeType":"CPT"},{"id":4322,"precertRequired":false,"billingCode":"68115","codeType":"CPT"},{"id":4323,"precertRequired":false,"billingCode":"68130","codeType":"CPT"},{"id":4324,"precertRequired":false,"billingCode":"68135","codeType":"CPT"},{"id":4325,"precertRequired":false,"billingCode":"68200","codeType":"CPT"},{"id":4326,"precertRequired":false,"billingCode":"68320","codeType":"CPT"},{"id":4327,"precertRequired":false,"billingCode":"68325","codeType":"CPT"},{"id":4328,"precertRequired":false,"billingCode":"68326","codeType":"CPT"},{"id":4329,"precertRequired":false,"billingCode":"68328","codeType":"CPT"},{"id":4330,"precertRequired":false,"billingCode":"68330","codeType":"CPT"},{"id":4331,"precertRequired":false,"billingCode":"68335","codeType":"CPT"},{"id":4332,"precertRequired":false,"billingCode":"68340","codeType":"CPT"},{"id":4333,"precertRequired":false,"billingCode":"68360","codeType":"CPT"},{"id":4334,"precertRequired":false,"billingCode":"68362","codeType":"CPT"},{"id":4335,"precertRequired":false,"billingCode":"68371","codeType":"CPT"},{"id":4337,"precertRequired":false,"billingCode":"68400","codeType":"CPT"},{"id":4338,"precertRequired":false,"billingCode":"68420","codeType":"CPT"},{"id":4339,"precertRequired":false,"billingCode":"68440","codeType":"CPT"},{"id":4340,"precertRequired":false,"billingCode":"68500","codeType":"CPT"},{"id":4341,"precertRequired":false,"billingCode":"68505","codeType":"CPT"},{"id":4342,"precertRequired":false,"billingCode":"68510","codeType":"CPT"},{"id":4344,"precertRequired":false,"billingCode":"68720","codeType":"CPT"},{"id":4345,"precertRequired":false,"billingCode":"68801","codeType":"CPT"},{"id":4346,"precertRequired":false,"billingCode":"68850","codeType":"CPT"},{"id":5614,"precertRequired":false,"billingCode":"83861","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6651,"precertRequired":false,"billingCode":"92071","codeType":"CPT"},{"id":6652,"precertRequired":false,"billingCode":"92072","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6688,"precertRequired":false,"billingCode":"92325","codeType":"CPT"},{"id":6689,"precertRequired":false,"billingCode":"92326","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6697,"precertRequired":false,"billingCode":"92358","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7338,"precertRequired":false,"billingCode":"99172","codeType":"CPT"},{"id":7339,"precertRequired":false,"billingCode":"99173","codeType":"CPT"},{"id":7340,"precertRequired":false,"billingCode":"99174","codeType":"CPT"},{"id":7341,"precertRequired":false,"billingCode":"99177","codeType":"CPT"},{"id":7624,"precertRequired":false,"billingCode":"2022F","codeType":"CPT"},{"id":7846,"precertRequired":false,"billingCode":"A6410","codeType":"HCPCS"},{"id":7847,"precertRequired":false,"billingCode":"A6411","codeType":"HCPCS"},{"id":7848,"precertRequired":false,"billingCode":"A6412","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8156,"precertRequired":false,"billingCode":"G0186","codeType":"HCPCS"},{"id":9170,"precertRequired":true,"billingCode":"15115","codeType":"CPT"},{"id":9171,"precertRequired":true,"billingCode":"15116","codeType":"CPT"},{"id":9172,"precertRequired":true,"billingCode":"15120","codeType":"CPT"},{"id":9173,"precertRequired":true,"billingCode":"15121","codeType":"CPT"},{"id":9174,"precertRequired":true,"billingCode":"15135","codeType":"CPT"},{"id":9175,"precertRequired":true,"billingCode":"15136","codeType":"CPT"},{"id":9958,"precertRequired":false,"billingCode":"15823","codeType":"CPT"},{"id":11595,"precertRequired":false,"billingCode":"65265","codeType":"CPT"},{"id":11597,"precertRequired":false,"billingCode":"66175","codeType":"CPT"},{"id":11606,"precertRequired":false,"billingCode":"68745","codeType":"CPT"},{"id":11607,"precertRequired":false,"billingCode":"68750","codeType":"CPT"},{"id":11608,"precertRequired":false,"billingCode":"68760","codeType":"CPT"},{"id":11609,"precertRequired":false,"billingCode":"68761","codeType":"CPT"},{"id":11610,"precertRequired":false,"billingCode":"68770","codeType":"CPT"},{"id":11611,"precertRequired":false,"billingCode":"68810","codeType":"CPT"},{"id":11612,"precertRequired":false,"billingCode":"68811","codeType":"CPT"},{"id":11613,"precertRequired":false,"billingCode":"68815","codeType":"CPT"},{"id":11614,"precertRequired":false,"billingCode":"68816","codeType":"CPT"},{"id":11615,"precertRequired":false,"billingCode":"68840","codeType":"CPT"},{"id":11616,"precertRequired":false,"billingCode":"0191T","codeType":"CPT"},{"id":11618,"precertRequired":false,"billingCode":"0376T","codeType":"CPT"},{"id":11619,"precertRequired":false,"billingCode":"0402T","codeType":"CPT"},{"id":11620,"precertRequired":false,"billingCode":"0449T","codeType":"CPT"},{"id":11622,"precertRequired":false,"billingCode":"0474T","codeType":"CPT"},{"id":11624,"precertRequired":false,"billingCode":"2019F","codeType":"CPT"},{"id":11625,"precertRequired":false,"billingCode":"2021F","codeType":"CPT"},{"id":11626,"precertRequired":false,"billingCode":"2027F","codeType":"CPT"},{"id":13477,"precertRequired":false,"billingCode":"15820","codeType":"CPT"},{"id":13478,"precertRequired":false,"billingCode":"15821","codeType":"CPT"},{"id":13479,"precertRequired":false,"billingCode":"15822","codeType":"CPT"},{"id":13480,"precertRequired":false,"billingCode":"66987","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5536,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":8,"precertRequired":false,"billingCode":"00140","codeType":"CPT"},{"id":9,"precertRequired":false,"billingCode":"00142","codeType":"CPT"},{"id":11,"precertRequired":false,"billingCode":"00145","codeType":"CPT"},{"id":12,"precertRequired":false,"billingCode":"00147","codeType":"CPT"},{"id":13,"precertRequired":false,"billingCode":"00148","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":5537,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5538,"description":"Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4155,"precertRequired":false,"billingCode":"66020","codeType":"CPT"},{"id":4156,"precertRequired":false,"billingCode":"66030","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5539,"description":"Intravitreal anti-VEGF injections according to VA protocol (see below)\r\n7a. VA Protocol: The following initial treatment is recommended and approved - A series of 3 monthly bevacizumab injections per eye with re-evaluation. At the end of the series if there is measurable improvement, patient will continue on this treatment for up to 8 total injections per eye for this episode of care. If patient shows no measurable improvement to the initial series of injections, additional request for services is needed with accompanying medical justification must be submitted to request other medications or procedures to treat the condition indicated on the consult, including ranibizumab, aflibercept, intraocular steroid implants, laser, or vitrectomy.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4208,"precertRequired":false,"billingCode":"67025","codeType":"CPT"},{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5540,"description":"Inpatient or observation admission for surgical procedure, if medically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5541,"description":"Inpatient admission or observation status for complications related to the procedure\r\nNote: Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":5542,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]}]}},{"Seoc":{"id":483,"seocKey":53,"name":"Eye Care Comprehensive 6 months_PRCT","seocId":"SSC_EYE CARE COMPREHENSIVE 6 MONTHS_1.1.3_PRCT","versionNumber":"1.1.3","description":"This authorization covers services associated with all medical care listed below as clinically necessary. These services can be provided by an Optometrist or Ophthalmologist.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic images/laboratories/studies relevant to the referred condition\r\n3. Procedures and pathology services relevant to the referred condition\r\n4. Anesthesia consultation related to the procedure\r\n5. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n6. Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website\r\n7. Intravitreal anti-VEGF injections according to VA protocol (see below)             \r\na. VA Protocol: The following initial treatment is recommended and approved - A series of 3 monthly bevacizumab injections per eye with re-evaluation. At the end of the series if there is measurable improvement, patient will continue on this treatment for up to 8 total injections per eye for this episode of care. If patient shows no measurable improvement to the initial series of injections, additional request for services is needed with accompanying medical justification must be submitted to request other medications or procedures to treat the condition indicated on the consult, including ranibizumab, aflibercept, intraocular steroid implants, laser, or vitrectomy\r\n8. Inpatient or observation admission for surgical procedure, if medically necessary\r\n9. Inpatient admission or observation status for complications related to the procedure     \r\nNote: ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery\r\n10. Follow-up visits for this episode of care     \r\na.    Follow-up images/studies/laboratories as indicated","maxAllowableVisits":null,"disclaimer":"*VA authorization excludes coverage of premium IOLs (toric, multifocal, accommodating), and refractive and cosmetic surgery that does not correct a functional disability\r\n* VA (and Veterans) will not pay extra for laser assisted cataract surgery with conventional intraocular lens implant in accordance with Medicare policy and CMS rulings. \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","QASP":"General Care","categoryOfCare":"OPHTHALMOLOGY","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207W00000X"}],"services":[{"id":2755,"description":"Initial outpatient evaluation and treatment for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2756,"description":"Diagnostic images/laboratories/studies relevant to the referred condition","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4716,"precertRequired":false,"billingCode":"76514","codeType":"CPT"},{"id":4717,"precertRequired":false,"billingCode":"76516","codeType":"CPT"},{"id":4718,"precertRequired":false,"billingCode":"76519","codeType":"CPT"},{"id":4719,"precertRequired":false,"billingCode":"76529","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6656,"precertRequired":false,"billingCode":"92100","codeType":"CPT"},{"id":6657,"precertRequired":false,"billingCode":"92132","codeType":"CPT"},{"id":6658,"precertRequired":false,"billingCode":"92133","codeType":"CPT"},{"id":6659,"precertRequired":false,"billingCode":"92134","codeType":"CPT"},{"id":6660,"precertRequired":false,"billingCode":"92136","codeType":"CPT"},{"id":6661,"precertRequired":false,"billingCode":"92145","codeType":"CPT"},{"id":6662,"precertRequired":false,"billingCode":"92225","codeType":"CPT"},{"id":6663,"precertRequired":false,"billingCode":"92226","codeType":"CPT"},{"id":6664,"precertRequired":false,"billingCode":"92227","codeType":"CPT"},{"id":6665,"precertRequired":false,"billingCode":"92228","codeType":"CPT"},{"id":6666,"precertRequired":false,"billingCode":"92230","codeType":"CPT"},{"id":6667,"precertRequired":false,"billingCode":"92235","codeType":"CPT"},{"id":6668,"precertRequired":false,"billingCode":"92240","codeType":"CPT"},{"id":6669,"precertRequired":false,"billingCode":"92242","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":6671,"precertRequired":false,"billingCode":"92260","codeType":"CPT"},{"id":6672,"precertRequired":false,"billingCode":"92265","codeType":"CPT"},{"id":6673,"precertRequired":false,"billingCode":"92270","codeType":"CPT"},{"id":6675,"precertRequired":false,"billingCode":"92283","codeType":"CPT"},{"id":6676,"precertRequired":false,"billingCode":"92284","codeType":"CPT"},{"id":6677,"precertRequired":false,"billingCode":"92285","codeType":"CPT"},{"id":6678,"precertRequired":false,"billingCode":"92286","codeType":"CPT"},{"id":7536,"precertRequired":false,"billingCode":"0329T","codeType":"CPT"},{"id":7537,"precertRequired":false,"billingCode":"0330T","codeType":"CPT"},{"id":7554,"precertRequired":false,"billingCode":"0378T","codeType":"CPT"},{"id":7555,"precertRequired":false,"billingCode":"0379T","codeType":"CPT"},{"id":7556,"precertRequired":false,"billingCode":"0380T","codeType":"CPT"},{"id":11591,"precertRequired":false,"billingCode":"92273","codeType":"CPT"},{"id":11592,"precertRequired":false,"billingCode":"92274","codeType":"CPT"},{"id":11593,"precertRequired":false,"billingCode":"0509T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2757,"description":"Procedures and pathology services relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4084,"precertRequired":false,"billingCode":"65091","codeType":"CPT"},{"id":4085,"precertRequired":false,"billingCode":"65093","codeType":"CPT"},{"id":4086,"precertRequired":false,"billingCode":"65101","codeType":"CPT"},{"id":4087,"precertRequired":false,"billingCode":"65103","codeType":"CPT"},{"id":4088,"precertRequired":false,"billingCode":"65105","codeType":"CPT"},{"id":4089,"precertRequired":false,"billingCode":"65110","codeType":"CPT"},{"id":4090,"precertRequired":false,"billingCode":"65112","codeType":"CPT"},{"id":4091,"precertRequired":false,"billingCode":"65114","codeType":"CPT"},{"id":4092,"precertRequired":false,"billingCode":"65130","codeType":"CPT"},{"id":4093,"precertRequired":false,"billingCode":"65135","codeType":"CPT"},{"id":4094,"precertRequired":false,"billingCode":"65140","codeType":"CPT"},{"id":4095,"precertRequired":false,"billingCode":"65150","codeType":"CPT"},{"id":4096,"precertRequired":false,"billingCode":"65155","codeType":"CPT"},{"id":4097,"precertRequired":false,"billingCode":"65175","codeType":"CPT"},{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4099,"precertRequired":false,"billingCode":"65210","codeType":"CPT"},{"id":4100,"precertRequired":false,"billingCode":"65220","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4104,"precertRequired":false,"billingCode":"65260","codeType":"CPT"},{"id":4105,"precertRequired":false,"billingCode":"65270","codeType":"CPT"},{"id":4106,"precertRequired":false,"billingCode":"65272","codeType":"CPT"},{"id":4107,"precertRequired":false,"billingCode":"65273","codeType":"CPT"},{"id":4108,"precertRequired":false,"billingCode":"65275","codeType":"CPT"},{"id":4109,"precertRequired":false,"billingCode":"65280","codeType":"CPT"},{"id":4110,"precertRequired":false,"billingCode":"65285","codeType":"CPT"},{"id":4111,"precertRequired":false,"billingCode":"65286","codeType":"CPT"},{"id":4112,"precertRequired":false,"billingCode":"65290","codeType":"CPT"},{"id":4113,"precertRequired":false,"billingCode":"65400","codeType":"CPT"},{"id":4114,"precertRequired":false,"billingCode":"65410","codeType":"CPT"},{"id":4115,"precertRequired":false,"billingCode":"65420","codeType":"CPT"},{"id":4116,"precertRequired":false,"billingCode":"65426","codeType":"CPT"},{"id":4117,"precertRequired":false,"billingCode":"65430","codeType":"CPT"},{"id":4118,"precertRequired":false,"billingCode":"65435","codeType":"CPT"},{"id":4119,"precertRequired":false,"billingCode":"65436","codeType":"CPT"},{"id":4120,"precertRequired":false,"billingCode":"65450","codeType":"CPT"},{"id":4121,"precertRequired":false,"billingCode":"65600","codeType":"CPT"},{"id":4122,"precertRequired":false,"billingCode":"65710","codeType":"CPT"},{"id":4123,"precertRequired":false,"billingCode":"65730","codeType":"CPT"},{"id":4124,"precertRequired":false,"billingCode":"65750","codeType":"CPT"},{"id":4125,"precertRequired":false,"billingCode":"65755","codeType":"CPT"},{"id":4126,"precertRequired":false,"billingCode":"65756","codeType":"CPT"},{"id":4127,"precertRequired":false,"billingCode":"65757","codeType":"CPT"},{"id":4128,"precertRequired":false,"billingCode":"65760","codeType":"CPT"},{"id":4129,"precertRequired":false,"billingCode":"65765","codeType":"CPT"},{"id":4130,"precertRequired":false,"billingCode":"65767","codeType":"CPT"},{"id":4131,"precertRequired":false,"billingCode":"65770","codeType":"CPT"},{"id":4132,"precertRequired":false,"billingCode":"65771","codeType":"CPT"},{"id":4133,"precertRequired":false,"billingCode":"65772","codeType":"CPT"},{"id":4134,"precertRequired":false,"billingCode":"65775","codeType":"CPT"},{"id":4135,"precertRequired":false,"billingCode":"65778","codeType":"CPT"},{"id":4136,"precertRequired":false,"billingCode":"65779","codeType":"CPT"},{"id":4137,"precertRequired":false,"billingCode":"65780","codeType":"CPT"},{"id":4138,"precertRequired":false,"billingCode":"65781","codeType":"CPT"},{"id":4139,"precertRequired":false,"billingCode":"65782","codeType":"CPT"},{"id":4141,"precertRequired":false,"billingCode":"65800","codeType":"CPT"},{"id":4142,"precertRequired":false,"billingCode":"65810","codeType":"CPT"},{"id":4143,"precertRequired":false,"billingCode":"65815","codeType":"CPT"},{"id":4144,"precertRequired":false,"billingCode":"65820","codeType":"CPT"},{"id":4145,"precertRequired":false,"billingCode":"65850","codeType":"CPT"},{"id":4146,"precertRequired":false,"billingCode":"65855","codeType":"CPT"},{"id":4147,"precertRequired":false,"billingCode":"65860","codeType":"CPT"},{"id":4148,"precertRequired":false,"billingCode":"65865","codeType":"CPT"},{"id":4149,"precertRequired":false,"billingCode":"65870","codeType":"CPT"},{"id":4150,"precertRequired":false,"billingCode":"65875","codeType":"CPT"},{"id":4151,"precertRequired":false,"billingCode":"65880","codeType":"CPT"},{"id":4152,"precertRequired":false,"billingCode":"65900","codeType":"CPT"},{"id":4153,"precertRequired":false,"billingCode":"65920","codeType":"CPT"},{"id":4154,"precertRequired":false,"billingCode":"65930","codeType":"CPT"},{"id":4155,"precertRequired":false,"billingCode":"66020","codeType":"CPT"},{"id":4157,"precertRequired":false,"billingCode":"66130","codeType":"CPT"},{"id":4158,"precertRequired":false,"billingCode":"66150","codeType":"CPT"},{"id":4159,"precertRequired":false,"billingCode":"66155","codeType":"CPT"},{"id":4160,"precertRequired":false,"billingCode":"66160","codeType":"CPT"},{"id":4161,"precertRequired":false,"billingCode":"66170","codeType":"CPT"},{"id":4162,"precertRequired":false,"billingCode":"66172","codeType":"CPT"},{"id":4163,"precertRequired":false,"billingCode":"66174","codeType":"CPT"},{"id":4164,"precertRequired":false,"billingCode":"66179","codeType":"CPT"},{"id":4165,"precertRequired":false,"billingCode":"66180","codeType":"CPT"},{"id":4166,"precertRequired":false,"billingCode":"66183","codeType":"CPT"},{"id":4167,"precertRequired":false,"billingCode":"66184","codeType":"CPT"},{"id":4168,"precertRequired":false,"billingCode":"66185","codeType":"CPT"},{"id":4170,"precertRequired":false,"billingCode":"66225","codeType":"CPT"},{"id":4171,"precertRequired":false,"billingCode":"66250","codeType":"CPT"},{"id":4172,"precertRequired":false,"billingCode":"66500","codeType":"CPT"},{"id":4174,"precertRequired":false,"billingCode":"66600","codeType":"CPT"},{"id":4175,"precertRequired":false,"billingCode":"66605","codeType":"CPT"},{"id":4176,"precertRequired":false,"billingCode":"66625","codeType":"CPT"},{"id":4177,"precertRequired":false,"billingCode":"66630","codeType":"CPT"},{"id":4178,"precertRequired":false,"billingCode":"66635","codeType":"CPT"},{"id":4179,"precertRequired":false,"billingCode":"66680","codeType":"CPT"},{"id":4180,"precertRequired":false,"billingCode":"66682","codeType":"CPT"},{"id":4181,"precertRequired":false,"billingCode":"66700","codeType":"CPT"},{"id":4182,"precertRequired":false,"billingCode":"66710","codeType":"CPT"},{"id":4183,"precertRequired":false,"billingCode":"66711","codeType":"CPT"},{"id":4184,"precertRequired":false,"billingCode":"66720","codeType":"CPT"},{"id":4185,"precertRequired":false,"billingCode":"66740","codeType":"CPT"},{"id":4186,"precertRequired":false,"billingCode":"66761","codeType":"CPT"},{"id":4187,"precertRequired":false,"billingCode":"66762","codeType":"CPT"},{"id":4188,"precertRequired":false,"billingCode":"66770","codeType":"CPT"},{"id":4189,"precertRequired":false,"billingCode":"66820","codeType":"CPT"},{"id":4190,"precertRequired":false,"billingCode":"66821","codeType":"CPT"},{"id":4191,"precertRequired":false,"billingCode":"66825","codeType":"CPT"},{"id":4192,"precertRequired":false,"billingCode":"66830","codeType":"CPT"},{"id":4193,"precertRequired":false,"billingCode":"66840","codeType":"CPT"},{"id":4194,"precertRequired":false,"billingCode":"66850","codeType":"CPT"},{"id":4195,"precertRequired":false,"billingCode":"66852","codeType":"CPT"},{"id":4196,"precertRequired":false,"billingCode":"66920","codeType":"CPT"},{"id":4197,"precertRequired":false,"billingCode":"66930","codeType":"CPT"},{"id":4198,"precertRequired":false,"billingCode":"66940","codeType":"CPT"},{"id":4200,"precertRequired":false,"billingCode":"66983","codeType":"CPT"},{"id":4201,"precertRequired":false,"billingCode":"66984","codeType":"CPT"},{"id":4202,"precertRequired":false,"billingCode":"66985","codeType":"CPT"},{"id":4203,"precertRequired":false,"billingCode":"66986","codeType":"CPT"},{"id":4204,"precertRequired":false,"billingCode":"66990","codeType":"CPT"},{"id":4205,"precertRequired":false,"billingCode":"67005","codeType":"CPT"},{"id":4206,"precertRequired":false,"billingCode":"67010","codeType":"CPT"},{"id":4207,"precertRequired":false,"billingCode":"67015","codeType":"CPT"},{"id":4208,"precertRequired":false,"billingCode":"67025","codeType":"CPT"},{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":4211,"precertRequired":false,"billingCode":"67030","codeType":"CPT"},{"id":4212,"precertRequired":false,"billingCode":"67031","codeType":"CPT"},{"id":4213,"precertRequired":false,"billingCode":"67036","codeType":"CPT"},{"id":4214,"precertRequired":false,"billingCode":"67039","codeType":"CPT"},{"id":4215,"precertRequired":false,"billingCode":"67040","codeType":"CPT"},{"id":4216,"precertRequired":false,"billingCode":"67041","codeType":"CPT"},{"id":4217,"precertRequired":false,"billingCode":"67042","codeType":"CPT"},{"id":4218,"precertRequired":false,"billingCode":"67043","codeType":"CPT"},{"id":4220,"precertRequired":false,"billingCode":"67101","codeType":"CPT"},{"id":4221,"precertRequired":false,"billingCode":"67105","codeType":"CPT"},{"id":4222,"precertRequired":false,"billingCode":"67107","codeType":"CPT"},{"id":4223,"precertRequired":false,"billingCode":"67108","codeType":"CPT"},{"id":4224,"precertRequired":false,"billingCode":"67110","codeType":"CPT"},{"id":4225,"precertRequired":false,"billingCode":"67113","codeType":"CPT"},{"id":4226,"precertRequired":false,"billingCode":"67115","codeType":"CPT"},{"id":4227,"precertRequired":false,"billingCode":"67120","codeType":"CPT"},{"id":4228,"precertRequired":false,"billingCode":"67121","codeType":"CPT"},{"id":4229,"precertRequired":false,"billingCode":"67141","codeType":"CPT"},{"id":4230,"precertRequired":false,"billingCode":"67145","codeType":"CPT"},{"id":4231,"precertRequired":false,"billingCode":"67208","codeType":"CPT"},{"id":4232,"precertRequired":false,"billingCode":"67210","codeType":"CPT"},{"id":4233,"precertRequired":false,"billingCode":"67218","codeType":"CPT"},{"id":4234,"precertRequired":false,"billingCode":"67220","codeType":"CPT"},{"id":4235,"precertRequired":false,"billingCode":"67221","codeType":"CPT"},{"id":4236,"precertRequired":false,"billingCode":"67225","codeType":"CPT"},{"id":4237,"precertRequired":false,"billingCode":"67227","codeType":"CPT"},{"id":4238,"precertRequired":false,"billingCode":"67228","codeType":"CPT"},{"id":4239,"precertRequired":false,"billingCode":"67250","codeType":"CPT"},{"id":4240,"precertRequired":false,"billingCode":"67255","codeType":"CPT"},{"id":4241,"precertRequired":false,"billingCode":"67299","codeType":"CPT"},{"id":4242,"precertRequired":false,"billingCode":"67311","codeType":"CPT"},{"id":4243,"precertRequired":false,"billingCode":"67312","codeType":"CPT"},{"id":4244,"precertRequired":false,"billingCode":"67314","codeType":"CPT"},{"id":4245,"precertRequired":false,"billingCode":"67316","codeType":"CPT"},{"id":4246,"precertRequired":false,"billingCode":"67318","codeType":"CPT"},{"id":4247,"precertRequired":false,"billingCode":"67320","codeType":"CPT"},{"id":4248,"precertRequired":false,"billingCode":"67331","codeType":"CPT"},{"id":4249,"precertRequired":false,"billingCode":"67332","codeType":"CPT"},{"id":4250,"precertRequired":false,"billingCode":"67334","codeType":"CPT"},{"id":4251,"precertRequired":false,"billingCode":"67335","codeType":"CPT"},{"id":4252,"precertRequired":false,"billingCode":"67340","codeType":"CPT"},{"id":4253,"precertRequired":false,"billingCode":"67343","codeType":"CPT"},{"id":4254,"precertRequired":false,"billingCode":"67345","codeType":"CPT"},{"id":4255,"precertRequired":false,"billingCode":"67346","codeType":"CPT"},{"id":4256,"precertRequired":false,"billingCode":"67399","codeType":"CPT"},{"id":4257,"precertRequired":false,"billingCode":"67400","codeType":"CPT"},{"id":4258,"precertRequired":false,"billingCode":"67405","codeType":"CPT"},{"id":4259,"precertRequired":false,"billingCode":"67412","codeType":"CPT"},{"id":4260,"precertRequired":false,"billingCode":"67413","codeType":"CPT"},{"id":4261,"precertRequired":false,"billingCode":"67414","codeType":"CPT"},{"id":4262,"precertRequired":false,"billingCode":"67415","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4268,"precertRequired":false,"billingCode":"67500","codeType":"CPT"},{"id":4269,"precertRequired":false,"billingCode":"67505","codeType":"CPT"},{"id":4270,"precertRequired":false,"billingCode":"67515","codeType":"CPT"},{"id":4271,"precertRequired":false,"billingCode":"67550","codeType":"CPT"},{"id":4272,"precertRequired":false,"billingCode":"67560","codeType":"CPT"},{"id":4273,"precertRequired":false,"billingCode":"67570","codeType":"CPT"},{"id":4274,"precertRequired":false,"billingCode":"67599","codeType":"CPT"},{"id":4275,"precertRequired":false,"billingCode":"67700","codeType":"CPT"},{"id":4276,"precertRequired":false,"billingCode":"67710","codeType":"CPT"},{"id":4277,"precertRequired":false,"billingCode":"67715","codeType":"CPT"},{"id":4278,"precertRequired":false,"billingCode":"67800","codeType":"CPT"},{"id":4279,"precertRequired":false,"billingCode":"67801","codeType":"CPT"},{"id":4280,"precertRequired":false,"billingCode":"67805","codeType":"CPT"},{"id":4281,"precertRequired":false,"billingCode":"67808","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4284,"precertRequired":false,"billingCode":"67825","codeType":"CPT"},{"id":4285,"precertRequired":false,"billingCode":"67830","codeType":"CPT"},{"id":4286,"precertRequired":false,"billingCode":"67835","codeType":"CPT"},{"id":4287,"precertRequired":false,"billingCode":"67840","codeType":"CPT"},{"id":4288,"precertRequired":false,"billingCode":"67850","codeType":"CPT"},{"id":4289,"precertRequired":false,"billingCode":"67875","codeType":"CPT"},{"id":4290,"precertRequired":false,"billingCode":"67880","codeType":"CPT"},{"id":4291,"precertRequired":false,"billingCode":"67882","codeType":"CPT"},{"id":4292,"precertRequired":false,"billingCode":"67900","codeType":"CPT"},{"id":4293,"precertRequired":false,"billingCode":"67901","codeType":"CPT"},{"id":4294,"precertRequired":false,"billingCode":"67902","codeType":"CPT"},{"id":4295,"precertRequired":false,"billingCode":"67903","codeType":"CPT"},{"id":4296,"precertRequired":false,"billingCode":"67904","codeType":"CPT"},{"id":4297,"precertRequired":false,"billingCode":"67906","codeType":"CPT"},{"id":4298,"precertRequired":false,"billingCode":"67908","codeType":"CPT"},{"id":4299,"precertRequired":false,"billingCode":"67909","codeType":"CPT"},{"id":4300,"precertRequired":false,"billingCode":"67911","codeType":"CPT"},{"id":4301,"precertRequired":false,"billingCode":"67912","codeType":"CPT"},{"id":4302,"precertRequired":false,"billingCode":"67916","codeType":"CPT"},{"id":4303,"precertRequired":false,"billingCode":"67917","codeType":"CPT"},{"id":4304,"precertRequired":false,"billingCode":"67921","codeType":"CPT"},{"id":4305,"precertRequired":false,"billingCode":"67922","codeType":"CPT"},{"id":4306,"precertRequired":false,"billingCode":"67923","codeType":"CPT"},{"id":4307,"precertRequired":false,"billingCode":"67924","codeType":"CPT"},{"id":4308,"precertRequired":false,"billingCode":"67930","codeType":"CPT"},{"id":4309,"precertRequired":false,"billingCode":"67935","codeType":"CPT"},{"id":4310,"precertRequired":false,"billingCode":"67950","codeType":"CPT"},{"id":4311,"precertRequired":false,"billingCode":"67961","codeType":"CPT"},{"id":4312,"precertRequired":false,"billingCode":"67966","codeType":"CPT"},{"id":4313,"precertRequired":false,"billingCode":"67971","codeType":"CPT"},{"id":4314,"precertRequired":false,"billingCode":"67973","codeType":"CPT"},{"id":4315,"precertRequired":false,"billingCode":"67974","codeType":"CPT"},{"id":4316,"precertRequired":false,"billingCode":"67975","codeType":"CPT"},{"id":4317,"precertRequired":false,"billingCode":"67999","codeType":"CPT"},{"id":4318,"precertRequired":false,"billingCode":"68020","codeType":"CPT"},{"id":4319,"precertRequired":false,"billingCode":"68040","codeType":"CPT"},{"id":4321,"precertRequired":false,"billingCode":"68110","codeType":"CPT"},{"id":4322,"precertRequired":false,"billingCode":"68115","codeType":"CPT"},{"id":4323,"precertRequired":false,"billingCode":"68130","codeType":"CPT"},{"id":4324,"precertRequired":false,"billingCode":"68135","codeType":"CPT"},{"id":4325,"precertRequired":false,"billingCode":"68200","codeType":"CPT"},{"id":4326,"precertRequired":false,"billingCode":"68320","codeType":"CPT"},{"id":4327,"precertRequired":false,"billingCode":"68325","codeType":"CPT"},{"id":4328,"precertRequired":false,"billingCode":"68326","codeType":"CPT"},{"id":4329,"precertRequired":false,"billingCode":"68328","codeType":"CPT"},{"id":4330,"precertRequired":false,"billingCode":"68330","codeType":"CPT"},{"id":4331,"precertRequired":false,"billingCode":"68335","codeType":"CPT"},{"id":4332,"precertRequired":false,"billingCode":"68340","codeType":"CPT"},{"id":4333,"precertRequired":false,"billingCode":"68360","codeType":"CPT"},{"id":4334,"precertRequired":false,"billingCode":"68362","codeType":"CPT"},{"id":4335,"precertRequired":false,"billingCode":"68371","codeType":"CPT"},{"id":4336,"precertRequired":false,"billingCode":"68399","codeType":"CPT"},{"id":4337,"precertRequired":false,"billingCode":"68400","codeType":"CPT"},{"id":4338,"precertRequired":false,"billingCode":"68420","codeType":"CPT"},{"id":4339,"precertRequired":false,"billingCode":"68440","codeType":"CPT"},{"id":4340,"precertRequired":false,"billingCode":"68500","codeType":"CPT"},{"id":4341,"precertRequired":false,"billingCode":"68505","codeType":"CPT"},{"id":4342,"precertRequired":false,"billingCode":"68510","codeType":"CPT"},{"id":4343,"precertRequired":false,"billingCode":"68550","codeType":"CPT"},{"id":4344,"precertRequired":false,"billingCode":"68720","codeType":"CPT"},{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6651,"precertRequired":false,"billingCode":"92071","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6688,"precertRequired":false,"billingCode":"92325","codeType":"CPT"},{"id":6689,"precertRequired":false,"billingCode":"92326","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6697,"precertRequired":false,"billingCode":"92358","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"},{"id":6700,"precertRequired":false,"billingCode":"92499","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7338,"precertRequired":false,"billingCode":"99172","codeType":"CPT"},{"id":7339,"precertRequired":false,"billingCode":"99173","codeType":"CPT"},{"id":7340,"precertRequired":false,"billingCode":"99174","codeType":"CPT"},{"id":7341,"precertRequired":false,"billingCode":"99177","codeType":"CPT"},{"id":7846,"precertRequired":false,"billingCode":"A6410","codeType":"HCPCS"},{"id":7848,"precertRequired":false,"billingCode":"A6412","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8156,"precertRequired":false,"billingCode":"G0186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2758,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":9,"precertRequired":false,"billingCode":"00142","codeType":"CPT"},{"id":11,"precertRequired":false,"billingCode":"00145","codeType":"CPT"},{"id":12,"precertRequired":false,"billingCode":"00147","codeType":"CPT"},{"id":13,"precertRequired":false,"billingCode":"00148","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":2759,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2760,"description":"Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2761,"description":"Intravitreal anti-VEGF injections according to VA protocol (see Procedural Overview no.7 for specific information about VA protocol)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2762,"description":"Inpatient or observation admission for surgical procedure, if medically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2763,"description":"Inpatient admission or observation status for complications related to the procedure Note: ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":2764,"description":"Follow-up visits for this episode of care a.Follow-up images/studies/laboratories as indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]}]}},{"Seoc":{"id":280,"seocKey":53,"name":"Eye Care Comprehensive 6 months_PRCT","seocId":"SSC_EYE CARE COMPREHENSIVE 6 MONTHS_1.1.2_PRCT","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below as clinically necessary. These services can be provided by an Optometrist or Ophthalmologist.","effectiveDate":"01-03-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic images/laboratories/studies relevant to the referred condition\r\n3. Procedures and pathology services relevant to the referred condition\r\n4. Anesthesia consultation related to the procedure\r\n5. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n6. Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website\r\n7. Intravitreal anti-VEGF injections according to VA protocol (see below)             \r\na. VA Protocol: The following initial treatment is recommended and approved - A series of 3 monthly bevacizumab injections per eye with re-evaluation. At the end of the series if there is measurable improvement, patient will continue on this treatment for up to 8 total injections per eye for this episode of care. If patient shows no measurable improvement to the initial series of injections, additional request for services is needed with accompanying medical justification must be submitted to request other medications or procedures to treat the condition indicated on the consult, including ranibizumab, aflibercept, intraocular steroid implants, laser, or vitrectomy\r\n8. Inpatient or observation admission for surgical procedure, if medically necessary\r\n9. Inpatient admission or observation status for complications related to the procedure     \r\nNote: ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery\r\n10. Follow-up visits for this episode of care     \r\na.    Follow-up images/studies/laboratories as indicated","maxAllowableVisits":null,"disclaimer":"* Additional consultations related to the referred condition require VA review and approval.\r\n* Community Provider must follow VA Protocol and non-formulary medication approval process for intravitreal anti-VEGF injections as well as intraocular steroid injections and steroid implants\r\n*VA authorization excludes coverage of premium IOLs (toric, multifocal, accommodating), and refractive and cosmetic surgery that does not correct a functional disability\r\n* VA (and Veterans) will not pay extra for laser assisted cataract surgery with conventional intraocular lens implant in accordance with Medicare policy and CMS rulings. \r\n* Durable Medical Equipment [DME], prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"OPHTHALMOLOGY","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"207W00000X"}],"services":[{"id":1175,"description":"Initial outpatient evaluation and treatment for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1176,"description":"Diagnostic images/laboratories/studies relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4716,"precertRequired":false,"billingCode":"76514","codeType":"CPT"},{"id":4717,"precertRequired":false,"billingCode":"76516","codeType":"CPT"},{"id":4718,"precertRequired":false,"billingCode":"76519","codeType":"CPT"},{"id":4719,"precertRequired":false,"billingCode":"76529","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6656,"precertRequired":false,"billingCode":"92100","codeType":"CPT"},{"id":6657,"precertRequired":false,"billingCode":"92132","codeType":"CPT"},{"id":6658,"precertRequired":false,"billingCode":"92133","codeType":"CPT"},{"id":6659,"precertRequired":false,"billingCode":"92134","codeType":"CPT"},{"id":6660,"precertRequired":false,"billingCode":"92136","codeType":"CPT"},{"id":6661,"precertRequired":false,"billingCode":"92145","codeType":"CPT"},{"id":6662,"precertRequired":false,"billingCode":"92225","codeType":"CPT"},{"id":6663,"precertRequired":false,"billingCode":"92226","codeType":"CPT"},{"id":6664,"precertRequired":false,"billingCode":"92227","codeType":"CPT"},{"id":6665,"precertRequired":false,"billingCode":"92228","codeType":"CPT"},{"id":6666,"precertRequired":false,"billingCode":"92230","codeType":"CPT"},{"id":6667,"precertRequired":false,"billingCode":"92235","codeType":"CPT"},{"id":6668,"precertRequired":false,"billingCode":"92240","codeType":"CPT"},{"id":6669,"precertRequired":false,"billingCode":"92242","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":6671,"precertRequired":false,"billingCode":"92260","codeType":"CPT"},{"id":6672,"precertRequired":false,"billingCode":"92265","codeType":"CPT"},{"id":6673,"precertRequired":false,"billingCode":"92270","codeType":"CPT"},{"id":6674,"precertRequired":false,"billingCode":"92275","codeType":"CPT"},{"id":6675,"precertRequired":false,"billingCode":"92283","codeType":"CPT"},{"id":6676,"precertRequired":false,"billingCode":"92284","codeType":"CPT"},{"id":6677,"precertRequired":false,"billingCode":"92285","codeType":"CPT"},{"id":6678,"precertRequired":false,"billingCode":"92286","codeType":"CPT"},{"id":7536,"precertRequired":false,"billingCode":"0329T","codeType":"CPT"},{"id":7537,"precertRequired":false,"billingCode":"0330T","codeType":"CPT"},{"id":7554,"precertRequired":false,"billingCode":"0378T","codeType":"CPT"},{"id":7555,"precertRequired":false,"billingCode":"0379T","codeType":"CPT"},{"id":7556,"precertRequired":false,"billingCode":"0380T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1177,"description":"Procedures and pathology services relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4084,"precertRequired":false,"billingCode":"65091","codeType":"CPT"},{"id":4085,"precertRequired":false,"billingCode":"65093","codeType":"CPT"},{"id":4086,"precertRequired":false,"billingCode":"65101","codeType":"CPT"},{"id":4087,"precertRequired":false,"billingCode":"65103","codeType":"CPT"},{"id":4088,"precertRequired":false,"billingCode":"65105","codeType":"CPT"},{"id":4089,"precertRequired":false,"billingCode":"65110","codeType":"CPT"},{"id":4090,"precertRequired":false,"billingCode":"65112","codeType":"CPT"},{"id":4091,"precertRequired":false,"billingCode":"65114","codeType":"CPT"},{"id":4092,"precertRequired":false,"billingCode":"65130","codeType":"CPT"},{"id":4093,"precertRequired":false,"billingCode":"65135","codeType":"CPT"},{"id":4094,"precertRequired":false,"billingCode":"65140","codeType":"CPT"},{"id":4095,"precertRequired":false,"billingCode":"65150","codeType":"CPT"},{"id":4096,"precertRequired":false,"billingCode":"65155","codeType":"CPT"},{"id":4097,"precertRequired":false,"billingCode":"65175","codeType":"CPT"},{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4099,"precertRequired":false,"billingCode":"65210","codeType":"CPT"},{"id":4100,"precertRequired":false,"billingCode":"65220","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4102,"precertRequired":false,"billingCode":"65225","codeType":"CPT"},{"id":4104,"precertRequired":false,"billingCode":"65260","codeType":"CPT"},{"id":4105,"precertRequired":false,"billingCode":"65270","codeType":"CPT"},{"id":4106,"precertRequired":false,"billingCode":"65272","codeType":"CPT"},{"id":4107,"precertRequired":false,"billingCode":"65273","codeType":"CPT"},{"id":4108,"precertRequired":false,"billingCode":"65275","codeType":"CPT"},{"id":4109,"precertRequired":false,"billingCode":"65280","codeType":"CPT"},{"id":4110,"precertRequired":false,"billingCode":"65285","codeType":"CPT"},{"id":4111,"precertRequired":false,"billingCode":"65286","codeType":"CPT"},{"id":4112,"precertRequired":false,"billingCode":"65290","codeType":"CPT"},{"id":4113,"precertRequired":false,"billingCode":"65400","codeType":"CPT"},{"id":4114,"precertRequired":false,"billingCode":"65410","codeType":"CPT"},{"id":4115,"precertRequired":false,"billingCode":"65420","codeType":"CPT"},{"id":4116,"precertRequired":false,"billingCode":"65426","codeType":"CPT"},{"id":4117,"precertRequired":false,"billingCode":"65430","codeType":"CPT"},{"id":4118,"precertRequired":false,"billingCode":"65435","codeType":"CPT"},{"id":4119,"precertRequired":false,"billingCode":"65436","codeType":"CPT"},{"id":4120,"precertRequired":false,"billingCode":"65450","codeType":"CPT"},{"id":4121,"precertRequired":false,"billingCode":"65600","codeType":"CPT"},{"id":4122,"precertRequired":false,"billingCode":"65710","codeType":"CPT"},{"id":4123,"precertRequired":false,"billingCode":"65730","codeType":"CPT"},{"id":4124,"precertRequired":false,"billingCode":"65750","codeType":"CPT"},{"id":4125,"precertRequired":false,"billingCode":"65755","codeType":"CPT"},{"id":4126,"precertRequired":false,"billingCode":"65756","codeType":"CPT"},{"id":4127,"precertRequired":false,"billingCode":"65757","codeType":"CPT"},{"id":4128,"precertRequired":false,"billingCode":"65760","codeType":"CPT"},{"id":4129,"precertRequired":false,"billingCode":"65765","codeType":"CPT"},{"id":4130,"precertRequired":false,"billingCode":"65767","codeType":"CPT"},{"id":4131,"precertRequired":false,"billingCode":"65770","codeType":"CPT"},{"id":4132,"precertRequired":false,"billingCode":"65771","codeType":"CPT"},{"id":4133,"precertRequired":false,"billingCode":"65772","codeType":"CPT"},{"id":4134,"precertRequired":false,"billingCode":"65775","codeType":"CPT"},{"id":4135,"precertRequired":false,"billingCode":"65778","codeType":"CPT"},{"id":4136,"precertRequired":false,"billingCode":"65779","codeType":"CPT"},{"id":4137,"precertRequired":false,"billingCode":"65780","codeType":"CPT"},{"id":4138,"precertRequired":false,"billingCode":"65781","codeType":"CPT"},{"id":4139,"precertRequired":false,"billingCode":"65782","codeType":"CPT"},{"id":4140,"precertRequired":false,"billingCode":"65783","codeType":"CPT"},{"id":4141,"precertRequired":false,"billingCode":"65800","codeType":"CPT"},{"id":4142,"precertRequired":false,"billingCode":"65810","codeType":"CPT"},{"id":4143,"precertRequired":false,"billingCode":"65815","codeType":"CPT"},{"id":4144,"precertRequired":false,"billingCode":"65820","codeType":"CPT"},{"id":4145,"precertRequired":false,"billingCode":"65850","codeType":"CPT"},{"id":4146,"precertRequired":false,"billingCode":"65855","codeType":"CPT"},{"id":4147,"precertRequired":false,"billingCode":"65860","codeType":"CPT"},{"id":4148,"precertRequired":false,"billingCode":"65865","codeType":"CPT"},{"id":4149,"precertRequired":false,"billingCode":"65870","codeType":"CPT"},{"id":4150,"precertRequired":false,"billingCode":"65875","codeType":"CPT"},{"id":4151,"precertRequired":false,"billingCode":"65880","codeType":"CPT"},{"id":4152,"precertRequired":false,"billingCode":"65900","codeType":"CPT"},{"id":4153,"precertRequired":false,"billingCode":"65920","codeType":"CPT"},{"id":4154,"precertRequired":false,"billingCode":"65930","codeType":"CPT"},{"id":4155,"precertRequired":false,"billingCode":"66020","codeType":"CPT"},{"id":4157,"precertRequired":false,"billingCode":"66130","codeType":"CPT"},{"id":4158,"precertRequired":false,"billingCode":"66150","codeType":"CPT"},{"id":4159,"precertRequired":false,"billingCode":"66155","codeType":"CPT"},{"id":4160,"precertRequired":false,"billingCode":"66160","codeType":"CPT"},{"id":4161,"precertRequired":false,"billingCode":"66170","codeType":"CPT"},{"id":4162,"precertRequired":false,"billingCode":"66172","codeType":"CPT"},{"id":4163,"precertRequired":false,"billingCode":"66174","codeType":"CPT"},{"id":4164,"precertRequired":false,"billingCode":"66179","codeType":"CPT"},{"id":4165,"precertRequired":false,"billingCode":"66180","codeType":"CPT"},{"id":4166,"precertRequired":false,"billingCode":"66183","codeType":"CPT"},{"id":4167,"precertRequired":false,"billingCode":"66184","codeType":"CPT"},{"id":4168,"precertRequired":false,"billingCode":"66185","codeType":"CPT"},{"id":4169,"precertRequired":false,"billingCode":"66220","codeType":"CPT"},{"id":4170,"precertRequired":false,"billingCode":"66225","codeType":"CPT"},{"id":4171,"precertRequired":false,"billingCode":"66250","codeType":"CPT"},{"id":4172,"precertRequired":false,"billingCode":"66500","codeType":"CPT"},{"id":4174,"precertRequired":false,"billingCode":"66600","codeType":"CPT"},{"id":4175,"precertRequired":false,"billingCode":"66605","codeType":"CPT"},{"id":4176,"precertRequired":false,"billingCode":"66625","codeType":"CPT"},{"id":4177,"precertRequired":false,"billingCode":"66630","codeType":"CPT"},{"id":4178,"precertRequired":false,"billingCode":"66635","codeType":"CPT"},{"id":4179,"precertRequired":false,"billingCode":"66680","codeType":"CPT"},{"id":4180,"precertRequired":false,"billingCode":"66682","codeType":"CPT"},{"id":4181,"precertRequired":false,"billingCode":"66700","codeType":"CPT"},{"id":4182,"precertRequired":false,"billingCode":"66710","codeType":"CPT"},{"id":4183,"precertRequired":false,"billingCode":"66711","codeType":"CPT"},{"id":4184,"precertRequired":false,"billingCode":"66720","codeType":"CPT"},{"id":4185,"precertRequired":false,"billingCode":"66740","codeType":"CPT"},{"id":4186,"precertRequired":false,"billingCode":"66761","codeType":"CPT"},{"id":4187,"precertRequired":false,"billingCode":"66762","codeType":"CPT"},{"id":4188,"precertRequired":false,"billingCode":"66770","codeType":"CPT"},{"id":4189,"precertRequired":false,"billingCode":"66820","codeType":"CPT"},{"id":4190,"precertRequired":false,"billingCode":"66821","codeType":"CPT"},{"id":4191,"precertRequired":false,"billingCode":"66825","codeType":"CPT"},{"id":4192,"precertRequired":false,"billingCode":"66830","codeType":"CPT"},{"id":4193,"precertRequired":false,"billingCode":"66840","codeType":"CPT"},{"id":4194,"precertRequired":false,"billingCode":"66850","codeType":"CPT"},{"id":4195,"precertRequired":false,"billingCode":"66852","codeType":"CPT"},{"id":4196,"precertRequired":false,"billingCode":"66920","codeType":"CPT"},{"id":4197,"precertRequired":false,"billingCode":"66930","codeType":"CPT"},{"id":4198,"precertRequired":false,"billingCode":"66940","codeType":"CPT"},{"id":4200,"precertRequired":false,"billingCode":"66983","codeType":"CPT"},{"id":4201,"precertRequired":false,"billingCode":"66984","codeType":"CPT"},{"id":4202,"precertRequired":false,"billingCode":"66985","codeType":"CPT"},{"id":4203,"precertRequired":false,"billingCode":"66986","codeType":"CPT"},{"id":4204,"precertRequired":false,"billingCode":"66990","codeType":"CPT"},{"id":4205,"precertRequired":false,"billingCode":"67005","codeType":"CPT"},{"id":4206,"precertRequired":false,"billingCode":"67010","codeType":"CPT"},{"id":4207,"precertRequired":false,"billingCode":"67015","codeType":"CPT"},{"id":4208,"precertRequired":false,"billingCode":"67025","codeType":"CPT"},{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":4211,"precertRequired":false,"billingCode":"67030","codeType":"CPT"},{"id":4212,"precertRequired":false,"billingCode":"67031","codeType":"CPT"},{"id":4213,"precertRequired":false,"billingCode":"67036","codeType":"CPT"},{"id":4214,"precertRequired":false,"billingCode":"67039","codeType":"CPT"},{"id":4215,"precertRequired":false,"billingCode":"67040","codeType":"CPT"},{"id":4216,"precertRequired":false,"billingCode":"67041","codeType":"CPT"},{"id":4217,"precertRequired":false,"billingCode":"67042","codeType":"CPT"},{"id":4218,"precertRequired":false,"billingCode":"67043","codeType":"CPT"},{"id":4219,"precertRequired":false,"billingCode":"67075","codeType":"CPT"},{"id":4220,"precertRequired":false,"billingCode":"67101","codeType":"CPT"},{"id":4221,"precertRequired":false,"billingCode":"67105","codeType":"CPT"},{"id":4222,"precertRequired":false,"billingCode":"67107","codeType":"CPT"},{"id":4223,"precertRequired":false,"billingCode":"67108","codeType":"CPT"},{"id":4224,"precertRequired":false,"billingCode":"67110","codeType":"CPT"},{"id":4225,"precertRequired":false,"billingCode":"67113","codeType":"CPT"},{"id":4226,"precertRequired":false,"billingCode":"67115","codeType":"CPT"},{"id":4227,"precertRequired":false,"billingCode":"67120","codeType":"CPT"},{"id":4228,"precertRequired":false,"billingCode":"67121","codeType":"CPT"},{"id":4229,"precertRequired":false,"billingCode":"67141","codeType":"CPT"},{"id":4230,"precertRequired":false,"billingCode":"67145","codeType":"CPT"},{"id":4231,"precertRequired":false,"billingCode":"67208","codeType":"CPT"},{"id":4232,"precertRequired":false,"billingCode":"67210","codeType":"CPT"},{"id":4233,"precertRequired":false,"billingCode":"67218","codeType":"CPT"},{"id":4234,"precertRequired":false,"billingCode":"67220","codeType":"CPT"},{"id":4235,"precertRequired":false,"billingCode":"67221","codeType":"CPT"},{"id":4236,"precertRequired":false,"billingCode":"67225","codeType":"CPT"},{"id":4237,"precertRequired":false,"billingCode":"67227","codeType":"CPT"},{"id":4238,"precertRequired":false,"billingCode":"67228","codeType":"CPT"},{"id":4239,"precertRequired":false,"billingCode":"67250","codeType":"CPT"},{"id":4240,"precertRequired":false,"billingCode":"67255","codeType":"CPT"},{"id":4241,"precertRequired":false,"billingCode":"67299","codeType":"CPT"},{"id":4242,"precertRequired":false,"billingCode":"67311","codeType":"CPT"},{"id":4243,"precertRequired":false,"billingCode":"67312","codeType":"CPT"},{"id":4244,"precertRequired":false,"billingCode":"67314","codeType":"CPT"},{"id":4245,"precertRequired":false,"billingCode":"67316","codeType":"CPT"},{"id":4246,"precertRequired":false,"billingCode":"67318","codeType":"CPT"},{"id":4247,"precertRequired":false,"billingCode":"67320","codeType":"CPT"},{"id":4248,"precertRequired":false,"billingCode":"67331","codeType":"CPT"},{"id":4249,"precertRequired":false,"billingCode":"67332","codeType":"CPT"},{"id":4250,"precertRequired":false,"billingCode":"67334","codeType":"CPT"},{"id":4251,"precertRequired":false,"billingCode":"67335","codeType":"CPT"},{"id":4252,"precertRequired":false,"billingCode":"67340","codeType":"CPT"},{"id":4253,"precertRequired":false,"billingCode":"67343","codeType":"CPT"},{"id":4254,"precertRequired":false,"billingCode":"67345","codeType":"CPT"},{"id":4255,"precertRequired":false,"billingCode":"67346","codeType":"CPT"},{"id":4256,"precertRequired":false,"billingCode":"67399","codeType":"CPT"},{"id":4257,"precertRequired":false,"billingCode":"67400","codeType":"CPT"},{"id":4258,"precertRequired":false,"billingCode":"67405","codeType":"CPT"},{"id":4259,"precertRequired":false,"billingCode":"67412","codeType":"CPT"},{"id":4260,"precertRequired":false,"billingCode":"67413","codeType":"CPT"},{"id":4261,"precertRequired":false,"billingCode":"67414","codeType":"CPT"},{"id":4262,"precertRequired":false,"billingCode":"67415","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4268,"precertRequired":false,"billingCode":"67500","codeType":"CPT"},{"id":4269,"precertRequired":false,"billingCode":"67505","codeType":"CPT"},{"id":4270,"precertRequired":false,"billingCode":"67515","codeType":"CPT"},{"id":4271,"precertRequired":false,"billingCode":"67550","codeType":"CPT"},{"id":4272,"precertRequired":false,"billingCode":"67560","codeType":"CPT"},{"id":4273,"precertRequired":false,"billingCode":"67570","codeType":"CPT"},{"id":4274,"precertRequired":false,"billingCode":"67599","codeType":"CPT"},{"id":4275,"precertRequired":false,"billingCode":"67700","codeType":"CPT"},{"id":4276,"precertRequired":false,"billingCode":"67710","codeType":"CPT"},{"id":4277,"precertRequired":false,"billingCode":"67715","codeType":"CPT"},{"id":4278,"precertRequired":false,"billingCode":"67800","codeType":"CPT"},{"id":4279,"precertRequired":false,"billingCode":"67801","codeType":"CPT"},{"id":4280,"precertRequired":false,"billingCode":"67805","codeType":"CPT"},{"id":4281,"precertRequired":false,"billingCode":"67808","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4284,"precertRequired":false,"billingCode":"67825","codeType":"CPT"},{"id":4285,"precertRequired":false,"billingCode":"67830","codeType":"CPT"},{"id":4286,"precertRequired":false,"billingCode":"67835","codeType":"CPT"},{"id":4287,"precertRequired":false,"billingCode":"67840","codeType":"CPT"},{"id":4288,"precertRequired":false,"billingCode":"67850","codeType":"CPT"},{"id":4289,"precertRequired":false,"billingCode":"67875","codeType":"CPT"},{"id":4290,"precertRequired":false,"billingCode":"67880","codeType":"CPT"},{"id":4291,"precertRequired":false,"billingCode":"67882","codeType":"CPT"},{"id":4292,"precertRequired":false,"billingCode":"67900","codeType":"CPT"},{"id":4293,"precertRequired":false,"billingCode":"67901","codeType":"CPT"},{"id":4294,"precertRequired":false,"billingCode":"67902","codeType":"CPT"},{"id":4295,"precertRequired":false,"billingCode":"67903","codeType":"CPT"},{"id":4296,"precertRequired":false,"billingCode":"67904","codeType":"CPT"},{"id":4297,"precertRequired":false,"billingCode":"67906","codeType":"CPT"},{"id":4298,"precertRequired":false,"billingCode":"67908","codeType":"CPT"},{"id":4299,"precertRequired":false,"billingCode":"67909","codeType":"CPT"},{"id":4300,"precertRequired":false,"billingCode":"67911","codeType":"CPT"},{"id":4301,"precertRequired":false,"billingCode":"67912","codeType":"CPT"},{"id":4302,"precertRequired":false,"billingCode":"67916","codeType":"CPT"},{"id":4303,"precertRequired":false,"billingCode":"67917","codeType":"CPT"},{"id":4304,"precertRequired":false,"billingCode":"67921","codeType":"CPT"},{"id":4305,"precertRequired":false,"billingCode":"67922","codeType":"CPT"},{"id":4306,"precertRequired":false,"billingCode":"67923","codeType":"CPT"},{"id":4307,"precertRequired":false,"billingCode":"67924","codeType":"CPT"},{"id":4308,"precertRequired":false,"billingCode":"67930","codeType":"CPT"},{"id":4309,"precertRequired":false,"billingCode":"67935","codeType":"CPT"},{"id":4310,"precertRequired":false,"billingCode":"67950","codeType":"CPT"},{"id":4311,"precertRequired":false,"billingCode":"67961","codeType":"CPT"},{"id":4312,"precertRequired":false,"billingCode":"67966","codeType":"CPT"},{"id":4313,"precertRequired":false,"billingCode":"67971","codeType":"CPT"},{"id":4314,"precertRequired":false,"billingCode":"67973","codeType":"CPT"},{"id":4315,"precertRequired":false,"billingCode":"67974","codeType":"CPT"},{"id":4316,"precertRequired":false,"billingCode":"67975","codeType":"CPT"},{"id":4317,"precertRequired":false,"billingCode":"67999","codeType":"CPT"},{"id":4318,"precertRequired":false,"billingCode":"68020","codeType":"CPT"},{"id":4319,"precertRequired":false,"billingCode":"68040","codeType":"CPT"},{"id":4321,"precertRequired":false,"billingCode":"68110","codeType":"CPT"},{"id":4322,"precertRequired":false,"billingCode":"68115","codeType":"CPT"},{"id":4323,"precertRequired":false,"billingCode":"68130","codeType":"CPT"},{"id":4324,"precertRequired":false,"billingCode":"68135","codeType":"CPT"},{"id":4325,"precertRequired":false,"billingCode":"68200","codeType":"CPT"},{"id":4326,"precertRequired":false,"billingCode":"68320","codeType":"CPT"},{"id":4327,"precertRequired":false,"billingCode":"68325","codeType":"CPT"},{"id":4328,"precertRequired":false,"billingCode":"68326","codeType":"CPT"},{"id":4329,"precertRequired":false,"billingCode":"68328","codeType":"CPT"},{"id":4330,"precertRequired":false,"billingCode":"68330","codeType":"CPT"},{"id":4331,"precertRequired":false,"billingCode":"68335","codeType":"CPT"},{"id":4332,"precertRequired":false,"billingCode":"68340","codeType":"CPT"},{"id":4333,"precertRequired":false,"billingCode":"68360","codeType":"CPT"},{"id":4334,"precertRequired":false,"billingCode":"68362","codeType":"CPT"},{"id":4335,"precertRequired":false,"billingCode":"68371","codeType":"CPT"},{"id":4336,"precertRequired":false,"billingCode":"68399","codeType":"CPT"},{"id":4337,"precertRequired":false,"billingCode":"68400","codeType":"CPT"},{"id":4338,"precertRequired":false,"billingCode":"68420","codeType":"CPT"},{"id":4339,"precertRequired":false,"billingCode":"68440","codeType":"CPT"},{"id":4340,"precertRequired":false,"billingCode":"68500","codeType":"CPT"},{"id":4341,"precertRequired":false,"billingCode":"68505","codeType":"CPT"},{"id":4342,"precertRequired":false,"billingCode":"68510","codeType":"CPT"},{"id":4343,"precertRequired":false,"billingCode":"68550","codeType":"CPT"},{"id":4344,"precertRequired":false,"billingCode":"68720","codeType":"CPT"},{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6651,"precertRequired":false,"billingCode":"92071","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6688,"precertRequired":false,"billingCode":"92325","codeType":"CPT"},{"id":6689,"precertRequired":false,"billingCode":"92326","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6697,"precertRequired":false,"billingCode":"92358","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"},{"id":6700,"precertRequired":false,"billingCode":"92499","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7338,"precertRequired":false,"billingCode":"99172","codeType":"CPT"},{"id":7339,"precertRequired":false,"billingCode":"99173","codeType":"CPT"},{"id":7340,"precertRequired":false,"billingCode":"99174","codeType":"CPT"},{"id":7341,"precertRequired":false,"billingCode":"99177","codeType":"CPT"},{"id":7846,"precertRequired":false,"billingCode":"A6410","codeType":"HCPCS"},{"id":7848,"precertRequired":false,"billingCode":"A6412","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8156,"precertRequired":false,"billingCode":"G0186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1178,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":9,"precertRequired":false,"billingCode":"00142","codeType":"CPT"},{"id":11,"precertRequired":false,"billingCode":"00145","codeType":"CPT"},{"id":12,"precertRequired":false,"billingCode":"00147","codeType":"CPT"},{"id":13,"precertRequired":false,"billingCode":"00148","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1179,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5146,"precertRequired":false,"billingCode":"81004","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1180,"description":"Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1181,"description":"Intravitreal anti-VEGF injections according to VA protocol (see Procedural Overview no.7 for specific information about VA protocol)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1182,"description":"Inpatient or observation admission for surgical procedure, if medically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1183,"description":"Inpatient admission or observation status for complications related to the procedure Note: ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":1184,"description":"Follow-up visits for this episode of care a.Follow-up images/studies/laboratories as indicated. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]}]}},{"Seoc":{"id":147,"seocKey":53,"name":"Eye Care Comprehensive 6 months_PRCT","seocId":"SSC_EYE CARE COMPREHENSIVE 6 MONTHS_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below as clinically necessary. These services can be provided by an Optometrist or Ophthalmologist.","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition\r\n2. Diagnostic images/laboratories/studies relevant to the referred condition\r\n3. Procedures and pathology services relevant to the referred condition\r\n4. Anesthesia consultation related to the procedure\r\n5. Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR\r\n6. Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website\r\n7. Intravitreal anti-VEGF injections according to VA protocol (see below)             \r\na. VA Protocol: The following initial treatment is recommended and approved - A series of 3 monthly bevacizumab injections per eye with re-evaluation. At the end of the series if there is measurable improvement, patient will continue on this treatment for up to 8 total injections per eye for this episode of care. If patient shows no measurable improvement to the initial series of injections, additional request for services is needed with accompanying medical justification must be submitted to request other medications or procedures to treat the condition indicated on the consult, including ranibizumab, aflibercept, intraocular steroid implants, laser, or vitrectomy\r\n8. Inpatient or observation admission for surgical procedure, if medically necessary\r\n9. Inpatient admission or observation status for complications related to the procedure     \r\nNote: ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery\r\n10. Follow-up visits for this episode of care     \r\na.    Follow-up images/studies/laboratories as indicated","maxAllowableVisits":999,"disclaimer":"* Additional consultations related to the referred condition require VA review and approval.\r\n* Community Provider must follow VA Protocol and non-formulary medication approval process for intravitreal anti-VEGF injections as well as intraocular steroid injections and steroid implants\r\n*VA authorization excludes coverage of premium IOLs (toric, multifocal, accommodating), and refractive and cosmetic surgery that does not correct a functional disability\r\n* VA (and Veterans) will not pay extra for laser assisted cataract surgery with conventional intraocular lens implant in accordance with Medicare policy and CMS rulings. \r\n* Durable Medical Equipment [DME], prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"OPHTHALMOLOGY","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":165,"description":"Initial outpatient evaluation and treatment for the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":166,"description":"Diagnostic images/laboratories/studies relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4716,"precertRequired":false,"billingCode":"76514","codeType":"CPT"},{"id":4717,"precertRequired":false,"billingCode":"76516","codeType":"CPT"},{"id":4718,"precertRequired":false,"billingCode":"76519","codeType":"CPT"},{"id":4719,"precertRequired":false,"billingCode":"76529","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6656,"precertRequired":false,"billingCode":"92100","codeType":"CPT"},{"id":6657,"precertRequired":false,"billingCode":"92132","codeType":"CPT"},{"id":6658,"precertRequired":false,"billingCode":"92133","codeType":"CPT"},{"id":6659,"precertRequired":false,"billingCode":"92134","codeType":"CPT"},{"id":6660,"precertRequired":false,"billingCode":"92136","codeType":"CPT"},{"id":6661,"precertRequired":false,"billingCode":"92145","codeType":"CPT"},{"id":6662,"precertRequired":false,"billingCode":"92225","codeType":"CPT"},{"id":6663,"precertRequired":false,"billingCode":"92226","codeType":"CPT"},{"id":6664,"precertRequired":false,"billingCode":"92227","codeType":"CPT"},{"id":6665,"precertRequired":false,"billingCode":"92228","codeType":"CPT"},{"id":6666,"precertRequired":false,"billingCode":"92230","codeType":"CPT"},{"id":6667,"precertRequired":false,"billingCode":"92235","codeType":"CPT"},{"id":6668,"precertRequired":false,"billingCode":"92240","codeType":"CPT"},{"id":6669,"precertRequired":false,"billingCode":"92242","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":6671,"precertRequired":false,"billingCode":"92260","codeType":"CPT"},{"id":6672,"precertRequired":false,"billingCode":"92265","codeType":"CPT"},{"id":6673,"precertRequired":false,"billingCode":"92270","codeType":"CPT"},{"id":6674,"precertRequired":false,"billingCode":"92275","codeType":"CPT"},{"id":6675,"precertRequired":false,"billingCode":"92283","codeType":"CPT"},{"id":6676,"precertRequired":false,"billingCode":"92284","codeType":"CPT"},{"id":6677,"precertRequired":false,"billingCode":"92285","codeType":"CPT"},{"id":6678,"precertRequired":false,"billingCode":"92286","codeType":"CPT"},{"id":7536,"precertRequired":false,"billingCode":"0329T","codeType":"CPT"},{"id":7537,"precertRequired":false,"billingCode":"0330T","codeType":"CPT"},{"id":7554,"precertRequired":false,"billingCode":"0378T","codeType":"CPT"},{"id":7555,"precertRequired":false,"billingCode":"0379T","codeType":"CPT"},{"id":7556,"precertRequired":false,"billingCode":"0380T","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":167,"description":"Procedures and pathology services relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4084,"precertRequired":false,"billingCode":"65091","codeType":"CPT"},{"id":4085,"precertRequired":false,"billingCode":"65093","codeType":"CPT"},{"id":4086,"precertRequired":false,"billingCode":"65101","codeType":"CPT"},{"id":4087,"precertRequired":false,"billingCode":"65103","codeType":"CPT"},{"id":4088,"precertRequired":false,"billingCode":"65105","codeType":"CPT"},{"id":4089,"precertRequired":false,"billingCode":"65110","codeType":"CPT"},{"id":4090,"precertRequired":false,"billingCode":"65112","codeType":"CPT"},{"id":4091,"precertRequired":false,"billingCode":"65114","codeType":"CPT"},{"id":4092,"precertRequired":false,"billingCode":"65130","codeType":"CPT"},{"id":4093,"precertRequired":false,"billingCode":"65135","codeType":"CPT"},{"id":4094,"precertRequired":false,"billingCode":"65140","codeType":"CPT"},{"id":4095,"precertRequired":false,"billingCode":"65150","codeType":"CPT"},{"id":4096,"precertRequired":false,"billingCode":"65155","codeType":"CPT"},{"id":4097,"precertRequired":false,"billingCode":"65175","codeType":"CPT"},{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4099,"precertRequired":false,"billingCode":"65210","codeType":"CPT"},{"id":4100,"precertRequired":false,"billingCode":"65220","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4102,"precertRequired":false,"billingCode":"65225","codeType":"CPT"},{"id":4104,"precertRequired":false,"billingCode":"65260","codeType":"CPT"},{"id":4105,"precertRequired":false,"billingCode":"65270","codeType":"CPT"},{"id":4106,"precertRequired":false,"billingCode":"65272","codeType":"CPT"},{"id":4107,"precertRequired":false,"billingCode":"65273","codeType":"CPT"},{"id":4108,"precertRequired":false,"billingCode":"65275","codeType":"CPT"},{"id":4109,"precertRequired":false,"billingCode":"65280","codeType":"CPT"},{"id":4110,"precertRequired":false,"billingCode":"65285","codeType":"CPT"},{"id":4111,"precertRequired":false,"billingCode":"65286","codeType":"CPT"},{"id":4112,"precertRequired":false,"billingCode":"65290","codeType":"CPT"},{"id":4113,"precertRequired":false,"billingCode":"65400","codeType":"CPT"},{"id":4114,"precertRequired":false,"billingCode":"65410","codeType":"CPT"},{"id":4115,"precertRequired":false,"billingCode":"65420","codeType":"CPT"},{"id":4116,"precertRequired":false,"billingCode":"65426","codeType":"CPT"},{"id":4117,"precertRequired":false,"billingCode":"65430","codeType":"CPT"},{"id":4118,"precertRequired":false,"billingCode":"65435","codeType":"CPT"},{"id":4119,"precertRequired":false,"billingCode":"65436","codeType":"CPT"},{"id":4120,"precertRequired":false,"billingCode":"65450","codeType":"CPT"},{"id":4121,"precertRequired":false,"billingCode":"65600","codeType":"CPT"},{"id":4122,"precertRequired":false,"billingCode":"65710","codeType":"CPT"},{"id":4123,"precertRequired":false,"billingCode":"65730","codeType":"CPT"},{"id":4124,"precertRequired":false,"billingCode":"65750","codeType":"CPT"},{"id":4125,"precertRequired":false,"billingCode":"65755","codeType":"CPT"},{"id":4126,"precertRequired":false,"billingCode":"65756","codeType":"CPT"},{"id":4127,"precertRequired":false,"billingCode":"65757","codeType":"CPT"},{"id":4128,"precertRequired":false,"billingCode":"65760","codeType":"CPT"},{"id":4129,"precertRequired":false,"billingCode":"65765","codeType":"CPT"},{"id":4130,"precertRequired":false,"billingCode":"65767","codeType":"CPT"},{"id":4131,"precertRequired":false,"billingCode":"65770","codeType":"CPT"},{"id":4132,"precertRequired":false,"billingCode":"65771","codeType":"CPT"},{"id":4133,"precertRequired":false,"billingCode":"65772","codeType":"CPT"},{"id":4134,"precertRequired":false,"billingCode":"65775","codeType":"CPT"},{"id":4135,"precertRequired":false,"billingCode":"65778","codeType":"CPT"},{"id":4136,"precertRequired":false,"billingCode":"65779","codeType":"CPT"},{"id":4137,"precertRequired":false,"billingCode":"65780","codeType":"CPT"},{"id":4138,"precertRequired":false,"billingCode":"65781","codeType":"CPT"},{"id":4139,"precertRequired":false,"billingCode":"65782","codeType":"CPT"},{"id":4140,"precertRequired":false,"billingCode":"65783","codeType":"CPT"},{"id":4141,"precertRequired":false,"billingCode":"65800","codeType":"CPT"},{"id":4142,"precertRequired":false,"billingCode":"65810","codeType":"CPT"},{"id":4143,"precertRequired":false,"billingCode":"65815","codeType":"CPT"},{"id":4144,"precertRequired":false,"billingCode":"65820","codeType":"CPT"},{"id":4145,"precertRequired":false,"billingCode":"65850","codeType":"CPT"},{"id":4146,"precertRequired":false,"billingCode":"65855","codeType":"CPT"},{"id":4147,"precertRequired":false,"billingCode":"65860","codeType":"CPT"},{"id":4148,"precertRequired":false,"billingCode":"65865","codeType":"CPT"},{"id":4149,"precertRequired":false,"billingCode":"65870","codeType":"CPT"},{"id":4150,"precertRequired":false,"billingCode":"65875","codeType":"CPT"},{"id":4151,"precertRequired":false,"billingCode":"65880","codeType":"CPT"},{"id":4152,"precertRequired":false,"billingCode":"65900","codeType":"CPT"},{"id":4153,"precertRequired":false,"billingCode":"65920","codeType":"CPT"},{"id":4154,"precertRequired":false,"billingCode":"65930","codeType":"CPT"},{"id":4155,"precertRequired":false,"billingCode":"66020","codeType":"CPT"},{"id":4157,"precertRequired":false,"billingCode":"66130","codeType":"CPT"},{"id":4158,"precertRequired":false,"billingCode":"66150","codeType":"CPT"},{"id":4159,"precertRequired":false,"billingCode":"66155","codeType":"CPT"},{"id":4160,"precertRequired":false,"billingCode":"66160","codeType":"CPT"},{"id":4161,"precertRequired":false,"billingCode":"66170","codeType":"CPT"},{"id":4162,"precertRequired":false,"billingCode":"66172","codeType":"CPT"},{"id":4163,"precertRequired":false,"billingCode":"66174","codeType":"CPT"},{"id":4164,"precertRequired":false,"billingCode":"66179","codeType":"CPT"},{"id":4165,"precertRequired":false,"billingCode":"66180","codeType":"CPT"},{"id":4166,"precertRequired":false,"billingCode":"66183","codeType":"CPT"},{"id":4167,"precertRequired":false,"billingCode":"66184","codeType":"CPT"},{"id":4168,"precertRequired":false,"billingCode":"66185","codeType":"CPT"},{"id":4169,"precertRequired":false,"billingCode":"66220","codeType":"CPT"},{"id":4170,"precertRequired":false,"billingCode":"66225","codeType":"CPT"},{"id":4171,"precertRequired":false,"billingCode":"66250","codeType":"CPT"},{"id":4172,"precertRequired":false,"billingCode":"66500","codeType":"CPT"},{"id":4174,"precertRequired":false,"billingCode":"66600","codeType":"CPT"},{"id":4175,"precertRequired":false,"billingCode":"66605","codeType":"CPT"},{"id":4176,"precertRequired":false,"billingCode":"66625","codeType":"CPT"},{"id":4177,"precertRequired":false,"billingCode":"66630","codeType":"CPT"},{"id":4178,"precertRequired":false,"billingCode":"66635","codeType":"CPT"},{"id":4179,"precertRequired":false,"billingCode":"66680","codeType":"CPT"},{"id":4180,"precertRequired":false,"billingCode":"66682","codeType":"CPT"},{"id":4181,"precertRequired":false,"billingCode":"66700","codeType":"CPT"},{"id":4182,"precertRequired":false,"billingCode":"66710","codeType":"CPT"},{"id":4183,"precertRequired":false,"billingCode":"66711","codeType":"CPT"},{"id":4184,"precertRequired":false,"billingCode":"66720","codeType":"CPT"},{"id":4185,"precertRequired":false,"billingCode":"66740","codeType":"CPT"},{"id":4186,"precertRequired":false,"billingCode":"66761","codeType":"CPT"},{"id":4187,"precertRequired":false,"billingCode":"66762","codeType":"CPT"},{"id":4188,"precertRequired":false,"billingCode":"66770","codeType":"CPT"},{"id":4189,"precertRequired":false,"billingCode":"66820","codeType":"CPT"},{"id":4190,"precertRequired":false,"billingCode":"66821","codeType":"CPT"},{"id":4191,"precertRequired":false,"billingCode":"66825","codeType":"CPT"},{"id":4192,"precertRequired":false,"billingCode":"66830","codeType":"CPT"},{"id":4193,"precertRequired":false,"billingCode":"66840","codeType":"CPT"},{"id":4194,"precertRequired":false,"billingCode":"66850","codeType":"CPT"},{"id":4195,"precertRequired":false,"billingCode":"66852","codeType":"CPT"},{"id":4196,"precertRequired":false,"billingCode":"66920","codeType":"CPT"},{"id":4197,"precertRequired":false,"billingCode":"66930","codeType":"CPT"},{"id":4198,"precertRequired":false,"billingCode":"66940","codeType":"CPT"},{"id":4200,"precertRequired":false,"billingCode":"66983","codeType":"CPT"},{"id":4201,"precertRequired":false,"billingCode":"66984","codeType":"CPT"},{"id":4202,"precertRequired":false,"billingCode":"66985","codeType":"CPT"},{"id":4203,"precertRequired":false,"billingCode":"66986","codeType":"CPT"},{"id":4204,"precertRequired":false,"billingCode":"66990","codeType":"CPT"},{"id":4205,"precertRequired":false,"billingCode":"67005","codeType":"CPT"},{"id":4206,"precertRequired":false,"billingCode":"67010","codeType":"CPT"},{"id":4207,"precertRequired":false,"billingCode":"67015","codeType":"CPT"},{"id":4208,"precertRequired":false,"billingCode":"67025","codeType":"CPT"},{"id":4209,"precertRequired":false,"billingCode":"67027","codeType":"CPT"},{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":4211,"precertRequired":false,"billingCode":"67030","codeType":"CPT"},{"id":4212,"precertRequired":false,"billingCode":"67031","codeType":"CPT"},{"id":4213,"precertRequired":false,"billingCode":"67036","codeType":"CPT"},{"id":4214,"precertRequired":false,"billingCode":"67039","codeType":"CPT"},{"id":4215,"precertRequired":false,"billingCode":"67040","codeType":"CPT"},{"id":4216,"precertRequired":false,"billingCode":"67041","codeType":"CPT"},{"id":4217,"precertRequired":false,"billingCode":"67042","codeType":"CPT"},{"id":4218,"precertRequired":false,"billingCode":"67043","codeType":"CPT"},{"id":4219,"precertRequired":false,"billingCode":"67075","codeType":"CPT"},{"id":4220,"precertRequired":false,"billingCode":"67101","codeType":"CPT"},{"id":4221,"precertRequired":false,"billingCode":"67105","codeType":"CPT"},{"id":4222,"precertRequired":false,"billingCode":"67107","codeType":"CPT"},{"id":4223,"precertRequired":false,"billingCode":"67108","codeType":"CPT"},{"id":4224,"precertRequired":false,"billingCode":"67110","codeType":"CPT"},{"id":4225,"precertRequired":false,"billingCode":"67113","codeType":"CPT"},{"id":4226,"precertRequired":false,"billingCode":"67115","codeType":"CPT"},{"id":4227,"precertRequired":false,"billingCode":"67120","codeType":"CPT"},{"id":4228,"precertRequired":false,"billingCode":"67121","codeType":"CPT"},{"id":4229,"precertRequired":false,"billingCode":"67141","codeType":"CPT"},{"id":4230,"precertRequired":false,"billingCode":"67145","codeType":"CPT"},{"id":4231,"precertRequired":false,"billingCode":"67208","codeType":"CPT"},{"id":4232,"precertRequired":false,"billingCode":"67210","codeType":"CPT"},{"id":4233,"precertRequired":false,"billingCode":"67218","codeType":"CPT"},{"id":4234,"precertRequired":false,"billingCode":"67220","codeType":"CPT"},{"id":4235,"precertRequired":false,"billingCode":"67221","codeType":"CPT"},{"id":4236,"precertRequired":false,"billingCode":"67225","codeType":"CPT"},{"id":4237,"precertRequired":false,"billingCode":"67227","codeType":"CPT"},{"id":4238,"precertRequired":false,"billingCode":"67228","codeType":"CPT"},{"id":4239,"precertRequired":false,"billingCode":"67250","codeType":"CPT"},{"id":4240,"precertRequired":false,"billingCode":"67255","codeType":"CPT"},{"id":4241,"precertRequired":false,"billingCode":"67299","codeType":"CPT"},{"id":4242,"precertRequired":false,"billingCode":"67311","codeType":"CPT"},{"id":4243,"precertRequired":false,"billingCode":"67312","codeType":"CPT"},{"id":4244,"precertRequired":false,"billingCode":"67314","codeType":"CPT"},{"id":4245,"precertRequired":false,"billingCode":"67316","codeType":"CPT"},{"id":4246,"precertRequired":false,"billingCode":"67318","codeType":"CPT"},{"id":4247,"precertRequired":false,"billingCode":"67320","codeType":"CPT"},{"id":4248,"precertRequired":false,"billingCode":"67331","codeType":"CPT"},{"id":4249,"precertRequired":false,"billingCode":"67332","codeType":"CPT"},{"id":4250,"precertRequired":false,"billingCode":"67334","codeType":"CPT"},{"id":4251,"precertRequired":false,"billingCode":"67335","codeType":"CPT"},{"id":4252,"precertRequired":false,"billingCode":"67340","codeType":"CPT"},{"id":4253,"precertRequired":false,"billingCode":"67343","codeType":"CPT"},{"id":4254,"precertRequired":false,"billingCode":"67345","codeType":"CPT"},{"id":4255,"precertRequired":false,"billingCode":"67346","codeType":"CPT"},{"id":4256,"precertRequired":false,"billingCode":"67399","codeType":"CPT"},{"id":4257,"precertRequired":false,"billingCode":"67400","codeType":"CPT"},{"id":4258,"precertRequired":false,"billingCode":"67405","codeType":"CPT"},{"id":4259,"precertRequired":false,"billingCode":"67412","codeType":"CPT"},{"id":4260,"precertRequired":false,"billingCode":"67413","codeType":"CPT"},{"id":4261,"precertRequired":false,"billingCode":"67414","codeType":"CPT"},{"id":4262,"precertRequired":false,"billingCode":"67415","codeType":"CPT"},{"id":4263,"precertRequired":false,"billingCode":"67420","codeType":"CPT"},{"id":4264,"precertRequired":false,"billingCode":"67430","codeType":"CPT"},{"id":4265,"precertRequired":false,"billingCode":"67440","codeType":"CPT"},{"id":4266,"precertRequired":false,"billingCode":"67445","codeType":"CPT"},{"id":4267,"precertRequired":false,"billingCode":"67450","codeType":"CPT"},{"id":4268,"precertRequired":false,"billingCode":"67500","codeType":"CPT"},{"id":4269,"precertRequired":false,"billingCode":"67505","codeType":"CPT"},{"id":4270,"precertRequired":false,"billingCode":"67515","codeType":"CPT"},{"id":4271,"precertRequired":false,"billingCode":"67550","codeType":"CPT"},{"id":4272,"precertRequired":false,"billingCode":"67560","codeType":"CPT"},{"id":4273,"precertRequired":false,"billingCode":"67570","codeType":"CPT"},{"id":4274,"precertRequired":false,"billingCode":"67599","codeType":"CPT"},{"id":4275,"precertRequired":false,"billingCode":"67700","codeType":"CPT"},{"id":4276,"precertRequired":false,"billingCode":"67710","codeType":"CPT"},{"id":4277,"precertRequired":false,"billingCode":"67715","codeType":"CPT"},{"id":4278,"precertRequired":false,"billingCode":"67800","codeType":"CPT"},{"id":4279,"precertRequired":false,"billingCode":"67801","codeType":"CPT"},{"id":4280,"precertRequired":false,"billingCode":"67805","codeType":"CPT"},{"id":4281,"precertRequired":false,"billingCode":"67808","codeType":"CPT"},{"id":4282,"precertRequired":false,"billingCode":"67810","codeType":"CPT"},{"id":4284,"precertRequired":false,"billingCode":"67825","codeType":"CPT"},{"id":4285,"precertRequired":false,"billingCode":"67830","codeType":"CPT"},{"id":4286,"precertRequired":false,"billingCode":"67835","codeType":"CPT"},{"id":4287,"precertRequired":false,"billingCode":"67840","codeType":"CPT"},{"id":4288,"precertRequired":false,"billingCode":"67850","codeType":"CPT"},{"id":4289,"precertRequired":false,"billingCode":"67875","codeType":"CPT"},{"id":4290,"precertRequired":false,"billingCode":"67880","codeType":"CPT"},{"id":4291,"precertRequired":false,"billingCode":"67882","codeType":"CPT"},{"id":4292,"precertRequired":false,"billingCode":"67900","codeType":"CPT"},{"id":4293,"precertRequired":false,"billingCode":"67901","codeType":"CPT"},{"id":4294,"precertRequired":false,"billingCode":"67902","codeType":"CPT"},{"id":4295,"precertRequired":false,"billingCode":"67903","codeType":"CPT"},{"id":4296,"precertRequired":false,"billingCode":"67904","codeType":"CPT"},{"id":4297,"precertRequired":false,"billingCode":"67906","codeType":"CPT"},{"id":4298,"precertRequired":false,"billingCode":"67908","codeType":"CPT"},{"id":4299,"precertRequired":false,"billingCode":"67909","codeType":"CPT"},{"id":4300,"precertRequired":false,"billingCode":"67911","codeType":"CPT"},{"id":4301,"precertRequired":false,"billingCode":"67912","codeType":"CPT"},{"id":4302,"precertRequired":false,"billingCode":"67916","codeType":"CPT"},{"id":4303,"precertRequired":false,"billingCode":"67917","codeType":"CPT"},{"id":4304,"precertRequired":false,"billingCode":"67921","codeType":"CPT"},{"id":4305,"precertRequired":false,"billingCode":"67922","codeType":"CPT"},{"id":4306,"precertRequired":false,"billingCode":"67923","codeType":"CPT"},{"id":4307,"precertRequired":false,"billingCode":"67924","codeType":"CPT"},{"id":4308,"precertRequired":false,"billingCode":"67930","codeType":"CPT"},{"id":4309,"precertRequired":false,"billingCode":"67935","codeType":"CPT"},{"id":4310,"precertRequired":false,"billingCode":"67950","codeType":"CPT"},{"id":4311,"precertRequired":false,"billingCode":"67961","codeType":"CPT"},{"id":4312,"precertRequired":false,"billingCode":"67966","codeType":"CPT"},{"id":4313,"precertRequired":false,"billingCode":"67971","codeType":"CPT"},{"id":4314,"precertRequired":false,"billingCode":"67973","codeType":"CPT"},{"id":4315,"precertRequired":false,"billingCode":"67974","codeType":"CPT"},{"id":4316,"precertRequired":false,"billingCode":"67975","codeType":"CPT"},{"id":4317,"precertRequired":false,"billingCode":"67999","codeType":"CPT"},{"id":4318,"precertRequired":false,"billingCode":"68020","codeType":"CPT"},{"id":4319,"precertRequired":false,"billingCode":"68040","codeType":"CPT"},{"id":4321,"precertRequired":false,"billingCode":"68110","codeType":"CPT"},{"id":4322,"precertRequired":false,"billingCode":"68115","codeType":"CPT"},{"id":4323,"precertRequired":false,"billingCode":"68130","codeType":"CPT"},{"id":4324,"precertRequired":false,"billingCode":"68135","codeType":"CPT"},{"id":4325,"precertRequired":false,"billingCode":"68200","codeType":"CPT"},{"id":4326,"precertRequired":false,"billingCode":"68320","codeType":"CPT"},{"id":4327,"precertRequired":false,"billingCode":"68325","codeType":"CPT"},{"id":4328,"precertRequired":false,"billingCode":"68326","codeType":"CPT"},{"id":4329,"precertRequired":false,"billingCode":"68328","codeType":"CPT"},{"id":4330,"precertRequired":false,"billingCode":"68330","codeType":"CPT"},{"id":4331,"precertRequired":false,"billingCode":"68335","codeType":"CPT"},{"id":4332,"precertRequired":false,"billingCode":"68340","codeType":"CPT"},{"id":4333,"precertRequired":false,"billingCode":"68360","codeType":"CPT"},{"id":4334,"precertRequired":false,"billingCode":"68362","codeType":"CPT"},{"id":4335,"precertRequired":false,"billingCode":"68371","codeType":"CPT"},{"id":4336,"precertRequired":false,"billingCode":"68399","codeType":"CPT"},{"id":4337,"precertRequired":false,"billingCode":"68400","codeType":"CPT"},{"id":4338,"precertRequired":false,"billingCode":"68420","codeType":"CPT"},{"id":4339,"precertRequired":false,"billingCode":"68440","codeType":"CPT"},{"id":4340,"precertRequired":false,"billingCode":"68500","codeType":"CPT"},{"id":4341,"precertRequired":false,"billingCode":"68505","codeType":"CPT"},{"id":4342,"precertRequired":false,"billingCode":"68510","codeType":"CPT"},{"id":4343,"precertRequired":false,"billingCode":"68550","codeType":"CPT"},{"id":4344,"precertRequired":false,"billingCode":"68720","codeType":"CPT"},{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6645,"precertRequired":false,"billingCode":"92018","codeType":"CPT"},{"id":6646,"precertRequired":false,"billingCode":"92019","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6651,"precertRequired":false,"billingCode":"92071","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6688,"precertRequired":false,"billingCode":"92325","codeType":"CPT"},{"id":6689,"precertRequired":false,"billingCode":"92326","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6697,"precertRequired":false,"billingCode":"92358","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"},{"id":6700,"precertRequired":false,"billingCode":"92499","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7338,"precertRequired":false,"billingCode":"99172","codeType":"CPT"},{"id":7339,"precertRequired":false,"billingCode":"99173","codeType":"CPT"},{"id":7340,"precertRequired":false,"billingCode":"99174","codeType":"CPT"},{"id":7341,"precertRequired":false,"billingCode":"99177","codeType":"CPT"},{"id":7846,"precertRequired":false,"billingCode":"A6410","codeType":"HCPCS"},{"id":7848,"precertRequired":false,"billingCode":"A6412","codeType":"HCPCS"},{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"},{"id":8156,"precertRequired":false,"billingCode":"G0186","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":168,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":9,"precertRequired":false,"billingCode":"00142","codeType":"CPT"},{"id":11,"precertRequired":false,"billingCode":"00145","codeType":"CPT"},{"id":12,"precertRequired":false,"billingCode":"00147","codeType":"CPT"},{"id":13,"precertRequired":false,"billingCode":"00148","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":169,"description":"Pre-operative medical and cardiac clearance as indicated, to include H+P/labs, EKG, CXR","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5146,"precertRequired":false,"billingCode":"81004","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":170,"description":"Intraocular Injections according to VA protocol (see below). Additional options can be found on the VA Formulary website. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":171,"description":"Intravitreal anti-VEGF injections according to VA protocol (see Procedural Overview no.7 for specific information about VA protocol)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":4210,"precertRequired":false,"billingCode":"67028","codeType":"CPT"},{"id":7995,"precertRequired":false,"billingCode":"C9257","codeType":"HCPCS"},{"id":8413,"precertRequired":false,"billingCode":"J1120","codeType":"HCPCS"},{"id":8429,"precertRequired":false,"billingCode":"J1452","codeType":"HCPCS"},{"id":8512,"precertRequired":false,"billingCode":"J3396","codeType":"HCPCS"},{"id":8543,"precertRequired":false,"billingCode":"J7313","codeType":"HCPCS"},{"id":8590,"precertRequired":false,"billingCode":"J9035","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":172,"description":"Inpatient or observation admission for surgical procedure, if medically necessary","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":173,"description":"Inpatient admission or observation status for complications related to the procedure Note: ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]},{"id":174,"description":"Follow-up visits for this episode of care a.Follow-up images/studies/laboratories as indicated. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"18-Ophthalmology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207WX0009X"},{"HPTC":"207WX0108X"},{"HPTC":"207WX0109X"},{"HPTC":"207WX0107X"},{"HPTC":"207W00000X"},{"HPTC":"207WX0120X"},{"HPTC":"207WX0200X"},{"HPTC":"207WX0110X"}]}]}},{"Seoc":{"id":550,"seocKey":54,"name":"Eye Care Examination_PRCT","seocId":"MSC_EYE CARE EXAMINATION_1.3.5_PRCT","versionNumber":"1.3.5","description":"This authorization covers services associated with all medical care listed below as clinically indicated. These services can be provided by an Optometrist or Ophthalmologist.","effectiveDate":"07-28-2019","endDate":null,"duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the one (1) routine eye exam\r\n2. Diagnostic images, labs, studies relevant to the patient complaint/condition\r\n3. Procedures relevant to the patient complaint/condition\r\n4. One (1) follow up visit for patient complaint/condition","maxAllowableVisits":null,"disclaimer":"* Eyeglasses are not authorized with this referral. Eyeglass prescriptions, if indicated, will be provided to the Veteran to bring to their local VA facility in person for obtaining eyeglasses or provided per local VA facility policy.\r\n * Cosmetic contact lenses are not authorized with this referral, and medically necessary contact lens requests require VA review and approval.\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","QASP":"General Care","categoryOfCare":"OPTOMETRY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"152WC0802X"},{"hptc":"207WX0120X"}],"services":[{"id":3160,"description":"Initial outpatient evaluation and treatment for the one (1) routine eye exam","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":3161,"description":"Diagnostic images, labs, studies relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":3162,"description":"Procedures relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":3163,"description":"One (1) follow up visit for patient complaint/condition","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]}]}},{"Seoc":{"id":279,"seocKey":54,"name":"Eye Care Examination_PRCT","seocId":"MSC_EYE CARE EXAMINATION_1.3.4_PRCT","versionNumber":"1.3.4","description":"This authorization covers services associated with all medical care listed below as clinically indicated. These services can be provided by an Optometrist or Ophthalmologist.","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the one (1) routine eye exam\r\n2. Diagnostic images, labs, studies relevant to the patient complaint/condition\r\n3. Procedures relevant to the patient complaint/condition\r\n4. One (1) follow up visit for patient complaint/condition","maxAllowableVisits":null,"disclaimer":"* Eyeglasses are not authorized with this referral. Eyeglass prescriptions, if indicated, will be provided to the Veteran to bring to their local VA facility in person for obtaining eyeglasses or provided per local VA facility policy.\r\n * Cosmetic contact lenses are not authorized with this referral, and medically necessary contact lens requests require VA review and approval.\r\n* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* All routine medications will be provided by VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n* The Veteran will be required to pay out-of-pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"OPTOMETRY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"152WC0802X"},{"hptc":"207WX0120X"}],"services":[{"id":1171,"description":"Initial outpatient evaluation and treatment for the one (1) routine eye exam","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":1172,"description":"Diagnostic images, labs, studies relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":1173,"description":"Procedures relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":1174,"description":"One (1) follow up visit for patient complaint/condition","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]}]}},{"Seoc":{"id":148,"seocKey":54,"name":"Eye Care Examination_PRCT","seocId":"MSC_EYE CARE EXAMINATION_1.3.3_PRCT","versionNumber":"1.3.3","description":"This authorization covers services associated with all medical care listed below as clinically indicated. These services can be provided by an Optometrist or Ophthalmologist.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the one (1) routine eye exam\r\n2. Diagnostic images, labs, studies relevant to the patient complaint/condition\r\n3. Procedures relevant to the patient complaint/condition\r\n4. One (1) follow up visit for patient complaint/condition","maxAllowableVisits":999,"disclaimer":"* Eyeglasses are not authorized with this referral. Eyeglass prescriptions, if indicated, will be provided to the Veteran to bring to their local VA facility in person for obtaining eyeglasses or provided per local VA facility policy.\r\n * Cosmetic contact lenses are not authorized with this referral, and medically necessary contact lens requests require VA review and approval.\r\n* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* All routine medications will be provided by VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n* The Veteran will be required to pay out-of-pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"OPTOMETRY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":175,"description":"Initial outpatient evaluation and treatment for the one (1) routine eye exam","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":176,"description":"Diagnostic images, labs, studies relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":8123,"precertRequired":false,"billingCode":"G0117","codeType":"HCPCS"},{"id":8124,"precertRequired":false,"billingCode":"G0118","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":177,"description":"Procedures relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6648,"precertRequired":false,"billingCode":"92025","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6684,"precertRequired":false,"billingCode":"92314","codeType":"CPT"},{"id":6685,"precertRequired":false,"billingCode":"92315","codeType":"CPT"},{"id":6686,"precertRequired":false,"billingCode":"92316","codeType":"CPT"},{"id":6687,"precertRequired":false,"billingCode":"92317","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6695,"precertRequired":false,"billingCode":"92354","codeType":"CPT"},{"id":6696,"precertRequired":false,"billingCode":"92355","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":178,"description":"One (1) follow up visit for patient complaint/condition","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]}]}},{"Seoc":{"id":41,"seocKey":54,"name":"Optometry_PRCT","seocId":"MSC_OPTOMETRY_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"12-07-2018","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the one (1) routine eye exam\r\n2. Diagnostic images, labs, studies relevant to the referred condition\r\n3. Procedures and pathology services relevant to the referred condition\r\n4. One (1) follow up visit for eye glass fitting","maxAllowableVisits":999,"disclaimer":"*** Eyeglasses are not authorized with this referral. Eyeglass prescriptions, if indicated, will be provided to the Veteran to bring to their local VA facility in person for obtaining eyeglasses per local policy.\r\n**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"OPTOMETRY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":418,"description":"Initial outpatient evaluation and treatment for the one (1) routine eye exam","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6640,"precertRequired":false,"billingCode":"92002","codeType":"CPT"},{"id":6641,"precertRequired":false,"billingCode":"92004","codeType":"CPT"},{"id":6642,"precertRequired":false,"billingCode":"92012","codeType":"CPT"},{"id":6643,"precertRequired":false,"billingCode":"92014","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":419,"description":"Diagnostic images, labs, studies relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4716,"precertRequired":false,"billingCode":"76514","codeType":"CPT"},{"id":6647,"precertRequired":false,"billingCode":"92020","codeType":"CPT"},{"id":6657,"precertRequired":false,"billingCode":"92132","codeType":"CPT"},{"id":6658,"precertRequired":false,"billingCode":"92133","codeType":"CPT"},{"id":6659,"precertRequired":false,"billingCode":"92134","codeType":"CPT"},{"id":6662,"precertRequired":false,"billingCode":"92225","codeType":"CPT"},{"id":6663,"precertRequired":false,"billingCode":"92226","codeType":"CPT"},{"id":6664,"precertRequired":false,"billingCode":"92227","codeType":"CPT"},{"id":6665,"precertRequired":false,"billingCode":"92228","codeType":"CPT"},{"id":6670,"precertRequired":false,"billingCode":"92250","codeType":"CPT"},{"id":6677,"precertRequired":false,"billingCode":"92285","codeType":"CPT"},{"id":6715,"precertRequired":false,"billingCode":"92534","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":420,"description":"Procedures and pathology services relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":4098,"precertRequired":false,"billingCode":"65205","codeType":"CPT"},{"id":4101,"precertRequired":false,"billingCode":"65222","codeType":"CPT"},{"id":4345,"precertRequired":false,"billingCode":"68801","codeType":"CPT"},{"id":6644,"precertRequired":false,"billingCode":"92015","codeType":"CPT"},{"id":6649,"precertRequired":false,"billingCode":"92060","codeType":"CPT"},{"id":6650,"precertRequired":false,"billingCode":"92065","codeType":"CPT"},{"id":6651,"precertRequired":false,"billingCode":"92071","codeType":"CPT"},{"id":6652,"precertRequired":false,"billingCode":"92072","codeType":"CPT"},{"id":6653,"precertRequired":false,"billingCode":"92081","codeType":"CPT"},{"id":6654,"precertRequired":false,"billingCode":"92082","codeType":"CPT"},{"id":6655,"precertRequired":false,"billingCode":"92083","codeType":"CPT"},{"id":6657,"precertRequired":false,"billingCode":"92132","codeType":"CPT"},{"id":6715,"precertRequired":false,"billingCode":"92534","codeType":"CPT"},{"id":7624,"precertRequired":false,"billingCode":"2022F","codeType":"CPT"},{"id":8907,"precertRequired":false,"billingCode":"S3000","codeType":"HCPCS"},{"id":9089,"precertRequired":false,"billingCode":"V2624","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]},{"id":421,"description":"One (1) follow up visit for eye glass fitting","frequency":null,"frequencyType":"","visits":1,"codeRequired":"YES","clinicalServices":[{"clinicalService":"41-Optometry"}],"billingCodes":[{"id":6680,"precertRequired":true,"billingCode":"92310","codeType":"CPT"},{"id":6681,"precertRequired":true,"billingCode":"92311","codeType":"CPT"},{"id":6682,"precertRequired":true,"billingCode":"92312","codeType":"CPT"},{"id":6683,"precertRequired":true,"billingCode":"92313","codeType":"CPT"},{"id":6690,"precertRequired":false,"billingCode":"92340","codeType":"CPT"},{"id":6691,"precertRequired":false,"billingCode":"92341","codeType":"CPT"},{"id":6692,"precertRequired":false,"billingCode":"92342","codeType":"CPT"},{"id":6693,"precertRequired":false,"billingCode":"92352","codeType":"CPT"},{"id":6694,"precertRequired":false,"billingCode":"92353","codeType":"CPT"},{"id":6698,"precertRequired":false,"billingCode":"92370","codeType":"CPT"},{"id":6699,"precertRequired":false,"billingCode":"92371","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"152WL0500X"},{"HPTC":"152WC0802X"},{"HPTC":"152W00000X"},{"HPTC":"152WS0006X"},{"HPTC":"152WV0400X"},{"HPTC":"152WP0200X"},{"HPTC":"152WX0102X"}]}]}},{"Seoc":{"id":10,"seocKey":54,"name":"Optometry_PRCT","seocId":"MSC_OPTOMETRY_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"05-15-2017","endDate":"11-01-2017","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the one (1) routine eye exam\r\n2. Diagnostic images, labs, studies relevant to the patient complaint/condition\r\n3. Procedures and pathology services relevant to the patient complaint/condition\r\na. Follow-up visits for this episode of care","maxAllowableVisits":999,"disclaimer":"**Additional consultation to Ophthalmology needed relevant to the referred condition will require VA review (send documentation to VA for review)\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"OPTOMETRY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":1300,"description":"HSRM placeholder","frequency":null,"frequencyType":"","visits":1,"codeRequired":"NO ","clinicalServices":[{"clinicalService":"01-General practice"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"208D00000X"}]}]}},{"Seoc":{"id":1732,"seocKey":55,"name":"General Surgery_REV_PRCT","seocId":"SSC_GENERAL SURGERY_1.0.6_REV_PRCT","versionNumber":"1.0.6","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":180,"REV":true,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for the referred condition indicated on the consult order\r\n2.  Diagnostic imaging relevant to the referred condition on the consult order\r\n3.  Diagnostic studies relevant to the referred condition on the consult order\r\n4.  Labs and pathology relevant to the referred condition on the consult order \r\n5.  Procedures relevant to the referred condition on the consult order including but not limited to:  I&D, biopsy, lesion excision with repair, port placement etc.\r\n6.   Anesthesia consultation related to the procedure\r\n7.   Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)\r\n8.   Inpatient or observation admission for surgery/procedure if indicated\r\n9.   Inpatient admission or observation status for complications related to the surgery/procedure\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning\r\n10. Follow-up visits for this episode of care relevant to the referred condition on the consult order","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"SURGERY GENERAL","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"208600000X"}],"services":[{"id":5030,"description":"Diagnostic imaging relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4367,"precertRequired":false,"billingCode":"70015","codeType":"CPT"},{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4517,"precertRequired":false,"billingCode":"73110","codeType":"CPT"},{"id":4520,"precertRequired":false,"billingCode":"73130","codeType":"CPT"},{"id":4521,"precertRequired":false,"billingCode":"73140","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4541,"precertRequired":false,"billingCode":"73552","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"},{"id":4543,"precertRequired":false,"billingCode":"73562","codeType":"CPT"},{"id":4544,"precertRequired":false,"billingCode":"73564","codeType":"CPT"},{"id":4547,"precertRequired":false,"billingCode":"73590","codeType":"CPT"},{"id":4550,"precertRequired":false,"billingCode":"73610","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4584,"precertRequired":false,"billingCode":"74190","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4605,"precertRequired":false,"billingCode":"74300","codeType":"CPT"},{"id":4606,"precertRequired":false,"billingCode":"74301","codeType":"CPT"},{"id":4607,"precertRequired":false,"billingCode":"74328","codeType":"CPT"},{"id":4608,"precertRequired":false,"billingCode":"74329","codeType":"CPT"},{"id":4609,"precertRequired":false,"billingCode":"74330","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4611,"precertRequired":false,"billingCode":"74355","codeType":"CPT"},{"id":4612,"precertRequired":false,"billingCode":"74360","codeType":"CPT"},{"id":4613,"precertRequired":false,"billingCode":"74363","codeType":"CPT"},{"id":4639,"precertRequired":false,"billingCode":"75600","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4646,"precertRequired":false,"billingCode":"75710","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4661,"precertRequired":false,"billingCode":"75809","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4667,"precertRequired":false,"billingCode":"75831","codeType":"CPT"},{"id":4668,"precertRequired":false,"billingCode":"75833","codeType":"CPT"},{"id":4669,"precertRequired":false,"billingCode":"75840","codeType":"CPT"},{"id":4670,"precertRequired":false,"billingCode":"75842","codeType":"CPT"},{"id":4671,"precertRequired":false,"billingCode":"75860","codeType":"CPT"},{"id":4672,"precertRequired":false,"billingCode":"75870","codeType":"CPT"},{"id":4673,"precertRequired":false,"billingCode":"75872","codeType":"CPT"},{"id":4674,"precertRequired":false,"billingCode":"75880","codeType":"CPT"},{"id":4675,"precertRequired":false,"billingCode":"75885","codeType":"CPT"},{"id":4676,"precertRequired":false,"billingCode":"75887","codeType":"CPT"},{"id":4677,"precertRequired":false,"billingCode":"75889","codeType":"CPT"},{"id":4678,"precertRequired":false,"billingCode":"75891","codeType":"CPT"},{"id":4679,"precertRequired":false,"billingCode":"75893","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4682,"precertRequired":false,"billingCode":"75901","codeType":"CPT"},{"id":4683,"precertRequired":false,"billingCode":"75902","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4691,"precertRequired":false,"billingCode":"75989","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4697,"precertRequired":false,"billingCode":"76100","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4700,"precertRequired":false,"billingCode":"76120","codeType":"CPT"},{"id":4701,"precertRequired":false,"billingCode":"76125","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4706,"precertRequired":false,"billingCode":"76390","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4726,"precertRequired":false,"billingCode":"76706","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4759,"precertRequired":false,"billingCode":"76882","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4770,"precertRequired":false,"billingCode":"76970","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4792,"precertRequired":false,"billingCode":"77071","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4797,"precertRequired":false,"billingCode":"77077","codeType":"CPT"},{"id":4801,"precertRequired":false,"billingCode":"77084","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4910,"precertRequired":false,"billingCode":"78261","codeType":"CPT"},{"id":4918,"precertRequired":false,"billingCode":"78278","codeType":"CPT"},{"id":4919,"precertRequired":false,"billingCode":"78282","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4921,"precertRequired":false,"billingCode":"78291","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4925,"precertRequired":false,"billingCode":"78315","codeType":"CPT"},{"id":4930,"precertRequired":false,"billingCode":"78414","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4932,"precertRequired":false,"billingCode":"78445","codeType":"CPT"},{"id":4937,"precertRequired":false,"billingCode":"78456","codeType":"CPT"},{"id":4938,"precertRequired":false,"billingCode":"78457","codeType":"CPT"},{"id":4939,"precertRequired":false,"billingCode":"78458","codeType":"CPT"},{"id":4969,"precertRequired":false,"billingCode":"78660","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4985,"precertRequired":false,"billingCode":"78804","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"},{"id":4990,"precertRequired":false,"billingCode":"78811","codeType":"CPT"},{"id":4991,"precertRequired":false,"billingCode":"78812","codeType":"CPT"},{"id":4992,"precertRequired":false,"billingCode":"78813","codeType":"CPT"},{"id":4993,"precertRequired":false,"billingCode":"78814","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":4995,"precertRequired":false,"billingCode":"78816","codeType":"CPT"},{"id":9769,"precertRequired":true,"billingCode":"77046","codeType":"CPT"},{"id":9770,"precertRequired":true,"billingCode":"77047","codeType":"CPT"},{"id":9771,"precertRequired":true,"billingCode":"77048","codeType":"CPT"},{"id":9772,"precertRequired":true,"billingCode":"77049","codeType":"CPT"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"},{"id":13321,"precertRequired":true,"billingCode":"70490","codeType":"CPT"},{"id":13322,"precertRequired":true,"billingCode":"70491","codeType":"CPT"},{"id":13323,"precertRequired":true,"billingCode":"70492","codeType":"CPT"},{"id":13324,"precertRequired":true,"billingCode":"70496","codeType":"CPT"},{"id":13325,"precertRequired":true,"billingCode":"70498","codeType":"CPT"},{"id":13326,"precertRequired":true,"billingCode":"70545","codeType":"CPT"},{"id":13327,"precertRequired":true,"billingCode":"70546","codeType":"CPT"},{"id":13328,"precertRequired":true,"billingCode":"70547","codeType":"CPT"},{"id":13329,"precertRequired":true,"billingCode":"70548","codeType":"CPT"},{"id":13330,"precertRequired":true,"billingCode":"70554","codeType":"CPT"},{"id":13331,"precertRequired":true,"billingCode":"70555","codeType":"CPT"},{"id":13332,"precertRequired":true,"billingCode":"70557","codeType":"CPT"},{"id":13333,"precertRequired":true,"billingCode":"70558","codeType":"CPT"},{"id":13334,"precertRequired":true,"billingCode":"70559","codeType":"CPT"},{"id":13335,"precertRequired":true,"billingCode":"76000","codeType":"CPT"},{"id":13411,"precertRequired":false,"billingCode":"74248","codeType":"CPT"},{"id":13412,"precertRequired":false,"billingCode":"78830","codeType":"CPT"},{"id":13413,"precertRequired":false,"billingCode":"78831","codeType":"CPT"},{"id":13414,"precertRequired":false,"billingCode":"78832","codeType":"CPT"},{"id":13443,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":13444,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":13445,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":13656,"precertRequired":true,"billingCode":"71260","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5031,"description":"Diagnostic studies relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"},{"id":6619,"precertRequired":false,"billingCode":"91010","codeType":"CPT"},{"id":6634,"precertRequired":false,"billingCode":"91120","codeType":"CPT"},{"id":6635,"precertRequired":false,"billingCode":"91122","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6965,"precertRequired":false,"billingCode":"93880","codeType":"CPT"},{"id":6966,"precertRequired":false,"billingCode":"93882","codeType":"CPT"},{"id":6973,"precertRequired":false,"billingCode":"93922","codeType":"CPT"},{"id":6974,"precertRequired":false,"billingCode":"93923","codeType":"CPT"},{"id":6975,"precertRequired":false,"billingCode":"93924","codeType":"CPT"},{"id":6976,"precertRequired":false,"billingCode":"93925","codeType":"CPT"},{"id":6977,"precertRequired":false,"billingCode":"93926","codeType":"CPT"},{"id":6980,"precertRequired":false,"billingCode":"93970","codeType":"CPT"},{"id":6981,"precertRequired":false,"billingCode":"93971","codeType":"CPT"},{"id":6982,"precertRequired":false,"billingCode":"93975","codeType":"CPT"},{"id":6984,"precertRequired":false,"billingCode":"93978","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7110,"precertRequired":false,"billingCode":"95886","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":5032,"description":"Labs and pathology relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5140,"precertRequired":false,"billingCode":"80500","codeType":"CPT"},{"id":5141,"precertRequired":false,"billingCode":"80502","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5340,"precertRequired":false,"billingCode":"81500","codeType":"CPT"},{"id":5341,"precertRequired":false,"billingCode":"81503","codeType":"CPT"},{"id":5372,"precertRequired":false,"billingCode":"82040","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5382,"precertRequired":false,"billingCode":"82105","codeType":"CPT"},{"id":5384,"precertRequired":false,"billingCode":"82107","codeType":"CPT"},{"id":5395,"precertRequired":false,"billingCode":"82150","codeType":"CPT"},{"id":5409,"precertRequired":false,"billingCode":"82248","codeType":"CPT"},{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5420,"precertRequired":false,"billingCode":"82310","codeType":"CPT"},{"id":5421,"precertRequired":false,"billingCode":"82330","codeType":"CPT"},{"id":5432,"precertRequired":false,"billingCode":"82378","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5469,"precertRequired":false,"billingCode":"82607","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5499,"precertRequired":false,"billingCode":"82746","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5522,"precertRequired":false,"billingCode":"82948","codeType":"CPT"},{"id":5528,"precertRequired":false,"billingCode":"82962","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5578,"precertRequired":false,"billingCode":"83550","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5586,"precertRequired":false,"billingCode":"83630","codeType":"CPT"},{"id":5587,"precertRequired":false,"billingCode":"83631","codeType":"CPT"},{"id":5597,"precertRequired":false,"billingCode":"83690","codeType":"CPT"},{"id":5603,"precertRequired":false,"billingCode":"83718","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5634,"precertRequired":false,"billingCode":"83970","codeType":"CPT"},{"id":5649,"precertRequired":false,"billingCode":"84100","codeType":"CPT"},{"id":5657,"precertRequired":false,"billingCode":"84132","codeType":"CPT"},{"id":5659,"precertRequired":false,"billingCode":"84134","codeType":"CPT"},{"id":5668,"precertRequired":false,"billingCode":"84152","codeType":"CPT"},{"id":5669,"precertRequired":false,"billingCode":"84153","codeType":"CPT"},{"id":5670,"precertRequired":false,"billingCode":"84154","codeType":"CPT"},{"id":5714,"precertRequired":false,"billingCode":"84425","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5727,"precertRequired":false,"billingCode":"84460","codeType":"CPT"},{"id":5728,"precertRequired":false,"billingCode":"84466","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5740,"precertRequired":false,"billingCode":"84520","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5905,"precertRequired":false,"billingCode":"86300","codeType":"CPT"},{"id":5906,"precertRequired":false,"billingCode":"86301","codeType":"CPT"},{"id":5907,"precertRequired":false,"billingCode":"86304","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6065,"precertRequired":false,"billingCode":"86850","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6075,"precertRequired":false,"billingCode":"86901","codeType":"CPT"},{"id":6085,"precertRequired":false,"billingCode":"86923","codeType":"CPT"},{"id":6108,"precertRequired":false,"billingCode":"87045","codeType":"CPT"},{"id":6109,"precertRequired":false,"billingCode":"87046","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6112,"precertRequired":false,"billingCode":"87073","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6143,"precertRequired":false,"billingCode":"87177","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6236,"precertRequired":false,"billingCode":"87505","codeType":"CPT"},{"id":6237,"precertRequired":false,"billingCode":"87506","codeType":"CPT"},{"id":6238,"precertRequired":false,"billingCode":"87507","codeType":"CPT"},{"id":6288,"precertRequired":false,"billingCode":"87641","codeType":"CPT"},{"id":6340,"precertRequired":false,"billingCode":"88108","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6369,"precertRequired":false,"billingCode":"88184","codeType":"CPT"},{"id":6370,"precertRequired":false,"billingCode":"88185","codeType":"CPT"},{"id":6371,"precertRequired":false,"billingCode":"88187","codeType":"CPT"},{"id":6372,"precertRequired":false,"billingCode":"88188","codeType":"CPT"},{"id":6373,"precertRequired":false,"billingCode":"88189","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6411,"precertRequired":false,"billingCode":"88314","codeType":"CPT"},{"id":6412,"precertRequired":false,"billingCode":"88319","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6414,"precertRequired":false,"billingCode":"88323","codeType":"CPT"},{"id":6415,"precertRequired":false,"billingCode":"88325","codeType":"CPT"},{"id":6416,"precertRequired":false,"billingCode":"88329","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6419,"precertRequired":false,"billingCode":"88333","codeType":"CPT"},{"id":6420,"precertRequired":false,"billingCode":"88334","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6423,"precertRequired":false,"billingCode":"88344","codeType":"CPT"},{"id":6424,"precertRequired":false,"billingCode":"88346","codeType":"CPT"},{"id":6425,"precertRequired":false,"billingCode":"88348","codeType":"CPT"},{"id":6426,"precertRequired":false,"billingCode":"88350","codeType":"CPT"},{"id":6427,"precertRequired":false,"billingCode":"88355","codeType":"CPT"},{"id":6428,"precertRequired":false,"billingCode":"88356","codeType":"CPT"},{"id":6429,"precertRequired":false,"billingCode":"88358","codeType":"CPT"},{"id":6430,"precertRequired":false,"billingCode":"88360","codeType":"CPT"},{"id":6431,"precertRequired":false,"billingCode":"88361","codeType":"CPT"},{"id":6432,"precertRequired":false,"billingCode":"88362","codeType":"CPT"},{"id":6433,"precertRequired":false,"billingCode":"88363","codeType":"CPT"},{"id":6434,"precertRequired":false,"billingCode":"88364","codeType":"CPT"},{"id":6435,"precertRequired":false,"billingCode":"88365","codeType":"CPT"},{"id":6436,"precertRequired":false,"billingCode":"88366","codeType":"CPT"},{"id":6437,"precertRequired":false,"billingCode":"88367","codeType":"CPT"},{"id":6438,"precertRequired":false,"billingCode":"88368","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"},{"id":6440,"precertRequired":false,"billingCode":"88371","codeType":"CPT"},{"id":6441,"precertRequired":false,"billingCode":"88372","codeType":"CPT"},{"id":6442,"precertRequired":false,"billingCode":"88373","codeType":"CPT"},{"id":6443,"precertRequired":false,"billingCode":"88374","codeType":"CPT"},{"id":6444,"precertRequired":false,"billingCode":"88375","codeType":"CPT"},{"id":6445,"precertRequired":false,"billingCode":"88377","codeType":"CPT"},{"id":6446,"precertRequired":false,"billingCode":"88380","codeType":"CPT"},{"id":6447,"precertRequired":false,"billingCode":"88381","codeType":"CPT"},{"id":6448,"precertRequired":false,"billingCode":"88387","codeType":"CPT"},{"id":6449,"precertRequired":false,"billingCode":"88388","codeType":"CPT"},{"id":6456,"precertRequired":false,"billingCode":"89049","codeType":"CPT"},{"id":6457,"precertRequired":false,"billingCode":"89050","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":8206,"precertRequired":false,"billingCode":"G0416","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5033,"description":"Procedures relevant to the referred condition on the consult order including but not limited to:  I&D, biopsy, lesion excision with repair, port placement etc.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":243,"precertRequired":false,"billingCode":"11010","codeType":"CPT"},{"id":244,"precertRequired":false,"billingCode":"11011","codeType":"CPT"},{"id":245,"precertRequired":false,"billingCode":"11012","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":248,"precertRequired":false,"billingCode":"11044","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":250,"precertRequired":false,"billingCode":"11046","codeType":"CPT"},{"id":251,"precertRequired":false,"billingCode":"11047","codeType":"CPT"},{"id":257,"precertRequired":false,"billingCode":"11200","codeType":"CPT"},{"id":258,"precertRequired":false,"billingCode":"11201","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":313,"precertRequired":false,"billingCode":"11719","codeType":"CPT"},{"id":314,"precertRequired":false,"billingCode":"11720","codeType":"CPT"},{"id":315,"precertRequired":false,"billingCode":"11721","codeType":"CPT"},{"id":316,"precertRequired":false,"billingCode":"11730","codeType":"CPT"},{"id":317,"precertRequired":false,"billingCode":"11732","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":319,"precertRequired":false,"billingCode":"11750","codeType":"CPT"},{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":321,"precertRequired":false,"billingCode":"11760","codeType":"CPT"},{"id":322,"precertRequired":false,"billingCode":"11762","codeType":"CPT"},{"id":323,"precertRequired":false,"billingCode":"11765","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":329,"precertRequired":false,"billingCode":"11960","codeType":"CPT"},{"id":330,"precertRequired":false,"billingCode":"11970","codeType":"CPT"},{"id":331,"precertRequired":false,"billingCode":"11971","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":374,"precertRequired":false,"billingCode":"13120","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":383,"precertRequired":false,"billingCode":"13160","codeType":"CPT"},{"id":384,"precertRequired":false,"billingCode":"14000","codeType":"CPT"},{"id":385,"precertRequired":false,"billingCode":"14001","codeType":"CPT"},{"id":386,"precertRequired":false,"billingCode":"14020","codeType":"CPT"},{"id":387,"precertRequired":false,"billingCode":"14021","codeType":"CPT"},{"id":388,"precertRequired":true,"billingCode":"14040","codeType":"CPT"},{"id":389,"precertRequired":false,"billingCode":"14041","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":392,"precertRequired":true,"billingCode":"14301","codeType":"CPT"},{"id":393,"precertRequired":false,"billingCode":"14302","codeType":"CPT"},{"id":395,"precertRequired":false,"billingCode":"15040","codeType":"CPT"},{"id":396,"precertRequired":false,"billingCode":"15050","codeType":"CPT"},{"id":397,"precertRequired":false,"billingCode":"15150","codeType":"CPT"},{"id":398,"precertRequired":false,"billingCode":"15151","codeType":"CPT"},{"id":399,"precertRequired":false,"billingCode":"15155","codeType":"CPT"},{"id":400,"precertRequired":false,"billingCode":"15156","codeType":"CPT"},{"id":401,"precertRequired":false,"billingCode":"15157","codeType":"CPT"},{"id":402,"precertRequired":false,"billingCode":"15200","codeType":"CPT"},{"id":403,"precertRequired":false,"billingCode":"15201","codeType":"CPT"},{"id":404,"precertRequired":false,"billingCode":"15220","codeType":"CPT"},{"id":405,"precertRequired":false,"billingCode":"15221","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":410,"precertRequired":false,"billingCode":"15271","codeType":"CPT"},{"id":411,"precertRequired":false,"billingCode":"15272","codeType":"CPT"},{"id":412,"precertRequired":false,"billingCode":"15273","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":415,"precertRequired":false,"billingCode":"15570","codeType":"CPT"},{"id":416,"precertRequired":false,"billingCode":"15572","codeType":"CPT"},{"id":417,"precertRequired":false,"billingCode":"15574","codeType":"CPT"},{"id":418,"precertRequired":false,"billingCode":"15576","codeType":"CPT"},{"id":419,"precertRequired":false,"billingCode":"15600","codeType":"CPT"},{"id":420,"precertRequired":false,"billingCode":"15610","codeType":"CPT"},{"id":421,"precertRequired":false,"billingCode":"15620","codeType":"CPT"},{"id":422,"precertRequired":false,"billingCode":"15630","codeType":"CPT"},{"id":423,"precertRequired":false,"billingCode":"15650","codeType":"CPT"},{"id":424,"precertRequired":false,"billingCode":"15730","codeType":"CPT"},{"id":425,"precertRequired":false,"billingCode":"15731","codeType":"CPT"},{"id":426,"precertRequired":false,"billingCode":"15733","codeType":"CPT"},{"id":427,"precertRequired":false,"billingCode":"15734","codeType":"CPT"},{"id":428,"precertRequired":false,"billingCode":"15736","codeType":"CPT"},{"id":429,"precertRequired":false,"billingCode":"15738","codeType":"CPT"},{"id":430,"precertRequired":false,"billingCode":"15740","codeType":"CPT"},{"id":431,"precertRequired":false,"billingCode":"15750","codeType":"CPT"},{"id":432,"precertRequired":false,"billingCode":"15756","codeType":"CPT"},{"id":433,"precertRequired":false,"billingCode":"15757","codeType":"CPT"},{"id":434,"precertRequired":false,"billingCode":"15758","codeType":"CPT"},{"id":435,"precertRequired":false,"billingCode":"15760","codeType":"CPT"},{"id":436,"precertRequired":false,"billingCode":"15770","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":443,"precertRequired":false,"billingCode":"15850","codeType":"CPT"},{"id":444,"precertRequired":false,"billingCode":"15852","codeType":"CPT"},{"id":445,"precertRequired":false,"billingCode":"15860","codeType":"CPT"},{"id":446,"precertRequired":false,"billingCode":"15920","codeType":"CPT"},{"id":447,"precertRequired":false,"billingCode":"15922","codeType":"CPT"},{"id":448,"precertRequired":false,"billingCode":"15931","codeType":"CPT"},{"id":449,"precertRequired":false,"billingCode":"15933","codeType":"CPT"},{"id":450,"precertRequired":false,"billingCode":"15934","codeType":"CPT"},{"id":451,"precertRequired":false,"billingCode":"15935","codeType":"CPT"},{"id":452,"precertRequired":false,"billingCode":"15936","codeType":"CPT"},{"id":453,"precertRequired":false,"billingCode":"15937","codeType":"CPT"},{"id":454,"precertRequired":false,"billingCode":"15940","codeType":"CPT"},{"id":455,"precertRequired":false,"billingCode":"15941","codeType":"CPT"},{"id":456,"precertRequired":false,"billingCode":"15944","codeType":"CPT"},{"id":457,"precertRequired":false,"billingCode":"15945","codeType":"CPT"},{"id":458,"precertRequired":false,"billingCode":"15946","codeType":"CPT"},{"id":459,"precertRequired":false,"billingCode":"15950","codeType":"CPT"},{"id":460,"precertRequired":false,"billingCode":"15951","codeType":"CPT"},{"id":461,"precertRequired":false,"billingCode":"15952","codeType":"CPT"},{"id":462,"precertRequired":false,"billingCode":"15953","codeType":"CPT"},{"id":463,"precertRequired":false,"billingCode":"15956","codeType":"CPT"},{"id":464,"precertRequired":false,"billingCode":"15958","codeType":"CPT"},{"id":465,"precertRequired":false,"billingCode":"16000","codeType":"CPT"},{"id":466,"precertRequired":false,"billingCode":"16020","codeType":"CPT"},{"id":467,"precertRequired":false,"billingCode":"16025","codeType":"CPT"},{"id":468,"precertRequired":false,"billingCode":"16030","codeType":"CPT"},{"id":469,"precertRequired":false,"billingCode":"16035","codeType":"CPT"},{"id":470,"precertRequired":false,"billingCode":"16036","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":474,"precertRequired":false,"billingCode":"17106","codeType":"CPT"},{"id":475,"precertRequired":false,"billingCode":"17107","codeType":"CPT"},{"id":476,"precertRequired":false,"billingCode":"17108","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":498,"precertRequired":false,"billingCode":"17311","codeType":"CPT"},{"id":499,"precertRequired":true,"billingCode":"17312","codeType":"CPT"},{"id":500,"precertRequired":true,"billingCode":"17313","codeType":"CPT"},{"id":501,"precertRequired":true,"billingCode":"17314","codeType":"CPT"},{"id":502,"precertRequired":true,"billingCode":"17315","codeType":"CPT"},{"id":503,"precertRequired":false,"billingCode":"19000","codeType":"CPT"},{"id":504,"precertRequired":false,"billingCode":"19001","codeType":"CPT"},{"id":505,"precertRequired":false,"billingCode":"19020","codeType":"CPT"},{"id":506,"precertRequired":false,"billingCode":"19030","codeType":"CPT"},{"id":507,"precertRequired":false,"billingCode":"19081","codeType":"CPT"},{"id":508,"precertRequired":false,"billingCode":"19082","codeType":"CPT"},{"id":509,"precertRequired":false,"billingCode":"19083","codeType":"CPT"},{"id":510,"precertRequired":false,"billingCode":"19084","codeType":"CPT"},{"id":511,"precertRequired":false,"billingCode":"19085","codeType":"CPT"},{"id":512,"precertRequired":false,"billingCode":"19086","codeType":"CPT"},{"id":513,"precertRequired":false,"billingCode":"19100","codeType":"CPT"},{"id":514,"precertRequired":false,"billingCode":"19101","codeType":"CPT"},{"id":515,"precertRequired":false,"billingCode":"19105","codeType":"CPT"},{"id":516,"precertRequired":false,"billingCode":"19120","codeType":"CPT"},{"id":517,"precertRequired":false,"billingCode":"19125","codeType":"CPT"},{"id":518,"precertRequired":false,"billingCode":"19126","codeType":"CPT"},{"id":522,"precertRequired":false,"billingCode":"19281","codeType":"CPT"},{"id":523,"precertRequired":false,"billingCode":"19282","codeType":"CPT"},{"id":524,"precertRequired":false,"billingCode":"19283","codeType":"CPT"},{"id":525,"precertRequired":false,"billingCode":"19284","codeType":"CPT"},{"id":526,"precertRequired":false,"billingCode":"19285","codeType":"CPT"},{"id":527,"precertRequired":false,"billingCode":"19286","codeType":"CPT"},{"id":528,"precertRequired":false,"billingCode":"19287","codeType":"CPT"},{"id":529,"precertRequired":false,"billingCode":"19288","codeType":"CPT"},{"id":534,"precertRequired":false,"billingCode":"19300","codeType":"CPT"},{"id":535,"precertRequired":false,"billingCode":"19301","codeType":"CPT"},{"id":536,"precertRequired":false,"billingCode":"19302","codeType":"CPT"},{"id":537,"precertRequired":false,"billingCode":"19303","codeType":"CPT"},{"id":539,"precertRequired":false,"billingCode":"19305","codeType":"CPT"},{"id":540,"precertRequired":false,"billingCode":"19306","codeType":"CPT"},{"id":541,"precertRequired":false,"billingCode":"19307","codeType":"CPT"},{"id":543,"precertRequired":false,"billingCode":"20100","codeType":"CPT"},{"id":544,"precertRequired":false,"billingCode":"20101","codeType":"CPT"},{"id":545,"precertRequired":false,"billingCode":"20102","codeType":"CPT"},{"id":546,"precertRequired":false,"billingCode":"20103","codeType":"CPT"},{"id":547,"precertRequired":false,"billingCode":"20150","codeType":"CPT"},{"id":548,"precertRequired":false,"billingCode":"20200","codeType":"CPT"},{"id":549,"precertRequired":false,"billingCode":"20205","codeType":"CPT"},{"id":550,"precertRequired":false,"billingCode":"20206","codeType":"CPT"},{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":552,"precertRequired":false,"billingCode":"20225","codeType":"CPT"},{"id":553,"precertRequired":false,"billingCode":"20240","codeType":"CPT"},{"id":554,"precertRequired":false,"billingCode":"20245","codeType":"CPT"},{"id":555,"precertRequired":true,"billingCode":"20250","codeType":"CPT"},{"id":556,"precertRequired":true,"billingCode":"20251","codeType":"CPT"},{"id":557,"precertRequired":false,"billingCode":"20500","codeType":"CPT"},{"id":558,"precertRequired":false,"billingCode":"20501","codeType":"CPT"},{"id":559,"precertRequired":false,"billingCode":"20520","codeType":"CPT"},{"id":560,"precertRequired":false,"billingCode":"20525","codeType":"CPT"},{"id":561,"precertRequired":true,"billingCode":"20526","codeType":"CPT"},{"id":562,"precertRequired":true,"billingCode":"20527","codeType":"CPT"},{"id":563,"precertRequired":true,"billingCode":"20550","codeType":"CPT"},{"id":564,"precertRequired":true,"billingCode":"20551","codeType":"CPT"},{"id":565,"precertRequired":true,"billingCode":"20552","codeType":"CPT"},{"id":566,"precertRequired":true,"billingCode":"20553","codeType":"CPT"},{"id":567,"precertRequired":false,"billingCode":"20555","codeType":"CPT"},{"id":568,"precertRequired":true,"billingCode":"20600","codeType":"CPT"},{"id":569,"precertRequired":true,"billingCode":"20604","codeType":"CPT"},{"id":570,"precertRequired":true,"billingCode":"20605","codeType":"CPT"},{"id":571,"precertRequired":true,"billingCode":"20606","codeType":"CPT"},{"id":572,"precertRequired":true,"billingCode":"20610","codeType":"CPT"},{"id":573,"precertRequired":true,"billingCode":"20611","codeType":"CPT"},{"id":574,"precertRequired":false,"billingCode":"20612","codeType":"CPT"},{"id":575,"precertRequired":false,"billingCode":"20615","codeType":"CPT"},{"id":582,"precertRequired":false,"billingCode":"20665","codeType":"CPT"},{"id":583,"precertRequired":false,"billingCode":"20670","codeType":"CPT"},{"id":584,"precertRequired":false,"billingCode":"20680","codeType":"CPT"},{"id":591,"precertRequired":false,"billingCode":"20900","codeType":"CPT"},{"id":592,"precertRequired":false,"billingCode":"20902","codeType":"CPT"},{"id":593,"precertRequired":false,"billingCode":"20910","codeType":"CPT"},{"id":594,"precertRequired":false,"billingCode":"20912","codeType":"CPT"},{"id":595,"precertRequired":false,"billingCode":"20920","codeType":"CPT"},{"id":596,"precertRequired":false,"billingCode":"20922","codeType":"CPT"},{"id":597,"precertRequired":false,"billingCode":"20924","codeType":"CPT"},{"id":600,"precertRequired":false,"billingCode":"20950","codeType":"CPT"},{"id":609,"precertRequired":false,"billingCode":"20982","codeType":"CPT"},{"id":610,"precertRequired":false,"billingCode":"20983","codeType":"CPT"},{"id":611,"precertRequired":false,"billingCode":"20985","codeType":"CPT"},{"id":723,"precertRequired":false,"billingCode":"21501","codeType":"CPT"},{"id":724,"precertRequired":false,"billingCode":"21502","codeType":"CPT"},{"id":725,"precertRequired":false,"billingCode":"21510","codeType":"CPT"},{"id":726,"precertRequired":true,"billingCode":"21550","codeType":"CPT"},{"id":727,"precertRequired":true,"billingCode":"21552","codeType":"CPT"},{"id":728,"precertRequired":true,"billingCode":"21554","codeType":"CPT"},{"id":729,"precertRequired":true,"billingCode":"21555","codeType":"CPT"},{"id":730,"precertRequired":true,"billingCode":"21556","codeType":"CPT"},{"id":731,"precertRequired":true,"billingCode":"21557","codeType":"CPT"},{"id":732,"precertRequired":true,"billingCode":"21558","codeType":"CPT"},{"id":733,"precertRequired":true,"billingCode":"21600","codeType":"CPT"},{"id":734,"precertRequired":true,"billingCode":"21610","codeType":"CPT"},{"id":735,"precertRequired":true,"billingCode":"21615","codeType":"CPT"},{"id":736,"precertRequired":true,"billingCode":"21616","codeType":"CPT"},{"id":737,"precertRequired":true,"billingCode":"21620","codeType":"CPT"},{"id":738,"precertRequired":true,"billingCode":"21627","codeType":"CPT"},{"id":739,"precertRequired":true,"billingCode":"21630","codeType":"CPT"},{"id":740,"precertRequired":true,"billingCode":"21632","codeType":"CPT"},{"id":741,"precertRequired":false,"billingCode":"21685","codeType":"CPT"},{"id":742,"precertRequired":true,"billingCode":"21700","codeType":"CPT"},{"id":743,"precertRequired":true,"billingCode":"21705","codeType":"CPT"},{"id":744,"precertRequired":true,"billingCode":"21720","codeType":"CPT"},{"id":745,"precertRequired":true,"billingCode":"21725","codeType":"CPT"},{"id":746,"precertRequired":true,"billingCode":"21740","codeType":"CPT"},{"id":747,"precertRequired":true,"billingCode":"21742","codeType":"CPT"},{"id":748,"precertRequired":true,"billingCode":"21743","codeType":"CPT"},{"id":749,"precertRequired":true,"billingCode":"21750","codeType":"CPT"},{"id":750,"precertRequired":true,"billingCode":"21811","codeType":"CPT"},{"id":751,"precertRequired":true,"billingCode":"21812","codeType":"CPT"},{"id":752,"precertRequired":true,"billingCode":"21813","codeType":"CPT"},{"id":755,"precertRequired":false,"billingCode":"21920","codeType":"CPT"},{"id":756,"precertRequired":false,"billingCode":"21925","codeType":"CPT"},{"id":757,"precertRequired":false,"billingCode":"21930","codeType":"CPT"},{"id":758,"precertRequired":false,"billingCode":"21931","codeType":"CPT"},{"id":759,"precertRequired":false,"billingCode":"21932","codeType":"CPT"},{"id":760,"precertRequired":false,"billingCode":"21933","codeType":"CPT"},{"id":761,"precertRequired":false,"billingCode":"21935","codeType":"CPT"},{"id":762,"precertRequired":false,"billingCode":"21936","codeType":"CPT"},{"id":763,"precertRequired":true,"billingCode":"22010","codeType":"CPT"},{"id":764,"precertRequired":false,"billingCode":"22015","codeType":"CPT"},{"id":775,"precertRequired":false,"billingCode":"22900","codeType":"CPT"},{"id":776,"precertRequired":false,"billingCode":"22901","codeType":"CPT"},{"id":777,"precertRequired":false,"billingCode":"22902","codeType":"CPT"},{"id":778,"precertRequired":false,"billingCode":"22903","codeType":"CPT"},{"id":779,"precertRequired":false,"billingCode":"22904","codeType":"CPT"},{"id":780,"precertRequired":false,"billingCode":"22905","codeType":"CPT"},{"id":781,"precertRequired":false,"billingCode":"23000","codeType":"CPT"},{"id":782,"precertRequired":false,"billingCode":"23020","codeType":"CPT"},{"id":783,"precertRequired":false,"billingCode":"23030","codeType":"CPT"},{"id":784,"precertRequired":false,"billingCode":"23031","codeType":"CPT"},{"id":785,"precertRequired":false,"billingCode":"23035","codeType":"CPT"},{"id":786,"precertRequired":false,"billingCode":"23040","codeType":"CPT"},{"id":787,"precertRequired":false,"billingCode":"23044","codeType":"CPT"},{"id":788,"precertRequired":false,"billingCode":"23065","codeType":"CPT"},{"id":789,"precertRequired":false,"billingCode":"23066","codeType":"CPT"},{"id":790,"precertRequired":false,"billingCode":"23071","codeType":"CPT"},{"id":791,"precertRequired":false,"billingCode":"23073","codeType":"CPT"},{"id":792,"precertRequired":false,"billingCode":"23075","codeType":"CPT"},{"id":793,"precertRequired":false,"billingCode":"23076","codeType":"CPT"},{"id":794,"precertRequired":false,"billingCode":"23077","codeType":"CPT"},{"id":795,"precertRequired":false,"billingCode":"23078","codeType":"CPT"},{"id":885,"precertRequired":false,"billingCode":"23930","codeType":"CPT"},{"id":886,"precertRequired":false,"billingCode":"23931","codeType":"CPT"},{"id":887,"precertRequired":false,"billingCode":"23935","codeType":"CPT"},{"id":888,"precertRequired":false,"billingCode":"24000","codeType":"CPT"},{"id":889,"precertRequired":false,"billingCode":"24006","codeType":"CPT"},{"id":890,"precertRequired":false,"billingCode":"24065","codeType":"CPT"},{"id":891,"precertRequired":false,"billingCode":"24066","codeType":"CPT"},{"id":892,"precertRequired":false,"billingCode":"24071","codeType":"CPT"},{"id":893,"precertRequired":false,"billingCode":"24073","codeType":"CPT"},{"id":894,"precertRequired":false,"billingCode":"24075","codeType":"CPT"},{"id":895,"precertRequired":false,"billingCode":"24076","codeType":"CPT"},{"id":896,"precertRequired":false,"billingCode":"24077","codeType":"CPT"},{"id":897,"precertRequired":false,"billingCode":"24079","codeType":"CPT"},{"id":898,"precertRequired":false,"billingCode":"24100","codeType":"CPT"},{"id":899,"precertRequired":false,"billingCode":"24101","codeType":"CPT"},{"id":921,"precertRequired":false,"billingCode":"24200","codeType":"CPT"},{"id":922,"precertRequired":false,"billingCode":"24201","codeType":"CPT"},{"id":992,"precertRequired":false,"billingCode":"24900","codeType":"CPT"},{"id":993,"precertRequired":false,"billingCode":"24920","codeType":"CPT"},{"id":994,"precertRequired":false,"billingCode":"24925","codeType":"CPT"},{"id":995,"precertRequired":false,"billingCode":"24930","codeType":"CPT"},{"id":996,"precertRequired":false,"billingCode":"24931","codeType":"CPT"},{"id":997,"precertRequired":false,"billingCode":"24935","codeType":"CPT"},{"id":1001,"precertRequired":false,"billingCode":"25020","codeType":"CPT"},{"id":1002,"precertRequired":false,"billingCode":"25023","codeType":"CPT"},{"id":1003,"precertRequired":false,"billingCode":"25024","codeType":"CPT"},{"id":1004,"precertRequired":false,"billingCode":"25025","codeType":"CPT"},{"id":1005,"precertRequired":false,"billingCode":"25028","codeType":"CPT"},{"id":1006,"precertRequired":false,"billingCode":"25031","codeType":"CPT"},{"id":1007,"precertRequired":false,"billingCode":"25035","codeType":"CPT"},{"id":1008,"precertRequired":false,"billingCode":"25040","codeType":"CPT"},{"id":1009,"precertRequired":false,"billingCode":"25065","codeType":"CPT"},{"id":1010,"precertRequired":false,"billingCode":"25066","codeType":"CPT"},{"id":1011,"precertRequired":false,"billingCode":"25071","codeType":"CPT"},{"id":1012,"precertRequired":false,"billingCode":"25073","codeType":"CPT"},{"id":1013,"precertRequired":false,"billingCode":"25075","codeType":"CPT"},{"id":1014,"precertRequired":false,"billingCode":"25076","codeType":"CPT"},{"id":1015,"precertRequired":false,"billingCode":"25077","codeType":"CPT"},{"id":1016,"precertRequired":false,"billingCode":"25078","codeType":"CPT"},{"id":1065,"precertRequired":false,"billingCode":"25320","codeType":"CPT"},{"id":1145,"precertRequired":false,"billingCode":"25900","codeType":"CPT"},{"id":1146,"precertRequired":false,"billingCode":"25905","codeType":"CPT"},{"id":1147,"precertRequired":false,"billingCode":"25907","codeType":"CPT"},{"id":1148,"precertRequired":false,"billingCode":"25909","codeType":"CPT"},{"id":1150,"precertRequired":false,"billingCode":"25920","codeType":"CPT"},{"id":1151,"precertRequired":false,"billingCode":"25922","codeType":"CPT"},{"id":1152,"precertRequired":false,"billingCode":"25924","codeType":"CPT"},{"id":1153,"precertRequired":false,"billingCode":"25927","codeType":"CPT"},{"id":1154,"precertRequired":false,"billingCode":"25929","codeType":"CPT"},{"id":1155,"precertRequired":false,"billingCode":"25931","codeType":"CPT"},{"id":1156,"precertRequired":false,"billingCode":"26010","codeType":"CPT"},{"id":1157,"precertRequired":false,"billingCode":"26011","codeType":"CPT"},{"id":1158,"precertRequired":false,"billingCode":"26020","codeType":"CPT"},{"id":1159,"precertRequired":false,"billingCode":"26025","codeType":"CPT"},{"id":1160,"precertRequired":false,"billingCode":"26030","codeType":"CPT"},{"id":1161,"precertRequired":false,"billingCode":"26034","codeType":"CPT"},{"id":1162,"precertRequired":false,"billingCode":"26035","codeType":"CPT"},{"id":1163,"precertRequired":false,"billingCode":"26037","codeType":"CPT"},{"id":1164,"precertRequired":false,"billingCode":"26040","codeType":"CPT"},{"id":1165,"precertRequired":false,"billingCode":"26045","codeType":"CPT"},{"id":1166,"precertRequired":false,"billingCode":"26055","codeType":"CPT"},{"id":1174,"precertRequired":false,"billingCode":"26111","codeType":"CPT"},{"id":1175,"precertRequired":false,"billingCode":"26113","codeType":"CPT"},{"id":1176,"precertRequired":false,"billingCode":"26115","codeType":"CPT"},{"id":1177,"precertRequired":false,"billingCode":"26116","codeType":"CPT"},{"id":1178,"precertRequired":false,"billingCode":"26117","codeType":"CPT"},{"id":1179,"precertRequired":false,"billingCode":"26118","codeType":"CPT"},{"id":1180,"precertRequired":false,"billingCode":"26121","codeType":"CPT"},{"id":1181,"precertRequired":false,"billingCode":"26123","codeType":"CPT"},{"id":1182,"precertRequired":false,"billingCode":"26125","codeType":"CPT"},{"id":1213,"precertRequired":false,"billingCode":"26392","codeType":"CPT"},{"id":1326,"precertRequired":false,"billingCode":"26910","codeType":"CPT"},{"id":1327,"precertRequired":false,"billingCode":"26951","codeType":"CPT"},{"id":1328,"precertRequired":false,"billingCode":"26952","codeType":"CPT"},{"id":1329,"precertRequired":false,"billingCode":"26990","codeType":"CPT"},{"id":1330,"precertRequired":false,"billingCode":"26991","codeType":"CPT"},{"id":1331,"precertRequired":false,"billingCode":"26992","codeType":"CPT"},{"id":1337,"precertRequired":false,"billingCode":"27025","codeType":"CPT"},{"id":1338,"precertRequired":false,"billingCode":"27027","codeType":"CPT"},{"id":1343,"precertRequired":false,"billingCode":"27040","codeType":"CPT"},{"id":1344,"precertRequired":false,"billingCode":"27041","codeType":"CPT"},{"id":1345,"precertRequired":false,"billingCode":"27043","codeType":"CPT"},{"id":1346,"precertRequired":false,"billingCode":"27045","codeType":"CPT"},{"id":1347,"precertRequired":false,"billingCode":"27047","codeType":"CPT"},{"id":1348,"precertRequired":false,"billingCode":"27048","codeType":"CPT"},{"id":1349,"precertRequired":false,"billingCode":"27049","codeType":"CPT"},{"id":1353,"precertRequired":false,"billingCode":"27057","codeType":"CPT"},{"id":1354,"precertRequired":false,"billingCode":"27059","codeType":"CPT"},{"id":1367,"precertRequired":false,"billingCode":"27086","codeType":"CPT"},{"id":1368,"precertRequired":false,"billingCode":"27087","codeType":"CPT"},{"id":1447,"precertRequired":false,"billingCode":"27290","codeType":"CPT"},{"id":1448,"precertRequired":false,"billingCode":"27295","codeType":"CPT"},{"id":1450,"precertRequired":false,"billingCode":"27301","codeType":"CPT"},{"id":1451,"precertRequired":false,"billingCode":"27303","codeType":"CPT"},{"id":1452,"precertRequired":false,"billingCode":"27305","codeType":"CPT"},{"id":1456,"precertRequired":false,"billingCode":"27323","codeType":"CPT"},{"id":1457,"precertRequired":false,"billingCode":"27324","codeType":"CPT"},{"id":1460,"precertRequired":false,"billingCode":"27327","codeType":"CPT"},{"id":1461,"precertRequired":false,"billingCode":"27328","codeType":"CPT"},{"id":1462,"precertRequired":false,"billingCode":"27329","codeType":"CPT"},{"id":1469,"precertRequired":false,"billingCode":"27337","codeType":"CPT"},{"id":1470,"precertRequired":false,"billingCode":"27339","codeType":"CPT"},{"id":1472,"precertRequired":false,"billingCode":"27345","codeType":"CPT"},{"id":1480,"precertRequired":false,"billingCode":"27364","codeType":"CPT"},{"id":1481,"precertRequired":false,"billingCode":"27365","codeType":"CPT"},{"id":1483,"precertRequired":false,"billingCode":"27372","codeType":"CPT"},{"id":1494,"precertRequired":false,"billingCode":"27396","codeType":"CPT"},{"id":1541,"precertRequired":false,"billingCode":"27496","codeType":"CPT"},{"id":1542,"precertRequired":false,"billingCode":"27497","codeType":"CPT"},{"id":1543,"precertRequired":false,"billingCode":"27498","codeType":"CPT"},{"id":1544,"precertRequired":false,"billingCode":"27499","codeType":"CPT"},{"id":1545,"precertRequired":false,"billingCode":"27500","codeType":"CPT"},{"id":1578,"precertRequired":false,"billingCode":"27590","codeType":"CPT"},{"id":1579,"precertRequired":false,"billingCode":"27591","codeType":"CPT"},{"id":1580,"precertRequired":false,"billingCode":"27592","codeType":"CPT"},{"id":1581,"precertRequired":false,"billingCode":"27594","codeType":"CPT"},{"id":1582,"precertRequired":false,"billingCode":"27596","codeType":"CPT"},{"id":1583,"precertRequired":false,"billingCode":"27598","codeType":"CPT"},{"id":1584,"precertRequired":false,"billingCode":"27600","codeType":"CPT"},{"id":1585,"precertRequired":false,"billingCode":"27601","codeType":"CPT"},{"id":1586,"precertRequired":false,"billingCode":"27602","codeType":"CPT"},{"id":1587,"precertRequired":false,"billingCode":"27603","codeType":"CPT"},{"id":1588,"precertRequired":false,"billingCode":"27604","codeType":"CPT"},{"id":1591,"precertRequired":false,"billingCode":"27607","codeType":"CPT"},{"id":1594,"precertRequired":false,"billingCode":"27613","codeType":"CPT"},{"id":1595,"precertRequired":false,"billingCode":"27614","codeType":"CPT"},{"id":1596,"precertRequired":false,"billingCode":"27615","codeType":"CPT"},{"id":1597,"precertRequired":false,"billingCode":"27616","codeType":"CPT"},{"id":1598,"precertRequired":false,"billingCode":"27618","codeType":"CPT"},{"id":1599,"precertRequired":false,"billingCode":"27619","codeType":"CPT"},{"id":1697,"precertRequired":false,"billingCode":"27880","codeType":"CPT"},{"id":1698,"precertRequired":false,"billingCode":"27881","codeType":"CPT"},{"id":1699,"precertRequired":false,"billingCode":"27882","codeType":"CPT"},{"id":1700,"precertRequired":false,"billingCode":"27884","codeType":"CPT"},{"id":1701,"precertRequired":false,"billingCode":"27886","codeType":"CPT"},{"id":1702,"precertRequired":false,"billingCode":"27888","codeType":"CPT"},{"id":1703,"precertRequired":false,"billingCode":"27889","codeType":"CPT"},{"id":1704,"precertRequired":false,"billingCode":"27892","codeType":"CPT"},{"id":1705,"precertRequired":false,"billingCode":"27893","codeType":"CPT"},{"id":1706,"precertRequired":false,"billingCode":"27894","codeType":"CPT"},{"id":1707,"precertRequired":false,"billingCode":"28001","codeType":"CPT"},{"id":1708,"precertRequired":false,"billingCode":"28002","codeType":"CPT"},{"id":1709,"precertRequired":false,"billingCode":"28003","codeType":"CPT"},{"id":1710,"precertRequired":false,"billingCode":"28005","codeType":"CPT"},{"id":1711,"precertRequired":false,"billingCode":"28008","codeType":"CPT"},{"id":1718,"precertRequired":false,"billingCode":"28039","codeType":"CPT"},{"id":1719,"precertRequired":false,"billingCode":"28041","codeType":"CPT"},{"id":1720,"precertRequired":false,"billingCode":"28043","codeType":"CPT"},{"id":1721,"precertRequired":false,"billingCode":"28045","codeType":"CPT"},{"id":1728,"precertRequired":true,"billingCode":"28060","codeType":"CPT"},{"id":1729,"precertRequired":true,"billingCode":"28062","codeType":"CPT"},{"id":1732,"precertRequired":true,"billingCode":"28080","codeType":"CPT"},{"id":1751,"precertRequired":false,"billingCode":"28119","codeType":"CPT"},{"id":1764,"precertRequired":false,"billingCode":"28190","codeType":"CPT"},{"id":1765,"precertRequired":false,"billingCode":"28192","codeType":"CPT"},{"id":1766,"precertRequired":false,"billingCode":"28193","codeType":"CPT"},{"id":1791,"precertRequired":false,"billingCode":"28289","codeType":"CPT"},{"id":1792,"precertRequired":false,"billingCode":"28291","codeType":"CPT"},{"id":1793,"precertRequired":false,"billingCode":"28292","codeType":"CPT"},{"id":1794,"precertRequired":false,"billingCode":"28295","codeType":"CPT"},{"id":1795,"precertRequired":false,"billingCode":"28296","codeType":"CPT"},{"id":1796,"precertRequired":false,"billingCode":"28297","codeType":"CPT"},{"id":1797,"precertRequired":false,"billingCode":"28298","codeType":"CPT"},{"id":1798,"precertRequired":false,"billingCode":"28299","codeType":"CPT"},{"id":1876,"precertRequired":false,"billingCode":"28800","codeType":"CPT"},{"id":1877,"precertRequired":false,"billingCode":"28805","codeType":"CPT"},{"id":1878,"precertRequired":false,"billingCode":"28810","codeType":"CPT"},{"id":1879,"precertRequired":false,"billingCode":"28820","codeType":"CPT"},{"id":1880,"precertRequired":false,"billingCode":"28825","codeType":"CPT"},{"id":1940,"precertRequired":false,"billingCode":"29822","codeType":"CPT"},{"id":1941,"precertRequired":false,"billingCode":"29823","codeType":"CPT"},{"id":1943,"precertRequired":false,"billingCode":"29825","codeType":"CPT"},{"id":1975,"precertRequired":false,"billingCode":"30100","codeType":"CPT"},{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1993,"precertRequired":false,"billingCode":"31237","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":2002,"precertRequired":false,"billingCode":"31535","codeType":"CPT"},{"id":2003,"precertRequired":false,"billingCode":"31536","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2024,"precertRequired":false,"billingCode":"31622","codeType":"CPT"},{"id":2025,"precertRequired":false,"billingCode":"31623","codeType":"CPT"},{"id":2026,"precertRequired":false,"billingCode":"31624","codeType":"CPT"},{"id":2027,"precertRequired":false,"billingCode":"31625","codeType":"CPT"},{"id":2028,"precertRequired":false,"billingCode":"31626","codeType":"CPT"},{"id":2029,"precertRequired":false,"billingCode":"31627","codeType":"CPT"},{"id":2030,"precertRequired":false,"billingCode":"31628","codeType":"CPT"},{"id":2031,"precertRequired":false,"billingCode":"31629","codeType":"CPT"},{"id":2032,"precertRequired":false,"billingCode":"31630","codeType":"CPT"},{"id":2033,"precertRequired":false,"billingCode":"31631","codeType":"CPT"},{"id":2034,"precertRequired":false,"billingCode":"31632","codeType":"CPT"},{"id":2035,"precertRequired":false,"billingCode":"31633","codeType":"CPT"},{"id":2036,"precertRequired":false,"billingCode":"31634","codeType":"CPT"},{"id":2037,"precertRequired":false,"billingCode":"31635","codeType":"CPT"},{"id":2038,"precertRequired":false,"billingCode":"31636","codeType":"CPT"},{"id":2039,"precertRequired":false,"billingCode":"31637","codeType":"CPT"},{"id":2040,"precertRequired":false,"billingCode":"31638","codeType":"CPT"},{"id":2041,"precertRequired":false,"billingCode":"31640","codeType":"CPT"},{"id":2042,"precertRequired":false,"billingCode":"31641","codeType":"CPT"},{"id":2043,"precertRequired":false,"billingCode":"31643","codeType":"CPT"},{"id":2044,"precertRequired":false,"billingCode":"31645","codeType":"CPT"},{"id":2045,"precertRequired":false,"billingCode":"31646","codeType":"CPT"},{"id":2046,"precertRequired":false,"billingCode":"31647","codeType":"CPT"},{"id":2047,"precertRequired":false,"billingCode":"31648","codeType":"CPT"},{"id":2048,"precertRequired":false,"billingCode":"31649","codeType":"CPT"},{"id":2049,"precertRequired":false,"billingCode":"31651","codeType":"CPT"},{"id":2050,"precertRequired":false,"billingCode":"31652","codeType":"CPT"},{"id":2051,"precertRequired":false,"billingCode":"31653","codeType":"CPT"},{"id":2052,"precertRequired":false,"billingCode":"31654","codeType":"CPT"},{"id":2053,"precertRequired":false,"billingCode":"31660","codeType":"CPT"},{"id":2054,"precertRequired":false,"billingCode":"31661","codeType":"CPT"},{"id":2077,"precertRequired":true,"billingCode":"32096","codeType":"CPT"},{"id":2078,"precertRequired":true,"billingCode":"32097","codeType":"CPT"},{"id":2079,"precertRequired":true,"billingCode":"32098","codeType":"CPT"},{"id":2083,"precertRequired":true,"billingCode":"32124","codeType":"CPT"},{"id":2096,"precertRequired":false,"billingCode":"32405","codeType":"CPT"},{"id":2114,"precertRequired":true,"billingCode":"32554","codeType":"CPT"},{"id":2115,"precertRequired":true,"billingCode":"32555","codeType":"CPT"},{"id":2116,"precertRequired":true,"billingCode":"32556","codeType":"CPT"},{"id":2117,"precertRequired":true,"billingCode":"32557","codeType":"CPT"},{"id":2149,"precertRequired":true,"billingCode":"32674","codeType":"CPT"},{"id":2151,"precertRequired":true,"billingCode":"32800","codeType":"CPT"},{"id":2152,"precertRequired":true,"billingCode":"32810","codeType":"CPT"},{"id":2153,"precertRequired":true,"billingCode":"32815","codeType":"CPT"},{"id":2164,"precertRequired":true,"billingCode":"32940","codeType":"CPT"},{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2567,"precertRequired":false,"billingCode":"36565","codeType":"CPT"},{"id":2568,"precertRequired":false,"billingCode":"36566","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2572,"precertRequired":false,"billingCode":"36571","codeType":"CPT"},{"id":2573,"precertRequired":false,"billingCode":"36575","codeType":"CPT"},{"id":2574,"precertRequired":false,"billingCode":"36576","codeType":"CPT"},{"id":2580,"precertRequired":false,"billingCode":"36584","codeType":"CPT"},{"id":2581,"precertRequired":false,"billingCode":"36585","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2583,"precertRequired":false,"billingCode":"36590","codeType":"CPT"},{"id":2633,"precertRequired":false,"billingCode":"37200","codeType":"CPT"},{"id":2662,"precertRequired":false,"billingCode":"37241","codeType":"CPT"},{"id":2663,"precertRequired":false,"billingCode":"37242","codeType":"CPT"},{"id":2664,"precertRequired":false,"billingCode":"37243","codeType":"CPT"},{"id":2665,"precertRequired":false,"billingCode":"37244","codeType":"CPT"},{"id":2674,"precertRequired":false,"billingCode":"38100","codeType":"CPT"},{"id":2675,"precertRequired":false,"billingCode":"38101","codeType":"CPT"},{"id":2676,"precertRequired":false,"billingCode":"38102","codeType":"CPT"},{"id":2677,"precertRequired":false,"billingCode":"38115","codeType":"CPT"},{"id":2678,"precertRequired":false,"billingCode":"38120","codeType":"CPT"},{"id":2682,"precertRequired":false,"billingCode":"38300","codeType":"CPT"},{"id":2683,"precertRequired":false,"billingCode":"38305","codeType":"CPT"},{"id":2684,"precertRequired":false,"billingCode":"38308","codeType":"CPT"},{"id":2685,"precertRequired":false,"billingCode":"38380","codeType":"CPT"},{"id":2686,"precertRequired":true,"billingCode":"38381","codeType":"CPT"},{"id":2687,"precertRequired":false,"billingCode":"38382","codeType":"CPT"},{"id":2688,"precertRequired":false,"billingCode":"38500","codeType":"CPT"},{"id":2689,"precertRequired":false,"billingCode":"38505","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2691,"precertRequired":false,"billingCode":"38520","codeType":"CPT"},{"id":2692,"precertRequired":false,"billingCode":"38525","codeType":"CPT"},{"id":2693,"precertRequired":false,"billingCode":"38530","codeType":"CPT"},{"id":2694,"precertRequired":false,"billingCode":"38542","codeType":"CPT"},{"id":2695,"precertRequired":false,"billingCode":"38550","codeType":"CPT"},{"id":2696,"precertRequired":false,"billingCode":"38555","codeType":"CPT"},{"id":2697,"precertRequired":false,"billingCode":"38562","codeType":"CPT"},{"id":2698,"precertRequired":false,"billingCode":"38564","codeType":"CPT"},{"id":2699,"precertRequired":false,"billingCode":"38570","codeType":"CPT"},{"id":2700,"precertRequired":false,"billingCode":"38571","codeType":"CPT"},{"id":2701,"precertRequired":false,"billingCode":"38572","codeType":"CPT"},{"id":2702,"precertRequired":false,"billingCode":"38573","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2704,"precertRequired":false,"billingCode":"38720","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2706,"precertRequired":false,"billingCode":"38740","codeType":"CPT"},{"id":2707,"precertRequired":false,"billingCode":"38745","codeType":"CPT"},{"id":2708,"precertRequired":false,"billingCode":"38746","codeType":"CPT"},{"id":2709,"precertRequired":false,"billingCode":"38747","codeType":"CPT"},{"id":2710,"precertRequired":false,"billingCode":"38760","codeType":"CPT"},{"id":2711,"precertRequired":false,"billingCode":"38765","codeType":"CPT"},{"id":2712,"precertRequired":false,"billingCode":"38770","codeType":"CPT"},{"id":2713,"precertRequired":false,"billingCode":"38780","codeType":"CPT"},{"id":2714,"precertRequired":false,"billingCode":"38790","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":2725,"precertRequired":false,"billingCode":"41100","codeType":"CPT"},{"id":2726,"precertRequired":false,"billingCode":"41105","codeType":"CPT"},{"id":2727,"precertRequired":false,"billingCode":"41108","codeType":"CPT"},{"id":2729,"precertRequired":false,"billingCode":"42100","codeType":"CPT"},{"id":2730,"precertRequired":false,"billingCode":"42300","codeType":"CPT"},{"id":2731,"precertRequired":false,"billingCode":"42310","codeType":"CPT"},{"id":2734,"precertRequired":false,"billingCode":"42700","codeType":"CPT"},{"id":2735,"precertRequired":false,"billingCode":"42800","codeType":"CPT"},{"id":2736,"precertRequired":false,"billingCode":"42804","codeType":"CPT"},{"id":2737,"precertRequired":false,"billingCode":"42806","codeType":"CPT"},{"id":2739,"precertRequired":false,"billingCode":"43020","codeType":"CPT"},{"id":2741,"precertRequired":false,"billingCode":"43045","codeType":"CPT"},{"id":2748,"precertRequired":false,"billingCode":"43116","codeType":"CPT"},{"id":2749,"precertRequired":false,"billingCode":"43117","codeType":"CPT"},{"id":2750,"precertRequired":false,"billingCode":"43118","codeType":"CPT"},{"id":2751,"precertRequired":false,"billingCode":"43121","codeType":"CPT"},{"id":2752,"precertRequired":false,"billingCode":"43122","codeType":"CPT"},{"id":2753,"precertRequired":false,"billingCode":"43123","codeType":"CPT"},{"id":2754,"precertRequired":false,"billingCode":"43124","codeType":"CPT"},{"id":2755,"precertRequired":false,"billingCode":"43130","codeType":"CPT"},{"id":2756,"precertRequired":false,"billingCode":"43135","codeType":"CPT"},{"id":2757,"precertRequired":false,"billingCode":"43180","codeType":"CPT"},{"id":2758,"precertRequired":false,"billingCode":"43191","codeType":"CPT"},{"id":2759,"precertRequired":false,"billingCode":"43192","codeType":"CPT"},{"id":2760,"precertRequired":false,"billingCode":"43193","codeType":"CPT"},{"id":2761,"precertRequired":false,"billingCode":"43194","codeType":"CPT"},{"id":2762,"precertRequired":false,"billingCode":"43195","codeType":"CPT"},{"id":2763,"precertRequired":false,"billingCode":"43196","codeType":"CPT"},{"id":2764,"precertRequired":false,"billingCode":"43197","codeType":"CPT"},{"id":2765,"precertRequired":false,"billingCode":"43198","codeType":"CPT"},{"id":2766,"precertRequired":false,"billingCode":"43200","codeType":"CPT"},{"id":2767,"precertRequired":false,"billingCode":"43201","codeType":"CPT"},{"id":2768,"precertRequired":false,"billingCode":"43202","codeType":"CPT"},{"id":2769,"precertRequired":false,"billingCode":"43204","codeType":"CPT"},{"id":2770,"precertRequired":false,"billingCode":"43205","codeType":"CPT"},{"id":2771,"precertRequired":false,"billingCode":"43206","codeType":"CPT"},{"id":2772,"precertRequired":false,"billingCode":"43210","codeType":"CPT"},{"id":2773,"precertRequired":false,"billingCode":"43211","codeType":"CPT"},{"id":2774,"precertRequired":false,"billingCode":"43212","codeType":"CPT"},{"id":2775,"precertRequired":false,"billingCode":"43213","codeType":"CPT"},{"id":2776,"precertRequired":false,"billingCode":"43214","codeType":"CPT"},{"id":2777,"precertRequired":false,"billingCode":"43215","codeType":"CPT"},{"id":2778,"precertRequired":false,"billingCode":"43216","codeType":"CPT"},{"id":2779,"precertRequired":false,"billingCode":"43217","codeType":"CPT"},{"id":2781,"precertRequired":false,"billingCode":"43220","codeType":"CPT"},{"id":2782,"precertRequired":false,"billingCode":"43226","codeType":"CPT"},{"id":2783,"precertRequired":false,"billingCode":"43227","codeType":"CPT"},{"id":2784,"precertRequired":false,"billingCode":"43229","codeType":"CPT"},{"id":2785,"precertRequired":false,"billingCode":"43231","codeType":"CPT"},{"id":2786,"precertRequired":false,"billingCode":"43232","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2790,"precertRequired":false,"billingCode":"43237","codeType":"CPT"},{"id":2791,"precertRequired":false,"billingCode":"43238","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2795,"precertRequired":false,"billingCode":"43242","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2810,"precertRequired":false,"billingCode":"43259","codeType":"CPT"},{"id":2811,"precertRequired":false,"billingCode":"43260","codeType":"CPT"},{"id":2812,"precertRequired":false,"billingCode":"43261","codeType":"CPT"},{"id":2813,"precertRequired":false,"billingCode":"43262","codeType":"CPT"},{"id":2814,"precertRequired":false,"billingCode":"43263","codeType":"CPT"},{"id":2815,"precertRequired":false,"billingCode":"43264","codeType":"CPT"},{"id":2816,"precertRequired":false,"billingCode":"43265","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2819,"precertRequired":false,"billingCode":"43273","codeType":"CPT"},{"id":2820,"precertRequired":false,"billingCode":"43274","codeType":"CPT"},{"id":2821,"precertRequired":false,"billingCode":"43275","codeType":"CPT"},{"id":2822,"precertRequired":false,"billingCode":"43276","codeType":"CPT"},{"id":2823,"precertRequired":false,"billingCode":"43277","codeType":"CPT"},{"id":2824,"precertRequired":false,"billingCode":"43278","codeType":"CPT"},{"id":2825,"precertRequired":false,"billingCode":"43279","codeType":"CPT"},{"id":2826,"precertRequired":false,"billingCode":"43280","codeType":"CPT"},{"id":2827,"precertRequired":false,"billingCode":"43281","codeType":"CPT"},{"id":2828,"precertRequired":false,"billingCode":"43282","codeType":"CPT"},{"id":2829,"precertRequired":false,"billingCode":"43283","codeType":"CPT"},{"id":2830,"precertRequired":false,"billingCode":"43284","codeType":"CPT"},{"id":2831,"precertRequired":false,"billingCode":"43285","codeType":"CPT"},{"id":2832,"precertRequired":false,"billingCode":"43286","codeType":"CPT"},{"id":2833,"precertRequired":false,"billingCode":"43287","codeType":"CPT"},{"id":2834,"precertRequired":false,"billingCode":"43288","codeType":"CPT"},{"id":2836,"precertRequired":false,"billingCode":"43300","codeType":"CPT"},{"id":2837,"precertRequired":false,"billingCode":"43305","codeType":"CPT"},{"id":2838,"precertRequired":false,"billingCode":"43310","codeType":"CPT"},{"id":2839,"precertRequired":false,"billingCode":"43312","codeType":"CPT"},{"id":2840,"precertRequired":false,"billingCode":"43313","codeType":"CPT"},{"id":2841,"precertRequired":false,"billingCode":"43314","codeType":"CPT"},{"id":2842,"precertRequired":false,"billingCode":"43320","codeType":"CPT"},{"id":2843,"precertRequired":false,"billingCode":"43325","codeType":"CPT"},{"id":2844,"precertRequired":false,"billingCode":"43327","codeType":"CPT"},{"id":2845,"precertRequired":false,"billingCode":"43328","codeType":"CPT"},{"id":2846,"precertRequired":false,"billingCode":"43330","codeType":"CPT"},{"id":2847,"precertRequired":false,"billingCode":"43331","codeType":"CPT"},{"id":2848,"precertRequired":false,"billingCode":"43332","codeType":"CPT"},{"id":2849,"precertRequired":false,"billingCode":"43333","codeType":"CPT"},{"id":2850,"precertRequired":false,"billingCode":"43334","codeType":"CPT"},{"id":2851,"precertRequired":false,"billingCode":"43335","codeType":"CPT"},{"id":2852,"precertRequired":false,"billingCode":"43336","codeType":"CPT"},{"id":2853,"precertRequired":false,"billingCode":"43337","codeType":"CPT"},{"id":2854,"precertRequired":false,"billingCode":"43338","codeType":"CPT"},{"id":2855,"precertRequired":false,"billingCode":"43340","codeType":"CPT"},{"id":2856,"precertRequired":false,"billingCode":"43341","codeType":"CPT"},{"id":2857,"precertRequired":false,"billingCode":"43351","codeType":"CPT"},{"id":2858,"precertRequired":false,"billingCode":"43352","codeType":"CPT"},{"id":2859,"precertRequired":false,"billingCode":"43360","codeType":"CPT"},{"id":2860,"precertRequired":false,"billingCode":"43361","codeType":"CPT"},{"id":2861,"precertRequired":false,"billingCode":"43400","codeType":"CPT"},{"id":2863,"precertRequired":false,"billingCode":"43405","codeType":"CPT"},{"id":2864,"precertRequired":false,"billingCode":"43410","codeType":"CPT"},{"id":2865,"precertRequired":false,"billingCode":"43415","codeType":"CPT"},{"id":2866,"precertRequired":false,"billingCode":"43420","codeType":"CPT"},{"id":2867,"precertRequired":false,"billingCode":"43425","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":2869,"precertRequired":false,"billingCode":"43453","codeType":"CPT"},{"id":2870,"precertRequired":false,"billingCode":"43460","codeType":"CPT"},{"id":2871,"precertRequired":false,"billingCode":"43496","codeType":"CPT"},{"id":2873,"precertRequired":false,"billingCode":"43500","codeType":"CPT"},{"id":2874,"precertRequired":false,"billingCode":"43501","codeType":"CPT"},{"id":2875,"precertRequired":false,"billingCode":"43502","codeType":"CPT"},{"id":2876,"precertRequired":false,"billingCode":"43510","codeType":"CPT"},{"id":2877,"precertRequired":false,"billingCode":"43520","codeType":"CPT"},{"id":2878,"precertRequired":false,"billingCode":"43605","codeType":"CPT"},{"id":2879,"precertRequired":false,"billingCode":"43610","codeType":"CPT"},{"id":2880,"precertRequired":false,"billingCode":"43611","codeType":"CPT"},{"id":2881,"precertRequired":false,"billingCode":"43620","codeType":"CPT"},{"id":2882,"precertRequired":false,"billingCode":"43621","codeType":"CPT"},{"id":2883,"precertRequired":false,"billingCode":"43622","codeType":"CPT"},{"id":2884,"precertRequired":false,"billingCode":"43631","codeType":"CPT"},{"id":2885,"precertRequired":false,"billingCode":"43632","codeType":"CPT"},{"id":2886,"precertRequired":false,"billingCode":"43633","codeType":"CPT"},{"id":2887,"precertRequired":false,"billingCode":"43634","codeType":"CPT"},{"id":2888,"precertRequired":false,"billingCode":"43635","codeType":"CPT"},{"id":2889,"precertRequired":false,"billingCode":"43640","codeType":"CPT"},{"id":2890,"precertRequired":false,"billingCode":"43641","codeType":"CPT"},{"id":2891,"precertRequired":false,"billingCode":"43644","codeType":"CPT"},{"id":2892,"precertRequired":false,"billingCode":"43645","codeType":"CPT"},{"id":2893,"precertRequired":false,"billingCode":"43647","codeType":"CPT"},{"id":2894,"precertRequired":false,"billingCode":"43648","codeType":"CPT"},{"id":2895,"precertRequired":false,"billingCode":"43651","codeType":"CPT"},{"id":2896,"precertRequired":false,"billingCode":"43652","codeType":"CPT"},{"id":2897,"precertRequired":false,"billingCode":"43653","codeType":"CPT"},{"id":2898,"precertRequired":false,"billingCode":"43752","codeType":"CPT"},{"id":2899,"precertRequired":false,"billingCode":"43753","codeType":"CPT"},{"id":2900,"precertRequired":false,"billingCode":"43754","codeType":"CPT"},{"id":2901,"precertRequired":false,"billingCode":"43755","codeType":"CPT"},{"id":2902,"precertRequired":false,"billingCode":"43756","codeType":"CPT"},{"id":2903,"precertRequired":false,"billingCode":"43757","codeType":"CPT"},{"id":2905,"precertRequired":false,"billingCode":"43761","codeType":"CPT"},{"id":2906,"precertRequired":false,"billingCode":"43770","codeType":"CPT"},{"id":2907,"precertRequired":false,"billingCode":"43771","codeType":"CPT"},{"id":2908,"precertRequired":false,"billingCode":"43772","codeType":"CPT"},{"id":2909,"precertRequired":false,"billingCode":"43773","codeType":"CPT"},{"id":2910,"precertRequired":false,"billingCode":"43774","codeType":"CPT"},{"id":2911,"precertRequired":false,"billingCode":"43775","codeType":"CPT"},{"id":2912,"precertRequired":false,"billingCode":"43800","codeType":"CPT"},{"id":2913,"precertRequired":false,"billingCode":"43810","codeType":"CPT"},{"id":2914,"precertRequired":false,"billingCode":"43820","codeType":"CPT"},{"id":2915,"precertRequired":false,"billingCode":"43825","codeType":"CPT"},{"id":2916,"precertRequired":false,"billingCode":"43830","codeType":"CPT"},{"id":2918,"precertRequired":false,"billingCode":"43832","codeType":"CPT"},{"id":2919,"precertRequired":false,"billingCode":"43840","codeType":"CPT"},{"id":2920,"precertRequired":false,"billingCode":"43842","codeType":"CPT"},{"id":2921,"precertRequired":false,"billingCode":"43843","codeType":"CPT"},{"id":2922,"precertRequired":false,"billingCode":"43845","codeType":"CPT"},{"id":2923,"precertRequired":false,"billingCode":"43846","codeType":"CPT"},{"id":2924,"precertRequired":false,"billingCode":"43847","codeType":"CPT"},{"id":2925,"precertRequired":false,"billingCode":"43848","codeType":"CPT"},{"id":2926,"precertRequired":false,"billingCode":"43850","codeType":"CPT"},{"id":2927,"precertRequired":false,"billingCode":"43855","codeType":"CPT"},{"id":2928,"precertRequired":false,"billingCode":"43860","codeType":"CPT"},{"id":2929,"precertRequired":false,"billingCode":"43865","codeType":"CPT"},{"id":2930,"precertRequired":false,"billingCode":"43870","codeType":"CPT"},{"id":2931,"precertRequired":false,"billingCode":"43880","codeType":"CPT"},{"id":2932,"precertRequired":false,"billingCode":"43881","codeType":"CPT"},{"id":2933,"precertRequired":false,"billingCode":"43882","codeType":"CPT"},{"id":2934,"precertRequired":false,"billingCode":"43886","codeType":"CPT"},{"id":2935,"precertRequired":false,"billingCode":"43887","codeType":"CPT"},{"id":2936,"precertRequired":false,"billingCode":"43888","codeType":"CPT"},{"id":2937,"precertRequired":false,"billingCode":"44005","codeType":"CPT"},{"id":2938,"precertRequired":false,"billingCode":"44010","codeType":"CPT"},{"id":2939,"precertRequired":false,"billingCode":"44015","codeType":"CPT"},{"id":2940,"precertRequired":false,"billingCode":"44020","codeType":"CPT"},{"id":2941,"precertRequired":false,"billingCode":"44021","codeType":"CPT"},{"id":2942,"precertRequired":false,"billingCode":"44025","codeType":"CPT"},{"id":2943,"precertRequired":false,"billingCode":"44050","codeType":"CPT"},{"id":2944,"precertRequired":false,"billingCode":"44055","codeType":"CPT"},{"id":2945,"precertRequired":false,"billingCode":"44100","codeType":"CPT"},{"id":2946,"precertRequired":false,"billingCode":"44110","codeType":"CPT"},{"id":2947,"precertRequired":false,"billingCode":"44111","codeType":"CPT"},{"id":2948,"precertRequired":false,"billingCode":"44120","codeType":"CPT"},{"id":2949,"precertRequired":false,"billingCode":"44121","codeType":"CPT"},{"id":2950,"precertRequired":false,"billingCode":"44125","codeType":"CPT"},{"id":2951,"precertRequired":false,"billingCode":"44126","codeType":"CPT"},{"id":2952,"precertRequired":false,"billingCode":"44127","codeType":"CPT"},{"id":2953,"precertRequired":false,"billingCode":"44128","codeType":"CPT"},{"id":2954,"precertRequired":false,"billingCode":"44130","codeType":"CPT"},{"id":2960,"precertRequired":false,"billingCode":"44139","codeType":"CPT"},{"id":2961,"precertRequired":false,"billingCode":"44140","codeType":"CPT"},{"id":2962,"precertRequired":false,"billingCode":"44141","codeType":"CPT"},{"id":2963,"precertRequired":false,"billingCode":"44143","codeType":"CPT"},{"id":2964,"precertRequired":false,"billingCode":"44144","codeType":"CPT"},{"id":2965,"precertRequired":false,"billingCode":"44145","codeType":"CPT"},{"id":2966,"precertRequired":false,"billingCode":"44146","codeType":"CPT"},{"id":2967,"precertRequired":false,"billingCode":"44147","codeType":"CPT"},{"id":2968,"precertRequired":false,"billingCode":"44150","codeType":"CPT"},{"id":2969,"precertRequired":false,"billingCode":"44151","codeType":"CPT"},{"id":2970,"precertRequired":false,"billingCode":"44155","codeType":"CPT"},{"id":2971,"precertRequired":false,"billingCode":"44156","codeType":"CPT"},{"id":2972,"precertRequired":false,"billingCode":"44157","codeType":"CPT"},{"id":2973,"precertRequired":false,"billingCode":"44158","codeType":"CPT"},{"id":2974,"precertRequired":false,"billingCode":"44160","codeType":"CPT"},{"id":2975,"precertRequired":false,"billingCode":"44180","codeType":"CPT"},{"id":2976,"precertRequired":false,"billingCode":"44186","codeType":"CPT"},{"id":2977,"precertRequired":false,"billingCode":"44187","codeType":"CPT"},{"id":2978,"precertRequired":false,"billingCode":"44188","codeType":"CPT"},{"id":2979,"precertRequired":false,"billingCode":"44202","codeType":"CPT"},{"id":2980,"precertRequired":false,"billingCode":"44203","codeType":"CPT"},{"id":2981,"precertRequired":false,"billingCode":"44204","codeType":"CPT"},{"id":2982,"precertRequired":false,"billingCode":"44205","codeType":"CPT"},{"id":2983,"precertRequired":false,"billingCode":"44206","codeType":"CPT"},{"id":2984,"precertRequired":false,"billingCode":"44207","codeType":"CPT"},{"id":2985,"precertRequired":false,"billingCode":"44208","codeType":"CPT"},{"id":2986,"precertRequired":false,"billingCode":"44210","codeType":"CPT"},{"id":2987,"precertRequired":false,"billingCode":"44211","codeType":"CPT"},{"id":2988,"precertRequired":false,"billingCode":"44212","codeType":"CPT"},{"id":2989,"precertRequired":false,"billingCode":"44213","codeType":"CPT"},{"id":2990,"precertRequired":false,"billingCode":"44227","codeType":"CPT"},{"id":2991,"precertRequired":false,"billingCode":"44300","codeType":"CPT"},{"id":2992,"precertRequired":false,"billingCode":"44310","codeType":"CPT"},{"id":2993,"precertRequired":false,"billingCode":"44312","codeType":"CPT"},{"id":2994,"precertRequired":false,"billingCode":"44314","codeType":"CPT"},{"id":2995,"precertRequired":false,"billingCode":"44316","codeType":"CPT"},{"id":2996,"precertRequired":false,"billingCode":"44320","codeType":"CPT"},{"id":2997,"precertRequired":false,"billingCode":"44322","codeType":"CPT"},{"id":2998,"precertRequired":false,"billingCode":"44340","codeType":"CPT"},{"id":2999,"precertRequired":false,"billingCode":"44345","codeType":"CPT"},{"id":3000,"precertRequired":false,"billingCode":"44346","codeType":"CPT"},{"id":3001,"precertRequired":false,"billingCode":"44360","codeType":"CPT"},{"id":3002,"precertRequired":false,"billingCode":"44361","codeType":"CPT"},{"id":3003,"precertRequired":false,"billingCode":"44363","codeType":"CPT"},{"id":3004,"precertRequired":false,"billingCode":"44364","codeType":"CPT"},{"id":3005,"precertRequired":false,"billingCode":"44365","codeType":"CPT"},{"id":3006,"precertRequired":false,"billingCode":"44366","codeType":"CPT"},{"id":3007,"precertRequired":false,"billingCode":"44369","codeType":"CPT"},{"id":3008,"precertRequired":false,"billingCode":"44370","codeType":"CPT"},{"id":3009,"precertRequired":false,"billingCode":"44372","codeType":"CPT"},{"id":3010,"precertRequired":false,"billingCode":"44373","codeType":"CPT"},{"id":3011,"precertRequired":false,"billingCode":"44376","codeType":"CPT"},{"id":3012,"precertRequired":false,"billingCode":"44377","codeType":"CPT"},{"id":3013,"precertRequired":false,"billingCode":"44378","codeType":"CPT"},{"id":3014,"precertRequired":false,"billingCode":"44379","codeType":"CPT"},{"id":3015,"precertRequired":false,"billingCode":"44380","codeType":"CPT"},{"id":3016,"precertRequired":false,"billingCode":"44381","codeType":"CPT"},{"id":3017,"precertRequired":false,"billingCode":"44382","codeType":"CPT"},{"id":3018,"precertRequired":false,"billingCode":"44384","codeType":"CPT"},{"id":3019,"precertRequired":false,"billingCode":"44385","codeType":"CPT"},{"id":3020,"precertRequired":false,"billingCode":"44386","codeType":"CPT"},{"id":3021,"precertRequired":false,"billingCode":"44388","codeType":"CPT"},{"id":3022,"precertRequired":false,"billingCode":"44389","codeType":"CPT"},{"id":3023,"precertRequired":false,"billingCode":"44390","codeType":"CPT"},{"id":3024,"precertRequired":false,"billingCode":"44391","codeType":"CPT"},{"id":3025,"precertRequired":false,"billingCode":"44392","codeType":"CPT"},{"id":3026,"precertRequired":false,"billingCode":"44394","codeType":"CPT"},{"id":3027,"precertRequired":false,"billingCode":"44401","codeType":"CPT"},{"id":3028,"precertRequired":false,"billingCode":"44402","codeType":"CPT"},{"id":3029,"precertRequired":false,"billingCode":"44403","codeType":"CPT"},{"id":3030,"precertRequired":false,"billingCode":"44404","codeType":"CPT"},{"id":3031,"precertRequired":false,"billingCode":"44405","codeType":"CPT"},{"id":3032,"precertRequired":false,"billingCode":"44406","codeType":"CPT"},{"id":3033,"precertRequired":false,"billingCode":"44407","codeType":"CPT"},{"id":3034,"precertRequired":false,"billingCode":"44408","codeType":"CPT"},{"id":3035,"precertRequired":false,"billingCode":"44500","codeType":"CPT"},{"id":3036,"precertRequired":false,"billingCode":"44602","codeType":"CPT"},{"id":3037,"precertRequired":false,"billingCode":"44603","codeType":"CPT"},{"id":3038,"precertRequired":false,"billingCode":"44604","codeType":"CPT"},{"id":3039,"precertRequired":false,"billingCode":"44605","codeType":"CPT"},{"id":3040,"precertRequired":false,"billingCode":"44615","codeType":"CPT"},{"id":3041,"precertRequired":false,"billingCode":"44620","codeType":"CPT"},{"id":3042,"precertRequired":false,"billingCode":"44625","codeType":"CPT"},{"id":3043,"precertRequired":false,"billingCode":"44626","codeType":"CPT"},{"id":3044,"precertRequired":false,"billingCode":"44640","codeType":"CPT"},{"id":3045,"precertRequired":false,"billingCode":"44650","codeType":"CPT"},{"id":3046,"precertRequired":false,"billingCode":"44660","codeType":"CPT"},{"id":3047,"precertRequired":false,"billingCode":"44661","codeType":"CPT"},{"id":3048,"precertRequired":false,"billingCode":"44680","codeType":"CPT"},{"id":3049,"precertRequired":false,"billingCode":"44700","codeType":"CPT"},{"id":3050,"precertRequired":false,"billingCode":"44701","codeType":"CPT"},{"id":3056,"precertRequired":false,"billingCode":"44800","codeType":"CPT"},{"id":3057,"precertRequired":false,"billingCode":"44820","codeType":"CPT"},{"id":3058,"precertRequired":false,"billingCode":"44850","codeType":"CPT"},{"id":3059,"precertRequired":false,"billingCode":"44900","codeType":"CPT"},{"id":3060,"precertRequired":false,"billingCode":"44950","codeType":"CPT"},{"id":3061,"precertRequired":false,"billingCode":"44955","codeType":"CPT"},{"id":3062,"precertRequired":false,"billingCode":"44960","codeType":"CPT"},{"id":3063,"precertRequired":false,"billingCode":"44970","codeType":"CPT"},{"id":3064,"precertRequired":false,"billingCode":"45000","codeType":"CPT"},{"id":3065,"precertRequired":false,"billingCode":"45005","codeType":"CPT"},{"id":3066,"precertRequired":false,"billingCode":"45020","codeType":"CPT"},{"id":3067,"precertRequired":false,"billingCode":"45100","codeType":"CPT"},{"id":3068,"precertRequired":false,"billingCode":"45108","codeType":"CPT"},{"id":3069,"precertRequired":false,"billingCode":"45110","codeType":"CPT"},{"id":3070,"precertRequired":false,"billingCode":"45111","codeType":"CPT"},{"id":3071,"precertRequired":false,"billingCode":"45112","codeType":"CPT"},{"id":3072,"precertRequired":false,"billingCode":"45113","codeType":"CPT"},{"id":3073,"precertRequired":false,"billingCode":"45114","codeType":"CPT"},{"id":3074,"precertRequired":false,"billingCode":"45116","codeType":"CPT"},{"id":3075,"precertRequired":false,"billingCode":"45119","codeType":"CPT"},{"id":3076,"precertRequired":false,"billingCode":"45120","codeType":"CPT"},{"id":3077,"precertRequired":false,"billingCode":"45121","codeType":"CPT"},{"id":3078,"precertRequired":false,"billingCode":"45123","codeType":"CPT"},{"id":3079,"precertRequired":false,"billingCode":"45126","codeType":"CPT"},{"id":3080,"precertRequired":false,"billingCode":"45130","codeType":"CPT"},{"id":3081,"precertRequired":false,"billingCode":"45135","codeType":"CPT"},{"id":3082,"precertRequired":false,"billingCode":"45136","codeType":"CPT"},{"id":3083,"precertRequired":false,"billingCode":"45150","codeType":"CPT"},{"id":3084,"precertRequired":false,"billingCode":"45160","codeType":"CPT"},{"id":3085,"precertRequired":false,"billingCode":"45171","codeType":"CPT"},{"id":3086,"precertRequired":false,"billingCode":"45172","codeType":"CPT"},{"id":3087,"precertRequired":false,"billingCode":"45190","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3123,"precertRequired":false,"billingCode":"45388","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3129,"precertRequired":false,"billingCode":"45395","codeType":"CPT"},{"id":3130,"precertRequired":false,"billingCode":"45397","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"},{"id":3132,"precertRequired":false,"billingCode":"45400","codeType":"CPT"},{"id":3133,"precertRequired":false,"billingCode":"45402","codeType":"CPT"},{"id":3134,"precertRequired":false,"billingCode":"45500","codeType":"CPT"},{"id":3135,"precertRequired":false,"billingCode":"45505","codeType":"CPT"},{"id":3136,"precertRequired":false,"billingCode":"45520","codeType":"CPT"},{"id":3137,"precertRequired":false,"billingCode":"45540","codeType":"CPT"},{"id":3138,"precertRequired":false,"billingCode":"45541","codeType":"CPT"},{"id":3139,"precertRequired":false,"billingCode":"45550","codeType":"CPT"},{"id":3140,"precertRequired":false,"billingCode":"45560","codeType":"CPT"},{"id":3141,"precertRequired":false,"billingCode":"45562","codeType":"CPT"},{"id":3142,"precertRequired":false,"billingCode":"45563","codeType":"CPT"},{"id":3143,"precertRequired":false,"billingCode":"45800","codeType":"CPT"},{"id":3144,"precertRequired":false,"billingCode":"45805","codeType":"CPT"},{"id":3145,"precertRequired":false,"billingCode":"45820","codeType":"CPT"},{"id":3146,"precertRequired":false,"billingCode":"45825","codeType":"CPT"},{"id":3147,"precertRequired":false,"billingCode":"45900","codeType":"CPT"},{"id":3148,"precertRequired":false,"billingCode":"45905","codeType":"CPT"},{"id":3149,"precertRequired":false,"billingCode":"45910","codeType":"CPT"},{"id":3150,"precertRequired":false,"billingCode":"45915","codeType":"CPT"},{"id":3151,"precertRequired":false,"billingCode":"45990","codeType":"CPT"},{"id":3152,"precertRequired":false,"billingCode":"46020","codeType":"CPT"},{"id":3153,"precertRequired":false,"billingCode":"46030","codeType":"CPT"},{"id":3154,"precertRequired":false,"billingCode":"46040","codeType":"CPT"},{"id":3155,"precertRequired":false,"billingCode":"46045","codeType":"CPT"},{"id":3156,"precertRequired":false,"billingCode":"46050","codeType":"CPT"},{"id":3157,"precertRequired":false,"billingCode":"46060","codeType":"CPT"},{"id":3158,"precertRequired":false,"billingCode":"46080","codeType":"CPT"},{"id":3159,"precertRequired":false,"billingCode":"46083","codeType":"CPT"},{"id":3160,"precertRequired":false,"billingCode":"46200","codeType":"CPT"},{"id":3161,"precertRequired":false,"billingCode":"46220","codeType":"CPT"},{"id":3162,"precertRequired":false,"billingCode":"46221","codeType":"CPT"},{"id":3163,"precertRequired":false,"billingCode":"46230","codeType":"CPT"},{"id":3164,"precertRequired":false,"billingCode":"46250","codeType":"CPT"},{"id":3165,"precertRequired":false,"billingCode":"46255","codeType":"CPT"},{"id":3166,"precertRequired":false,"billingCode":"46257","codeType":"CPT"},{"id":3167,"precertRequired":false,"billingCode":"46258","codeType":"CPT"},{"id":3168,"precertRequired":false,"billingCode":"46260","codeType":"CPT"},{"id":3169,"precertRequired":false,"billingCode":"46261","codeType":"CPT"},{"id":3170,"precertRequired":false,"billingCode":"46262","codeType":"CPT"},{"id":3171,"precertRequired":false,"billingCode":"46270","codeType":"CPT"},{"id":3172,"precertRequired":false,"billingCode":"46275","codeType":"CPT"},{"id":3173,"precertRequired":false,"billingCode":"46280","codeType":"CPT"},{"id":3174,"precertRequired":false,"billingCode":"46285","codeType":"CPT"},{"id":3175,"precertRequired":false,"billingCode":"46288","codeType":"CPT"},{"id":3176,"precertRequired":false,"billingCode":"46320","codeType":"CPT"},{"id":3177,"precertRequired":false,"billingCode":"46500","codeType":"CPT"},{"id":3178,"precertRequired":false,"billingCode":"46505","codeType":"CPT"},{"id":3179,"precertRequired":false,"billingCode":"46600","codeType":"CPT"},{"id":3180,"precertRequired":false,"billingCode":"46601","codeType":"CPT"},{"id":3181,"precertRequired":false,"billingCode":"46604","codeType":"CPT"},{"id":3182,"precertRequired":false,"billingCode":"46606","codeType":"CPT"},{"id":3183,"precertRequired":false,"billingCode":"46607","codeType":"CPT"},{"id":3184,"precertRequired":false,"billingCode":"46608","codeType":"CPT"},{"id":3185,"precertRequired":false,"billingCode":"46610","codeType":"CPT"},{"id":3186,"precertRequired":false,"billingCode":"46611","codeType":"CPT"},{"id":3187,"precertRequired":false,"billingCode":"46612","codeType":"CPT"},{"id":3188,"precertRequired":false,"billingCode":"46614","codeType":"CPT"},{"id":3189,"precertRequired":false,"billingCode":"46615","codeType":"CPT"},{"id":3190,"precertRequired":false,"billingCode":"46700","codeType":"CPT"},{"id":3191,"precertRequired":false,"billingCode":"46706","codeType":"CPT"},{"id":3192,"precertRequired":false,"billingCode":"46707","codeType":"CPT"},{"id":3193,"precertRequired":false,"billingCode":"46710","codeType":"CPT"},{"id":3194,"precertRequired":false,"billingCode":"46712","codeType":"CPT"},{"id":3195,"precertRequired":false,"billingCode":"46715","codeType":"CPT"},{"id":3196,"precertRequired":false,"billingCode":"46716","codeType":"CPT"},{"id":3197,"precertRequired":false,"billingCode":"46730","codeType":"CPT"},{"id":3198,"precertRequired":false,"billingCode":"46735","codeType":"CPT"},{"id":3199,"precertRequired":false,"billingCode":"46740","codeType":"CPT"},{"id":3200,"precertRequired":false,"billingCode":"46742","codeType":"CPT"},{"id":3201,"precertRequired":false,"billingCode":"46744","codeType":"CPT"},{"id":3202,"precertRequired":false,"billingCode":"46746","codeType":"CPT"},{"id":3204,"precertRequired":false,"billingCode":"46748","codeType":"CPT"},{"id":3205,"precertRequired":false,"billingCode":"46750","codeType":"CPT"},{"id":3207,"precertRequired":false,"billingCode":"46753","codeType":"CPT"},{"id":3208,"precertRequired":false,"billingCode":"46754","codeType":"CPT"},{"id":3209,"precertRequired":false,"billingCode":"46760","codeType":"CPT"},{"id":3210,"precertRequired":false,"billingCode":"46761","codeType":"CPT"},{"id":3212,"precertRequired":false,"billingCode":"46900","codeType":"CPT"},{"id":3213,"precertRequired":false,"billingCode":"46910","codeType":"CPT"},{"id":3214,"precertRequired":false,"billingCode":"46917","codeType":"CPT"},{"id":3215,"precertRequired":false,"billingCode":"46922","codeType":"CPT"},{"id":3216,"precertRequired":false,"billingCode":"46924","codeType":"CPT"},{"id":3217,"precertRequired":false,"billingCode":"46930","codeType":"CPT"},{"id":3218,"precertRequired":false,"billingCode":"46940","codeType":"CPT"},{"id":3219,"precertRequired":false,"billingCode":"46942","codeType":"CPT"},{"id":3220,"precertRequired":false,"billingCode":"46945","codeType":"CPT"},{"id":3221,"precertRequired":false,"billingCode":"46946","codeType":"CPT"},{"id":3222,"precertRequired":false,"billingCode":"46947","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3226,"precertRequired":false,"billingCode":"47010","codeType":"CPT"},{"id":3227,"precertRequired":false,"billingCode":"47015","codeType":"CPT"},{"id":3228,"precertRequired":false,"billingCode":"47100","codeType":"CPT"},{"id":3229,"precertRequired":false,"billingCode":"47120","codeType":"CPT"},{"id":3230,"precertRequired":false,"billingCode":"47122","codeType":"CPT"},{"id":3231,"precertRequired":false,"billingCode":"47125","codeType":"CPT"},{"id":3232,"precertRequired":false,"billingCode":"47130","codeType":"CPT"},{"id":3243,"precertRequired":false,"billingCode":"47300","codeType":"CPT"},{"id":3244,"precertRequired":false,"billingCode":"47350","codeType":"CPT"},{"id":3245,"precertRequired":false,"billingCode":"47360","codeType":"CPT"},{"id":3246,"precertRequired":false,"billingCode":"47361","codeType":"CPT"},{"id":3247,"precertRequired":false,"billingCode":"47362","codeType":"CPT"},{"id":3248,"precertRequired":false,"billingCode":"47371","codeType":"CPT"},{"id":3249,"precertRequired":false,"billingCode":"47381","codeType":"CPT"},{"id":3250,"precertRequired":false,"billingCode":"47382","codeType":"CPT"},{"id":3251,"precertRequired":false,"billingCode":"47383","codeType":"CPT"},{"id":3252,"precertRequired":false,"billingCode":"47400","codeType":"CPT"},{"id":3253,"precertRequired":false,"billingCode":"47420","codeType":"CPT"},{"id":3254,"precertRequired":false,"billingCode":"47425","codeType":"CPT"},{"id":3255,"precertRequired":false,"billingCode":"47460","codeType":"CPT"},{"id":3257,"precertRequired":false,"billingCode":"47490","codeType":"CPT"},{"id":3258,"precertRequired":false,"billingCode":"47531","codeType":"CPT"},{"id":3259,"precertRequired":false,"billingCode":"47532","codeType":"CPT"},{"id":3260,"precertRequired":false,"billingCode":"47533","codeType":"CPT"},{"id":3261,"precertRequired":false,"billingCode":"47534","codeType":"CPT"},{"id":3262,"precertRequired":false,"billingCode":"47535","codeType":"CPT"},{"id":3263,"precertRequired":false,"billingCode":"47536","codeType":"CPT"},{"id":3264,"precertRequired":false,"billingCode":"47537","codeType":"CPT"},{"id":3265,"precertRequired":false,"billingCode":"47538","codeType":"CPT"},{"id":3266,"precertRequired":false,"billingCode":"47539","codeType":"CPT"},{"id":3267,"precertRequired":false,"billingCode":"47540","codeType":"CPT"},{"id":3268,"precertRequired":false,"billingCode":"47541","codeType":"CPT"},{"id":3269,"precertRequired":false,"billingCode":"47542","codeType":"CPT"},{"id":3271,"precertRequired":false,"billingCode":"47544","codeType":"CPT"},{"id":3272,"precertRequired":false,"billingCode":"47550","codeType":"CPT"},{"id":3275,"precertRequired":false,"billingCode":"47554","codeType":"CPT"},{"id":3276,"precertRequired":false,"billingCode":"47555","codeType":"CPT"},{"id":3277,"precertRequired":false,"billingCode":"47556","codeType":"CPT"},{"id":3278,"precertRequired":false,"billingCode":"47562","codeType":"CPT"},{"id":3279,"precertRequired":false,"billingCode":"47563","codeType":"CPT"},{"id":3280,"precertRequired":false,"billingCode":"47564","codeType":"CPT"},{"id":3281,"precertRequired":false,"billingCode":"47570","codeType":"CPT"},{"id":3282,"precertRequired":false,"billingCode":"47600","codeType":"CPT"},{"id":3283,"precertRequired":false,"billingCode":"47605","codeType":"CPT"},{"id":3284,"precertRequired":false,"billingCode":"47610","codeType":"CPT"},{"id":3285,"precertRequired":false,"billingCode":"47612","codeType":"CPT"},{"id":3286,"precertRequired":false,"billingCode":"47620","codeType":"CPT"},{"id":3287,"precertRequired":false,"billingCode":"47700","codeType":"CPT"},{"id":3288,"precertRequired":false,"billingCode":"47701","codeType":"CPT"},{"id":3289,"precertRequired":false,"billingCode":"47711","codeType":"CPT"},{"id":3290,"precertRequired":false,"billingCode":"47712","codeType":"CPT"},{"id":3291,"precertRequired":false,"billingCode":"47715","codeType":"CPT"},{"id":3292,"precertRequired":false,"billingCode":"47720","codeType":"CPT"},{"id":3293,"precertRequired":false,"billingCode":"47721","codeType":"CPT"},{"id":3294,"precertRequired":false,"billingCode":"47740","codeType":"CPT"},{"id":3295,"precertRequired":false,"billingCode":"47741","codeType":"CPT"},{"id":3296,"precertRequired":false,"billingCode":"47760","codeType":"CPT"},{"id":3297,"precertRequired":false,"billingCode":"47765","codeType":"CPT"},{"id":3298,"precertRequired":false,"billingCode":"47780","codeType":"CPT"},{"id":3299,"precertRequired":false,"billingCode":"47785","codeType":"CPT"},{"id":3300,"precertRequired":false,"billingCode":"47800","codeType":"CPT"},{"id":3301,"precertRequired":false,"billingCode":"47801","codeType":"CPT"},{"id":3302,"precertRequired":false,"billingCode":"47802","codeType":"CPT"},{"id":3303,"precertRequired":false,"billingCode":"48000","codeType":"CPT"},{"id":3304,"precertRequired":false,"billingCode":"48001","codeType":"CPT"},{"id":3305,"precertRequired":false,"billingCode":"48020","codeType":"CPT"},{"id":3306,"precertRequired":false,"billingCode":"48100","codeType":"CPT"},{"id":3307,"precertRequired":false,"billingCode":"48102","codeType":"CPT"},{"id":3308,"precertRequired":false,"billingCode":"48105","codeType":"CPT"},{"id":3309,"precertRequired":false,"billingCode":"48120","codeType":"CPT"},{"id":3310,"precertRequired":false,"billingCode":"48148","codeType":"CPT"},{"id":3311,"precertRequired":false,"billingCode":"48150","codeType":"CPT"},{"id":3312,"precertRequired":false,"billingCode":"48152","codeType":"CPT"},{"id":3313,"precertRequired":false,"billingCode":"48153","codeType":"CPT"},{"id":3314,"precertRequired":false,"billingCode":"48154","codeType":"CPT"},{"id":3315,"precertRequired":false,"billingCode":"48155","codeType":"CPT"},{"id":3316,"precertRequired":false,"billingCode":"48160","codeType":"CPT"},{"id":3317,"precertRequired":false,"billingCode":"48400","codeType":"CPT"},{"id":3318,"precertRequired":false,"billingCode":"48500","codeType":"CPT"},{"id":3319,"precertRequired":false,"billingCode":"48510","codeType":"CPT"},{"id":3320,"precertRequired":false,"billingCode":"48520","codeType":"CPT"},{"id":3321,"precertRequired":false,"billingCode":"48540","codeType":"CPT"},{"id":3322,"precertRequired":false,"billingCode":"48545","codeType":"CPT"},{"id":3323,"precertRequired":false,"billingCode":"48547","codeType":"CPT"},{"id":3324,"precertRequired":false,"billingCode":"48548","codeType":"CPT"},{"id":3330,"precertRequired":false,"billingCode":"49002","codeType":"CPT"},{"id":3331,"precertRequired":false,"billingCode":"49010","codeType":"CPT"},{"id":3332,"precertRequired":false,"billingCode":"49020","codeType":"CPT"},{"id":3333,"precertRequired":false,"billingCode":"49040","codeType":"CPT"},{"id":3334,"precertRequired":false,"billingCode":"49060","codeType":"CPT"},{"id":3335,"precertRequired":false,"billingCode":"49062","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3337,"precertRequired":false,"billingCode":"49083","codeType":"CPT"},{"id":3338,"precertRequired":false,"billingCode":"49084","codeType":"CPT"},{"id":3339,"precertRequired":false,"billingCode":"49180","codeType":"CPT"},{"id":3340,"precertRequired":false,"billingCode":"49185","codeType":"CPT"},{"id":3341,"precertRequired":false,"billingCode":"49203","codeType":"CPT"},{"id":3342,"precertRequired":false,"billingCode":"49204","codeType":"CPT"},{"id":3343,"precertRequired":false,"billingCode":"49205","codeType":"CPT"},{"id":3344,"precertRequired":false,"billingCode":"49220","codeType":"CPT"},{"id":3345,"precertRequired":false,"billingCode":"49250","codeType":"CPT"},{"id":3346,"precertRequired":false,"billingCode":"49255","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3350,"precertRequired":false,"billingCode":"49323","codeType":"CPT"},{"id":3351,"precertRequired":false,"billingCode":"49324","codeType":"CPT"},{"id":3352,"precertRequired":false,"billingCode":"49325","codeType":"CPT"},{"id":3353,"precertRequired":false,"billingCode":"49326","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3356,"precertRequired":false,"billingCode":"49400","codeType":"CPT"},{"id":3357,"precertRequired":false,"billingCode":"49402","codeType":"CPT"},{"id":3358,"precertRequired":false,"billingCode":"49405","codeType":"CPT"},{"id":3359,"precertRequired":false,"billingCode":"49406","codeType":"CPT"},{"id":3360,"precertRequired":false,"billingCode":"49407","codeType":"CPT"},{"id":3361,"precertRequired":false,"billingCode":"49411","codeType":"CPT"},{"id":3362,"precertRequired":false,"billingCode":"49412","codeType":"CPT"},{"id":3363,"precertRequired":false,"billingCode":"49418","codeType":"CPT"},{"id":3364,"precertRequired":false,"billingCode":"49419","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"},{"id":3368,"precertRequired":false,"billingCode":"49423","codeType":"CPT"},{"id":3369,"precertRequired":false,"billingCode":"49424","codeType":"CPT"},{"id":3370,"precertRequired":false,"billingCode":"49425","codeType":"CPT"},{"id":3371,"precertRequired":false,"billingCode":"49426","codeType":"CPT"},{"id":3372,"precertRequired":false,"billingCode":"49427","codeType":"CPT"},{"id":3373,"precertRequired":false,"billingCode":"49428","codeType":"CPT"},{"id":3374,"precertRequired":false,"billingCode":"49429","codeType":"CPT"},{"id":3375,"precertRequired":false,"billingCode":"49435","codeType":"CPT"},{"id":3376,"precertRequired":false,"billingCode":"49436","codeType":"CPT"},{"id":3377,"precertRequired":false,"billingCode":"49440","codeType":"CPT"},{"id":3378,"precertRequired":false,"billingCode":"49441","codeType":"CPT"},{"id":3379,"precertRequired":false,"billingCode":"49442","codeType":"CPT"},{"id":3380,"precertRequired":false,"billingCode":"49446","codeType":"CPT"},{"id":3381,"precertRequired":false,"billingCode":"49450","codeType":"CPT"},{"id":3382,"precertRequired":false,"billingCode":"49451","codeType":"CPT"},{"id":3383,"precertRequired":false,"billingCode":"49452","codeType":"CPT"},{"id":3384,"precertRequired":false,"billingCode":"49460","codeType":"CPT"},{"id":3385,"precertRequired":false,"billingCode":"49465","codeType":"CPT"},{"id":3386,"precertRequired":false,"billingCode":"50200","codeType":"CPT"},{"id":3435,"precertRequired":false,"billingCode":"51798","codeType":"CPT"},{"id":3439,"precertRequired":false,"billingCode":"51990","codeType":"CPT"},{"id":3440,"precertRequired":false,"billingCode":"51992","codeType":"CPT"},{"id":3446,"precertRequired":false,"billingCode":"52204","codeType":"CPT"},{"id":3490,"precertRequired":false,"billingCode":"53040","codeType":"CPT"},{"id":3491,"precertRequired":false,"billingCode":"53060","codeType":"CPT"},{"id":3492,"precertRequired":false,"billingCode":"53200","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3516,"precertRequired":false,"billingCode":"54105","codeType":"CPT"},{"id":3519,"precertRequired":false,"billingCode":"54162","codeType":"CPT"},{"id":3527,"precertRequired":false,"billingCode":"54640","codeType":"CPT"},{"id":3528,"precertRequired":false,"billingCode":"54800","codeType":"CPT"},{"id":3529,"precertRequired":false,"billingCode":"54865","codeType":"CPT"},{"id":3534,"precertRequired":false,"billingCode":"55100","codeType":"CPT"},{"id":3540,"precertRequired":false,"billingCode":"55540","codeType":"CPT"},{"id":3541,"precertRequired":false,"billingCode":"55550","codeType":"CPT"},{"id":3550,"precertRequired":false,"billingCode":"56405","codeType":"CPT"},{"id":3551,"precertRequired":false,"billingCode":"56420","codeType":"CPT"},{"id":3553,"precertRequired":false,"billingCode":"56441","codeType":"CPT"},{"id":3562,"precertRequired":false,"billingCode":"56631","codeType":"CPT"},{"id":3563,"precertRequired":false,"billingCode":"56632","codeType":"CPT"},{"id":3565,"precertRequired":false,"billingCode":"56634","codeType":"CPT"},{"id":3566,"precertRequired":false,"billingCode":"56637","codeType":"CPT"},{"id":3567,"precertRequired":false,"billingCode":"56640","codeType":"CPT"},{"id":3573,"precertRequired":false,"billingCode":"56821","codeType":"CPT"},{"id":3574,"precertRequired":false,"billingCode":"57000","codeType":"CPT"},{"id":3575,"precertRequired":false,"billingCode":"57010","codeType":"CPT"},{"id":3576,"precertRequired":false,"billingCode":"57020","codeType":"CPT"},{"id":3577,"precertRequired":false,"billingCode":"57022","codeType":"CPT"},{"id":3578,"precertRequired":false,"billingCode":"57023","codeType":"CPT"},{"id":3616,"precertRequired":false,"billingCode":"57300","codeType":"CPT"},{"id":3617,"precertRequired":false,"billingCode":"57305","codeType":"CPT"},{"id":3618,"precertRequired":false,"billingCode":"57307","codeType":"CPT"},{"id":3619,"precertRequired":false,"billingCode":"57308","codeType":"CPT"},{"id":3620,"precertRequired":false,"billingCode":"57310","codeType":"CPT"},{"id":3621,"precertRequired":false,"billingCode":"57311","codeType":"CPT"},{"id":3622,"precertRequired":false,"billingCode":"57320","codeType":"CPT"},{"id":3623,"precertRequired":false,"billingCode":"57330","codeType":"CPT"},{"id":3630,"precertRequired":false,"billingCode":"57425","codeType":"CPT"},{"id":3631,"precertRequired":false,"billingCode":"57426","codeType":"CPT"},{"id":3638,"precertRequired":false,"billingCode":"57500","codeType":"CPT"},{"id":3639,"precertRequired":false,"billingCode":"57505","codeType":"CPT"},{"id":3641,"precertRequired":false,"billingCode":"57511","codeType":"CPT"},{"id":3642,"precertRequired":false,"billingCode":"57513","codeType":"CPT"},{"id":3643,"precertRequired":false,"billingCode":"57520","codeType":"CPT"},{"id":3644,"precertRequired":false,"billingCode":"57522","codeType":"CPT"},{"id":3645,"precertRequired":false,"billingCode":"57530","codeType":"CPT"},{"id":3646,"precertRequired":false,"billingCode":"57531","codeType":"CPT"},{"id":3647,"precertRequired":false,"billingCode":"57540","codeType":"CPT"},{"id":3648,"precertRequired":false,"billingCode":"57545","codeType":"CPT"},{"id":3649,"precertRequired":false,"billingCode":"57550","codeType":"CPT"},{"id":3650,"precertRequired":false,"billingCode":"57555","codeType":"CPT"},{"id":3651,"precertRequired":false,"billingCode":"57556","codeType":"CPT"},{"id":3652,"precertRequired":false,"billingCode":"57558","codeType":"CPT"},{"id":3655,"precertRequired":false,"billingCode":"57800","codeType":"CPT"},{"id":3656,"precertRequired":false,"billingCode":"58100","codeType":"CPT"},{"id":3657,"precertRequired":false,"billingCode":"58110","codeType":"CPT"},{"id":3658,"precertRequired":false,"billingCode":"58120","codeType":"CPT"},{"id":3659,"precertRequired":false,"billingCode":"58140","codeType":"CPT"},{"id":3660,"precertRequired":false,"billingCode":"58145","codeType":"CPT"},{"id":3661,"precertRequired":false,"billingCode":"58146","codeType":"CPT"},{"id":3662,"precertRequired":false,"billingCode":"58150","codeType":"CPT"},{"id":3663,"precertRequired":false,"billingCode":"58152","codeType":"CPT"},{"id":3664,"precertRequired":false,"billingCode":"58180","codeType":"CPT"},{"id":3665,"precertRequired":false,"billingCode":"58200","codeType":"CPT"},{"id":3666,"precertRequired":false,"billingCode":"58210","codeType":"CPT"},{"id":3667,"precertRequired":false,"billingCode":"58240","codeType":"CPT"},{"id":3668,"precertRequired":false,"billingCode":"58260","codeType":"CPT"},{"id":3669,"precertRequired":false,"billingCode":"58262","codeType":"CPT"},{"id":3670,"precertRequired":false,"billingCode":"58263","codeType":"CPT"},{"id":3671,"precertRequired":false,"billingCode":"58267","codeType":"CPT"},{"id":3672,"precertRequired":false,"billingCode":"58270","codeType":"CPT"},{"id":3673,"precertRequired":false,"billingCode":"58275","codeType":"CPT"},{"id":3674,"precertRequired":false,"billingCode":"58280","codeType":"CPT"},{"id":3675,"precertRequired":false,"billingCode":"58285","codeType":"CPT"},{"id":3676,"precertRequired":false,"billingCode":"58290","codeType":"CPT"},{"id":3677,"precertRequired":false,"billingCode":"58291","codeType":"CPT"},{"id":3678,"precertRequired":false,"billingCode":"58292","codeType":"CPT"},{"id":3679,"precertRequired":false,"billingCode":"58293","codeType":"CPT"},{"id":3680,"precertRequired":false,"billingCode":"58294","codeType":"CPT"},{"id":3695,"precertRequired":false,"billingCode":"58541","codeType":"CPT"},{"id":3696,"precertRequired":false,"billingCode":"58542","codeType":"CPT"},{"id":3697,"precertRequired":false,"billingCode":"58543","codeType":"CPT"},{"id":3698,"precertRequired":false,"billingCode":"58544","codeType":"CPT"},{"id":3699,"precertRequired":false,"billingCode":"58545","codeType":"CPT"},{"id":3700,"precertRequired":false,"billingCode":"58546","codeType":"CPT"},{"id":3701,"precertRequired":false,"billingCode":"58548","codeType":"CPT"},{"id":3702,"precertRequired":false,"billingCode":"58550","codeType":"CPT"},{"id":3703,"precertRequired":false,"billingCode":"58552","codeType":"CPT"},{"id":3704,"precertRequired":false,"billingCode":"58553","codeType":"CPT"},{"id":3705,"precertRequired":false,"billingCode":"58554","codeType":"CPT"},{"id":3706,"precertRequired":false,"billingCode":"58555","codeType":"CPT"},{"id":3707,"precertRequired":false,"billingCode":"58558","codeType":"CPT"},{"id":3708,"precertRequired":false,"billingCode":"58559","codeType":"CPT"},{"id":3709,"precertRequired":false,"billingCode":"58560","codeType":"CPT"},{"id":3710,"precertRequired":false,"billingCode":"58561","codeType":"CPT"},{"id":3711,"precertRequired":false,"billingCode":"58562","codeType":"CPT"},{"id":3712,"precertRequired":false,"billingCode":"58563","codeType":"CPT"},{"id":3713,"precertRequired":false,"billingCode":"58565","codeType":"CPT"},{"id":3714,"precertRequired":false,"billingCode":"58570","codeType":"CPT"},{"id":3715,"precertRequired":false,"billingCode":"58571","codeType":"CPT"},{"id":3716,"precertRequired":false,"billingCode":"58572","codeType":"CPT"},{"id":3717,"precertRequired":false,"billingCode":"58573","codeType":"CPT"},{"id":3718,"precertRequired":false,"billingCode":"58575","codeType":"CPT"},{"id":3723,"precertRequired":false,"billingCode":"58611","codeType":"CPT"},{"id":3725,"precertRequired":false,"billingCode":"58660","codeType":"CPT"},{"id":3726,"precertRequired":false,"billingCode":"58661","codeType":"CPT"},{"id":3727,"precertRequired":false,"billingCode":"58662","codeType":"CPT"},{"id":3728,"precertRequired":true,"billingCode":"58670","codeType":"CPT"},{"id":3729,"precertRequired":false,"billingCode":"58671","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3732,"precertRequired":false,"billingCode":"58674","codeType":"CPT"},{"id":3735,"precertRequired":false,"billingCode":"58720","codeType":"CPT"},{"id":3736,"precertRequired":false,"billingCode":"58740","codeType":"CPT"},{"id":3741,"precertRequired":false,"billingCode":"58800","codeType":"CPT"},{"id":3742,"precertRequired":false,"billingCode":"58805","codeType":"CPT"},{"id":3743,"precertRequired":false,"billingCode":"58820","codeType":"CPT"},{"id":3744,"precertRequired":false,"billingCode":"58822","codeType":"CPT"},{"id":3749,"precertRequired":false,"billingCode":"58940","codeType":"CPT"},{"id":3750,"precertRequired":false,"billingCode":"58943","codeType":"CPT"},{"id":3751,"precertRequired":false,"billingCode":"58950","codeType":"CPT"},{"id":3752,"precertRequired":false,"billingCode":"58951","codeType":"CPT"},{"id":3753,"precertRequired":false,"billingCode":"58952","codeType":"CPT"},{"id":3754,"precertRequired":false,"billingCode":"58953","codeType":"CPT"},{"id":3755,"precertRequired":false,"billingCode":"58954","codeType":"CPT"},{"id":3756,"precertRequired":false,"billingCode":"58956","codeType":"CPT"},{"id":3757,"precertRequired":false,"billingCode":"58957","codeType":"CPT"},{"id":3758,"precertRequired":false,"billingCode":"58958","codeType":"CPT"},{"id":3759,"precertRequired":false,"billingCode":"58960","codeType":"CPT"},{"id":3786,"precertRequired":false,"billingCode":"59160","codeType":"CPT"},{"id":3801,"precertRequired":false,"billingCode":"59514","codeType":"CPT"},{"id":3802,"precertRequired":false,"billingCode":"59515","codeType":"CPT"},{"id":3803,"precertRequired":false,"billingCode":"59525","codeType":"CPT"},{"id":3808,"precertRequired":false,"billingCode":"59620","codeType":"CPT"},{"id":3809,"precertRequired":false,"billingCode":"59622","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3847,"precertRequired":false,"billingCode":"60512","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3849,"precertRequired":false,"billingCode":"60521","codeType":"CPT"},{"id":3850,"precertRequired":false,"billingCode":"60522","codeType":"CPT"},{"id":3853,"precertRequired":false,"billingCode":"60600","codeType":"CPT"},{"id":3854,"precertRequired":false,"billingCode":"60605","codeType":"CPT"},{"id":4009,"precertRequired":false,"billingCode":"64721","codeType":"CPT"},{"id":4038,"precertRequired":false,"billingCode":"64795","codeType":"CPT"},{"id":4275,"precertRequired":false,"billingCode":"67700","codeType":"CPT"},{"id":4290,"precertRequired":false,"billingCode":"67880","codeType":"CPT"},{"id":4291,"precertRequired":false,"billingCode":"67882","codeType":"CPT"},{"id":4348,"precertRequired":false,"billingCode":"69000","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4356,"precertRequired":true,"billingCode":"69222","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":7282,"precertRequired":false,"billingCode":"97598","codeType":"CPT"},{"id":7283,"precertRequired":false,"billingCode":"97602","codeType":"CPT"},{"id":7284,"precertRequired":false,"billingCode":"97605","codeType":"CPT"},{"id":7285,"precertRequired":false,"billingCode":"97606","codeType":"CPT"},{"id":7286,"precertRequired":false,"billingCode":"97607","codeType":"CPT"},{"id":7287,"precertRequired":false,"billingCode":"97608","codeType":"CPT"},{"id":7288,"precertRequired":false,"billingCode":"97610","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":9153,"precertRequired":false,"billingCode":"10004","codeType":"CPT"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9155,"precertRequired":false,"billingCode":"10006","codeType":"CPT"},{"id":9156,"precertRequired":true,"billingCode":"10007","codeType":"CPT"},{"id":9157,"precertRequired":true,"billingCode":"10008","codeType":"CPT"},{"id":9158,"precertRequired":true,"billingCode":"10009","codeType":"CPT"},{"id":9159,"precertRequired":true,"billingCode":"10010","codeType":"CPT"},{"id":9160,"precertRequired":true,"billingCode":"10011","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9168,"precertRequired":true,"billingCode":"15004","codeType":"CPT"},{"id":9169,"precertRequired":true,"billingCode":"15005","codeType":"CPT"},{"id":9170,"precertRequired":true,"billingCode":"15115","codeType":"CPT"},{"id":9171,"precertRequired":true,"billingCode":"15116","codeType":"CPT"},{"id":9172,"precertRequired":true,"billingCode":"15120","codeType":"CPT"},{"id":9173,"precertRequired":true,"billingCode":"15121","codeType":"CPT"},{"id":9176,"precertRequired":true,"billingCode":"15277","codeType":"CPT"},{"id":9177,"precertRequired":true,"billingCode":"15278","codeType":"CPT"},{"id":9322,"precertRequired":true,"billingCode":"29837","codeType":"CPT"},{"id":9323,"precertRequired":true,"billingCode":"29838","codeType":"CPT"},{"id":9328,"precertRequired":true,"billingCode":"29848","codeType":"CPT"},{"id":9373,"precertRequired":true,"billingCode":"31238","codeType":"CPT"},{"id":9374,"precertRequired":true,"billingCode":"31239","codeType":"CPT"},{"id":9375,"precertRequired":true,"billingCode":"31240","codeType":"CPT"},{"id":9376,"precertRequired":true,"billingCode":"31241","codeType":"CPT"},{"id":9377,"precertRequired":true,"billingCode":"31253","codeType":"CPT"},{"id":9378,"precertRequired":true,"billingCode":"31254","codeType":"CPT"},{"id":9379,"precertRequired":true,"billingCode":"31255","codeType":"CPT"},{"id":9380,"precertRequired":true,"billingCode":"31256","codeType":"CPT"},{"id":9381,"precertRequired":true,"billingCode":"31257","codeType":"CPT"},{"id":9382,"precertRequired":true,"billingCode":"31259","codeType":"CPT"},{"id":9383,"precertRequired":true,"billingCode":"31267","codeType":"CPT"},{"id":9384,"precertRequired":true,"billingCode":"31276","codeType":"CPT"},{"id":9385,"precertRequired":true,"billingCode":"31287","codeType":"CPT"},{"id":9386,"precertRequired":true,"billingCode":"31288","codeType":"CPT"},{"id":9387,"precertRequired":true,"billingCode":"31290","codeType":"CPT"},{"id":9388,"precertRequired":true,"billingCode":"31291","codeType":"CPT"},{"id":9389,"precertRequired":true,"billingCode":"31292","codeType":"CPT"},{"id":9390,"precertRequired":true,"billingCode":"31293","codeType":"CPT"},{"id":9391,"precertRequired":true,"billingCode":"31294","codeType":"CPT"},{"id":9392,"precertRequired":true,"billingCode":"31295","codeType":"CPT"},{"id":9393,"precertRequired":true,"billingCode":"31296","codeType":"CPT"},{"id":9394,"precertRequired":true,"billingCode":"31297","codeType":"CPT"},{"id":9395,"precertRequired":true,"billingCode":"31298","codeType":"CPT"},{"id":9493,"precertRequired":true,"billingCode":"42000","codeType":"CPT"},{"id":9527,"precertRequired":true,"billingCode":"47370","codeType":"CPT"},{"id":9528,"precertRequired":true,"billingCode":"47900","codeType":"CPT"},{"id":9529,"precertRequired":true,"billingCode":"48140","codeType":"CPT"},{"id":9530,"precertRequired":true,"billingCode":"48145","codeType":"CPT"},{"id":9531,"precertRequired":true,"billingCode":"48146","codeType":"CPT"},{"id":9532,"precertRequired":true,"billingCode":"50020","codeType":"CPT"},{"id":9533,"precertRequired":true,"billingCode":"50040","codeType":"CPT"},{"id":9534,"precertRequired":true,"billingCode":"50045","codeType":"CPT"},{"id":9535,"precertRequired":true,"billingCode":"50060","codeType":"CPT"},{"id":9536,"precertRequired":true,"billingCode":"50065","codeType":"CPT"},{"id":9537,"precertRequired":true,"billingCode":"50070","codeType":"CPT"},{"id":9538,"precertRequired":true,"billingCode":"50075","codeType":"CPT"},{"id":9539,"precertRequired":true,"billingCode":"50080","codeType":"CPT"},{"id":9540,"precertRequired":true,"billingCode":"50081","codeType":"CPT"},{"id":9542,"precertRequired":true,"billingCode":"50120","codeType":"CPT"},{"id":9543,"precertRequired":true,"billingCode":"50125","codeType":"CPT"},{"id":9544,"precertRequired":true,"billingCode":"50130","codeType":"CPT"},{"id":9545,"precertRequired":true,"billingCode":"50135","codeType":"CPT"},{"id":9546,"precertRequired":true,"billingCode":"50205","codeType":"CPT"},{"id":9547,"precertRequired":true,"billingCode":"50220","codeType":"CPT"},{"id":9548,"precertRequired":true,"billingCode":"50225","codeType":"CPT"},{"id":9549,"precertRequired":true,"billingCode":"50234","codeType":"CPT"},{"id":9550,"precertRequired":true,"billingCode":"50236","codeType":"CPT"},{"id":9554,"precertRequired":true,"billingCode":"50542","codeType":"CPT"},{"id":9555,"precertRequired":true,"billingCode":"50543","codeType":"CPT"},{"id":9556,"precertRequired":true,"billingCode":"50544","codeType":"CPT"},{"id":9557,"precertRequired":true,"billingCode":"50545","codeType":"CPT"},{"id":9558,"precertRequired":true,"billingCode":"50553","codeType":"CPT"},{"id":9573,"precertRequired":true,"billingCode":"51080","codeType":"CPT"},{"id":9584,"precertRequired":true,"billingCode":"51575","codeType":"CPT"},{"id":9585,"precertRequired":true,"billingCode":"51580","codeType":"CPT"},{"id":9586,"precertRequired":true,"billingCode":"51585","codeType":"CPT"},{"id":9587,"precertRequired":true,"billingCode":"51590","codeType":"CPT"},{"id":9588,"precertRequired":true,"billingCode":"51595","codeType":"CPT"},{"id":9589,"precertRequired":false,"billingCode":"51597","codeType":"CPT"},{"id":9608,"precertRequired":true,"billingCode":"52700","codeType":"CPT"},{"id":9633,"precertRequired":true,"billingCode":"53500","codeType":"CPT"},{"id":9658,"precertRequired":true,"billingCode":"55801","codeType":"CPT"},{"id":9659,"precertRequired":true,"billingCode":"55810","codeType":"CPT"},{"id":9660,"precertRequired":true,"billingCode":"55812","codeType":"CPT"},{"id":9661,"precertRequired":true,"billingCode":"55815","codeType":"CPT"},{"id":9662,"precertRequired":true,"billingCode":"55821","codeType":"CPT"},{"id":9663,"precertRequired":true,"billingCode":"55831","codeType":"CPT"},{"id":9664,"precertRequired":true,"billingCode":"55840","codeType":"CPT"},{"id":9665,"precertRequired":true,"billingCode":"55842","codeType":"CPT"},{"id":9666,"precertRequired":true,"billingCode":"55845","codeType":"CPT"},{"id":9871,"precertRequired":false,"billingCode":"69005","codeType":"CPT"},{"id":9872,"precertRequired":false,"billingCode":"69020","codeType":"CPT"},{"id":9930,"precertRequired":false,"billingCode":"55862","codeType":"CPT"},{"id":9931,"precertRequired":false,"billingCode":"55865","codeType":"CPT"},{"id":9932,"precertRequired":false,"billingCode":"55866","codeType":"CPT"},{"id":9954,"precertRequired":false,"billingCode":"15002","codeType":"CPT"},{"id":9955,"precertRequired":false,"billingCode":"15003","codeType":"CPT"},{"id":9956,"precertRequired":false,"billingCode":"15100","codeType":"CPT"},{"id":9957,"precertRequired":false,"billingCode":"15777","codeType":"CPT"},{"id":9960,"precertRequired":false,"billingCode":"19316","codeType":"CPT"},{"id":9961,"precertRequired":false,"billingCode":"19318","codeType":"CPT"},{"id":9962,"precertRequired":false,"billingCode":"19324","codeType":"CPT"},{"id":9963,"precertRequired":false,"billingCode":"19325","codeType":"CPT"},{"id":9964,"precertRequired":false,"billingCode":"19328","codeType":"CPT"},{"id":9965,"precertRequired":false,"billingCode":"19330","codeType":"CPT"},{"id":9966,"precertRequired":false,"billingCode":"19340","codeType":"CPT"},{"id":9967,"precertRequired":false,"billingCode":"19342","codeType":"CPT"},{"id":9968,"precertRequired":false,"billingCode":"19350","codeType":"CPT"},{"id":9969,"precertRequired":false,"billingCode":"19357","codeType":"CPT"},{"id":9970,"precertRequired":false,"billingCode":"19361","codeType":"CPT"},{"id":9971,"precertRequired":false,"billingCode":"19364","codeType":"CPT"},{"id":9972,"precertRequired":false,"billingCode":"19366","codeType":"CPT"},{"id":9973,"precertRequired":false,"billingCode":"19367","codeType":"CPT"},{"id":9974,"precertRequired":false,"billingCode":"19368","codeType":"CPT"},{"id":9975,"precertRequired":false,"billingCode":"19369","codeType":"CPT"},{"id":9976,"precertRequired":false,"billingCode":"19370","codeType":"CPT"},{"id":9977,"precertRequired":false,"billingCode":"19371","codeType":"CPT"},{"id":9978,"precertRequired":false,"billingCode":"19380","codeType":"CPT"},{"id":9982,"precertRequired":false,"billingCode":"42305","codeType":"CPT"},{"id":9986,"precertRequired":false,"billingCode":"49904","codeType":"CPT"},{"id":10726,"precertRequired":false,"billingCode":"15101","codeType":"CPT"},{"id":10727,"precertRequired":false,"billingCode":"15110","codeType":"CPT"},{"id":10728,"precertRequired":false,"billingCode":"15111","codeType":"CPT"},{"id":10731,"precertRequired":false,"billingCode":"15152","codeType":"CPT"},{"id":10732,"precertRequired":false,"billingCode":"15274","codeType":"CPT"},{"id":11357,"precertRequired":false,"billingCode":"54150","codeType":"CPT"},{"id":11381,"precertRequired":false,"billingCode":"42320","codeType":"CPT"},{"id":11384,"precertRequired":false,"billingCode":"42400","codeType":"CPT"},{"id":11385,"precertRequired":false,"billingCode":"42405","codeType":"CPT"},{"id":11399,"precertRequired":false,"billingCode":"42720","codeType":"CPT"},{"id":11400,"precertRequired":false,"billingCode":"42725","codeType":"CPT"},{"id":11586,"precertRequired":false,"billingCode":"38792","codeType":"CPT"},{"id":11643,"precertRequired":false,"billingCode":"39540","codeType":"CPT"},{"id":11644,"precertRequired":false,"billingCode":"39541","codeType":"CPT"},{"id":11645,"precertRequired":false,"billingCode":"39545","codeType":"CPT"},{"id":11646,"precertRequired":false,"billingCode":"39560","codeType":"CPT"},{"id":11647,"precertRequired":false,"billingCode":"39561","codeType":"CPT"},{"id":11833,"precertRequired":false,"billingCode":"54120","codeType":"CPT"},{"id":11834,"precertRequired":false,"billingCode":"54125","codeType":"CPT"},{"id":11835,"precertRequired":false,"billingCode":"36573","codeType":"CPT"},{"id":11876,"precertRequired":false,"billingCode":"49505","codeType":"CPT"},{"id":11877,"precertRequired":false,"billingCode":"49507","codeType":"CPT"},{"id":11878,"precertRequired":false,"billingCode":"49520","codeType":"CPT"},{"id":11879,"precertRequired":false,"billingCode":"49521","codeType":"CPT"},{"id":11880,"precertRequired":false,"billingCode":"49525","codeType":"CPT"},{"id":11881,"precertRequired":false,"billingCode":"49560","codeType":"CPT"},{"id":11882,"precertRequired":false,"billingCode":"49561","codeType":"CPT"},{"id":11883,"precertRequired":false,"billingCode":"49565","codeType":"CPT"},{"id":11884,"precertRequired":false,"billingCode":"49566","codeType":"CPT"},{"id":11885,"precertRequired":false,"billingCode":"49568","codeType":"CPT"},{"id":11886,"precertRequired":false,"billingCode":"49652","codeType":"CPT"},{"id":11887,"precertRequired":false,"billingCode":"49653","codeType":"CPT"},{"id":11888,"precertRequired":false,"billingCode":"49654","codeType":"CPT"},{"id":11889,"precertRequired":false,"billingCode":"49655","codeType":"CPT"},{"id":11890,"precertRequired":false,"billingCode":"49656","codeType":"CPT"},{"id":11891,"precertRequired":false,"billingCode":"49657","codeType":"CPT"},{"id":11892,"precertRequired":false,"billingCode":"50546","codeType":"CPT"},{"id":11893,"precertRequired":false,"billingCode":"50548","codeType":"CPT"},{"id":11894,"precertRequired":false,"billingCode":"50945","codeType":"CPT"},{"id":11895,"precertRequired":false,"billingCode":"54690","codeType":"CPT"},{"id":11897,"precertRequired":false,"billingCode":"29846","codeType":"CPT"},{"id":11912,"precertRequired":false,"billingCode":"49000","codeType":"CPT"},{"id":11913,"precertRequired":false,"billingCode":"49900","codeType":"CPT"},{"id":12075,"precertRequired":false,"billingCode":"62161","codeType":"CPT"},{"id":12093,"precertRequired":false,"billingCode":"62263","codeType":"CPT"},{"id":12094,"precertRequired":false,"billingCode":"62264","codeType":"CPT"},{"id":12111,"precertRequired":false,"billingCode":"43762","codeType":"CPT"},{"id":12112,"precertRequired":false,"billingCode":"43763","codeType":"CPT"},{"id":12136,"precertRequired":false,"billingCode":"15851","codeType":"CPT"},{"id":12137,"precertRequired":false,"billingCode":"19110","codeType":"CPT"},{"id":12138,"precertRequired":false,"billingCode":"19112","codeType":"CPT"},{"id":12139,"precertRequired":false,"billingCode":"19355","codeType":"CPT"},{"id":12140,"precertRequired":false,"billingCode":"38531","codeType":"CPT"},{"id":12141,"precertRequired":false,"billingCode":"46916","codeType":"CPT"},{"id":12142,"precertRequired":false,"billingCode":"47380","codeType":"CPT"},{"id":12143,"precertRequired":false,"billingCode":"49540","codeType":"CPT"},{"id":12144,"precertRequired":false,"billingCode":"49550","codeType":"CPT"},{"id":12145,"precertRequired":false,"billingCode":"49553","codeType":"CPT"},{"id":12146,"precertRequired":false,"billingCode":"49555","codeType":"CPT"},{"id":12147,"precertRequired":false,"billingCode":"49557","codeType":"CPT"},{"id":12148,"precertRequired":false,"billingCode":"49570","codeType":"CPT"},{"id":12149,"precertRequired":false,"billingCode":"49572","codeType":"CPT"},{"id":12150,"precertRequired":false,"billingCode":"49585","codeType":"CPT"},{"id":12151,"precertRequired":false,"billingCode":"49587","codeType":"CPT"},{"id":12152,"precertRequired":false,"billingCode":"49590","codeType":"CPT"},{"id":12153,"precertRequired":false,"billingCode":"49650","codeType":"CPT"},{"id":12154,"precertRequired":false,"billingCode":"49651","codeType":"CPT"},{"id":12155,"precertRequired":false,"billingCode":"49905","codeType":"CPT"},{"id":12156,"precertRequired":false,"billingCode":"49906","codeType":"CPT"},{"id":12157,"precertRequired":false,"billingCode":"50230","codeType":"CPT"},{"id":12158,"precertRequired":false,"billingCode":"50240","codeType":"CPT"},{"id":12159,"precertRequired":false,"billingCode":"50250","codeType":"CPT"},{"id":12160,"precertRequired":false,"billingCode":"50280","codeType":"CPT"},{"id":12161,"precertRequired":false,"billingCode":"50290","codeType":"CPT"},{"id":12162,"precertRequired":false,"billingCode":"50400","codeType":"CPT"},{"id":12163,"precertRequired":false,"billingCode":"50405","codeType":"CPT"},{"id":12164,"precertRequired":false,"billingCode":"50500","codeType":"CPT"},{"id":12165,"precertRequired":false,"billingCode":"50520","codeType":"CPT"},{"id":12166,"precertRequired":false,"billingCode":"50525","codeType":"CPT"},{"id":12167,"precertRequired":false,"billingCode":"50526","codeType":"CPT"},{"id":12168,"precertRequired":false,"billingCode":"50540","codeType":"CPT"},{"id":12169,"precertRequired":false,"billingCode":"50541","codeType":"CPT"},{"id":12170,"precertRequired":false,"billingCode":"50551","codeType":"CPT"},{"id":12171,"precertRequired":false,"billingCode":"50555","codeType":"CPT"},{"id":12172,"precertRequired":false,"billingCode":"50557","codeType":"CPT"},{"id":12173,"precertRequired":false,"billingCode":"50561","codeType":"CPT"},{"id":12174,"precertRequired":false,"billingCode":"50562","codeType":"CPT"},{"id":12175,"precertRequired":false,"billingCode":"50810","codeType":"CPT"},{"id":12176,"precertRequired":false,"billingCode":"50947","codeType":"CPT"},{"id":12177,"precertRequired":false,"billingCode":"50948","codeType":"CPT"},{"id":12178,"precertRequired":false,"billingCode":"51596","codeType":"CPT"},{"id":12179,"precertRequired":false,"billingCode":"54130","codeType":"CPT"},{"id":12180,"precertRequired":false,"billingCode":"54135","codeType":"CPT"},{"id":12181,"precertRequired":false,"billingCode":"54450","codeType":"CPT"},{"id":12182,"precertRequired":false,"billingCode":"54692","codeType":"CPT"},{"id":13309,"precertRequired":true,"billingCode":"47480","codeType":"CPT"},{"id":13310,"precertRequired":true,"billingCode":"47543","codeType":"CPT"},{"id":13311,"precertRequired":true,"billingCode":"47552","codeType":"CPT"},{"id":13312,"precertRequired":true,"billingCode":"47553","codeType":"CPT"},{"id":13313,"precertRequired":true,"billingCode":"48554","codeType":"CPT"},{"id":13314,"precertRequired":true,"billingCode":"49320","codeType":"CPT"},{"id":13315,"precertRequired":true,"billingCode":"60540","codeType":"CPT"},{"id":13316,"precertRequired":true,"billingCode":"60545","codeType":"CPT"},{"id":13317,"precertRequired":true,"billingCode":"60650","codeType":"CPT"},{"id":13318,"precertRequired":true,"billingCode":"61575","codeType":"CPT"},{"id":13319,"precertRequired":true,"billingCode":"61576","codeType":"CPT"},{"id":13492,"precertRequired":false,"billingCode":"21601","codeType":"CPT"},{"id":13493,"precertRequired":false,"billingCode":"21602","codeType":"CPT"},{"id":13494,"precertRequired":false,"billingCode":"21603","codeType":"CPT"},{"id":13582,"precertRequired":false,"billingCode":"15769","codeType":"CPT"},{"id":13583,"precertRequired":false,"billingCode":"15771","codeType":"CPT"},{"id":13584,"precertRequired":false,"billingCode":"15772","codeType":"CPT"},{"id":13585,"precertRequired":false,"billingCode":"15773","codeType":"CPT"},{"id":13586,"precertRequired":false,"billingCode":"15774","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":5034,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":14,"precertRequired":false,"billingCode":"00160","codeType":"CPT"},{"id":17,"precertRequired":false,"billingCode":"00170","codeType":"CPT"},{"id":21,"precertRequired":false,"billingCode":"00190","codeType":"CPT"},{"id":22,"precertRequired":false,"billingCode":"00192","codeType":"CPT"},{"id":24,"precertRequired":false,"billingCode":"00211","codeType":"CPT"},{"id":25,"precertRequired":false,"billingCode":"00212","codeType":"CPT"},{"id":26,"precertRequired":false,"billingCode":"00214","codeType":"CPT"},{"id":27,"precertRequired":false,"billingCode":"00215","codeType":"CPT"},{"id":28,"precertRequired":false,"billingCode":"00216","codeType":"CPT"},{"id":29,"precertRequired":false,"billingCode":"00218","codeType":"CPT"},{"id":30,"precertRequired":false,"billingCode":"00220","codeType":"CPT"},{"id":31,"precertRequired":false,"billingCode":"00222","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":33,"precertRequired":false,"billingCode":"00320","codeType":"CPT"},{"id":36,"precertRequired":false,"billingCode":"00400","codeType":"CPT"},{"id":37,"precertRequired":false,"billingCode":"00402","codeType":"CPT"},{"id":38,"precertRequired":false,"billingCode":"00404","codeType":"CPT"},{"id":39,"precertRequired":false,"billingCode":"00406","codeType":"CPT"},{"id":40,"precertRequired":false,"billingCode":"00410","codeType":"CPT"},{"id":44,"precertRequired":false,"billingCode":"00472","codeType":"CPT"},{"id":45,"precertRequired":false,"billingCode":"00474","codeType":"CPT"},{"id":46,"precertRequired":false,"billingCode":"00500","codeType":"CPT"},{"id":47,"precertRequired":false,"billingCode":"00520","codeType":"CPT"},{"id":48,"precertRequired":false,"billingCode":"00522","codeType":"CPT"},{"id":49,"precertRequired":false,"billingCode":"00524","codeType":"CPT"},{"id":50,"precertRequired":false,"billingCode":"00528","codeType":"CPT"},{"id":51,"precertRequired":false,"billingCode":"00529","codeType":"CPT"},{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":57,"precertRequired":false,"billingCode":"00541","codeType":"CPT"},{"id":61,"precertRequired":false,"billingCode":"00550","codeType":"CPT"},{"id":69,"precertRequired":false,"billingCode":"00700","codeType":"CPT"},{"id":70,"precertRequired":false,"billingCode":"00702","codeType":"CPT"},{"id":71,"precertRequired":false,"billingCode":"00730","codeType":"CPT"},{"id":72,"precertRequired":false,"billingCode":"00731","codeType":"CPT"},{"id":73,"precertRequired":false,"billingCode":"00732","codeType":"CPT"},{"id":74,"precertRequired":false,"billingCode":"00750","codeType":"CPT"},{"id":75,"precertRequired":false,"billingCode":"00752","codeType":"CPT"},{"id":76,"precertRequired":false,"billingCode":"00754","codeType":"CPT"},{"id":77,"precertRequired":false,"billingCode":"00756","codeType":"CPT"},{"id":78,"precertRequired":false,"billingCode":"00770","codeType":"CPT"},{"id":79,"precertRequired":false,"billingCode":"00790","codeType":"CPT"},{"id":80,"precertRequired":false,"billingCode":"00792","codeType":"CPT"},{"id":81,"precertRequired":false,"billingCode":"00794","codeType":"CPT"},{"id":83,"precertRequired":false,"billingCode":"00797","codeType":"CPT"},{"id":84,"precertRequired":false,"billingCode":"00800","codeType":"CPT"},{"id":86,"precertRequired":false,"billingCode":"00811","codeType":"CPT"},{"id":87,"precertRequired":false,"billingCode":"00812","codeType":"CPT"},{"id":88,"precertRequired":false,"billingCode":"00813","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":90,"precertRequired":false,"billingCode":"00830","codeType":"CPT"},{"id":91,"precertRequired":false,"billingCode":"00832","codeType":"CPT"},{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":96,"precertRequired":false,"billingCode":"00844","codeType":"CPT"},{"id":100,"precertRequired":false,"billingCode":"00860","codeType":"CPT"},{"id":104,"precertRequired":false,"billingCode":"00866","codeType":"CPT"},{"id":111,"precertRequired":false,"billingCode":"00902","codeType":"CPT"},{"id":115,"precertRequired":false,"billingCode":"00910","codeType":"CPT"},{"id":120,"precertRequired":false,"billingCode":"00920","codeType":"CPT"},{"id":136,"precertRequired":false,"billingCode":"00952","codeType":"CPT"},{"id":138,"precertRequired":false,"billingCode":"01120","codeType":"CPT"},{"id":140,"precertRequired":false,"billingCode":"01140","codeType":"CPT"},{"id":141,"precertRequired":false,"billingCode":"01150","codeType":"CPT"},{"id":144,"precertRequired":false,"billingCode":"01173","codeType":"CPT"},{"id":155,"precertRequired":false,"billingCode":"01250","codeType":"CPT"},{"id":156,"precertRequired":false,"billingCode":"01260","codeType":"CPT"},{"id":158,"precertRequired":false,"billingCode":"01272","codeType":"CPT"},{"id":159,"precertRequired":false,"billingCode":"01274","codeType":"CPT"},{"id":160,"precertRequired":false,"billingCode":"01320","codeType":"CPT"},{"id":174,"precertRequired":false,"billingCode":"01442","codeType":"CPT"},{"id":175,"precertRequired":false,"billingCode":"01444","codeType":"CPT"},{"id":181,"precertRequired":false,"billingCode":"01480","codeType":"CPT"},{"id":191,"precertRequired":false,"billingCode":"01844","codeType":"CPT"},{"id":192,"precertRequired":false,"billingCode":"01916","codeType":"CPT"},{"id":195,"precertRequired":false,"billingCode":"01924","codeType":"CPT"},{"id":197,"precertRequired":false,"billingCode":"01926","codeType":"CPT"},{"id":203,"precertRequired":true,"billingCode":"01936","codeType":"CPT"},{"id":204,"precertRequired":false,"billingCode":"01951","codeType":"CPT"},{"id":205,"precertRequired":false,"billingCode":"01952","codeType":"CPT"},{"id":206,"precertRequired":false,"billingCode":"01953","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":8331,"precertRequired":false,"billingCode":"G9654","codeType":"HCPCS"},{"id":9142,"precertRequired":false,"billingCode":"00630","codeType":"CPT"},{"id":9145,"precertRequired":false,"billingCode":"00670","codeType":"CPT"},{"id":9146,"precertRequired":false,"billingCode":"01810","codeType":"CPT"},{"id":9149,"precertRequired":false,"billingCode":"01830","codeType":"CPT"},{"id":11815,"precertRequired":false,"billingCode":"00350","codeType":"CPT"},{"id":11858,"precertRequired":false,"billingCode":"01610","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":5035,"description":"Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5723,"precertRequired":false,"billingCode":"84445","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":5036,"description":"Inpatient or observation admission for surgery/procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":5037,"description":"Inpatient admission or observation status for complications related to the surgery/procedure\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":5038,"description":"Follow-up visits for this episode of care relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":5039,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]}]}},{"Seoc":{"id":1654,"seocKey":55,"name":"General Surgery_REV_PRCT","seocId":"SSC_GENERAL SURGERY_1.0.5_REV_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"11-12-2019","endDate":"06-08-2020","duration":180,"REV":true,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.   Diagnostic imaging relevant to the referred condition on the consult  \r\n3.   Diagnostic studies relevant to the referred condition on the consult  \r\n4.   Labs and pathology relevant to the referred condition on the consult \r\n5.   Procedures relevant to the referred condition on the consult including but not limited to:  I&D, biopsy, lesion excision with repair, port placement etc.\r\n6.    Anesthesia consultation related to the procedure\r\n7.    Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)\r\n8.    Inpatient or observation admission for surgery/procedure if indicated\r\n9.    Inpatient admission or observation status for complications related to the surgery/procedure\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure\r\n10.  Follow-up visits for this episode of care relevant to the referred condition on the consult","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"SURGERY GENERAL","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"208600000X"}],"services":[{"id":4633,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4367,"precertRequired":false,"billingCode":"70015","codeType":"CPT"},{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4416,"precertRequired":false,"billingCode":"70545","codeType":"CPT"},{"id":4417,"precertRequired":false,"billingCode":"70546","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4424,"precertRequired":false,"billingCode":"70554","codeType":"CPT"},{"id":4425,"precertRequired":false,"billingCode":"70555","codeType":"CPT"},{"id":4426,"precertRequired":false,"billingCode":"70557","codeType":"CPT"},{"id":4427,"precertRequired":false,"billingCode":"70558","codeType":"CPT"},{"id":4428,"precertRequired":false,"billingCode":"70559","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4517,"precertRequired":false,"billingCode":"73110","codeType":"CPT"},{"id":4520,"precertRequired":false,"billingCode":"73130","codeType":"CPT"},{"id":4521,"precertRequired":false,"billingCode":"73140","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4541,"precertRequired":false,"billingCode":"73552","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"},{"id":4543,"precertRequired":false,"billingCode":"73562","codeType":"CPT"},{"id":4544,"precertRequired":false,"billingCode":"73564","codeType":"CPT"},{"id":4547,"precertRequired":false,"billingCode":"73590","codeType":"CPT"},{"id":4550,"precertRequired":false,"billingCode":"73610","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4584,"precertRequired":false,"billingCode":"74190","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4605,"precertRequired":false,"billingCode":"74300","codeType":"CPT"},{"id":4606,"precertRequired":false,"billingCode":"74301","codeType":"CPT"},{"id":4607,"precertRequired":false,"billingCode":"74328","codeType":"CPT"},{"id":4608,"precertRequired":false,"billingCode":"74329","codeType":"CPT"},{"id":4609,"precertRequired":false,"billingCode":"74330","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4611,"precertRequired":false,"billingCode":"74355","codeType":"CPT"},{"id":4612,"precertRequired":false,"billingCode":"74360","codeType":"CPT"},{"id":4613,"precertRequired":false,"billingCode":"74363","codeType":"CPT"},{"id":4639,"precertRequired":false,"billingCode":"75600","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4646,"precertRequired":false,"billingCode":"75710","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4661,"precertRequired":false,"billingCode":"75809","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4667,"precertRequired":false,"billingCode":"75831","codeType":"CPT"},{"id":4668,"precertRequired":false,"billingCode":"75833","codeType":"CPT"},{"id":4669,"precertRequired":false,"billingCode":"75840","codeType":"CPT"},{"id":4670,"precertRequired":false,"billingCode":"75842","codeType":"CPT"},{"id":4671,"precertRequired":false,"billingCode":"75860","codeType":"CPT"},{"id":4672,"precertRequired":false,"billingCode":"75870","codeType":"CPT"},{"id":4673,"precertRequired":false,"billingCode":"75872","codeType":"CPT"},{"id":4674,"precertRequired":false,"billingCode":"75880","codeType":"CPT"},{"id":4675,"precertRequired":false,"billingCode":"75885","codeType":"CPT"},{"id":4676,"precertRequired":false,"billingCode":"75887","codeType":"CPT"},{"id":4677,"precertRequired":false,"billingCode":"75889","codeType":"CPT"},{"id":4678,"precertRequired":false,"billingCode":"75891","codeType":"CPT"},{"id":4679,"precertRequired":false,"billingCode":"75893","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4682,"precertRequired":false,"billingCode":"75901","codeType":"CPT"},{"id":4683,"precertRequired":false,"billingCode":"75902","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4691,"precertRequired":false,"billingCode":"75989","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4697,"precertRequired":false,"billingCode":"76100","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4700,"precertRequired":false,"billingCode":"76120","codeType":"CPT"},{"id":4701,"precertRequired":false,"billingCode":"76125","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4706,"precertRequired":false,"billingCode":"76390","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4726,"precertRequired":false,"billingCode":"76706","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4759,"precertRequired":false,"billingCode":"76882","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4770,"precertRequired":false,"billingCode":"76970","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4792,"precertRequired":false,"billingCode":"77071","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4797,"precertRequired":false,"billingCode":"77077","codeType":"CPT"},{"id":4801,"precertRequired":false,"billingCode":"77084","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4910,"precertRequired":false,"billingCode":"78261","codeType":"CPT"},{"id":4918,"precertRequired":false,"billingCode":"78278","codeType":"CPT"},{"id":4919,"precertRequired":false,"billingCode":"78282","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4921,"precertRequired":false,"billingCode":"78291","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4930,"precertRequired":false,"billingCode":"78414","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4932,"precertRequired":false,"billingCode":"78445","codeType":"CPT"},{"id":4937,"precertRequired":false,"billingCode":"78456","codeType":"CPT"},{"id":4938,"precertRequired":false,"billingCode":"78457","codeType":"CPT"},{"id":4939,"precertRequired":false,"billingCode":"78458","codeType":"CPT"},{"id":4969,"precertRequired":false,"billingCode":"78660","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4985,"precertRequired":false,"billingCode":"78804","codeType":"CPT"},{"id":4986,"precertRequired":false,"billingCode":"78805","codeType":"CPT"},{"id":4987,"precertRequired":false,"billingCode":"78806","codeType":"CPT"},{"id":4988,"precertRequired":false,"billingCode":"78807","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"},{"id":4990,"precertRequired":false,"billingCode":"78811","codeType":"CPT"},{"id":4991,"precertRequired":false,"billingCode":"78812","codeType":"CPT"},{"id":4992,"precertRequired":false,"billingCode":"78813","codeType":"CPT"},{"id":4993,"precertRequired":false,"billingCode":"78814","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":4995,"precertRequired":false,"billingCode":"78816","codeType":"CPT"},{"id":9769,"precertRequired":true,"billingCode":"77046","codeType":"CPT"},{"id":9770,"precertRequired":true,"billingCode":"77047","codeType":"CPT"},{"id":9771,"precertRequired":true,"billingCode":"77048","codeType":"CPT"},{"id":9772,"precertRequired":true,"billingCode":"77049","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":4634,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"},{"id":6619,"precertRequired":false,"billingCode":"91010","codeType":"CPT"},{"id":6634,"precertRequired":false,"billingCode":"91120","codeType":"CPT"},{"id":6635,"precertRequired":false,"billingCode":"91122","codeType":"CPT"},{"id":6825,"precertRequired":false,"billingCode":"93016","codeType":"CPT"},{"id":6826,"precertRequired":false,"billingCode":"93017","codeType":"CPT"},{"id":6827,"precertRequired":false,"billingCode":"93018","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6872,"precertRequired":false,"billingCode":"93308","codeType":"CPT"},{"id":6873,"precertRequired":false,"billingCode":"93312","codeType":"CPT"},{"id":6965,"precertRequired":false,"billingCode":"93880","codeType":"CPT"},{"id":6966,"precertRequired":false,"billingCode":"93882","codeType":"CPT"},{"id":6973,"precertRequired":false,"billingCode":"93922","codeType":"CPT"},{"id":6974,"precertRequired":false,"billingCode":"93923","codeType":"CPT"},{"id":6975,"precertRequired":false,"billingCode":"93924","codeType":"CPT"},{"id":6976,"precertRequired":false,"billingCode":"93925","codeType":"CPT"},{"id":6977,"precertRequired":false,"billingCode":"93926","codeType":"CPT"},{"id":6980,"precertRequired":false,"billingCode":"93970","codeType":"CPT"},{"id":6981,"precertRequired":false,"billingCode":"93971","codeType":"CPT"},{"id":6982,"precertRequired":false,"billingCode":"93975","codeType":"CPT"},{"id":6984,"precertRequired":false,"billingCode":"93978","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7029,"precertRequired":false,"billingCode":"94729","codeType":"CPT"},{"id":7031,"precertRequired":false,"billingCode":"94760","codeType":"CPT"},{"id":7110,"precertRequired":false,"billingCode":"95886","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":4635,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5140,"precertRequired":false,"billingCode":"80500","codeType":"CPT"},{"id":5141,"precertRequired":false,"billingCode":"80502","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5340,"precertRequired":false,"billingCode":"81500","codeType":"CPT"},{"id":5341,"precertRequired":false,"billingCode":"81503","codeType":"CPT"},{"id":5372,"precertRequired":false,"billingCode":"82040","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5382,"precertRequired":false,"billingCode":"82105","codeType":"CPT"},{"id":5384,"precertRequired":false,"billingCode":"82107","codeType":"CPT"},{"id":5395,"precertRequired":false,"billingCode":"82150","codeType":"CPT"},{"id":5409,"precertRequired":false,"billingCode":"82248","codeType":"CPT"},{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5420,"precertRequired":false,"billingCode":"82310","codeType":"CPT"},{"id":5421,"precertRequired":false,"billingCode":"82330","codeType":"CPT"},{"id":5432,"precertRequired":false,"billingCode":"82378","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5469,"precertRequired":false,"billingCode":"82607","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5499,"precertRequired":false,"billingCode":"82746","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5522,"precertRequired":false,"billingCode":"82948","codeType":"CPT"},{"id":5528,"precertRequired":false,"billingCode":"82962","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5578,"precertRequired":false,"billingCode":"83550","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5586,"precertRequired":false,"billingCode":"83630","codeType":"CPT"},{"id":5587,"precertRequired":false,"billingCode":"83631","codeType":"CPT"},{"id":5597,"precertRequired":false,"billingCode":"83690","codeType":"CPT"},{"id":5603,"precertRequired":false,"billingCode":"83718","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5634,"precertRequired":false,"billingCode":"83970","codeType":"CPT"},{"id":5649,"precertRequired":false,"billingCode":"84100","codeType":"CPT"},{"id":5657,"precertRequired":false,"billingCode":"84132","codeType":"CPT"},{"id":5659,"precertRequired":false,"billingCode":"84134","codeType":"CPT"},{"id":5668,"precertRequired":false,"billingCode":"84152","codeType":"CPT"},{"id":5669,"precertRequired":false,"billingCode":"84153","codeType":"CPT"},{"id":5670,"precertRequired":false,"billingCode":"84154","codeType":"CPT"},{"id":5714,"precertRequired":false,"billingCode":"84425","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5727,"precertRequired":false,"billingCode":"84460","codeType":"CPT"},{"id":5728,"precertRequired":false,"billingCode":"84466","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5740,"precertRequired":false,"billingCode":"84520","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5905,"precertRequired":false,"billingCode":"86300","codeType":"CPT"},{"id":5906,"precertRequired":false,"billingCode":"86301","codeType":"CPT"},{"id":5907,"precertRequired":false,"billingCode":"86304","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6065,"precertRequired":false,"billingCode":"86850","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6075,"precertRequired":false,"billingCode":"86901","codeType":"CPT"},{"id":6085,"precertRequired":false,"billingCode":"86923","codeType":"CPT"},{"id":6108,"precertRequired":false,"billingCode":"87045","codeType":"CPT"},{"id":6109,"precertRequired":false,"billingCode":"87046","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6112,"precertRequired":false,"billingCode":"87073","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6143,"precertRequired":false,"billingCode":"87177","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6236,"precertRequired":false,"billingCode":"87505","codeType":"CPT"},{"id":6237,"precertRequired":false,"billingCode":"87506","codeType":"CPT"},{"id":6238,"precertRequired":false,"billingCode":"87507","codeType":"CPT"},{"id":6288,"precertRequired":false,"billingCode":"87641","codeType":"CPT"},{"id":6340,"precertRequired":false,"billingCode":"88108","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6369,"precertRequired":false,"billingCode":"88184","codeType":"CPT"},{"id":6370,"precertRequired":false,"billingCode":"88185","codeType":"CPT"},{"id":6371,"precertRequired":false,"billingCode":"88187","codeType":"CPT"},{"id":6372,"precertRequired":false,"billingCode":"88188","codeType":"CPT"},{"id":6373,"precertRequired":false,"billingCode":"88189","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6411,"precertRequired":false,"billingCode":"88314","codeType":"CPT"},{"id":6412,"precertRequired":false,"billingCode":"88319","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6414,"precertRequired":false,"billingCode":"88323","codeType":"CPT"},{"id":6415,"precertRequired":false,"billingCode":"88325","codeType":"CPT"},{"id":6416,"precertRequired":false,"billingCode":"88329","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6419,"precertRequired":false,"billingCode":"88333","codeType":"CPT"},{"id":6420,"precertRequired":false,"billingCode":"88334","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6423,"precertRequired":false,"billingCode":"88344","codeType":"CPT"},{"id":6424,"precertRequired":false,"billingCode":"88346","codeType":"CPT"},{"id":6425,"precertRequired":false,"billingCode":"88348","codeType":"CPT"},{"id":6426,"precertRequired":false,"billingCode":"88350","codeType":"CPT"},{"id":6427,"precertRequired":false,"billingCode":"88355","codeType":"CPT"},{"id":6428,"precertRequired":false,"billingCode":"88356","codeType":"CPT"},{"id":6429,"precertRequired":false,"billingCode":"88358","codeType":"CPT"},{"id":6430,"precertRequired":false,"billingCode":"88360","codeType":"CPT"},{"id":6431,"precertRequired":false,"billingCode":"88361","codeType":"CPT"},{"id":6432,"precertRequired":false,"billingCode":"88362","codeType":"CPT"},{"id":6433,"precertRequired":false,"billingCode":"88363","codeType":"CPT"},{"id":6434,"precertRequired":false,"billingCode":"88364","codeType":"CPT"},{"id":6435,"precertRequired":false,"billingCode":"88365","codeType":"CPT"},{"id":6436,"precertRequired":false,"billingCode":"88366","codeType":"CPT"},{"id":6437,"precertRequired":false,"billingCode":"88367","codeType":"CPT"},{"id":6438,"precertRequired":false,"billingCode":"88368","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"},{"id":6440,"precertRequired":false,"billingCode":"88371","codeType":"CPT"},{"id":6441,"precertRequired":false,"billingCode":"88372","codeType":"CPT"},{"id":6442,"precertRequired":false,"billingCode":"88373","codeType":"CPT"},{"id":6443,"precertRequired":false,"billingCode":"88374","codeType":"CPT"},{"id":6444,"precertRequired":false,"billingCode":"88375","codeType":"CPT"},{"id":6445,"precertRequired":false,"billingCode":"88377","codeType":"CPT"},{"id":6446,"precertRequired":false,"billingCode":"88380","codeType":"CPT"},{"id":6447,"precertRequired":false,"billingCode":"88381","codeType":"CPT"},{"id":6448,"precertRequired":false,"billingCode":"88387","codeType":"CPT"},{"id":6449,"precertRequired":false,"billingCode":"88388","codeType":"CPT"},{"id":6456,"precertRequired":false,"billingCode":"89049","codeType":"CPT"},{"id":6457,"precertRequired":false,"billingCode":"89050","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":8206,"precertRequired":false,"billingCode":"G0416","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":4636,"description":"Procedures relevant to the referred condition on the consult including but not limited to:  I&D, biopsy, lesion excision with repair,port placement etc.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":243,"precertRequired":false,"billingCode":"11010","codeType":"CPT"},{"id":244,"precertRequired":false,"billingCode":"11011","codeType":"CPT"},{"id":245,"precertRequired":false,"billingCode":"11012","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":248,"precertRequired":false,"billingCode":"11044","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":250,"precertRequired":false,"billingCode":"11046","codeType":"CPT"},{"id":251,"precertRequired":false,"billingCode":"11047","codeType":"CPT"},{"id":257,"precertRequired":false,"billingCode":"11200","codeType":"CPT"},{"id":258,"precertRequired":false,"billingCode":"11201","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":313,"precertRequired":false,"billingCode":"11719","codeType":"CPT"},{"id":314,"precertRequired":false,"billingCode":"11720","codeType":"CPT"},{"id":315,"precertRequired":false,"billingCode":"11721","codeType":"CPT"},{"id":316,"precertRequired":false,"billingCode":"11730","codeType":"CPT"},{"id":317,"precertRequired":false,"billingCode":"11732","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":319,"precertRequired":false,"billingCode":"11750","codeType":"CPT"},{"id":320,"precertRequired":false,"billingCode":"11755","codeType":"CPT"},{"id":321,"precertRequired":false,"billingCode":"11760","codeType":"CPT"},{"id":322,"precertRequired":false,"billingCode":"11762","codeType":"CPT"},{"id":323,"precertRequired":false,"billingCode":"11765","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":329,"precertRequired":false,"billingCode":"11960","codeType":"CPT"},{"id":330,"precertRequired":false,"billingCode":"11970","codeType":"CPT"},{"id":331,"precertRequired":false,"billingCode":"11971","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":374,"precertRequired":false,"billingCode":"13120","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":383,"precertRequired":false,"billingCode":"13160","codeType":"CPT"},{"id":384,"precertRequired":false,"billingCode":"14000","codeType":"CPT"},{"id":385,"precertRequired":false,"billingCode":"14001","codeType":"CPT"},{"id":386,"precertRequired":false,"billingCode":"14020","codeType":"CPT"},{"id":387,"precertRequired":false,"billingCode":"14021","codeType":"CPT"},{"id":388,"precertRequired":true,"billingCode":"14040","codeType":"CPT"},{"id":389,"precertRequired":false,"billingCode":"14041","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":392,"precertRequired":true,"billingCode":"14301","codeType":"CPT"},{"id":393,"precertRequired":false,"billingCode":"14302","codeType":"CPT"},{"id":395,"precertRequired":false,"billingCode":"15040","codeType":"CPT"},{"id":396,"precertRequired":false,"billingCode":"15050","codeType":"CPT"},{"id":397,"precertRequired":false,"billingCode":"15150","codeType":"CPT"},{"id":398,"precertRequired":false,"billingCode":"15151","codeType":"CPT"},{"id":399,"precertRequired":false,"billingCode":"15155","codeType":"CPT"},{"id":400,"precertRequired":false,"billingCode":"15156","codeType":"CPT"},{"id":401,"precertRequired":false,"billingCode":"15157","codeType":"CPT"},{"id":402,"precertRequired":false,"billingCode":"15200","codeType":"CPT"},{"id":403,"precertRequired":false,"billingCode":"15201","codeType":"CPT"},{"id":404,"precertRequired":false,"billingCode":"15220","codeType":"CPT"},{"id":405,"precertRequired":false,"billingCode":"15221","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":410,"precertRequired":false,"billingCode":"15271","codeType":"CPT"},{"id":411,"precertRequired":false,"billingCode":"15272","codeType":"CPT"},{"id":412,"precertRequired":false,"billingCode":"15273","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":415,"precertRequired":false,"billingCode":"15570","codeType":"CPT"},{"id":416,"precertRequired":false,"billingCode":"15572","codeType":"CPT"},{"id":417,"precertRequired":false,"billingCode":"15574","codeType":"CPT"},{"id":418,"precertRequired":false,"billingCode":"15576","codeType":"CPT"},{"id":419,"precertRequired":false,"billingCode":"15600","codeType":"CPT"},{"id":420,"precertRequired":false,"billingCode":"15610","codeType":"CPT"},{"id":421,"precertRequired":false,"billingCode":"15620","codeType":"CPT"},{"id":422,"precertRequired":false,"billingCode":"15630","codeType":"CPT"},{"id":423,"precertRequired":false,"billingCode":"15650","codeType":"CPT"},{"id":424,"precertRequired":false,"billingCode":"15730","codeType":"CPT"},{"id":425,"precertRequired":false,"billingCode":"15731","codeType":"CPT"},{"id":426,"precertRequired":false,"billingCode":"15733","codeType":"CPT"},{"id":427,"precertRequired":false,"billingCode":"15734","codeType":"CPT"},{"id":428,"precertRequired":false,"billingCode":"15736","codeType":"CPT"},{"id":429,"precertRequired":false,"billingCode":"15738","codeType":"CPT"},{"id":430,"precertRequired":false,"billingCode":"15740","codeType":"CPT"},{"id":431,"precertRequired":false,"billingCode":"15750","codeType":"CPT"},{"id":432,"precertRequired":false,"billingCode":"15756","codeType":"CPT"},{"id":433,"precertRequired":false,"billingCode":"15757","codeType":"CPT"},{"id":434,"precertRequired":false,"billingCode":"15758","codeType":"CPT"},{"id":435,"precertRequired":false,"billingCode":"15760","codeType":"CPT"},{"id":436,"precertRequired":false,"billingCode":"15770","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":443,"precertRequired":false,"billingCode":"15850","codeType":"CPT"},{"id":444,"precertRequired":false,"billingCode":"15852","codeType":"CPT"},{"id":445,"precertRequired":false,"billingCode":"15860","codeType":"CPT"},{"id":446,"precertRequired":false,"billingCode":"15920","codeType":"CPT"},{"id":447,"precertRequired":false,"billingCode":"15922","codeType":"CPT"},{"id":448,"precertRequired":false,"billingCode":"15931","codeType":"CPT"},{"id":449,"precertRequired":false,"billingCode":"15933","codeType":"CPT"},{"id":450,"precertRequired":false,"billingCode":"15934","codeType":"CPT"},{"id":451,"precertRequired":false,"billingCode":"15935","codeType":"CPT"},{"id":452,"precertRequired":false,"billingCode":"15936","codeType":"CPT"},{"id":453,"precertRequired":false,"billingCode":"15937","codeType":"CPT"},{"id":454,"precertRequired":false,"billingCode":"15940","codeType":"CPT"},{"id":455,"precertRequired":false,"billingCode":"15941","codeType":"CPT"},{"id":456,"precertRequired":false,"billingCode":"15944","codeType":"CPT"},{"id":457,"precertRequired":false,"billingCode":"15945","codeType":"CPT"},{"id":458,"precertRequired":false,"billingCode":"15946","codeType":"CPT"},{"id":459,"precertRequired":false,"billingCode":"15950","codeType":"CPT"},{"id":460,"precertRequired":false,"billingCode":"15951","codeType":"CPT"},{"id":461,"precertRequired":false,"billingCode":"15952","codeType":"CPT"},{"id":462,"precertRequired":false,"billingCode":"15953","codeType":"CPT"},{"id":463,"precertRequired":false,"billingCode":"15956","codeType":"CPT"},{"id":464,"precertRequired":false,"billingCode":"15958","codeType":"CPT"},{"id":465,"precertRequired":false,"billingCode":"16000","codeType":"CPT"},{"id":466,"precertRequired":false,"billingCode":"16020","codeType":"CPT"},{"id":467,"precertRequired":false,"billingCode":"16025","codeType":"CPT"},{"id":468,"precertRequired":false,"billingCode":"16030","codeType":"CPT"},{"id":469,"precertRequired":false,"billingCode":"16035","codeType":"CPT"},{"id":470,"precertRequired":false,"billingCode":"16036","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":474,"precertRequired":false,"billingCode":"17106","codeType":"CPT"},{"id":475,"precertRequired":false,"billingCode":"17107","codeType":"CPT"},{"id":476,"precertRequired":false,"billingCode":"17108","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":498,"precertRequired":false,"billingCode":"17311","codeType":"CPT"},{"id":499,"precertRequired":true,"billingCode":"17312","codeType":"CPT"},{"id":500,"precertRequired":true,"billingCode":"17313","codeType":"CPT"},{"id":501,"precertRequired":true,"billingCode":"17314","codeType":"CPT"},{"id":502,"precertRequired":true,"billingCode":"17315","codeType":"CPT"},{"id":503,"precertRequired":false,"billingCode":"19000","codeType":"CPT"},{"id":504,"precertRequired":false,"billingCode":"19001","codeType":"CPT"},{"id":505,"precertRequired":false,"billingCode":"19020","codeType":"CPT"},{"id":506,"precertRequired":false,"billingCode":"19030","codeType":"CPT"},{"id":507,"precertRequired":false,"billingCode":"19081","codeType":"CPT"},{"id":508,"precertRequired":false,"billingCode":"19082","codeType":"CPT"},{"id":509,"precertRequired":false,"billingCode":"19083","codeType":"CPT"},{"id":510,"precertRequired":false,"billingCode":"19084","codeType":"CPT"},{"id":511,"precertRequired":false,"billingCode":"19085","codeType":"CPT"},{"id":512,"precertRequired":false,"billingCode":"19086","codeType":"CPT"},{"id":513,"precertRequired":false,"billingCode":"19100","codeType":"CPT"},{"id":514,"precertRequired":false,"billingCode":"19101","codeType":"CPT"},{"id":515,"precertRequired":false,"billingCode":"19105","codeType":"CPT"},{"id":516,"precertRequired":false,"billingCode":"19120","codeType":"CPT"},{"id":517,"precertRequired":false,"billingCode":"19125","codeType":"CPT"},{"id":518,"precertRequired":false,"billingCode":"19126","codeType":"CPT"},{"id":519,"precertRequired":false,"billingCode":"19260","codeType":"CPT"},{"id":520,"precertRequired":true,"billingCode":"19271","codeType":"CPT"},{"id":521,"precertRequired":true,"billingCode":"19272","codeType":"CPT"},{"id":522,"precertRequired":false,"billingCode":"19281","codeType":"CPT"},{"id":523,"precertRequired":false,"billingCode":"19282","codeType":"CPT"},{"id":524,"precertRequired":false,"billingCode":"19283","codeType":"CPT"},{"id":525,"precertRequired":false,"billingCode":"19284","codeType":"CPT"},{"id":526,"precertRequired":false,"billingCode":"19285","codeType":"CPT"},{"id":527,"precertRequired":false,"billingCode":"19286","codeType":"CPT"},{"id":528,"precertRequired":false,"billingCode":"19287","codeType":"CPT"},{"id":529,"precertRequired":false,"billingCode":"19288","codeType":"CPT"},{"id":534,"precertRequired":false,"billingCode":"19300","codeType":"CPT"},{"id":535,"precertRequired":false,"billingCode":"19301","codeType":"CPT"},{"id":536,"precertRequired":false,"billingCode":"19302","codeType":"CPT"},{"id":537,"precertRequired":false,"billingCode":"19303","codeType":"CPT"},{"id":538,"precertRequired":false,"billingCode":"19304","codeType":"CPT"},{"id":539,"precertRequired":false,"billingCode":"19305","codeType":"CPT"},{"id":540,"precertRequired":false,"billingCode":"19306","codeType":"CPT"},{"id":541,"precertRequired":false,"billingCode":"19307","codeType":"CPT"},{"id":543,"precertRequired":false,"billingCode":"20100","codeType":"CPT"},{"id":544,"precertRequired":false,"billingCode":"20101","codeType":"CPT"},{"id":545,"precertRequired":false,"billingCode":"20102","codeType":"CPT"},{"id":546,"precertRequired":false,"billingCode":"20103","codeType":"CPT"},{"id":547,"precertRequired":false,"billingCode":"20150","codeType":"CPT"},{"id":548,"precertRequired":false,"billingCode":"20200","codeType":"CPT"},{"id":549,"precertRequired":false,"billingCode":"20205","codeType":"CPT"},{"id":550,"precertRequired":false,"billingCode":"20206","codeType":"CPT"},{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":552,"precertRequired":false,"billingCode":"20225","codeType":"CPT"},{"id":553,"precertRequired":false,"billingCode":"20240","codeType":"CPT"},{"id":554,"precertRequired":false,"billingCode":"20245","codeType":"CPT"},{"id":555,"precertRequired":true,"billingCode":"20250","codeType":"CPT"},{"id":556,"precertRequired":true,"billingCode":"20251","codeType":"CPT"},{"id":557,"precertRequired":false,"billingCode":"20500","codeType":"CPT"},{"id":558,"precertRequired":false,"billingCode":"20501","codeType":"CPT"},{"id":559,"precertRequired":false,"billingCode":"20520","codeType":"CPT"},{"id":560,"precertRequired":false,"billingCode":"20525","codeType":"CPT"},{"id":561,"precertRequired":true,"billingCode":"20526","codeType":"CPT"},{"id":562,"precertRequired":true,"billingCode":"20527","codeType":"CPT"},{"id":563,"precertRequired":true,"billingCode":"20550","codeType":"CPT"},{"id":564,"precertRequired":true,"billingCode":"20551","codeType":"CPT"},{"id":565,"precertRequired":true,"billingCode":"20552","codeType":"CPT"},{"id":566,"precertRequired":true,"billingCode":"20553","codeType":"CPT"},{"id":567,"precertRequired":false,"billingCode":"20555","codeType":"CPT"},{"id":568,"precertRequired":true,"billingCode":"20600","codeType":"CPT"},{"id":569,"precertRequired":true,"billingCode":"20604","codeType":"CPT"},{"id":570,"precertRequired":true,"billingCode":"20605","codeType":"CPT"},{"id":571,"precertRequired":true,"billingCode":"20606","codeType":"CPT"},{"id":572,"precertRequired":true,"billingCode":"20610","codeType":"CPT"},{"id":573,"precertRequired":true,"billingCode":"20611","codeType":"CPT"},{"id":574,"precertRequired":false,"billingCode":"20612","codeType":"CPT"},{"id":575,"precertRequired":false,"billingCode":"20615","codeType":"CPT"},{"id":582,"precertRequired":false,"billingCode":"20665","codeType":"CPT"},{"id":583,"precertRequired":false,"billingCode":"20670","codeType":"CPT"},{"id":584,"precertRequired":false,"billingCode":"20680","codeType":"CPT"},{"id":591,"precertRequired":false,"billingCode":"20900","codeType":"CPT"},{"id":592,"precertRequired":false,"billingCode":"20902","codeType":"CPT"},{"id":593,"precertRequired":false,"billingCode":"20910","codeType":"CPT"},{"id":594,"precertRequired":false,"billingCode":"20912","codeType":"CPT"},{"id":595,"precertRequired":false,"billingCode":"20920","codeType":"CPT"},{"id":596,"precertRequired":false,"billingCode":"20922","codeType":"CPT"},{"id":597,"precertRequired":false,"billingCode":"20924","codeType":"CPT"},{"id":598,"precertRequired":false,"billingCode":"20926","codeType":"CPT"},{"id":600,"precertRequired":false,"billingCode":"20950","codeType":"CPT"},{"id":609,"precertRequired":false,"billingCode":"20982","codeType":"CPT"},{"id":610,"precertRequired":false,"billingCode":"20983","codeType":"CPT"},{"id":611,"precertRequired":false,"billingCode":"20985","codeType":"CPT"},{"id":723,"precertRequired":false,"billingCode":"21501","codeType":"CPT"},{"id":724,"precertRequired":false,"billingCode":"21502","codeType":"CPT"},{"id":725,"precertRequired":false,"billingCode":"21510","codeType":"CPT"},{"id":726,"precertRequired":true,"billingCode":"21550","codeType":"CPT"},{"id":727,"precertRequired":true,"billingCode":"21552","codeType":"CPT"},{"id":728,"precertRequired":true,"billingCode":"21554","codeType":"CPT"},{"id":729,"precertRequired":true,"billingCode":"21555","codeType":"CPT"},{"id":730,"precertRequired":true,"billingCode":"21556","codeType":"CPT"},{"id":731,"precertRequired":true,"billingCode":"21557","codeType":"CPT"},{"id":732,"precertRequired":true,"billingCode":"21558","codeType":"CPT"},{"id":733,"precertRequired":true,"billingCode":"21600","codeType":"CPT"},{"id":734,"precertRequired":true,"billingCode":"21610","codeType":"CPT"},{"id":735,"precertRequired":true,"billingCode":"21615","codeType":"CPT"},{"id":736,"precertRequired":true,"billingCode":"21616","codeType":"CPT"},{"id":737,"precertRequired":true,"billingCode":"21620","codeType":"CPT"},{"id":738,"precertRequired":true,"billingCode":"21627","codeType":"CPT"},{"id":739,"precertRequired":true,"billingCode":"21630","codeType":"CPT"},{"id":740,"precertRequired":true,"billingCode":"21632","codeType":"CPT"},{"id":741,"precertRequired":false,"billingCode":"21685","codeType":"CPT"},{"id":742,"precertRequired":true,"billingCode":"21700","codeType":"CPT"},{"id":743,"precertRequired":true,"billingCode":"21705","codeType":"CPT"},{"id":744,"precertRequired":true,"billingCode":"21720","codeType":"CPT"},{"id":745,"precertRequired":true,"billingCode":"21725","codeType":"CPT"},{"id":746,"precertRequired":true,"billingCode":"21740","codeType":"CPT"},{"id":747,"precertRequired":true,"billingCode":"21742","codeType":"CPT"},{"id":748,"precertRequired":true,"billingCode":"21743","codeType":"CPT"},{"id":749,"precertRequired":true,"billingCode":"21750","codeType":"CPT"},{"id":750,"precertRequired":true,"billingCode":"21811","codeType":"CPT"},{"id":751,"precertRequired":true,"billingCode":"21812","codeType":"CPT"},{"id":752,"precertRequired":true,"billingCode":"21813","codeType":"CPT"},{"id":755,"precertRequired":false,"billingCode":"21920","codeType":"CPT"},{"id":756,"precertRequired":false,"billingCode":"21925","codeType":"CPT"},{"id":757,"precertRequired":false,"billingCode":"21930","codeType":"CPT"},{"id":758,"precertRequired":false,"billingCode":"21931","codeType":"CPT"},{"id":759,"precertRequired":false,"billingCode":"21932","codeType":"CPT"},{"id":760,"precertRequired":false,"billingCode":"21933","codeType":"CPT"},{"id":761,"precertRequired":false,"billingCode":"21935","codeType":"CPT"},{"id":762,"precertRequired":false,"billingCode":"21936","codeType":"CPT"},{"id":763,"precertRequired":true,"billingCode":"22010","codeType":"CPT"},{"id":764,"precertRequired":false,"billingCode":"22015","codeType":"CPT"},{"id":775,"precertRequired":false,"billingCode":"22900","codeType":"CPT"},{"id":776,"precertRequired":false,"billingCode":"22901","codeType":"CPT"},{"id":777,"precertRequired":false,"billingCode":"22902","codeType":"CPT"},{"id":778,"precertRequired":false,"billingCode":"22903","codeType":"CPT"},{"id":779,"precertRequired":false,"billingCode":"22904","codeType":"CPT"},{"id":780,"precertRequired":false,"billingCode":"22905","codeType":"CPT"},{"id":781,"precertRequired":false,"billingCode":"23000","codeType":"CPT"},{"id":782,"precertRequired":false,"billingCode":"23020","codeType":"CPT"},{"id":783,"precertRequired":false,"billingCode":"23030","codeType":"CPT"},{"id":784,"precertRequired":false,"billingCode":"23031","codeType":"CPT"},{"id":785,"precertRequired":false,"billingCode":"23035","codeType":"CPT"},{"id":786,"precertRequired":false,"billingCode":"23040","codeType":"CPT"},{"id":787,"precertRequired":false,"billingCode":"23044","codeType":"CPT"},{"id":788,"precertRequired":false,"billingCode":"23065","codeType":"CPT"},{"id":789,"precertRequired":false,"billingCode":"23066","codeType":"CPT"},{"id":790,"precertRequired":false,"billingCode":"23071","codeType":"CPT"},{"id":791,"precertRequired":false,"billingCode":"23073","codeType":"CPT"},{"id":792,"precertRequired":false,"billingCode":"23075","codeType":"CPT"},{"id":793,"precertRequired":false,"billingCode":"23076","codeType":"CPT"},{"id":794,"precertRequired":false,"billingCode":"23077","codeType":"CPT"},{"id":795,"precertRequired":false,"billingCode":"23078","codeType":"CPT"},{"id":885,"precertRequired":false,"billingCode":"23930","codeType":"CPT"},{"id":886,"precertRequired":false,"billingCode":"23931","codeType":"CPT"},{"id":887,"precertRequired":false,"billingCode":"23935","codeType":"CPT"},{"id":888,"precertRequired":false,"billingCode":"24000","codeType":"CPT"},{"id":889,"precertRequired":false,"billingCode":"24006","codeType":"CPT"},{"id":890,"precertRequired":false,"billingCode":"24065","codeType":"CPT"},{"id":891,"precertRequired":false,"billingCode":"24066","codeType":"CPT"},{"id":892,"precertRequired":false,"billingCode":"24071","codeType":"CPT"},{"id":893,"precertRequired":false,"billingCode":"24073","codeType":"CPT"},{"id":894,"precertRequired":false,"billingCode":"24075","codeType":"CPT"},{"id":895,"precertRequired":false,"billingCode":"24076","codeType":"CPT"},{"id":896,"precertRequired":false,"billingCode":"24077","codeType":"CPT"},{"id":897,"precertRequired":false,"billingCode":"24079","codeType":"CPT"},{"id":898,"precertRequired":false,"billingCode":"24100","codeType":"CPT"},{"id":899,"precertRequired":false,"billingCode":"24101","codeType":"CPT"},{"id":921,"precertRequired":false,"billingCode":"24200","codeType":"CPT"},{"id":922,"precertRequired":false,"billingCode":"24201","codeType":"CPT"},{"id":992,"precertRequired":false,"billingCode":"24900","codeType":"CPT"},{"id":993,"precertRequired":false,"billingCode":"24920","codeType":"CPT"},{"id":994,"precertRequired":false,"billingCode":"24925","codeType":"CPT"},{"id":995,"precertRequired":false,"billingCode":"24930","codeType":"CPT"},{"id":996,"precertRequired":false,"billingCode":"24931","codeType":"CPT"},{"id":997,"precertRequired":false,"billingCode":"24935","codeType":"CPT"},{"id":1001,"precertRequired":false,"billingCode":"25020","codeType":"CPT"},{"id":1002,"precertRequired":false,"billingCode":"25023","codeType":"CPT"},{"id":1003,"precertRequired":false,"billingCode":"25024","codeType":"CPT"},{"id":1004,"precertRequired":false,"billingCode":"25025","codeType":"CPT"},{"id":1005,"precertRequired":false,"billingCode":"25028","codeType":"CPT"},{"id":1006,"precertRequired":false,"billingCode":"25031","codeType":"CPT"},{"id":1007,"precertRequired":false,"billingCode":"25035","codeType":"CPT"},{"id":1008,"precertRequired":false,"billingCode":"25040","codeType":"CPT"},{"id":1009,"precertRequired":false,"billingCode":"25065","codeType":"CPT"},{"id":1010,"precertRequired":false,"billingCode":"25066","codeType":"CPT"},{"id":1011,"precertRequired":false,"billingCode":"25071","codeType":"CPT"},{"id":1012,"precertRequired":false,"billingCode":"25073","codeType":"CPT"},{"id":1013,"precertRequired":false,"billingCode":"25075","codeType":"CPT"},{"id":1014,"precertRequired":false,"billingCode":"25076","codeType":"CPT"},{"id":1015,"precertRequired":false,"billingCode":"25077","codeType":"CPT"},{"id":1016,"precertRequired":false,"billingCode":"25078","codeType":"CPT"},{"id":1065,"precertRequired":false,"billingCode":"25320","codeType":"CPT"},{"id":1145,"precertRequired":false,"billingCode":"25900","codeType":"CPT"},{"id":1146,"precertRequired":false,"billingCode":"25905","codeType":"CPT"},{"id":1147,"precertRequired":false,"billingCode":"25907","codeType":"CPT"},{"id":1148,"precertRequired":false,"billingCode":"25909","codeType":"CPT"},{"id":1150,"precertRequired":false,"billingCode":"25920","codeType":"CPT"},{"id":1151,"precertRequired":false,"billingCode":"25922","codeType":"CPT"},{"id":1152,"precertRequired":false,"billingCode":"25924","codeType":"CPT"},{"id":1153,"precertRequired":false,"billingCode":"25927","codeType":"CPT"},{"id":1154,"precertRequired":false,"billingCode":"25929","codeType":"CPT"},{"id":1155,"precertRequired":false,"billingCode":"25931","codeType":"CPT"},{"id":1156,"precertRequired":false,"billingCode":"26010","codeType":"CPT"},{"id":1157,"precertRequired":false,"billingCode":"26011","codeType":"CPT"},{"id":1158,"precertRequired":false,"billingCode":"26020","codeType":"CPT"},{"id":1159,"precertRequired":false,"billingCode":"26025","codeType":"CPT"},{"id":1160,"precertRequired":false,"billingCode":"26030","codeType":"CPT"},{"id":1161,"precertRequired":false,"billingCode":"26034","codeType":"CPT"},{"id":1162,"precertRequired":false,"billingCode":"26035","codeType":"CPT"},{"id":1163,"precertRequired":false,"billingCode":"26037","codeType":"CPT"},{"id":1164,"precertRequired":false,"billingCode":"26040","codeType":"CPT"},{"id":1165,"precertRequired":false,"billingCode":"26045","codeType":"CPT"},{"id":1166,"precertRequired":false,"billingCode":"26055","codeType":"CPT"},{"id":1174,"precertRequired":false,"billingCode":"26111","codeType":"CPT"},{"id":1175,"precertRequired":false,"billingCode":"26113","codeType":"CPT"},{"id":1176,"precertRequired":false,"billingCode":"26115","codeType":"CPT"},{"id":1177,"precertRequired":false,"billingCode":"26116","codeType":"CPT"},{"id":1178,"precertRequired":false,"billingCode":"26117","codeType":"CPT"},{"id":1179,"precertRequired":false,"billingCode":"26118","codeType":"CPT"},{"id":1180,"precertRequired":false,"billingCode":"26121","codeType":"CPT"},{"id":1181,"precertRequired":false,"billingCode":"26123","codeType":"CPT"},{"id":1182,"precertRequired":false,"billingCode":"26125","codeType":"CPT"},{"id":1213,"precertRequired":false,"billingCode":"26392","codeType":"CPT"},{"id":1326,"precertRequired":false,"billingCode":"26910","codeType":"CPT"},{"id":1327,"precertRequired":false,"billingCode":"26951","codeType":"CPT"},{"id":1328,"precertRequired":false,"billingCode":"26952","codeType":"CPT"},{"id":1329,"precertRequired":false,"billingCode":"26990","codeType":"CPT"},{"id":1330,"precertRequired":false,"billingCode":"26991","codeType":"CPT"},{"id":1331,"precertRequired":false,"billingCode":"26992","codeType":"CPT"},{"id":1337,"precertRequired":false,"billingCode":"27025","codeType":"CPT"},{"id":1338,"precertRequired":false,"billingCode":"27027","codeType":"CPT"},{"id":1343,"precertRequired":false,"billingCode":"27040","codeType":"CPT"},{"id":1344,"precertRequired":false,"billingCode":"27041","codeType":"CPT"},{"id":1345,"precertRequired":false,"billingCode":"27043","codeType":"CPT"},{"id":1346,"precertRequired":false,"billingCode":"27045","codeType":"CPT"},{"id":1347,"precertRequired":false,"billingCode":"27047","codeType":"CPT"},{"id":1348,"precertRequired":false,"billingCode":"27048","codeType":"CPT"},{"id":1349,"precertRequired":false,"billingCode":"27049","codeType":"CPT"},{"id":1353,"precertRequired":false,"billingCode":"27057","codeType":"CPT"},{"id":1354,"precertRequired":false,"billingCode":"27059","codeType":"CPT"},{"id":1367,"precertRequired":false,"billingCode":"27086","codeType":"CPT"},{"id":1368,"precertRequired":false,"billingCode":"27087","codeType":"CPT"},{"id":1447,"precertRequired":false,"billingCode":"27290","codeType":"CPT"},{"id":1448,"precertRequired":false,"billingCode":"27295","codeType":"CPT"},{"id":1450,"precertRequired":false,"billingCode":"27301","codeType":"CPT"},{"id":1451,"precertRequired":false,"billingCode":"27303","codeType":"CPT"},{"id":1452,"precertRequired":false,"billingCode":"27305","codeType":"CPT"},{"id":1456,"precertRequired":false,"billingCode":"27323","codeType":"CPT"},{"id":1457,"precertRequired":false,"billingCode":"27324","codeType":"CPT"},{"id":1460,"precertRequired":false,"billingCode":"27327","codeType":"CPT"},{"id":1461,"precertRequired":false,"billingCode":"27328","codeType":"CPT"},{"id":1462,"precertRequired":false,"billingCode":"27329","codeType":"CPT"},{"id":1469,"precertRequired":false,"billingCode":"27337","codeType":"CPT"},{"id":1470,"precertRequired":false,"billingCode":"27339","codeType":"CPT"},{"id":1472,"precertRequired":false,"billingCode":"27345","codeType":"CPT"},{"id":1480,"precertRequired":false,"billingCode":"27364","codeType":"CPT"},{"id":1481,"precertRequired":false,"billingCode":"27365","codeType":"CPT"},{"id":1483,"precertRequired":false,"billingCode":"27372","codeType":"CPT"},{"id":1494,"precertRequired":false,"billingCode":"27396","codeType":"CPT"},{"id":1541,"precertRequired":false,"billingCode":"27496","codeType":"CPT"},{"id":1542,"precertRequired":false,"billingCode":"27497","codeType":"CPT"},{"id":1543,"precertRequired":false,"billingCode":"27498","codeType":"CPT"},{"id":1544,"precertRequired":false,"billingCode":"27499","codeType":"CPT"},{"id":1545,"precertRequired":false,"billingCode":"27500","codeType":"CPT"},{"id":1578,"precertRequired":false,"billingCode":"27590","codeType":"CPT"},{"id":1579,"precertRequired":false,"billingCode":"27591","codeType":"CPT"},{"id":1580,"precertRequired":false,"billingCode":"27592","codeType":"CPT"},{"id":1581,"precertRequired":false,"billingCode":"27594","codeType":"CPT"},{"id":1582,"precertRequired":false,"billingCode":"27596","codeType":"CPT"},{"id":1583,"precertRequired":false,"billingCode":"27598","codeType":"CPT"},{"id":1584,"precertRequired":false,"billingCode":"27600","codeType":"CPT"},{"id":1585,"precertRequired":false,"billingCode":"27601","codeType":"CPT"},{"id":1586,"precertRequired":false,"billingCode":"27602","codeType":"CPT"},{"id":1587,"precertRequired":false,"billingCode":"27603","codeType":"CPT"},{"id":1588,"precertRequired":false,"billingCode":"27604","codeType":"CPT"},{"id":1591,"precertRequired":false,"billingCode":"27607","codeType":"CPT"},{"id":1594,"precertRequired":false,"billingCode":"27613","codeType":"CPT"},{"id":1595,"precertRequired":false,"billingCode":"27614","codeType":"CPT"},{"id":1596,"precertRequired":false,"billingCode":"27615","codeType":"CPT"},{"id":1597,"precertRequired":false,"billingCode":"27616","codeType":"CPT"},{"id":1598,"precertRequired":false,"billingCode":"27618","codeType":"CPT"},{"id":1599,"precertRequired":false,"billingCode":"27619","codeType":"CPT"},{"id":1697,"precertRequired":false,"billingCode":"27880","codeType":"CPT"},{"id":1698,"precertRequired":false,"billingCode":"27881","codeType":"CPT"},{"id":1699,"precertRequired":false,"billingCode":"27882","codeType":"CPT"},{"id":1700,"precertRequired":false,"billingCode":"27884","codeType":"CPT"},{"id":1701,"precertRequired":false,"billingCode":"27886","codeType":"CPT"},{"id":1702,"precertRequired":false,"billingCode":"27888","codeType":"CPT"},{"id":1703,"precertRequired":false,"billingCode":"27889","codeType":"CPT"},{"id":1704,"precertRequired":false,"billingCode":"27892","codeType":"CPT"},{"id":1705,"precertRequired":false,"billingCode":"27893","codeType":"CPT"},{"id":1706,"precertRequired":false,"billingCode":"27894","codeType":"CPT"},{"id":1707,"precertRequired":false,"billingCode":"28001","codeType":"CPT"},{"id":1708,"precertRequired":false,"billingCode":"28002","codeType":"CPT"},{"id":1709,"precertRequired":false,"billingCode":"28003","codeType":"CPT"},{"id":1710,"precertRequired":false,"billingCode":"28005","codeType":"CPT"},{"id":1711,"precertRequired":false,"billingCode":"28008","codeType":"CPT"},{"id":1718,"precertRequired":false,"billingCode":"28039","codeType":"CPT"},{"id":1719,"precertRequired":false,"billingCode":"28041","codeType":"CPT"},{"id":1720,"precertRequired":false,"billingCode":"28043","codeType":"CPT"},{"id":1721,"precertRequired":false,"billingCode":"28045","codeType":"CPT"},{"id":1728,"precertRequired":true,"billingCode":"28060","codeType":"CPT"},{"id":1729,"precertRequired":true,"billingCode":"28062","codeType":"CPT"},{"id":1732,"precertRequired":true,"billingCode":"28080","codeType":"CPT"},{"id":1751,"precertRequired":false,"billingCode":"28119","codeType":"CPT"},{"id":1764,"precertRequired":false,"billingCode":"28190","codeType":"CPT"},{"id":1765,"precertRequired":false,"billingCode":"28192","codeType":"CPT"},{"id":1766,"precertRequired":false,"billingCode":"28193","codeType":"CPT"},{"id":1791,"precertRequired":false,"billingCode":"28289","codeType":"CPT"},{"id":1792,"precertRequired":false,"billingCode":"28291","codeType":"CPT"},{"id":1793,"precertRequired":false,"billingCode":"28292","codeType":"CPT"},{"id":1794,"precertRequired":false,"billingCode":"28295","codeType":"CPT"},{"id":1795,"precertRequired":false,"billingCode":"28296","codeType":"CPT"},{"id":1796,"precertRequired":false,"billingCode":"28297","codeType":"CPT"},{"id":1797,"precertRequired":false,"billingCode":"28298","codeType":"CPT"},{"id":1798,"precertRequired":false,"billingCode":"28299","codeType":"CPT"},{"id":1876,"precertRequired":false,"billingCode":"28800","codeType":"CPT"},{"id":1877,"precertRequired":false,"billingCode":"28805","codeType":"CPT"},{"id":1878,"precertRequired":false,"billingCode":"28810","codeType":"CPT"},{"id":1879,"precertRequired":false,"billingCode":"28820","codeType":"CPT"},{"id":1880,"precertRequired":false,"billingCode":"28825","codeType":"CPT"},{"id":1940,"precertRequired":false,"billingCode":"29822","codeType":"CPT"},{"id":1941,"precertRequired":false,"billingCode":"29823","codeType":"CPT"},{"id":1943,"precertRequired":false,"billingCode":"29825","codeType":"CPT"},{"id":1975,"precertRequired":false,"billingCode":"30100","codeType":"CPT"},{"id":1990,"precertRequired":false,"billingCode":"31231","codeType":"CPT"},{"id":1993,"precertRequired":false,"billingCode":"31237","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":2002,"precertRequired":false,"billingCode":"31535","codeType":"CPT"},{"id":2003,"precertRequired":false,"billingCode":"31536","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2010,"precertRequired":false,"billingCode":"31576","codeType":"CPT"},{"id":2024,"precertRequired":false,"billingCode":"31622","codeType":"CPT"},{"id":2025,"precertRequired":false,"billingCode":"31623","codeType":"CPT"},{"id":2026,"precertRequired":false,"billingCode":"31624","codeType":"CPT"},{"id":2027,"precertRequired":false,"billingCode":"31625","codeType":"CPT"},{"id":2028,"precertRequired":false,"billingCode":"31626","codeType":"CPT"},{"id":2029,"precertRequired":false,"billingCode":"31627","codeType":"CPT"},{"id":2030,"precertRequired":false,"billingCode":"31628","codeType":"CPT"},{"id":2031,"precertRequired":false,"billingCode":"31629","codeType":"CPT"},{"id":2032,"precertRequired":false,"billingCode":"31630","codeType":"CPT"},{"id":2033,"precertRequired":false,"billingCode":"31631","codeType":"CPT"},{"id":2034,"precertRequired":false,"billingCode":"31632","codeType":"CPT"},{"id":2035,"precertRequired":false,"billingCode":"31633","codeType":"CPT"},{"id":2036,"precertRequired":false,"billingCode":"31634","codeType":"CPT"},{"id":2037,"precertRequired":false,"billingCode":"31635","codeType":"CPT"},{"id":2038,"precertRequired":false,"billingCode":"31636","codeType":"CPT"},{"id":2039,"precertRequired":false,"billingCode":"31637","codeType":"CPT"},{"id":2040,"precertRequired":false,"billingCode":"31638","codeType":"CPT"},{"id":2041,"precertRequired":false,"billingCode":"31640","codeType":"CPT"},{"id":2042,"precertRequired":false,"billingCode":"31641","codeType":"CPT"},{"id":2043,"precertRequired":false,"billingCode":"31643","codeType":"CPT"},{"id":2044,"precertRequired":false,"billingCode":"31645","codeType":"CPT"},{"id":2045,"precertRequired":false,"billingCode":"31646","codeType":"CPT"},{"id":2046,"precertRequired":false,"billingCode":"31647","codeType":"CPT"},{"id":2047,"precertRequired":false,"billingCode":"31648","codeType":"CPT"},{"id":2048,"precertRequired":false,"billingCode":"31649","codeType":"CPT"},{"id":2049,"precertRequired":false,"billingCode":"31651","codeType":"CPT"},{"id":2050,"precertRequired":false,"billingCode":"31652","codeType":"CPT"},{"id":2051,"precertRequired":false,"billingCode":"31653","codeType":"CPT"},{"id":2052,"precertRequired":false,"billingCode":"31654","codeType":"CPT"},{"id":2053,"precertRequired":false,"billingCode":"31660","codeType":"CPT"},{"id":2054,"precertRequired":false,"billingCode":"31661","codeType":"CPT"},{"id":2077,"precertRequired":true,"billingCode":"32096","codeType":"CPT"},{"id":2078,"precertRequired":true,"billingCode":"32097","codeType":"CPT"},{"id":2079,"precertRequired":true,"billingCode":"32098","codeType":"CPT"},{"id":2083,"precertRequired":true,"billingCode":"32124","codeType":"CPT"},{"id":2096,"precertRequired":false,"billingCode":"32405","codeType":"CPT"},{"id":2114,"precertRequired":true,"billingCode":"32554","codeType":"CPT"},{"id":2115,"precertRequired":true,"billingCode":"32555","codeType":"CPT"},{"id":2116,"precertRequired":true,"billingCode":"32556","codeType":"CPT"},{"id":2117,"precertRequired":true,"billingCode":"32557","codeType":"CPT"},{"id":2149,"precertRequired":true,"billingCode":"32674","codeType":"CPT"},{"id":2151,"precertRequired":true,"billingCode":"32800","codeType":"CPT"},{"id":2152,"precertRequired":true,"billingCode":"32810","codeType":"CPT"},{"id":2153,"precertRequired":true,"billingCode":"32815","codeType":"CPT"},{"id":2164,"precertRequired":true,"billingCode":"32940","codeType":"CPT"},{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2567,"precertRequired":false,"billingCode":"36565","codeType":"CPT"},{"id":2568,"precertRequired":false,"billingCode":"36566","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2572,"precertRequired":false,"billingCode":"36571","codeType":"CPT"},{"id":2573,"precertRequired":false,"billingCode":"36575","codeType":"CPT"},{"id":2574,"precertRequired":false,"billingCode":"36576","codeType":"CPT"},{"id":2580,"precertRequired":false,"billingCode":"36584","codeType":"CPT"},{"id":2581,"precertRequired":false,"billingCode":"36585","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2583,"precertRequired":false,"billingCode":"36590","codeType":"CPT"},{"id":2633,"precertRequired":false,"billingCode":"37200","codeType":"CPT"},{"id":2662,"precertRequired":false,"billingCode":"37241","codeType":"CPT"},{"id":2663,"precertRequired":false,"billingCode":"37242","codeType":"CPT"},{"id":2664,"precertRequired":false,"billingCode":"37243","codeType":"CPT"},{"id":2665,"precertRequired":false,"billingCode":"37244","codeType":"CPT"},{"id":2674,"precertRequired":false,"billingCode":"38100","codeType":"CPT"},{"id":2675,"precertRequired":false,"billingCode":"38101","codeType":"CPT"},{"id":2676,"precertRequired":false,"billingCode":"38102","codeType":"CPT"},{"id":2677,"precertRequired":false,"billingCode":"38115","codeType":"CPT"},{"id":2678,"precertRequired":false,"billingCode":"38120","codeType":"CPT"},{"id":2682,"precertRequired":false,"billingCode":"38300","codeType":"CPT"},{"id":2683,"precertRequired":false,"billingCode":"38305","codeType":"CPT"},{"id":2684,"precertRequired":false,"billingCode":"38308","codeType":"CPT"},{"id":2685,"precertRequired":false,"billingCode":"38380","codeType":"CPT"},{"id":2686,"precertRequired":true,"billingCode":"38381","codeType":"CPT"},{"id":2687,"precertRequired":false,"billingCode":"38382","codeType":"CPT"},{"id":2688,"precertRequired":false,"billingCode":"38500","codeType":"CPT"},{"id":2689,"precertRequired":false,"billingCode":"38505","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2691,"precertRequired":false,"billingCode":"38520","codeType":"CPT"},{"id":2692,"precertRequired":false,"billingCode":"38525","codeType":"CPT"},{"id":2693,"precertRequired":false,"billingCode":"38530","codeType":"CPT"},{"id":2694,"precertRequired":false,"billingCode":"38542","codeType":"CPT"},{"id":2695,"precertRequired":false,"billingCode":"38550","codeType":"CPT"},{"id":2696,"precertRequired":false,"billingCode":"38555","codeType":"CPT"},{"id":2697,"precertRequired":false,"billingCode":"38562","codeType":"CPT"},{"id":2698,"precertRequired":false,"billingCode":"38564","codeType":"CPT"},{"id":2699,"precertRequired":false,"billingCode":"38570","codeType":"CPT"},{"id":2700,"precertRequired":false,"billingCode":"38571","codeType":"CPT"},{"id":2701,"precertRequired":false,"billingCode":"38572","codeType":"CPT"},{"id":2702,"precertRequired":false,"billingCode":"38573","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2704,"precertRequired":false,"billingCode":"38720","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2706,"precertRequired":false,"billingCode":"38740","codeType":"CPT"},{"id":2707,"precertRequired":false,"billingCode":"38745","codeType":"CPT"},{"id":2708,"precertRequired":false,"billingCode":"38746","codeType":"CPT"},{"id":2709,"precertRequired":false,"billingCode":"38747","codeType":"CPT"},{"id":2710,"precertRequired":false,"billingCode":"38760","codeType":"CPT"},{"id":2711,"precertRequired":false,"billingCode":"38765","codeType":"CPT"},{"id":2712,"precertRequired":false,"billingCode":"38770","codeType":"CPT"},{"id":2713,"precertRequired":false,"billingCode":"38780","codeType":"CPT"},{"id":2714,"precertRequired":false,"billingCode":"38790","codeType":"CPT"},{"id":2723,"precertRequired":false,"billingCode":"40490","codeType":"CPT"},{"id":2725,"precertRequired":false,"billingCode":"41100","codeType":"CPT"},{"id":2726,"precertRequired":false,"billingCode":"41105","codeType":"CPT"},{"id":2727,"precertRequired":false,"billingCode":"41108","codeType":"CPT"},{"id":2729,"precertRequired":false,"billingCode":"42100","codeType":"CPT"},{"id":2730,"precertRequired":false,"billingCode":"42300","codeType":"CPT"},{"id":2731,"precertRequired":false,"billingCode":"42310","codeType":"CPT"},{"id":2734,"precertRequired":false,"billingCode":"42700","codeType":"CPT"},{"id":2735,"precertRequired":false,"billingCode":"42800","codeType":"CPT"},{"id":2736,"precertRequired":false,"billingCode":"42804","codeType":"CPT"},{"id":2737,"precertRequired":false,"billingCode":"42806","codeType":"CPT"},{"id":2739,"precertRequired":false,"billingCode":"43020","codeType":"CPT"},{"id":2741,"precertRequired":false,"billingCode":"43045","codeType":"CPT"},{"id":2748,"precertRequired":false,"billingCode":"43116","codeType":"CPT"},{"id":2749,"precertRequired":false,"billingCode":"43117","codeType":"CPT"},{"id":2750,"precertRequired":false,"billingCode":"43118","codeType":"CPT"},{"id":2751,"precertRequired":false,"billingCode":"43121","codeType":"CPT"},{"id":2752,"precertRequired":false,"billingCode":"43122","codeType":"CPT"},{"id":2753,"precertRequired":false,"billingCode":"43123","codeType":"CPT"},{"id":2754,"precertRequired":false,"billingCode":"43124","codeType":"CPT"},{"id":2755,"precertRequired":false,"billingCode":"43130","codeType":"CPT"},{"id":2756,"precertRequired":false,"billingCode":"43135","codeType":"CPT"},{"id":2757,"precertRequired":false,"billingCode":"43180","codeType":"CPT"},{"id":2758,"precertRequired":false,"billingCode":"43191","codeType":"CPT"},{"id":2759,"precertRequired":false,"billingCode":"43192","codeType":"CPT"},{"id":2760,"precertRequired":false,"billingCode":"43193","codeType":"CPT"},{"id":2761,"precertRequired":false,"billingCode":"43194","codeType":"CPT"},{"id":2762,"precertRequired":false,"billingCode":"43195","codeType":"CPT"},{"id":2763,"precertRequired":false,"billingCode":"43196","codeType":"CPT"},{"id":2764,"precertRequired":false,"billingCode":"43197","codeType":"CPT"},{"id":2765,"precertRequired":false,"billingCode":"43198","codeType":"CPT"},{"id":2766,"precertRequired":false,"billingCode":"43200","codeType":"CPT"},{"id":2767,"precertRequired":false,"billingCode":"43201","codeType":"CPT"},{"id":2768,"precertRequired":false,"billingCode":"43202","codeType":"CPT"},{"id":2769,"precertRequired":false,"billingCode":"43204","codeType":"CPT"},{"id":2770,"precertRequired":false,"billingCode":"43205","codeType":"CPT"},{"id":2771,"precertRequired":false,"billingCode":"43206","codeType":"CPT"},{"id":2772,"precertRequired":false,"billingCode":"43210","codeType":"CPT"},{"id":2773,"precertRequired":false,"billingCode":"43211","codeType":"CPT"},{"id":2774,"precertRequired":false,"billingCode":"43212","codeType":"CPT"},{"id":2775,"precertRequired":false,"billingCode":"43213","codeType":"CPT"},{"id":2776,"precertRequired":false,"billingCode":"43214","codeType":"CPT"},{"id":2777,"precertRequired":false,"billingCode":"43215","codeType":"CPT"},{"id":2778,"precertRequired":false,"billingCode":"43216","codeType":"CPT"},{"id":2779,"precertRequired":false,"billingCode":"43217","codeType":"CPT"},{"id":2781,"precertRequired":false,"billingCode":"43220","codeType":"CPT"},{"id":2782,"precertRequired":false,"billingCode":"43226","codeType":"CPT"},{"id":2783,"precertRequired":false,"billingCode":"43227","codeType":"CPT"},{"id":2784,"precertRequired":false,"billingCode":"43229","codeType":"CPT"},{"id":2785,"precertRequired":false,"billingCode":"43231","codeType":"CPT"},{"id":2786,"precertRequired":false,"billingCode":"43232","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2790,"precertRequired":false,"billingCode":"43237","codeType":"CPT"},{"id":2791,"precertRequired":false,"billingCode":"43238","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2795,"precertRequired":false,"billingCode":"43242","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2810,"precertRequired":false,"billingCode":"43259","codeType":"CPT"},{"id":2811,"precertRequired":false,"billingCode":"43260","codeType":"CPT"},{"id":2812,"precertRequired":false,"billingCode":"43261","codeType":"CPT"},{"id":2813,"precertRequired":false,"billingCode":"43262","codeType":"CPT"},{"id":2814,"precertRequired":false,"billingCode":"43263","codeType":"CPT"},{"id":2815,"precertRequired":false,"billingCode":"43264","codeType":"CPT"},{"id":2816,"precertRequired":false,"billingCode":"43265","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2819,"precertRequired":false,"billingCode":"43273","codeType":"CPT"},{"id":2820,"precertRequired":false,"billingCode":"43274","codeType":"CPT"},{"id":2821,"precertRequired":false,"billingCode":"43275","codeType":"CPT"},{"id":2822,"precertRequired":false,"billingCode":"43276","codeType":"CPT"},{"id":2823,"precertRequired":false,"billingCode":"43277","codeType":"CPT"},{"id":2824,"precertRequired":false,"billingCode":"43278","codeType":"CPT"},{"id":2825,"precertRequired":false,"billingCode":"43279","codeType":"CPT"},{"id":2826,"precertRequired":false,"billingCode":"43280","codeType":"CPT"},{"id":2827,"precertRequired":false,"billingCode":"43281","codeType":"CPT"},{"id":2828,"precertRequired":false,"billingCode":"43282","codeType":"CPT"},{"id":2829,"precertRequired":false,"billingCode":"43283","codeType":"CPT"},{"id":2830,"precertRequired":false,"billingCode":"43284","codeType":"CPT"},{"id":2831,"precertRequired":false,"billingCode":"43285","codeType":"CPT"},{"id":2832,"precertRequired":false,"billingCode":"43286","codeType":"CPT"},{"id":2833,"precertRequired":false,"billingCode":"43287","codeType":"CPT"},{"id":2834,"precertRequired":false,"billingCode":"43288","codeType":"CPT"},{"id":2836,"precertRequired":false,"billingCode":"43300","codeType":"CPT"},{"id":2837,"precertRequired":false,"billingCode":"43305","codeType":"CPT"},{"id":2838,"precertRequired":false,"billingCode":"43310","codeType":"CPT"},{"id":2839,"precertRequired":false,"billingCode":"43312","codeType":"CPT"},{"id":2840,"precertRequired":false,"billingCode":"43313","codeType":"CPT"},{"id":2841,"precertRequired":false,"billingCode":"43314","codeType":"CPT"},{"id":2842,"precertRequired":false,"billingCode":"43320","codeType":"CPT"},{"id":2843,"precertRequired":false,"billingCode":"43325","codeType":"CPT"},{"id":2844,"precertRequired":false,"billingCode":"43327","codeType":"CPT"},{"id":2845,"precertRequired":false,"billingCode":"43328","codeType":"CPT"},{"id":2846,"precertRequired":false,"billingCode":"43330","codeType":"CPT"},{"id":2847,"precertRequired":false,"billingCode":"43331","codeType":"CPT"},{"id":2848,"precertRequired":false,"billingCode":"43332","codeType":"CPT"},{"id":2849,"precertRequired":false,"billingCode":"43333","codeType":"CPT"},{"id":2850,"precertRequired":false,"billingCode":"43334","codeType":"CPT"},{"id":2851,"precertRequired":false,"billingCode":"43335","codeType":"CPT"},{"id":2852,"precertRequired":false,"billingCode":"43336","codeType":"CPT"},{"id":2853,"precertRequired":false,"billingCode":"43337","codeType":"CPT"},{"id":2854,"precertRequired":false,"billingCode":"43338","codeType":"CPT"},{"id":2855,"precertRequired":false,"billingCode":"43340","codeType":"CPT"},{"id":2856,"precertRequired":false,"billingCode":"43341","codeType":"CPT"},{"id":2857,"precertRequired":false,"billingCode":"43351","codeType":"CPT"},{"id":2858,"precertRequired":false,"billingCode":"43352","codeType":"CPT"},{"id":2859,"precertRequired":false,"billingCode":"43360","codeType":"CPT"},{"id":2860,"precertRequired":false,"billingCode":"43361","codeType":"CPT"},{"id":2861,"precertRequired":false,"billingCode":"43400","codeType":"CPT"},{"id":2862,"precertRequired":false,"billingCode":"43401","codeType":"CPT"},{"id":2863,"precertRequired":false,"billingCode":"43405","codeType":"CPT"},{"id":2864,"precertRequired":false,"billingCode":"43410","codeType":"CPT"},{"id":2865,"precertRequired":false,"billingCode":"43415","codeType":"CPT"},{"id":2866,"precertRequired":false,"billingCode":"43420","codeType":"CPT"},{"id":2867,"precertRequired":false,"billingCode":"43425","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":2869,"precertRequired":false,"billingCode":"43453","codeType":"CPT"},{"id":2870,"precertRequired":false,"billingCode":"43460","codeType":"CPT"},{"id":2871,"precertRequired":false,"billingCode":"43496","codeType":"CPT"},{"id":2873,"precertRequired":false,"billingCode":"43500","codeType":"CPT"},{"id":2874,"precertRequired":false,"billingCode":"43501","codeType":"CPT"},{"id":2875,"precertRequired":false,"billingCode":"43502","codeType":"CPT"},{"id":2876,"precertRequired":false,"billingCode":"43510","codeType":"CPT"},{"id":2877,"precertRequired":false,"billingCode":"43520","codeType":"CPT"},{"id":2878,"precertRequired":false,"billingCode":"43605","codeType":"CPT"},{"id":2879,"precertRequired":false,"billingCode":"43610","codeType":"CPT"},{"id":2880,"precertRequired":false,"billingCode":"43611","codeType":"CPT"},{"id":2881,"precertRequired":false,"billingCode":"43620","codeType":"CPT"},{"id":2882,"precertRequired":false,"billingCode":"43621","codeType":"CPT"},{"id":2883,"precertRequired":false,"billingCode":"43622","codeType":"CPT"},{"id":2884,"precertRequired":false,"billingCode":"43631","codeType":"CPT"},{"id":2885,"precertRequired":false,"billingCode":"43632","codeType":"CPT"},{"id":2886,"precertRequired":false,"billingCode":"43633","codeType":"CPT"},{"id":2887,"precertRequired":false,"billingCode":"43634","codeType":"CPT"},{"id":2888,"precertRequired":false,"billingCode":"43635","codeType":"CPT"},{"id":2889,"precertRequired":false,"billingCode":"43640","codeType":"CPT"},{"id":2890,"precertRequired":false,"billingCode":"43641","codeType":"CPT"},{"id":2891,"precertRequired":false,"billingCode":"43644","codeType":"CPT"},{"id":2892,"precertRequired":false,"billingCode":"43645","codeType":"CPT"},{"id":2893,"precertRequired":false,"billingCode":"43647","codeType":"CPT"},{"id":2894,"precertRequired":false,"billingCode":"43648","codeType":"CPT"},{"id":2895,"precertRequired":false,"billingCode":"43651","codeType":"CPT"},{"id":2896,"precertRequired":false,"billingCode":"43652","codeType":"CPT"},{"id":2897,"precertRequired":false,"billingCode":"43653","codeType":"CPT"},{"id":2898,"precertRequired":false,"billingCode":"43752","codeType":"CPT"},{"id":2899,"precertRequired":false,"billingCode":"43753","codeType":"CPT"},{"id":2900,"precertRequired":false,"billingCode":"43754","codeType":"CPT"},{"id":2901,"precertRequired":false,"billingCode":"43755","codeType":"CPT"},{"id":2902,"precertRequired":false,"billingCode":"43756","codeType":"CPT"},{"id":2903,"precertRequired":false,"billingCode":"43757","codeType":"CPT"},{"id":2905,"precertRequired":false,"billingCode":"43761","codeType":"CPT"},{"id":2906,"precertRequired":false,"billingCode":"43770","codeType":"CPT"},{"id":2907,"precertRequired":false,"billingCode":"43771","codeType":"CPT"},{"id":2908,"precertRequired":false,"billingCode":"43772","codeType":"CPT"},{"id":2909,"precertRequired":false,"billingCode":"43773","codeType":"CPT"},{"id":2910,"precertRequired":false,"billingCode":"43774","codeType":"CPT"},{"id":2911,"precertRequired":false,"billingCode":"43775","codeType":"CPT"},{"id":2912,"precertRequired":false,"billingCode":"43800","codeType":"CPT"},{"id":2913,"precertRequired":false,"billingCode":"43810","codeType":"CPT"},{"id":2914,"precertRequired":false,"billingCode":"43820","codeType":"CPT"},{"id":2915,"precertRequired":false,"billingCode":"43825","codeType":"CPT"},{"id":2916,"precertRequired":false,"billingCode":"43830","codeType":"CPT"},{"id":2918,"precertRequired":false,"billingCode":"43832","codeType":"CPT"},{"id":2919,"precertRequired":false,"billingCode":"43840","codeType":"CPT"},{"id":2920,"precertRequired":false,"billingCode":"43842","codeType":"CPT"},{"id":2921,"precertRequired":false,"billingCode":"43843","codeType":"CPT"},{"id":2922,"precertRequired":false,"billingCode":"43845","codeType":"CPT"},{"id":2923,"precertRequired":false,"billingCode":"43846","codeType":"CPT"},{"id":2924,"precertRequired":false,"billingCode":"43847","codeType":"CPT"},{"id":2925,"precertRequired":false,"billingCode":"43848","codeType":"CPT"},{"id":2926,"precertRequired":false,"billingCode":"43850","codeType":"CPT"},{"id":2927,"precertRequired":false,"billingCode":"43855","codeType":"CPT"},{"id":2928,"precertRequired":false,"billingCode":"43860","codeType":"CPT"},{"id":2929,"precertRequired":false,"billingCode":"43865","codeType":"CPT"},{"id":2930,"precertRequired":false,"billingCode":"43870","codeType":"CPT"},{"id":2931,"precertRequired":false,"billingCode":"43880","codeType":"CPT"},{"id":2932,"precertRequired":false,"billingCode":"43881","codeType":"CPT"},{"id":2933,"precertRequired":false,"billingCode":"43882","codeType":"CPT"},{"id":2934,"precertRequired":false,"billingCode":"43886","codeType":"CPT"},{"id":2935,"precertRequired":false,"billingCode":"43887","codeType":"CPT"},{"id":2936,"precertRequired":false,"billingCode":"43888","codeType":"CPT"},{"id":2937,"precertRequired":false,"billingCode":"44005","codeType":"CPT"},{"id":2938,"precertRequired":false,"billingCode":"44010","codeType":"CPT"},{"id":2939,"precertRequired":false,"billingCode":"44015","codeType":"CPT"},{"id":2940,"precertRequired":false,"billingCode":"44020","codeType":"CPT"},{"id":2941,"precertRequired":false,"billingCode":"44021","codeType":"CPT"},{"id":2942,"precertRequired":false,"billingCode":"44025","codeType":"CPT"},{"id":2943,"precertRequired":false,"billingCode":"44050","codeType":"CPT"},{"id":2944,"precertRequired":false,"billingCode":"44055","codeType":"CPT"},{"id":2945,"precertRequired":false,"billingCode":"44100","codeType":"CPT"},{"id":2946,"precertRequired":false,"billingCode":"44110","codeType":"CPT"},{"id":2947,"precertRequired":false,"billingCode":"44111","codeType":"CPT"},{"id":2948,"precertRequired":false,"billingCode":"44120","codeType":"CPT"},{"id":2949,"precertRequired":false,"billingCode":"44121","codeType":"CPT"},{"id":2950,"precertRequired":false,"billingCode":"44125","codeType":"CPT"},{"id":2951,"precertRequired":false,"billingCode":"44126","codeType":"CPT"},{"id":2952,"precertRequired":false,"billingCode":"44127","codeType":"CPT"},{"id":2953,"precertRequired":false,"billingCode":"44128","codeType":"CPT"},{"id":2954,"precertRequired":false,"billingCode":"44130","codeType":"CPT"},{"id":2960,"precertRequired":false,"billingCode":"44139","codeType":"CPT"},{"id":2961,"precertRequired":false,"billingCode":"44140","codeType":"CPT"},{"id":2962,"precertRequired":false,"billingCode":"44141","codeType":"CPT"},{"id":2963,"precertRequired":false,"billingCode":"44143","codeType":"CPT"},{"id":2964,"precertRequired":false,"billingCode":"44144","codeType":"CPT"},{"id":2965,"precertRequired":false,"billingCode":"44145","codeType":"CPT"},{"id":2966,"precertRequired":false,"billingCode":"44146","codeType":"CPT"},{"id":2967,"precertRequired":false,"billingCode":"44147","codeType":"CPT"},{"id":2968,"precertRequired":false,"billingCode":"44150","codeType":"CPT"},{"id":2969,"precertRequired":false,"billingCode":"44151","codeType":"CPT"},{"id":2970,"precertRequired":false,"billingCode":"44155","codeType":"CPT"},{"id":2971,"precertRequired":false,"billingCode":"44156","codeType":"CPT"},{"id":2972,"precertRequired":false,"billingCode":"44157","codeType":"CPT"},{"id":2973,"precertRequired":false,"billingCode":"44158","codeType":"CPT"},{"id":2974,"precertRequired":false,"billingCode":"44160","codeType":"CPT"},{"id":2975,"precertRequired":false,"billingCode":"44180","codeType":"CPT"},{"id":2976,"precertRequired":false,"billingCode":"44186","codeType":"CPT"},{"id":2977,"precertRequired":false,"billingCode":"44187","codeType":"CPT"},{"id":2978,"precertRequired":false,"billingCode":"44188","codeType":"CPT"},{"id":2979,"precertRequired":false,"billingCode":"44202","codeType":"CPT"},{"id":2980,"precertRequired":false,"billingCode":"44203","codeType":"CPT"},{"id":2981,"precertRequired":false,"billingCode":"44204","codeType":"CPT"},{"id":2982,"precertRequired":false,"billingCode":"44205","codeType":"CPT"},{"id":2983,"precertRequired":false,"billingCode":"44206","codeType":"CPT"},{"id":2984,"precertRequired":false,"billingCode":"44207","codeType":"CPT"},{"id":2985,"precertRequired":false,"billingCode":"44208","codeType":"CPT"},{"id":2986,"precertRequired":false,"billingCode":"44210","codeType":"CPT"},{"id":2987,"precertRequired":false,"billingCode":"44211","codeType":"CPT"},{"id":2988,"precertRequired":false,"billingCode":"44212","codeType":"CPT"},{"id":2989,"precertRequired":false,"billingCode":"44213","codeType":"CPT"},{"id":2990,"precertRequired":false,"billingCode":"44227","codeType":"CPT"},{"id":2991,"precertRequired":false,"billingCode":"44300","codeType":"CPT"},{"id":2992,"precertRequired":false,"billingCode":"44310","codeType":"CPT"},{"id":2993,"precertRequired":false,"billingCode":"44312","codeType":"CPT"},{"id":2994,"precertRequired":false,"billingCode":"44314","codeType":"CPT"},{"id":2995,"precertRequired":false,"billingCode":"44316","codeType":"CPT"},{"id":2996,"precertRequired":false,"billingCode":"44320","codeType":"CPT"},{"id":2997,"precertRequired":false,"billingCode":"44322","codeType":"CPT"},{"id":2998,"precertRequired":false,"billingCode":"44340","codeType":"CPT"},{"id":2999,"precertRequired":false,"billingCode":"44345","codeType":"CPT"},{"id":3000,"precertRequired":false,"billingCode":"44346","codeType":"CPT"},{"id":3001,"precertRequired":false,"billingCode":"44360","codeType":"CPT"},{"id":3002,"precertRequired":false,"billingCode":"44361","codeType":"CPT"},{"id":3003,"precertRequired":false,"billingCode":"44363","codeType":"CPT"},{"id":3004,"precertRequired":false,"billingCode":"44364","codeType":"CPT"},{"id":3005,"precertRequired":false,"billingCode":"44365","codeType":"CPT"},{"id":3006,"precertRequired":false,"billingCode":"44366","codeType":"CPT"},{"id":3007,"precertRequired":false,"billingCode":"44369","codeType":"CPT"},{"id":3008,"precertRequired":false,"billingCode":"44370","codeType":"CPT"},{"id":3009,"precertRequired":false,"billingCode":"44372","codeType":"CPT"},{"id":3010,"precertRequired":false,"billingCode":"44373","codeType":"CPT"},{"id":3011,"precertRequired":false,"billingCode":"44376","codeType":"CPT"},{"id":3012,"precertRequired":false,"billingCode":"44377","codeType":"CPT"},{"id":3013,"precertRequired":false,"billingCode":"44378","codeType":"CPT"},{"id":3014,"precertRequired":false,"billingCode":"44379","codeType":"CPT"},{"id":3015,"precertRequired":false,"billingCode":"44380","codeType":"CPT"},{"id":3016,"precertRequired":false,"billingCode":"44381","codeType":"CPT"},{"id":3017,"precertRequired":false,"billingCode":"44382","codeType":"CPT"},{"id":3018,"precertRequired":false,"billingCode":"44384","codeType":"CPT"},{"id":3019,"precertRequired":false,"billingCode":"44385","codeType":"CPT"},{"id":3020,"precertRequired":false,"billingCode":"44386","codeType":"CPT"},{"id":3021,"precertRequired":false,"billingCode":"44388","codeType":"CPT"},{"id":3022,"precertRequired":false,"billingCode":"44389","codeType":"CPT"},{"id":3023,"precertRequired":false,"billingCode":"44390","codeType":"CPT"},{"id":3024,"precertRequired":false,"billingCode":"44391","codeType":"CPT"},{"id":3025,"precertRequired":false,"billingCode":"44392","codeType":"CPT"},{"id":3026,"precertRequired":false,"billingCode":"44394","codeType":"CPT"},{"id":3027,"precertRequired":false,"billingCode":"44401","codeType":"CPT"},{"id":3028,"precertRequired":false,"billingCode":"44402","codeType":"CPT"},{"id":3029,"precertRequired":false,"billingCode":"44403","codeType":"CPT"},{"id":3030,"precertRequired":false,"billingCode":"44404","codeType":"CPT"},{"id":3031,"precertRequired":false,"billingCode":"44405","codeType":"CPT"},{"id":3032,"precertRequired":false,"billingCode":"44406","codeType":"CPT"},{"id":3033,"precertRequired":false,"billingCode":"44407","codeType":"CPT"},{"id":3034,"precertRequired":false,"billingCode":"44408","codeType":"CPT"},{"id":3035,"precertRequired":false,"billingCode":"44500","codeType":"CPT"},{"id":3036,"precertRequired":false,"billingCode":"44602","codeType":"CPT"},{"id":3037,"precertRequired":false,"billingCode":"44603","codeType":"CPT"},{"id":3038,"precertRequired":false,"billingCode":"44604","codeType":"CPT"},{"id":3039,"precertRequired":false,"billingCode":"44605","codeType":"CPT"},{"id":3040,"precertRequired":false,"billingCode":"44615","codeType":"CPT"},{"id":3041,"precertRequired":false,"billingCode":"44620","codeType":"CPT"},{"id":3042,"precertRequired":false,"billingCode":"44625","codeType":"CPT"},{"id":3043,"precertRequired":false,"billingCode":"44626","codeType":"CPT"},{"id":3044,"precertRequired":false,"billingCode":"44640","codeType":"CPT"},{"id":3045,"precertRequired":false,"billingCode":"44650","codeType":"CPT"},{"id":3046,"precertRequired":false,"billingCode":"44660","codeType":"CPT"},{"id":3047,"precertRequired":false,"billingCode":"44661","codeType":"CPT"},{"id":3048,"precertRequired":false,"billingCode":"44680","codeType":"CPT"},{"id":3049,"precertRequired":false,"billingCode":"44700","codeType":"CPT"},{"id":3050,"precertRequired":false,"billingCode":"44701","codeType":"CPT"},{"id":3056,"precertRequired":false,"billingCode":"44800","codeType":"CPT"},{"id":3057,"precertRequired":false,"billingCode":"44820","codeType":"CPT"},{"id":3058,"precertRequired":false,"billingCode":"44850","codeType":"CPT"},{"id":3059,"precertRequired":false,"billingCode":"44900","codeType":"CPT"},{"id":3060,"precertRequired":false,"billingCode":"44950","codeType":"CPT"},{"id":3061,"precertRequired":false,"billingCode":"44955","codeType":"CPT"},{"id":3062,"precertRequired":false,"billingCode":"44960","codeType":"CPT"},{"id":3063,"precertRequired":false,"billingCode":"44970","codeType":"CPT"},{"id":3064,"precertRequired":false,"billingCode":"45000","codeType":"CPT"},{"id":3065,"precertRequired":false,"billingCode":"45005","codeType":"CPT"},{"id":3066,"precertRequired":false,"billingCode":"45020","codeType":"CPT"},{"id":3067,"precertRequired":false,"billingCode":"45100","codeType":"CPT"},{"id":3068,"precertRequired":false,"billingCode":"45108","codeType":"CPT"},{"id":3069,"precertRequired":false,"billingCode":"45110","codeType":"CPT"},{"id":3070,"precertRequired":false,"billingCode":"45111","codeType":"CPT"},{"id":3071,"precertRequired":false,"billingCode":"45112","codeType":"CPT"},{"id":3072,"precertRequired":false,"billingCode":"45113","codeType":"CPT"},{"id":3073,"precertRequired":false,"billingCode":"45114","codeType":"CPT"},{"id":3074,"precertRequired":false,"billingCode":"45116","codeType":"CPT"},{"id":3075,"precertRequired":false,"billingCode":"45119","codeType":"CPT"},{"id":3076,"precertRequired":false,"billingCode":"45120","codeType":"CPT"},{"id":3077,"precertRequired":false,"billingCode":"45121","codeType":"CPT"},{"id":3078,"precertRequired":false,"billingCode":"45123","codeType":"CPT"},{"id":3079,"precertRequired":false,"billingCode":"45126","codeType":"CPT"},{"id":3080,"precertRequired":false,"billingCode":"45130","codeType":"CPT"},{"id":3081,"precertRequired":false,"billingCode":"45135","codeType":"CPT"},{"id":3082,"precertRequired":false,"billingCode":"45136","codeType":"CPT"},{"id":3083,"precertRequired":false,"billingCode":"45150","codeType":"CPT"},{"id":3084,"precertRequired":false,"billingCode":"45160","codeType":"CPT"},{"id":3085,"precertRequired":false,"billingCode":"45171","codeType":"CPT"},{"id":3086,"precertRequired":false,"billingCode":"45172","codeType":"CPT"},{"id":3087,"precertRequired":false,"billingCode":"45190","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3123,"precertRequired":false,"billingCode":"45388","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3129,"precertRequired":false,"billingCode":"45395","codeType":"CPT"},{"id":3130,"precertRequired":false,"billingCode":"45397","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"},{"id":3132,"precertRequired":false,"billingCode":"45400","codeType":"CPT"},{"id":3133,"precertRequired":false,"billingCode":"45402","codeType":"CPT"},{"id":3134,"precertRequired":false,"billingCode":"45500","codeType":"CPT"},{"id":3135,"precertRequired":false,"billingCode":"45505","codeType":"CPT"},{"id":3136,"precertRequired":false,"billingCode":"45520","codeType":"CPT"},{"id":3137,"precertRequired":false,"billingCode":"45540","codeType":"CPT"},{"id":3138,"precertRequired":false,"billingCode":"45541","codeType":"CPT"},{"id":3139,"precertRequired":false,"billingCode":"45550","codeType":"CPT"},{"id":3140,"precertRequired":false,"billingCode":"45560","codeType":"CPT"},{"id":3141,"precertRequired":false,"billingCode":"45562","codeType":"CPT"},{"id":3142,"precertRequired":false,"billingCode":"45563","codeType":"CPT"},{"id":3143,"precertRequired":false,"billingCode":"45800","codeType":"CPT"},{"id":3144,"precertRequired":false,"billingCode":"45805","codeType":"CPT"},{"id":3145,"precertRequired":false,"billingCode":"45820","codeType":"CPT"},{"id":3146,"precertRequired":false,"billingCode":"45825","codeType":"CPT"},{"id":3147,"precertRequired":false,"billingCode":"45900","codeType":"CPT"},{"id":3148,"precertRequired":false,"billingCode":"45905","codeType":"CPT"},{"id":3149,"precertRequired":false,"billingCode":"45910","codeType":"CPT"},{"id":3150,"precertRequired":false,"billingCode":"45915","codeType":"CPT"},{"id":3151,"precertRequired":false,"billingCode":"45990","codeType":"CPT"},{"id":3152,"precertRequired":false,"billingCode":"46020","codeType":"CPT"},{"id":3153,"precertRequired":false,"billingCode":"46030","codeType":"CPT"},{"id":3154,"precertRequired":false,"billingCode":"46040","codeType":"CPT"},{"id":3155,"precertRequired":false,"billingCode":"46045","codeType":"CPT"},{"id":3156,"precertRequired":false,"billingCode":"46050","codeType":"CPT"},{"id":3157,"precertRequired":false,"billingCode":"46060","codeType":"CPT"},{"id":3158,"precertRequired":false,"billingCode":"46080","codeType":"CPT"},{"id":3159,"precertRequired":false,"billingCode":"46083","codeType":"CPT"},{"id":3160,"precertRequired":false,"billingCode":"46200","codeType":"CPT"},{"id":3161,"precertRequired":false,"billingCode":"46220","codeType":"CPT"},{"id":3162,"precertRequired":false,"billingCode":"46221","codeType":"CPT"},{"id":3163,"precertRequired":false,"billingCode":"46230","codeType":"CPT"},{"id":3164,"precertRequired":false,"billingCode":"46250","codeType":"CPT"},{"id":3165,"precertRequired":false,"billingCode":"46255","codeType":"CPT"},{"id":3166,"precertRequired":false,"billingCode":"46257","codeType":"CPT"},{"id":3167,"precertRequired":false,"billingCode":"46258","codeType":"CPT"},{"id":3168,"precertRequired":false,"billingCode":"46260","codeType":"CPT"},{"id":3169,"precertRequired":false,"billingCode":"46261","codeType":"CPT"},{"id":3170,"precertRequired":false,"billingCode":"46262","codeType":"CPT"},{"id":3171,"precertRequired":false,"billingCode":"46270","codeType":"CPT"},{"id":3172,"precertRequired":false,"billingCode":"46275","codeType":"CPT"},{"id":3173,"precertRequired":false,"billingCode":"46280","codeType":"CPT"},{"id":3174,"precertRequired":false,"billingCode":"46285","codeType":"CPT"},{"id":3175,"precertRequired":false,"billingCode":"46288","codeType":"CPT"},{"id":3176,"precertRequired":false,"billingCode":"46320","codeType":"CPT"},{"id":3177,"precertRequired":false,"billingCode":"46500","codeType":"CPT"},{"id":3178,"precertRequired":false,"billingCode":"46505","codeType":"CPT"},{"id":3179,"precertRequired":false,"billingCode":"46600","codeType":"CPT"},{"id":3180,"precertRequired":false,"billingCode":"46601","codeType":"CPT"},{"id":3181,"precertRequired":false,"billingCode":"46604","codeType":"CPT"},{"id":3182,"precertRequired":false,"billingCode":"46606","codeType":"CPT"},{"id":3183,"precertRequired":false,"billingCode":"46607","codeType":"CPT"},{"id":3184,"precertRequired":false,"billingCode":"46608","codeType":"CPT"},{"id":3185,"precertRequired":false,"billingCode":"46610","codeType":"CPT"},{"id":3186,"precertRequired":false,"billingCode":"46611","codeType":"CPT"},{"id":3187,"precertRequired":false,"billingCode":"46612","codeType":"CPT"},{"id":3188,"precertRequired":false,"billingCode":"46614","codeType":"CPT"},{"id":3189,"precertRequired":false,"billingCode":"46615","codeType":"CPT"},{"id":3190,"precertRequired":false,"billingCode":"46700","codeType":"CPT"},{"id":3191,"precertRequired":false,"billingCode":"46706","codeType":"CPT"},{"id":3192,"precertRequired":false,"billingCode":"46707","codeType":"CPT"},{"id":3193,"precertRequired":false,"billingCode":"46710","codeType":"CPT"},{"id":3194,"precertRequired":false,"billingCode":"46712","codeType":"CPT"},{"id":3195,"precertRequired":false,"billingCode":"46715","codeType":"CPT"},{"id":3196,"precertRequired":false,"billingCode":"46716","codeType":"CPT"},{"id":3197,"precertRequired":false,"billingCode":"46730","codeType":"CPT"},{"id":3198,"precertRequired":false,"billingCode":"46735","codeType":"CPT"},{"id":3199,"precertRequired":false,"billingCode":"46740","codeType":"CPT"},{"id":3200,"precertRequired":false,"billingCode":"46742","codeType":"CPT"},{"id":3201,"precertRequired":false,"billingCode":"46744","codeType":"CPT"},{"id":3202,"precertRequired":false,"billingCode":"46746","codeType":"CPT"},{"id":3204,"precertRequired":false,"billingCode":"46748","codeType":"CPT"},{"id":3205,"precertRequired":false,"billingCode":"46750","codeType":"CPT"},{"id":3207,"precertRequired":false,"billingCode":"46753","codeType":"CPT"},{"id":3208,"precertRequired":false,"billingCode":"46754","codeType":"CPT"},{"id":3209,"precertRequired":false,"billingCode":"46760","codeType":"CPT"},{"id":3210,"precertRequired":false,"billingCode":"46761","codeType":"CPT"},{"id":3212,"precertRequired":false,"billingCode":"46900","codeType":"CPT"},{"id":3213,"precertRequired":false,"billingCode":"46910","codeType":"CPT"},{"id":3214,"precertRequired":false,"billingCode":"46917","codeType":"CPT"},{"id":3215,"precertRequired":false,"billingCode":"46922","codeType":"CPT"},{"id":3216,"precertRequired":false,"billingCode":"46924","codeType":"CPT"},{"id":3217,"precertRequired":false,"billingCode":"46930","codeType":"CPT"},{"id":3218,"precertRequired":false,"billingCode":"46940","codeType":"CPT"},{"id":3219,"precertRequired":false,"billingCode":"46942","codeType":"CPT"},{"id":3220,"precertRequired":false,"billingCode":"46945","codeType":"CPT"},{"id":3221,"precertRequired":false,"billingCode":"46946","codeType":"CPT"},{"id":3222,"precertRequired":false,"billingCode":"46947","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3226,"precertRequired":false,"billingCode":"47010","codeType":"CPT"},{"id":3227,"precertRequired":false,"billingCode":"47015","codeType":"CPT"},{"id":3228,"precertRequired":false,"billingCode":"47100","codeType":"CPT"},{"id":3229,"precertRequired":false,"billingCode":"47120","codeType":"CPT"},{"id":3230,"precertRequired":false,"billingCode":"47122","codeType":"CPT"},{"id":3231,"precertRequired":false,"billingCode":"47125","codeType":"CPT"},{"id":3232,"precertRequired":false,"billingCode":"47130","codeType":"CPT"},{"id":3243,"precertRequired":false,"billingCode":"47300","codeType":"CPT"},{"id":3244,"precertRequired":false,"billingCode":"47350","codeType":"CPT"},{"id":3245,"precertRequired":false,"billingCode":"47360","codeType":"CPT"},{"id":3246,"precertRequired":false,"billingCode":"47361","codeType":"CPT"},{"id":3247,"precertRequired":false,"billingCode":"47362","codeType":"CPT"},{"id":3248,"precertRequired":false,"billingCode":"47371","codeType":"CPT"},{"id":3249,"precertRequired":false,"billingCode":"47381","codeType":"CPT"},{"id":3250,"precertRequired":false,"billingCode":"47382","codeType":"CPT"},{"id":3251,"precertRequired":false,"billingCode":"47383","codeType":"CPT"},{"id":3252,"precertRequired":false,"billingCode":"47400","codeType":"CPT"},{"id":3253,"precertRequired":false,"billingCode":"47420","codeType":"CPT"},{"id":3254,"precertRequired":false,"billingCode":"47425","codeType":"CPT"},{"id":3255,"precertRequired":false,"billingCode":"47460","codeType":"CPT"},{"id":3256,"precertRequired":false,"billingCode":"47480","codeType":"CPT"},{"id":3257,"precertRequired":false,"billingCode":"47490","codeType":"CPT"},{"id":3258,"precertRequired":false,"billingCode":"47531","codeType":"CPT"},{"id":3259,"precertRequired":false,"billingCode":"47532","codeType":"CPT"},{"id":3260,"precertRequired":false,"billingCode":"47533","codeType":"CPT"},{"id":3261,"precertRequired":false,"billingCode":"47534","codeType":"CPT"},{"id":3262,"precertRequired":false,"billingCode":"47535","codeType":"CPT"},{"id":3263,"precertRequired":false,"billingCode":"47536","codeType":"CPT"},{"id":3264,"precertRequired":false,"billingCode":"47537","codeType":"CPT"},{"id":3265,"precertRequired":false,"billingCode":"47538","codeType":"CPT"},{"id":3266,"precertRequired":false,"billingCode":"47539","codeType":"CPT"},{"id":3267,"precertRequired":false,"billingCode":"47540","codeType":"CPT"},{"id":3268,"precertRequired":false,"billingCode":"47541","codeType":"CPT"},{"id":3269,"precertRequired":false,"billingCode":"47542","codeType":"CPT"},{"id":3270,"precertRequired":false,"billingCode":"47543","codeType":"CPT"},{"id":3271,"precertRequired":false,"billingCode":"47544","codeType":"CPT"},{"id":3272,"precertRequired":false,"billingCode":"47550","codeType":"CPT"},{"id":3273,"precertRequired":false,"billingCode":"47552","codeType":"CPT"},{"id":3274,"precertRequired":false,"billingCode":"47553","codeType":"CPT"},{"id":3275,"precertRequired":false,"billingCode":"47554","codeType":"CPT"},{"id":3276,"precertRequired":false,"billingCode":"47555","codeType":"CPT"},{"id":3277,"precertRequired":false,"billingCode":"47556","codeType":"CPT"},{"id":3278,"precertRequired":false,"billingCode":"47562","codeType":"CPT"},{"id":3279,"precertRequired":false,"billingCode":"47563","codeType":"CPT"},{"id":3280,"precertRequired":false,"billingCode":"47564","codeType":"CPT"},{"id":3281,"precertRequired":false,"billingCode":"47570","codeType":"CPT"},{"id":3282,"precertRequired":false,"billingCode":"47600","codeType":"CPT"},{"id":3283,"precertRequired":false,"billingCode":"47605","codeType":"CPT"},{"id":3284,"precertRequired":false,"billingCode":"47610","codeType":"CPT"},{"id":3285,"precertRequired":false,"billingCode":"47612","codeType":"CPT"},{"id":3286,"precertRequired":false,"billingCode":"47620","codeType":"CPT"},{"id":3287,"precertRequired":false,"billingCode":"47700","codeType":"CPT"},{"id":3288,"precertRequired":false,"billingCode":"47701","codeType":"CPT"},{"id":3289,"precertRequired":false,"billingCode":"47711","codeType":"CPT"},{"id":3290,"precertRequired":false,"billingCode":"47712","codeType":"CPT"},{"id":3291,"precertRequired":false,"billingCode":"47715","codeType":"CPT"},{"id":3292,"precertRequired":false,"billingCode":"47720","codeType":"CPT"},{"id":3293,"precertRequired":false,"billingCode":"47721","codeType":"CPT"},{"id":3294,"precertRequired":false,"billingCode":"47740","codeType":"CPT"},{"id":3295,"precertRequired":false,"billingCode":"47741","codeType":"CPT"},{"id":3296,"precertRequired":false,"billingCode":"47760","codeType":"CPT"},{"id":3297,"precertRequired":false,"billingCode":"47765","codeType":"CPT"},{"id":3298,"precertRequired":false,"billingCode":"47780","codeType":"CPT"},{"id":3299,"precertRequired":false,"billingCode":"47785","codeType":"CPT"},{"id":3300,"precertRequired":false,"billingCode":"47800","codeType":"CPT"},{"id":3301,"precertRequired":false,"billingCode":"47801","codeType":"CPT"},{"id":3302,"precertRequired":false,"billingCode":"47802","codeType":"CPT"},{"id":3303,"precertRequired":false,"billingCode":"48000","codeType":"CPT"},{"id":3304,"precertRequired":false,"billingCode":"48001","codeType":"CPT"},{"id":3305,"precertRequired":false,"billingCode":"48020","codeType":"CPT"},{"id":3306,"precertRequired":false,"billingCode":"48100","codeType":"CPT"},{"id":3307,"precertRequired":false,"billingCode":"48102","codeType":"CPT"},{"id":3308,"precertRequired":false,"billingCode":"48105","codeType":"CPT"},{"id":3309,"precertRequired":false,"billingCode":"48120","codeType":"CPT"},{"id":3310,"precertRequired":false,"billingCode":"48148","codeType":"CPT"},{"id":3311,"precertRequired":false,"billingCode":"48150","codeType":"CPT"},{"id":3312,"precertRequired":false,"billingCode":"48152","codeType":"CPT"},{"id":3313,"precertRequired":false,"billingCode":"48153","codeType":"CPT"},{"id":3314,"precertRequired":false,"billingCode":"48154","codeType":"CPT"},{"id":3315,"precertRequired":false,"billingCode":"48155","codeType":"CPT"},{"id":3316,"precertRequired":false,"billingCode":"48160","codeType":"CPT"},{"id":3317,"precertRequired":false,"billingCode":"48400","codeType":"CPT"},{"id":3318,"precertRequired":false,"billingCode":"48500","codeType":"CPT"},{"id":3319,"precertRequired":false,"billingCode":"48510","codeType":"CPT"},{"id":3320,"precertRequired":false,"billingCode":"48520","codeType":"CPT"},{"id":3321,"precertRequired":false,"billingCode":"48540","codeType":"CPT"},{"id":3322,"precertRequired":false,"billingCode":"48545","codeType":"CPT"},{"id":3323,"precertRequired":false,"billingCode":"48547","codeType":"CPT"},{"id":3324,"precertRequired":false,"billingCode":"48548","codeType":"CPT"},{"id":3328,"precertRequired":false,"billingCode":"48554","codeType":"CPT"},{"id":3330,"precertRequired":false,"billingCode":"49002","codeType":"CPT"},{"id":3331,"precertRequired":false,"billingCode":"49010","codeType":"CPT"},{"id":3332,"precertRequired":false,"billingCode":"49020","codeType":"CPT"},{"id":3333,"precertRequired":false,"billingCode":"49040","codeType":"CPT"},{"id":3334,"precertRequired":false,"billingCode":"49060","codeType":"CPT"},{"id":3335,"precertRequired":false,"billingCode":"49062","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3337,"precertRequired":false,"billingCode":"49083","codeType":"CPT"},{"id":3338,"precertRequired":false,"billingCode":"49084","codeType":"CPT"},{"id":3339,"precertRequired":false,"billingCode":"49180","codeType":"CPT"},{"id":3340,"precertRequired":false,"billingCode":"49185","codeType":"CPT"},{"id":3341,"precertRequired":false,"billingCode":"49203","codeType":"CPT"},{"id":3342,"precertRequired":false,"billingCode":"49204","codeType":"CPT"},{"id":3343,"precertRequired":false,"billingCode":"49205","codeType":"CPT"},{"id":3344,"precertRequired":false,"billingCode":"49220","codeType":"CPT"},{"id":3345,"precertRequired":false,"billingCode":"49250","codeType":"CPT"},{"id":3346,"precertRequired":false,"billingCode":"49255","codeType":"CPT"},{"id":3347,"precertRequired":false,"billingCode":"49320","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3350,"precertRequired":false,"billingCode":"49323","codeType":"CPT"},{"id":3351,"precertRequired":false,"billingCode":"49324","codeType":"CPT"},{"id":3352,"precertRequired":false,"billingCode":"49325","codeType":"CPT"},{"id":3353,"precertRequired":false,"billingCode":"49326","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3356,"precertRequired":false,"billingCode":"49400","codeType":"CPT"},{"id":3357,"precertRequired":false,"billingCode":"49402","codeType":"CPT"},{"id":3358,"precertRequired":false,"billingCode":"49405","codeType":"CPT"},{"id":3359,"precertRequired":false,"billingCode":"49406","codeType":"CPT"},{"id":3360,"precertRequired":false,"billingCode":"49407","codeType":"CPT"},{"id":3361,"precertRequired":false,"billingCode":"49411","codeType":"CPT"},{"id":3362,"precertRequired":false,"billingCode":"49412","codeType":"CPT"},{"id":3363,"precertRequired":false,"billingCode":"49418","codeType":"CPT"},{"id":3364,"precertRequired":false,"billingCode":"49419","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"},{"id":3368,"precertRequired":false,"billingCode":"49423","codeType":"CPT"},{"id":3369,"precertRequired":false,"billingCode":"49424","codeType":"CPT"},{"id":3370,"precertRequired":false,"billingCode":"49425","codeType":"CPT"},{"id":3371,"precertRequired":false,"billingCode":"49426","codeType":"CPT"},{"id":3372,"precertRequired":false,"billingCode":"49427","codeType":"CPT"},{"id":3373,"precertRequired":false,"billingCode":"49428","codeType":"CPT"},{"id":3374,"precertRequired":false,"billingCode":"49429","codeType":"CPT"},{"id":3375,"precertRequired":false,"billingCode":"49435","codeType":"CPT"},{"id":3376,"precertRequired":false,"billingCode":"49436","codeType":"CPT"},{"id":3377,"precertRequired":false,"billingCode":"49440","codeType":"CPT"},{"id":3378,"precertRequired":false,"billingCode":"49441","codeType":"CPT"},{"id":3379,"precertRequired":false,"billingCode":"49442","codeType":"CPT"},{"id":3380,"precertRequired":false,"billingCode":"49446","codeType":"CPT"},{"id":3381,"precertRequired":false,"billingCode":"49450","codeType":"CPT"},{"id":3382,"precertRequired":false,"billingCode":"49451","codeType":"CPT"},{"id":3383,"precertRequired":false,"billingCode":"49452","codeType":"CPT"},{"id":3384,"precertRequired":false,"billingCode":"49460","codeType":"CPT"},{"id":3385,"precertRequired":false,"billingCode":"49465","codeType":"CPT"},{"id":3386,"precertRequired":false,"billingCode":"50200","codeType":"CPT"},{"id":3435,"precertRequired":false,"billingCode":"51798","codeType":"CPT"},{"id":3439,"precertRequired":false,"billingCode":"51990","codeType":"CPT"},{"id":3440,"precertRequired":false,"billingCode":"51992","codeType":"CPT"},{"id":3446,"precertRequired":false,"billingCode":"52204","codeType":"CPT"},{"id":3490,"precertRequired":false,"billingCode":"53040","codeType":"CPT"},{"id":3491,"precertRequired":false,"billingCode":"53060","codeType":"CPT"},{"id":3492,"precertRequired":false,"billingCode":"53200","codeType":"CPT"},{"id":3515,"precertRequired":false,"billingCode":"54100","codeType":"CPT"},{"id":3516,"precertRequired":false,"billingCode":"54105","codeType":"CPT"},{"id":3519,"precertRequired":false,"billingCode":"54162","codeType":"CPT"},{"id":3527,"precertRequired":false,"billingCode":"54640","codeType":"CPT"},{"id":3528,"precertRequired":false,"billingCode":"54800","codeType":"CPT"},{"id":3529,"precertRequired":false,"billingCode":"54865","codeType":"CPT"},{"id":3534,"precertRequired":false,"billingCode":"55100","codeType":"CPT"},{"id":3540,"precertRequired":false,"billingCode":"55540","codeType":"CPT"},{"id":3541,"precertRequired":false,"billingCode":"55550","codeType":"CPT"},{"id":3550,"precertRequired":false,"billingCode":"56405","codeType":"CPT"},{"id":3551,"precertRequired":false,"billingCode":"56420","codeType":"CPT"},{"id":3553,"precertRequired":false,"billingCode":"56441","codeType":"CPT"},{"id":3562,"precertRequired":false,"billingCode":"56631","codeType":"CPT"},{"id":3563,"precertRequired":false,"billingCode":"56632","codeType":"CPT"},{"id":3565,"precertRequired":false,"billingCode":"56634","codeType":"CPT"},{"id":3566,"precertRequired":false,"billingCode":"56637","codeType":"CPT"},{"id":3567,"precertRequired":false,"billingCode":"56640","codeType":"CPT"},{"id":3573,"precertRequired":false,"billingCode":"56821","codeType":"CPT"},{"id":3574,"precertRequired":false,"billingCode":"57000","codeType":"CPT"},{"id":3575,"precertRequired":false,"billingCode":"57010","codeType":"CPT"},{"id":3576,"precertRequired":false,"billingCode":"57020","codeType":"CPT"},{"id":3577,"precertRequired":false,"billingCode":"57022","codeType":"CPT"},{"id":3578,"precertRequired":false,"billingCode":"57023","codeType":"CPT"},{"id":3616,"precertRequired":false,"billingCode":"57300","codeType":"CPT"},{"id":3617,"precertRequired":false,"billingCode":"57305","codeType":"CPT"},{"id":3618,"precertRequired":false,"billingCode":"57307","codeType":"CPT"},{"id":3619,"precertRequired":false,"billingCode":"57308","codeType":"CPT"},{"id":3620,"precertRequired":false,"billingCode":"57310","codeType":"CPT"},{"id":3621,"precertRequired":false,"billingCode":"57311","codeType":"CPT"},{"id":3622,"precertRequired":false,"billingCode":"57320","codeType":"CPT"},{"id":3623,"precertRequired":false,"billingCode":"57330","codeType":"CPT"},{"id":3630,"precertRequired":false,"billingCode":"57425","codeType":"CPT"},{"id":3631,"precertRequired":false,"billingCode":"57426","codeType":"CPT"},{"id":3638,"precertRequired":false,"billingCode":"57500","codeType":"CPT"},{"id":3639,"precertRequired":false,"billingCode":"57505","codeType":"CPT"},{"id":3641,"precertRequired":false,"billingCode":"57511","codeType":"CPT"},{"id":3642,"precertRequired":false,"billingCode":"57513","codeType":"CPT"},{"id":3643,"precertRequired":false,"billingCode":"57520","codeType":"CPT"},{"id":3644,"precertRequired":false,"billingCode":"57522","codeType":"CPT"},{"id":3645,"precertRequired":false,"billingCode":"57530","codeType":"CPT"},{"id":3646,"precertRequired":false,"billingCode":"57531","codeType":"CPT"},{"id":3647,"precertRequired":false,"billingCode":"57540","codeType":"CPT"},{"id":3648,"precertRequired":false,"billingCode":"57545","codeType":"CPT"},{"id":3649,"precertRequired":false,"billingCode":"57550","codeType":"CPT"},{"id":3650,"precertRequired":false,"billingCode":"57555","codeType":"CPT"},{"id":3651,"precertRequired":false,"billingCode":"57556","codeType":"CPT"},{"id":3652,"precertRequired":false,"billingCode":"57558","codeType":"CPT"},{"id":3655,"precertRequired":false,"billingCode":"57800","codeType":"CPT"},{"id":3656,"precertRequired":false,"billingCode":"58100","codeType":"CPT"},{"id":3657,"precertRequired":false,"billingCode":"58110","codeType":"CPT"},{"id":3658,"precertRequired":false,"billingCode":"58120","codeType":"CPT"},{"id":3659,"precertRequired":false,"billingCode":"58140","codeType":"CPT"},{"id":3660,"precertRequired":false,"billingCode":"58145","codeType":"CPT"},{"id":3661,"precertRequired":false,"billingCode":"58146","codeType":"CPT"},{"id":3662,"precertRequired":false,"billingCode":"58150","codeType":"CPT"},{"id":3663,"precertRequired":false,"billingCode":"58152","codeType":"CPT"},{"id":3664,"precertRequired":false,"billingCode":"58180","codeType":"CPT"},{"id":3665,"precertRequired":false,"billingCode":"58200","codeType":"CPT"},{"id":3666,"precertRequired":false,"billingCode":"58210","codeType":"CPT"},{"id":3667,"precertRequired":false,"billingCode":"58240","codeType":"CPT"},{"id":3668,"precertRequired":false,"billingCode":"58260","codeType":"CPT"},{"id":3669,"precertRequired":false,"billingCode":"58262","codeType":"CPT"},{"id":3670,"precertRequired":false,"billingCode":"58263","codeType":"CPT"},{"id":3671,"precertRequired":false,"billingCode":"58267","codeType":"CPT"},{"id":3672,"precertRequired":false,"billingCode":"58270","codeType":"CPT"},{"id":3673,"precertRequired":false,"billingCode":"58275","codeType":"CPT"},{"id":3674,"precertRequired":false,"billingCode":"58280","codeType":"CPT"},{"id":3675,"precertRequired":false,"billingCode":"58285","codeType":"CPT"},{"id":3676,"precertRequired":false,"billingCode":"58290","codeType":"CPT"},{"id":3677,"precertRequired":false,"billingCode":"58291","codeType":"CPT"},{"id":3678,"precertRequired":false,"billingCode":"58292","codeType":"CPT"},{"id":3679,"precertRequired":false,"billingCode":"58293","codeType":"CPT"},{"id":3680,"precertRequired":false,"billingCode":"58294","codeType":"CPT"},{"id":3695,"precertRequired":false,"billingCode":"58541","codeType":"CPT"},{"id":3696,"precertRequired":false,"billingCode":"58542","codeType":"CPT"},{"id":3697,"precertRequired":false,"billingCode":"58543","codeType":"CPT"},{"id":3698,"precertRequired":false,"billingCode":"58544","codeType":"CPT"},{"id":3699,"precertRequired":false,"billingCode":"58545","codeType":"CPT"},{"id":3700,"precertRequired":false,"billingCode":"58546","codeType":"CPT"},{"id":3701,"precertRequired":false,"billingCode":"58548","codeType":"CPT"},{"id":3702,"precertRequired":false,"billingCode":"58550","codeType":"CPT"},{"id":3703,"precertRequired":false,"billingCode":"58552","codeType":"CPT"},{"id":3704,"precertRequired":false,"billingCode":"58553","codeType":"CPT"},{"id":3705,"precertRequired":false,"billingCode":"58554","codeType":"CPT"},{"id":3706,"precertRequired":false,"billingCode":"58555","codeType":"CPT"},{"id":3707,"precertRequired":false,"billingCode":"58558","codeType":"CPT"},{"id":3708,"precertRequired":false,"billingCode":"58559","codeType":"CPT"},{"id":3709,"precertRequired":false,"billingCode":"58560","codeType":"CPT"},{"id":3710,"precertRequired":false,"billingCode":"58561","codeType":"CPT"},{"id":3711,"precertRequired":false,"billingCode":"58562","codeType":"CPT"},{"id":3712,"precertRequired":false,"billingCode":"58563","codeType":"CPT"},{"id":3713,"precertRequired":false,"billingCode":"58565","codeType":"CPT"},{"id":3714,"precertRequired":false,"billingCode":"58570","codeType":"CPT"},{"id":3715,"precertRequired":false,"billingCode":"58571","codeType":"CPT"},{"id":3716,"precertRequired":false,"billingCode":"58572","codeType":"CPT"},{"id":3717,"precertRequired":false,"billingCode":"58573","codeType":"CPT"},{"id":3718,"precertRequired":false,"billingCode":"58575","codeType":"CPT"},{"id":3723,"precertRequired":false,"billingCode":"58611","codeType":"CPT"},{"id":3725,"precertRequired":false,"billingCode":"58660","codeType":"CPT"},{"id":3726,"precertRequired":false,"billingCode":"58661","codeType":"CPT"},{"id":3727,"precertRequired":false,"billingCode":"58662","codeType":"CPT"},{"id":3728,"precertRequired":true,"billingCode":"58670","codeType":"CPT"},{"id":3729,"precertRequired":false,"billingCode":"58671","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3732,"precertRequired":false,"billingCode":"58674","codeType":"CPT"},{"id":3735,"precertRequired":false,"billingCode":"58720","codeType":"CPT"},{"id":3736,"precertRequired":false,"billingCode":"58740","codeType":"CPT"},{"id":3741,"precertRequired":false,"billingCode":"58800","codeType":"CPT"},{"id":3742,"precertRequired":false,"billingCode":"58805","codeType":"CPT"},{"id":3743,"precertRequired":false,"billingCode":"58820","codeType":"CPT"},{"id":3744,"precertRequired":false,"billingCode":"58822","codeType":"CPT"},{"id":3749,"precertRequired":false,"billingCode":"58940","codeType":"CPT"},{"id":3750,"precertRequired":false,"billingCode":"58943","codeType":"CPT"},{"id":3751,"precertRequired":false,"billingCode":"58950","codeType":"CPT"},{"id":3752,"precertRequired":false,"billingCode":"58951","codeType":"CPT"},{"id":3753,"precertRequired":false,"billingCode":"58952","codeType":"CPT"},{"id":3754,"precertRequired":false,"billingCode":"58953","codeType":"CPT"},{"id":3755,"precertRequired":false,"billingCode":"58954","codeType":"CPT"},{"id":3756,"precertRequired":false,"billingCode":"58956","codeType":"CPT"},{"id":3757,"precertRequired":false,"billingCode":"58957","codeType":"CPT"},{"id":3758,"precertRequired":false,"billingCode":"58958","codeType":"CPT"},{"id":3759,"precertRequired":false,"billingCode":"58960","codeType":"CPT"},{"id":3786,"precertRequired":false,"billingCode":"59160","codeType":"CPT"},{"id":3801,"precertRequired":false,"billingCode":"59514","codeType":"CPT"},{"id":3802,"precertRequired":false,"billingCode":"59515","codeType":"CPT"},{"id":3803,"precertRequired":false,"billingCode":"59525","codeType":"CPT"},{"id":3808,"precertRequired":false,"billingCode":"59620","codeType":"CPT"},{"id":3809,"precertRequired":false,"billingCode":"59622","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3847,"precertRequired":false,"billingCode":"60512","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3849,"precertRequired":false,"billingCode":"60521","codeType":"CPT"},{"id":3850,"precertRequired":false,"billingCode":"60522","codeType":"CPT"},{"id":3851,"precertRequired":false,"billingCode":"60540","codeType":"CPT"},{"id":3852,"precertRequired":false,"billingCode":"60545","codeType":"CPT"},{"id":3853,"precertRequired":false,"billingCode":"60600","codeType":"CPT"},{"id":3854,"precertRequired":false,"billingCode":"60605","codeType":"CPT"},{"id":3855,"precertRequired":false,"billingCode":"60650","codeType":"CPT"},{"id":3857,"precertRequired":false,"billingCode":"61576","codeType":"CPT"},{"id":4009,"precertRequired":false,"billingCode":"64721","codeType":"CPT"},{"id":4038,"precertRequired":false,"billingCode":"64795","codeType":"CPT"},{"id":4275,"precertRequired":false,"billingCode":"67700","codeType":"CPT"},{"id":4290,"precertRequired":false,"billingCode":"67880","codeType":"CPT"},{"id":4291,"precertRequired":false,"billingCode":"67882","codeType":"CPT"},{"id":4348,"precertRequired":false,"billingCode":"69000","codeType":"CPT"},{"id":4355,"precertRequired":false,"billingCode":"69220","codeType":"CPT"},{"id":4356,"precertRequired":true,"billingCode":"69222","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":7282,"precertRequired":false,"billingCode":"97598","codeType":"CPT"},{"id":7283,"precertRequired":false,"billingCode":"97602","codeType":"CPT"},{"id":7284,"precertRequired":false,"billingCode":"97605","codeType":"CPT"},{"id":7285,"precertRequired":false,"billingCode":"97606","codeType":"CPT"},{"id":7286,"precertRequired":false,"billingCode":"97607","codeType":"CPT"},{"id":7287,"precertRequired":false,"billingCode":"97608","codeType":"CPT"},{"id":7288,"precertRequired":false,"billingCode":"97610","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":9153,"precertRequired":false,"billingCode":"10004","codeType":"CPT"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9155,"precertRequired":false,"billingCode":"10006","codeType":"CPT"},{"id":9156,"precertRequired":true,"billingCode":"10007","codeType":"CPT"},{"id":9157,"precertRequired":true,"billingCode":"10008","codeType":"CPT"},{"id":9158,"precertRequired":true,"billingCode":"10009","codeType":"CPT"},{"id":9159,"precertRequired":true,"billingCode":"10010","codeType":"CPT"},{"id":9160,"precertRequired":true,"billingCode":"10011","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":9168,"precertRequired":true,"billingCode":"15004","codeType":"CPT"},{"id":9169,"precertRequired":true,"billingCode":"15005","codeType":"CPT"},{"id":9170,"precertRequired":true,"billingCode":"15115","codeType":"CPT"},{"id":9171,"precertRequired":true,"billingCode":"15116","codeType":"CPT"},{"id":9172,"precertRequired":true,"billingCode":"15120","codeType":"CPT"},{"id":9173,"precertRequired":true,"billingCode":"15121","codeType":"CPT"},{"id":9176,"precertRequired":true,"billingCode":"15277","codeType":"CPT"},{"id":9177,"precertRequired":true,"billingCode":"15278","codeType":"CPT"},{"id":9322,"precertRequired":true,"billingCode":"29837","codeType":"CPT"},{"id":9323,"precertRequired":true,"billingCode":"29838","codeType":"CPT"},{"id":9328,"precertRequired":true,"billingCode":"29848","codeType":"CPT"},{"id":9373,"precertRequired":true,"billingCode":"31238","codeType":"CPT"},{"id":9374,"precertRequired":true,"billingCode":"31239","codeType":"CPT"},{"id":9375,"precertRequired":true,"billingCode":"31240","codeType":"CPT"},{"id":9376,"precertRequired":true,"billingCode":"31241","codeType":"CPT"},{"id":9377,"precertRequired":true,"billingCode":"31253","codeType":"CPT"},{"id":9378,"precertRequired":true,"billingCode":"31254","codeType":"CPT"},{"id":9379,"precertRequired":true,"billingCode":"31255","codeType":"CPT"},{"id":9380,"precertRequired":true,"billingCode":"31256","codeType":"CPT"},{"id":9381,"precertRequired":true,"billingCode":"31257","codeType":"CPT"},{"id":9382,"precertRequired":true,"billingCode":"31259","codeType":"CPT"},{"id":9383,"precertRequired":true,"billingCode":"31267","codeType":"CPT"},{"id":9384,"precertRequired":true,"billingCode":"31276","codeType":"CPT"},{"id":9385,"precertRequired":true,"billingCode":"31287","codeType":"CPT"},{"id":9386,"precertRequired":true,"billingCode":"31288","codeType":"CPT"},{"id":9387,"precertRequired":true,"billingCode":"31290","codeType":"CPT"},{"id":9388,"precertRequired":true,"billingCode":"31291","codeType":"CPT"},{"id":9389,"precertRequired":true,"billingCode":"31292","codeType":"CPT"},{"id":9390,"precertRequired":true,"billingCode":"31293","codeType":"CPT"},{"id":9391,"precertRequired":true,"billingCode":"31294","codeType":"CPT"},{"id":9392,"precertRequired":true,"billingCode":"31295","codeType":"CPT"},{"id":9393,"precertRequired":true,"billingCode":"31296","codeType":"CPT"},{"id":9394,"precertRequired":true,"billingCode":"31297","codeType":"CPT"},{"id":9395,"precertRequired":true,"billingCode":"31298","codeType":"CPT"},{"id":9493,"precertRequired":true,"billingCode":"42000","codeType":"CPT"},{"id":9527,"precertRequired":true,"billingCode":"47370","codeType":"CPT"},{"id":9528,"precertRequired":true,"billingCode":"47900","codeType":"CPT"},{"id":9529,"precertRequired":true,"billingCode":"48140","codeType":"CPT"},{"id":9530,"precertRequired":true,"billingCode":"48145","codeType":"CPT"},{"id":9531,"precertRequired":true,"billingCode":"48146","codeType":"CPT"},{"id":9532,"precertRequired":true,"billingCode":"50020","codeType":"CPT"},{"id":9533,"precertRequired":true,"billingCode":"50040","codeType":"CPT"},{"id":9534,"precertRequired":true,"billingCode":"50045","codeType":"CPT"},{"id":9535,"precertRequired":true,"billingCode":"50060","codeType":"CPT"},{"id":9536,"precertRequired":true,"billingCode":"50065","codeType":"CPT"},{"id":9537,"precertRequired":true,"billingCode":"50070","codeType":"CPT"},{"id":9538,"precertRequired":true,"billingCode":"50075","codeType":"CPT"},{"id":9539,"precertRequired":true,"billingCode":"50080","codeType":"CPT"},{"id":9540,"precertRequired":true,"billingCode":"50081","codeType":"CPT"},{"id":9542,"precertRequired":true,"billingCode":"50120","codeType":"CPT"},{"id":9543,"precertRequired":true,"billingCode":"50125","codeType":"CPT"},{"id":9544,"precertRequired":true,"billingCode":"50130","codeType":"CPT"},{"id":9545,"precertRequired":true,"billingCode":"50135","codeType":"CPT"},{"id":9546,"precertRequired":true,"billingCode":"50205","codeType":"CPT"},{"id":9547,"precertRequired":true,"billingCode":"50220","codeType":"CPT"},{"id":9548,"precertRequired":true,"billingCode":"50225","codeType":"CPT"},{"id":9549,"precertRequired":true,"billingCode":"50234","codeType":"CPT"},{"id":9550,"precertRequired":true,"billingCode":"50236","codeType":"CPT"},{"id":9554,"precertRequired":true,"billingCode":"50542","codeType":"CPT"},{"id":9555,"precertRequired":true,"billingCode":"50543","codeType":"CPT"},{"id":9556,"precertRequired":true,"billingCode":"50544","codeType":"CPT"},{"id":9557,"precertRequired":true,"billingCode":"50545","codeType":"CPT"},{"id":9558,"precertRequired":true,"billingCode":"50553","codeType":"CPT"},{"id":9573,"precertRequired":true,"billingCode":"51080","codeType":"CPT"},{"id":9584,"precertRequired":true,"billingCode":"51575","codeType":"CPT"},{"id":9585,"precertRequired":true,"billingCode":"51580","codeType":"CPT"},{"id":9586,"precertRequired":true,"billingCode":"51585","codeType":"CPT"},{"id":9587,"precertRequired":true,"billingCode":"51590","codeType":"CPT"},{"id":9588,"precertRequired":true,"billingCode":"51595","codeType":"CPT"},{"id":9589,"precertRequired":false,"billingCode":"51597","codeType":"CPT"},{"id":9608,"precertRequired":true,"billingCode":"52700","codeType":"CPT"},{"id":9633,"precertRequired":true,"billingCode":"53500","codeType":"CPT"},{"id":9658,"precertRequired":true,"billingCode":"55801","codeType":"CPT"},{"id":9659,"precertRequired":true,"billingCode":"55810","codeType":"CPT"},{"id":9660,"precertRequired":true,"billingCode":"55812","codeType":"CPT"},{"id":9661,"precertRequired":true,"billingCode":"55815","codeType":"CPT"},{"id":9662,"precertRequired":true,"billingCode":"55821","codeType":"CPT"},{"id":9663,"precertRequired":true,"billingCode":"55831","codeType":"CPT"},{"id":9664,"precertRequired":true,"billingCode":"55840","codeType":"CPT"},{"id":9665,"precertRequired":true,"billingCode":"55842","codeType":"CPT"},{"id":9666,"precertRequired":true,"billingCode":"55845","codeType":"CPT"},{"id":9871,"precertRequired":false,"billingCode":"69005","codeType":"CPT"},{"id":9872,"precertRequired":false,"billingCode":"69020","codeType":"CPT"},{"id":9930,"precertRequired":false,"billingCode":"55862","codeType":"CPT"},{"id":9931,"precertRequired":false,"billingCode":"55865","codeType":"CPT"},{"id":9932,"precertRequired":false,"billingCode":"55866","codeType":"CPT"},{"id":9954,"precertRequired":false,"billingCode":"15002","codeType":"CPT"},{"id":9955,"precertRequired":false,"billingCode":"15003","codeType":"CPT"},{"id":9956,"precertRequired":false,"billingCode":"15100","codeType":"CPT"},{"id":9957,"precertRequired":false,"billingCode":"15777","codeType":"CPT"},{"id":9960,"precertRequired":false,"billingCode":"19316","codeType":"CPT"},{"id":9961,"precertRequired":false,"billingCode":"19318","codeType":"CPT"},{"id":9962,"precertRequired":false,"billingCode":"19324","codeType":"CPT"},{"id":9963,"precertRequired":false,"billingCode":"19325","codeType":"CPT"},{"id":9964,"precertRequired":false,"billingCode":"19328","codeType":"CPT"},{"id":9965,"precertRequired":false,"billingCode":"19330","codeType":"CPT"},{"id":9966,"precertRequired":false,"billingCode":"19340","codeType":"CPT"},{"id":9967,"precertRequired":false,"billingCode":"19342","codeType":"CPT"},{"id":9968,"precertRequired":false,"billingCode":"19350","codeType":"CPT"},{"id":9969,"precertRequired":false,"billingCode":"19357","codeType":"CPT"},{"id":9970,"precertRequired":false,"billingCode":"19361","codeType":"CPT"},{"id":9971,"precertRequired":false,"billingCode":"19364","codeType":"CPT"},{"id":9972,"precertRequired":false,"billingCode":"19366","codeType":"CPT"},{"id":9973,"precertRequired":false,"billingCode":"19367","codeType":"CPT"},{"id":9974,"precertRequired":false,"billingCode":"19368","codeType":"CPT"},{"id":9975,"precertRequired":false,"billingCode":"19369","codeType":"CPT"},{"id":9976,"precertRequired":false,"billingCode":"19370","codeType":"CPT"},{"id":9977,"precertRequired":false,"billingCode":"19371","codeType":"CPT"},{"id":9978,"precertRequired":false,"billingCode":"19380","codeType":"CPT"},{"id":9982,"precertRequired":false,"billingCode":"42305","codeType":"CPT"},{"id":9986,"precertRequired":false,"billingCode":"49904","codeType":"CPT"},{"id":10726,"precertRequired":false,"billingCode":"15101","codeType":"CPT"},{"id":10727,"precertRequired":false,"billingCode":"15110","codeType":"CPT"},{"id":10728,"precertRequired":false,"billingCode":"15111","codeType":"CPT"},{"id":10731,"precertRequired":false,"billingCode":"15152","codeType":"CPT"},{"id":10732,"precertRequired":false,"billingCode":"15274","codeType":"CPT"},{"id":11357,"precertRequired":false,"billingCode":"54150","codeType":"CPT"},{"id":11381,"precertRequired":false,"billingCode":"42320","codeType":"CPT"},{"id":11384,"precertRequired":false,"billingCode":"42400","codeType":"CPT"},{"id":11385,"precertRequired":false,"billingCode":"42405","codeType":"CPT"},{"id":11399,"precertRequired":false,"billingCode":"42720","codeType":"CPT"},{"id":11400,"precertRequired":false,"billingCode":"42725","codeType":"CPT"},{"id":11586,"precertRequired":false,"billingCode":"38792","codeType":"CPT"},{"id":11643,"precertRequired":false,"billingCode":"39540","codeType":"CPT"},{"id":11644,"precertRequired":false,"billingCode":"39541","codeType":"CPT"},{"id":11645,"precertRequired":false,"billingCode":"39545","codeType":"CPT"},{"id":11646,"precertRequired":false,"billingCode":"39560","codeType":"CPT"},{"id":11647,"precertRequired":false,"billingCode":"39561","codeType":"CPT"},{"id":11833,"precertRequired":false,"billingCode":"54120","codeType":"CPT"},{"id":11834,"precertRequired":false,"billingCode":"54125","codeType":"CPT"},{"id":11835,"precertRequired":false,"billingCode":"36573","codeType":"CPT"},{"id":11876,"precertRequired":false,"billingCode":"49505","codeType":"CPT"},{"id":11877,"precertRequired":false,"billingCode":"49507","codeType":"CPT"},{"id":11878,"precertRequired":false,"billingCode":"49520","codeType":"CPT"},{"id":11879,"precertRequired":false,"billingCode":"49521","codeType":"CPT"},{"id":11880,"precertRequired":false,"billingCode":"49525","codeType":"CPT"},{"id":11881,"precertRequired":false,"billingCode":"49560","codeType":"CPT"},{"id":11882,"precertRequired":false,"billingCode":"49561","codeType":"CPT"},{"id":11883,"precertRequired":false,"billingCode":"49565","codeType":"CPT"},{"id":11884,"precertRequired":false,"billingCode":"49566","codeType":"CPT"},{"id":11885,"precertRequired":false,"billingCode":"49568","codeType":"CPT"},{"id":11886,"precertRequired":false,"billingCode":"49652","codeType":"CPT"},{"id":11887,"precertRequired":false,"billingCode":"49653","codeType":"CPT"},{"id":11888,"precertRequired":false,"billingCode":"49654","codeType":"CPT"},{"id":11889,"precertRequired":false,"billingCode":"49655","codeType":"CPT"},{"id":11890,"precertRequired":false,"billingCode":"49656","codeType":"CPT"},{"id":11891,"precertRequired":false,"billingCode":"49657","codeType":"CPT"},{"id":11892,"precertRequired":false,"billingCode":"50546","codeType":"CPT"},{"id":11893,"precertRequired":false,"billingCode":"50548","codeType":"CPT"},{"id":11894,"precertRequired":false,"billingCode":"50945","codeType":"CPT"},{"id":11895,"precertRequired":false,"billingCode":"54690","codeType":"CPT"},{"id":11897,"precertRequired":false,"billingCode":"29846","codeType":"CPT"},{"id":11912,"precertRequired":false,"billingCode":"49000","codeType":"CPT"},{"id":11913,"precertRequired":false,"billingCode":"49900","codeType":"CPT"},{"id":12043,"precertRequired":false,"billingCode":"61575","codeType":"CPT"},{"id":12075,"precertRequired":false,"billingCode":"62161","codeType":"CPT"},{"id":12093,"precertRequired":false,"billingCode":"62263","codeType":"CPT"},{"id":12094,"precertRequired":false,"billingCode":"62264","codeType":"CPT"},{"id":12111,"precertRequired":false,"billingCode":"43762","codeType":"CPT"},{"id":12112,"precertRequired":false,"billingCode":"43763","codeType":"CPT"},{"id":12136,"precertRequired":false,"billingCode":"15851","codeType":"CPT"},{"id":12137,"precertRequired":false,"billingCode":"19110","codeType":"CPT"},{"id":12138,"precertRequired":false,"billingCode":"19112","codeType":"CPT"},{"id":12139,"precertRequired":false,"billingCode":"19355","codeType":"CPT"},{"id":12140,"precertRequired":false,"billingCode":"38531","codeType":"CPT"},{"id":12141,"precertRequired":false,"billingCode":"46916","codeType":"CPT"},{"id":12142,"precertRequired":false,"billingCode":"47380","codeType":"CPT"},{"id":12143,"precertRequired":false,"billingCode":"49540","codeType":"CPT"},{"id":12144,"precertRequired":false,"billingCode":"49550","codeType":"CPT"},{"id":12145,"precertRequired":false,"billingCode":"49553","codeType":"CPT"},{"id":12146,"precertRequired":false,"billingCode":"49555","codeType":"CPT"},{"id":12147,"precertRequired":false,"billingCode":"49557","codeType":"CPT"},{"id":12148,"precertRequired":false,"billingCode":"49570","codeType":"CPT"},{"id":12149,"precertRequired":false,"billingCode":"49572","codeType":"CPT"},{"id":12150,"precertRequired":false,"billingCode":"49585","codeType":"CPT"},{"id":12151,"precertRequired":false,"billingCode":"49587","codeType":"CPT"},{"id":12152,"precertRequired":false,"billingCode":"49590","codeType":"CPT"},{"id":12153,"precertRequired":false,"billingCode":"49650","codeType":"CPT"},{"id":12154,"precertRequired":false,"billingCode":"49651","codeType":"CPT"},{"id":12155,"precertRequired":false,"billingCode":"49905","codeType":"CPT"},{"id":12156,"precertRequired":false,"billingCode":"49906","codeType":"CPT"},{"id":12157,"precertRequired":false,"billingCode":"50230","codeType":"CPT"},{"id":12158,"precertRequired":false,"billingCode":"50240","codeType":"CPT"},{"id":12159,"precertRequired":false,"billingCode":"50250","codeType":"CPT"},{"id":12160,"precertRequired":false,"billingCode":"50280","codeType":"CPT"},{"id":12161,"precertRequired":false,"billingCode":"50290","codeType":"CPT"},{"id":12162,"precertRequired":false,"billingCode":"50400","codeType":"CPT"},{"id":12163,"precertRequired":false,"billingCode":"50405","codeType":"CPT"},{"id":12164,"precertRequired":false,"billingCode":"50500","codeType":"CPT"},{"id":12165,"precertRequired":false,"billingCode":"50520","codeType":"CPT"},{"id":12166,"precertRequired":false,"billingCode":"50525","codeType":"CPT"},{"id":12167,"precertRequired":false,"billingCode":"50526","codeType":"CPT"},{"id":12168,"precertRequired":false,"billingCode":"50540","codeType":"CPT"},{"id":12169,"precertRequired":false,"billingCode":"50541","codeType":"CPT"},{"id":12170,"precertRequired":false,"billingCode":"50551","codeType":"CPT"},{"id":12171,"precertRequired":false,"billingCode":"50555","codeType":"CPT"},{"id":12172,"precertRequired":false,"billingCode":"50557","codeType":"CPT"},{"id":12173,"precertRequired":false,"billingCode":"50561","codeType":"CPT"},{"id":12174,"precertRequired":false,"billingCode":"50562","codeType":"CPT"},{"id":12175,"precertRequired":false,"billingCode":"50810","codeType":"CPT"},{"id":12176,"precertRequired":false,"billingCode":"50947","codeType":"CPT"},{"id":12177,"precertRequired":false,"billingCode":"50948","codeType":"CPT"},{"id":12178,"precertRequired":false,"billingCode":"51596","codeType":"CPT"},{"id":12179,"precertRequired":false,"billingCode":"54130","codeType":"CPT"},{"id":12180,"precertRequired":false,"billingCode":"54135","codeType":"CPT"},{"id":12181,"precertRequired":false,"billingCode":"54450","codeType":"CPT"},{"id":12182,"precertRequired":false,"billingCode":"54692","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":4637,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":14,"precertRequired":false,"billingCode":"00160","codeType":"CPT"},{"id":17,"precertRequired":false,"billingCode":"00170","codeType":"CPT"},{"id":21,"precertRequired":false,"billingCode":"00190","codeType":"CPT"},{"id":22,"precertRequired":false,"billingCode":"00192","codeType":"CPT"},{"id":24,"precertRequired":false,"billingCode":"00211","codeType":"CPT"},{"id":25,"precertRequired":false,"billingCode":"00212","codeType":"CPT"},{"id":26,"precertRequired":false,"billingCode":"00214","codeType":"CPT"},{"id":27,"precertRequired":false,"billingCode":"00215","codeType":"CPT"},{"id":28,"precertRequired":false,"billingCode":"00216","codeType":"CPT"},{"id":29,"precertRequired":false,"billingCode":"00218","codeType":"CPT"},{"id":30,"precertRequired":false,"billingCode":"00220","codeType":"CPT"},{"id":31,"precertRequired":false,"billingCode":"00222","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":33,"precertRequired":false,"billingCode":"00320","codeType":"CPT"},{"id":36,"precertRequired":false,"billingCode":"00400","codeType":"CPT"},{"id":37,"precertRequired":false,"billingCode":"00402","codeType":"CPT"},{"id":38,"precertRequired":false,"billingCode":"00404","codeType":"CPT"},{"id":39,"precertRequired":false,"billingCode":"00406","codeType":"CPT"},{"id":40,"precertRequired":false,"billingCode":"00410","codeType":"CPT"},{"id":44,"precertRequired":false,"billingCode":"00472","codeType":"CPT"},{"id":45,"precertRequired":false,"billingCode":"00474","codeType":"CPT"},{"id":46,"precertRequired":false,"billingCode":"00500","codeType":"CPT"},{"id":47,"precertRequired":false,"billingCode":"00520","codeType":"CPT"},{"id":48,"precertRequired":false,"billingCode":"00522","codeType":"CPT"},{"id":49,"precertRequired":false,"billingCode":"00524","codeType":"CPT"},{"id":50,"precertRequired":false,"billingCode":"00528","codeType":"CPT"},{"id":51,"precertRequired":false,"billingCode":"00529","codeType":"CPT"},{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":57,"precertRequired":false,"billingCode":"00541","codeType":"CPT"},{"id":61,"precertRequired":false,"billingCode":"00550","codeType":"CPT"},{"id":69,"precertRequired":false,"billingCode":"00700","codeType":"CPT"},{"id":70,"precertRequired":false,"billingCode":"00702","codeType":"CPT"},{"id":71,"precertRequired":false,"billingCode":"00730","codeType":"CPT"},{"id":72,"precertRequired":false,"billingCode":"00731","codeType":"CPT"},{"id":73,"precertRequired":false,"billingCode":"00732","codeType":"CPT"},{"id":74,"precertRequired":false,"billingCode":"00750","codeType":"CPT"},{"id":75,"precertRequired":false,"billingCode":"00752","codeType":"CPT"},{"id":76,"precertRequired":false,"billingCode":"00754","codeType":"CPT"},{"id":77,"precertRequired":false,"billingCode":"00756","codeType":"CPT"},{"id":78,"precertRequired":false,"billingCode":"00770","codeType":"CPT"},{"id":79,"precertRequired":false,"billingCode":"00790","codeType":"CPT"},{"id":80,"precertRequired":false,"billingCode":"00792","codeType":"CPT"},{"id":81,"precertRequired":false,"billingCode":"00794","codeType":"CPT"},{"id":83,"precertRequired":false,"billingCode":"00797","codeType":"CPT"},{"id":84,"precertRequired":false,"billingCode":"00800","codeType":"CPT"},{"id":86,"precertRequired":false,"billingCode":"00811","codeType":"CPT"},{"id":87,"precertRequired":false,"billingCode":"00812","codeType":"CPT"},{"id":88,"precertRequired":false,"billingCode":"00813","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":90,"precertRequired":false,"billingCode":"00830","codeType":"CPT"},{"id":91,"precertRequired":false,"billingCode":"00832","codeType":"CPT"},{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":96,"precertRequired":false,"billingCode":"00844","codeType":"CPT"},{"id":100,"precertRequired":false,"billingCode":"00860","codeType":"CPT"},{"id":104,"precertRequired":false,"billingCode":"00866","codeType":"CPT"},{"id":111,"precertRequired":false,"billingCode":"00902","codeType":"CPT"},{"id":115,"precertRequired":false,"billingCode":"00910","codeType":"CPT"},{"id":120,"precertRequired":false,"billingCode":"00920","codeType":"CPT"},{"id":136,"precertRequired":false,"billingCode":"00952","codeType":"CPT"},{"id":138,"precertRequired":false,"billingCode":"01120","codeType":"CPT"},{"id":140,"precertRequired":false,"billingCode":"01140","codeType":"CPT"},{"id":141,"precertRequired":false,"billingCode":"01150","codeType":"CPT"},{"id":144,"precertRequired":false,"billingCode":"01173","codeType":"CPT"},{"id":155,"precertRequired":false,"billingCode":"01250","codeType":"CPT"},{"id":156,"precertRequired":false,"billingCode":"01260","codeType":"CPT"},{"id":158,"precertRequired":false,"billingCode":"01272","codeType":"CPT"},{"id":159,"precertRequired":false,"billingCode":"01274","codeType":"CPT"},{"id":160,"precertRequired":false,"billingCode":"01320","codeType":"CPT"},{"id":174,"precertRequired":false,"billingCode":"01442","codeType":"CPT"},{"id":175,"precertRequired":false,"billingCode":"01444","codeType":"CPT"},{"id":181,"precertRequired":false,"billingCode":"01480","codeType":"CPT"},{"id":191,"precertRequired":false,"billingCode":"01844","codeType":"CPT"},{"id":192,"precertRequired":false,"billingCode":"01916","codeType":"CPT"},{"id":195,"precertRequired":false,"billingCode":"01924","codeType":"CPT"},{"id":197,"precertRequired":false,"billingCode":"01926","codeType":"CPT"},{"id":203,"precertRequired":true,"billingCode":"01936","codeType":"CPT"},{"id":204,"precertRequired":false,"billingCode":"01951","codeType":"CPT"},{"id":205,"precertRequired":false,"billingCode":"01952","codeType":"CPT"},{"id":206,"precertRequired":false,"billingCode":"01953","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":8331,"precertRequired":false,"billingCode":"G9654","codeType":"HCPCS"},{"id":9142,"precertRequired":false,"billingCode":"00630","codeType":"CPT"},{"id":9145,"precertRequired":false,"billingCode":"00670","codeType":"CPT"},{"id":9146,"precertRequired":false,"billingCode":"01810","codeType":"CPT"},{"id":9149,"precertRequired":false,"billingCode":"01830","codeType":"CPT"},{"id":11815,"precertRequired":false,"billingCode":"00350","codeType":"CPT"},{"id":11858,"precertRequired":false,"billingCode":"01610","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":4638,"description":"Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5723,"precertRequired":false,"billingCode":"84445","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":4639,"description":"Inpatient or observation admission for surgery/procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":4640,"description":"Inpatient admission or observation status for complications related to the surgery/procedure ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":4641,"description":"Follow-up visits for this episode of care relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":4642,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]}]}},{"Seoc":{"id":474,"seocKey":55,"name":"General Surgery_PRCT","seocId":"SSC_GENERAL SURGERY_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":"11-12-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.   Diagnostic imaging relevant to the referred condition on the consult  \r\n3.   Diagnostic studies relevant to the referred condition on the consult  \r\n4.   Labs and pathology relevant to the referred condition on the consult \r\n5.   Procedures relevant to the referred condition on the consult including but not limited to:  I&D, biopsy, lesion excision with repair, port placement etc.\r\n6.    Anesthesia consultation related to the procedure\r\n7.    Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)\r\n8.    Inpatient or observation admission for surgery/procedure if indicated\r\n9.    Inpatient admission or observation status for complications related to the surgery/procedure\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure\r\n10.  Follow-up visits for this episode of care relevant to the referred condition on the consult","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"SURGERY GENERAL","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"208600000X"}],"services":[{"id":2665,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4367,"precertRequired":false,"billingCode":"70015","codeType":"CPT"},{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4416,"precertRequired":false,"billingCode":"70545","codeType":"CPT"},{"id":4417,"precertRequired":false,"billingCode":"70546","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4424,"precertRequired":false,"billingCode":"70554","codeType":"CPT"},{"id":4425,"precertRequired":false,"billingCode":"70555","codeType":"CPT"},{"id":4426,"precertRequired":false,"billingCode":"70557","codeType":"CPT"},{"id":4427,"precertRequired":false,"billingCode":"70558","codeType":"CPT"},{"id":4428,"precertRequired":false,"billingCode":"70559","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4584,"precertRequired":false,"billingCode":"74190","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4605,"precertRequired":false,"billingCode":"74300","codeType":"CPT"},{"id":4606,"precertRequired":false,"billingCode":"74301","codeType":"CPT"},{"id":4607,"precertRequired":false,"billingCode":"74328","codeType":"CPT"},{"id":4608,"precertRequired":false,"billingCode":"74329","codeType":"CPT"},{"id":4609,"precertRequired":false,"billingCode":"74330","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4611,"precertRequired":false,"billingCode":"74355","codeType":"CPT"},{"id":4612,"precertRequired":false,"billingCode":"74360","codeType":"CPT"},{"id":4613,"precertRequired":false,"billingCode":"74363","codeType":"CPT"},{"id":4639,"precertRequired":false,"billingCode":"75600","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4661,"precertRequired":false,"billingCode":"75809","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4667,"precertRequired":false,"billingCode":"75831","codeType":"CPT"},{"id":4668,"precertRequired":false,"billingCode":"75833","codeType":"CPT"},{"id":4669,"precertRequired":false,"billingCode":"75840","codeType":"CPT"},{"id":4670,"precertRequired":false,"billingCode":"75842","codeType":"CPT"},{"id":4671,"precertRequired":false,"billingCode":"75860","codeType":"CPT"},{"id":4672,"precertRequired":false,"billingCode":"75870","codeType":"CPT"},{"id":4673,"precertRequired":false,"billingCode":"75872","codeType":"CPT"},{"id":4674,"precertRequired":false,"billingCode":"75880","codeType":"CPT"},{"id":4675,"precertRequired":false,"billingCode":"75885","codeType":"CPT"},{"id":4676,"precertRequired":false,"billingCode":"75887","codeType":"CPT"},{"id":4677,"precertRequired":false,"billingCode":"75889","codeType":"CPT"},{"id":4678,"precertRequired":false,"billingCode":"75891","codeType":"CPT"},{"id":4679,"precertRequired":false,"billingCode":"75893","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4682,"precertRequired":false,"billingCode":"75901","codeType":"CPT"},{"id":4683,"precertRequired":false,"billingCode":"75902","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4691,"precertRequired":false,"billingCode":"75989","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4697,"precertRequired":false,"billingCode":"76100","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4700,"precertRequired":false,"billingCode":"76120","codeType":"CPT"},{"id":4701,"precertRequired":false,"billingCode":"76125","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4706,"precertRequired":false,"billingCode":"76390","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4726,"precertRequired":false,"billingCode":"76706","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4770,"precertRequired":false,"billingCode":"76970","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4792,"precertRequired":false,"billingCode":"77071","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4797,"precertRequired":false,"billingCode":"77077","codeType":"CPT"},{"id":4801,"precertRequired":false,"billingCode":"77084","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4910,"precertRequired":false,"billingCode":"78261","codeType":"CPT"},{"id":4918,"precertRequired":false,"billingCode":"78278","codeType":"CPT"},{"id":4919,"precertRequired":false,"billingCode":"78282","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4921,"precertRequired":false,"billingCode":"78291","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4930,"precertRequired":false,"billingCode":"78414","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4932,"precertRequired":false,"billingCode":"78445","codeType":"CPT"},{"id":4937,"precertRequired":false,"billingCode":"78456","codeType":"CPT"},{"id":4938,"precertRequired":false,"billingCode":"78457","codeType":"CPT"},{"id":4939,"precertRequired":false,"billingCode":"78458","codeType":"CPT"},{"id":4969,"precertRequired":false,"billingCode":"78660","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4985,"precertRequired":false,"billingCode":"78804","codeType":"CPT"},{"id":4986,"precertRequired":false,"billingCode":"78805","codeType":"CPT"},{"id":4987,"precertRequired":false,"billingCode":"78806","codeType":"CPT"},{"id":4988,"precertRequired":false,"billingCode":"78807","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"},{"id":4990,"precertRequired":false,"billingCode":"78811","codeType":"CPT"},{"id":4991,"precertRequired":false,"billingCode":"78812","codeType":"CPT"},{"id":4992,"precertRequired":false,"billingCode":"78813","codeType":"CPT"},{"id":4993,"precertRequired":false,"billingCode":"78814","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":4995,"precertRequired":false,"billingCode":"78816","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2666,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2667,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5140,"precertRequired":false,"billingCode":"80500","codeType":"CPT"},{"id":5141,"precertRequired":false,"billingCode":"80502","codeType":"CPT"},{"id":5340,"precertRequired":false,"billingCode":"81500","codeType":"CPT"},{"id":5341,"precertRequired":false,"billingCode":"81503","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5382,"precertRequired":false,"billingCode":"82105","codeType":"CPT"},{"id":5383,"precertRequired":false,"billingCode":"82106","codeType":"CPT"},{"id":5384,"precertRequired":false,"billingCode":"82107","codeType":"CPT"},{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5432,"precertRequired":false,"billingCode":"82378","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5586,"precertRequired":false,"billingCode":"83630","codeType":"CPT"},{"id":5587,"precertRequired":false,"billingCode":"83631","codeType":"CPT"},{"id":5668,"precertRequired":false,"billingCode":"84152","codeType":"CPT"},{"id":5669,"precertRequired":false,"billingCode":"84153","codeType":"CPT"},{"id":5670,"precertRequired":false,"billingCode":"84154","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5905,"precertRequired":false,"billingCode":"86300","codeType":"CPT"},{"id":5906,"precertRequired":false,"billingCode":"86301","codeType":"CPT"},{"id":5907,"precertRequired":false,"billingCode":"86304","codeType":"CPT"},{"id":6108,"precertRequired":false,"billingCode":"87045","codeType":"CPT"},{"id":6109,"precertRequired":false,"billingCode":"87046","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6112,"precertRequired":false,"billingCode":"87073","codeType":"CPT"},{"id":6143,"precertRequired":false,"billingCode":"87177","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6236,"precertRequired":false,"billingCode":"87505","codeType":"CPT"},{"id":6237,"precertRequired":false,"billingCode":"87506","codeType":"CPT"},{"id":6238,"precertRequired":false,"billingCode":"87507","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6411,"precertRequired":false,"billingCode":"88314","codeType":"CPT"},{"id":6412,"precertRequired":false,"billingCode":"88319","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6414,"precertRequired":false,"billingCode":"88323","codeType":"CPT"},{"id":6415,"precertRequired":false,"billingCode":"88325","codeType":"CPT"},{"id":6416,"precertRequired":false,"billingCode":"88329","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6419,"precertRequired":false,"billingCode":"88333","codeType":"CPT"},{"id":6420,"precertRequired":false,"billingCode":"88334","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6423,"precertRequired":false,"billingCode":"88344","codeType":"CPT"},{"id":6424,"precertRequired":false,"billingCode":"88346","codeType":"CPT"},{"id":6425,"precertRequired":false,"billingCode":"88348","codeType":"CPT"},{"id":6426,"precertRequired":false,"billingCode":"88350","codeType":"CPT"},{"id":6427,"precertRequired":false,"billingCode":"88355","codeType":"CPT"},{"id":6428,"precertRequired":false,"billingCode":"88356","codeType":"CPT"},{"id":6429,"precertRequired":false,"billingCode":"88358","codeType":"CPT"},{"id":6430,"precertRequired":false,"billingCode":"88360","codeType":"CPT"},{"id":6431,"precertRequired":false,"billingCode":"88361","codeType":"CPT"},{"id":6432,"precertRequired":false,"billingCode":"88362","codeType":"CPT"},{"id":6433,"precertRequired":false,"billingCode":"88363","codeType":"CPT"},{"id":6434,"precertRequired":false,"billingCode":"88364","codeType":"CPT"},{"id":6435,"precertRequired":false,"billingCode":"88365","codeType":"CPT"},{"id":6436,"precertRequired":false,"billingCode":"88366","codeType":"CPT"},{"id":6437,"precertRequired":false,"billingCode":"88367","codeType":"CPT"},{"id":6438,"precertRequired":false,"billingCode":"88368","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"},{"id":6440,"precertRequired":false,"billingCode":"88371","codeType":"CPT"},{"id":6441,"precertRequired":false,"billingCode":"88372","codeType":"CPT"},{"id":6442,"precertRequired":false,"billingCode":"88373","codeType":"CPT"},{"id":6443,"precertRequired":false,"billingCode":"88374","codeType":"CPT"},{"id":6444,"precertRequired":false,"billingCode":"88375","codeType":"CPT"},{"id":6445,"precertRequired":false,"billingCode":"88377","codeType":"CPT"},{"id":6446,"precertRequired":false,"billingCode":"88380","codeType":"CPT"},{"id":6447,"precertRequired":false,"billingCode":"88381","codeType":"CPT"},{"id":6448,"precertRequired":false,"billingCode":"88387","codeType":"CPT"},{"id":6449,"precertRequired":false,"billingCode":"88388","codeType":"CPT"},{"id":6456,"precertRequired":false,"billingCode":"89049","codeType":"CPT"},{"id":6457,"precertRequired":false,"billingCode":"89050","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":8206,"precertRequired":false,"billingCode":"G0416","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":2668,"description":"Procedures relevant to the referred condition on the consult including but not limited to:  I&D, biopsy, lesion excision with repair,port placement etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":243,"precertRequired":false,"billingCode":"11010","codeType":"CPT"},{"id":244,"precertRequired":false,"billingCode":"11011","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":248,"precertRequired":false,"billingCode":"11044","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":250,"precertRequired":false,"billingCode":"11046","codeType":"CPT"},{"id":251,"precertRequired":false,"billingCode":"11047","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":329,"precertRequired":false,"billingCode":"11960","codeType":"CPT"},{"id":330,"precertRequired":false,"billingCode":"11970","codeType":"CPT"},{"id":331,"precertRequired":false,"billingCode":"11971","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":374,"precertRequired":false,"billingCode":"13120","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":383,"precertRequired":false,"billingCode":"13160","codeType":"CPT"},{"id":384,"precertRequired":false,"billingCode":"14000","codeType":"CPT"},{"id":385,"precertRequired":false,"billingCode":"14001","codeType":"CPT"},{"id":386,"precertRequired":false,"billingCode":"14020","codeType":"CPT"},{"id":387,"precertRequired":false,"billingCode":"14021","codeType":"CPT"},{"id":388,"precertRequired":true,"billingCode":"14040","codeType":"CPT"},{"id":389,"precertRequired":false,"billingCode":"14041","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":392,"precertRequired":true,"billingCode":"14301","codeType":"CPT"},{"id":393,"precertRequired":false,"billingCode":"14302","codeType":"CPT"},{"id":395,"precertRequired":false,"billingCode":"15040","codeType":"CPT"},{"id":396,"precertRequired":false,"billingCode":"15050","codeType":"CPT"},{"id":397,"precertRequired":false,"billingCode":"15150","codeType":"CPT"},{"id":398,"precertRequired":false,"billingCode":"15151","codeType":"CPT"},{"id":399,"precertRequired":false,"billingCode":"15155","codeType":"CPT"},{"id":400,"precertRequired":false,"billingCode":"15156","codeType":"CPT"},{"id":401,"precertRequired":false,"billingCode":"15157","codeType":"CPT"},{"id":402,"precertRequired":false,"billingCode":"15200","codeType":"CPT"},{"id":403,"precertRequired":false,"billingCode":"15201","codeType":"CPT"},{"id":404,"precertRequired":false,"billingCode":"15220","codeType":"CPT"},{"id":405,"precertRequired":false,"billingCode":"15221","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":410,"precertRequired":false,"billingCode":"15271","codeType":"CPT"},{"id":411,"precertRequired":false,"billingCode":"15272","codeType":"CPT"},{"id":412,"precertRequired":false,"billingCode":"15273","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":415,"precertRequired":false,"billingCode":"15570","codeType":"CPT"},{"id":416,"precertRequired":false,"billingCode":"15572","codeType":"CPT"},{"id":417,"precertRequired":false,"billingCode":"15574","codeType":"CPT"},{"id":418,"precertRequired":false,"billingCode":"15576","codeType":"CPT"},{"id":419,"precertRequired":false,"billingCode":"15600","codeType":"CPT"},{"id":420,"precertRequired":false,"billingCode":"15610","codeType":"CPT"},{"id":421,"precertRequired":false,"billingCode":"15620","codeType":"CPT"},{"id":422,"precertRequired":false,"billingCode":"15630","codeType":"CPT"},{"id":423,"precertRequired":false,"billingCode":"15650","codeType":"CPT"},{"id":424,"precertRequired":false,"billingCode":"15730","codeType":"CPT"},{"id":425,"precertRequired":false,"billingCode":"15731","codeType":"CPT"},{"id":426,"precertRequired":false,"billingCode":"15733","codeType":"CPT"},{"id":427,"precertRequired":false,"billingCode":"15734","codeType":"CPT"},{"id":428,"precertRequired":false,"billingCode":"15736","codeType":"CPT"},{"id":429,"precertRequired":false,"billingCode":"15738","codeType":"CPT"},{"id":430,"precertRequired":false,"billingCode":"15740","codeType":"CPT"},{"id":431,"precertRequired":false,"billingCode":"15750","codeType":"CPT"},{"id":432,"precertRequired":false,"billingCode":"15756","codeType":"CPT"},{"id":433,"precertRequired":false,"billingCode":"15757","codeType":"CPT"},{"id":434,"precertRequired":false,"billingCode":"15758","codeType":"CPT"},{"id":435,"precertRequired":false,"billingCode":"15760","codeType":"CPT"},{"id":436,"precertRequired":false,"billingCode":"15770","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":443,"precertRequired":false,"billingCode":"15850","codeType":"CPT"},{"id":444,"precertRequired":false,"billingCode":"15852","codeType":"CPT"},{"id":445,"precertRequired":false,"billingCode":"15860","codeType":"CPT"},{"id":446,"precertRequired":false,"billingCode":"15920","codeType":"CPT"},{"id":447,"precertRequired":false,"billingCode":"15922","codeType":"CPT"},{"id":448,"precertRequired":false,"billingCode":"15931","codeType":"CPT"},{"id":449,"precertRequired":false,"billingCode":"15933","codeType":"CPT"},{"id":450,"precertRequired":false,"billingCode":"15934","codeType":"CPT"},{"id":451,"precertRequired":false,"billingCode":"15935","codeType":"CPT"},{"id":452,"precertRequired":false,"billingCode":"15936","codeType":"CPT"},{"id":453,"precertRequired":false,"billingCode":"15937","codeType":"CPT"},{"id":454,"precertRequired":false,"billingCode":"15940","codeType":"CPT"},{"id":455,"precertRequired":false,"billingCode":"15941","codeType":"CPT"},{"id":456,"precertRequired":false,"billingCode":"15944","codeType":"CPT"},{"id":457,"precertRequired":false,"billingCode":"15945","codeType":"CPT"},{"id":458,"precertRequired":false,"billingCode":"15946","codeType":"CPT"},{"id":459,"precertRequired":false,"billingCode":"15950","codeType":"CPT"},{"id":460,"precertRequired":false,"billingCode":"15951","codeType":"CPT"},{"id":461,"precertRequired":false,"billingCode":"15952","codeType":"CPT"},{"id":462,"precertRequired":false,"billingCode":"15953","codeType":"CPT"},{"id":463,"precertRequired":false,"billingCode":"15956","codeType":"CPT"},{"id":464,"precertRequired":false,"billingCode":"15958","codeType":"CPT"},{"id":465,"precertRequired":false,"billingCode":"16000","codeType":"CPT"},{"id":466,"precertRequired":false,"billingCode":"16020","codeType":"CPT"},{"id":467,"precertRequired":false,"billingCode":"16025","codeType":"CPT"},{"id":468,"precertRequired":false,"billingCode":"16030","codeType":"CPT"},{"id":469,"precertRequired":false,"billingCode":"16035","codeType":"CPT"},{"id":470,"precertRequired":false,"billingCode":"16036","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":474,"precertRequired":false,"billingCode":"17106","codeType":"CPT"},{"id":475,"precertRequired":false,"billingCode":"17107","codeType":"CPT"},{"id":476,"precertRequired":false,"billingCode":"17108","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":503,"precertRequired":false,"billingCode":"19000","codeType":"CPT"},{"id":504,"precertRequired":false,"billingCode":"19001","codeType":"CPT"},{"id":505,"precertRequired":false,"billingCode":"19020","codeType":"CPT"},{"id":506,"precertRequired":false,"billingCode":"19030","codeType":"CPT"},{"id":507,"precertRequired":false,"billingCode":"19081","codeType":"CPT"},{"id":508,"precertRequired":false,"billingCode":"19082","codeType":"CPT"},{"id":509,"precertRequired":false,"billingCode":"19083","codeType":"CPT"},{"id":510,"precertRequired":false,"billingCode":"19084","codeType":"CPT"},{"id":511,"precertRequired":false,"billingCode":"19085","codeType":"CPT"},{"id":512,"precertRequired":false,"billingCode":"19086","codeType":"CPT"},{"id":513,"precertRequired":false,"billingCode":"19100","codeType":"CPT"},{"id":514,"precertRequired":false,"billingCode":"19101","codeType":"CPT"},{"id":515,"precertRequired":false,"billingCode":"19105","codeType":"CPT"},{"id":516,"precertRequired":false,"billingCode":"19120","codeType":"CPT"},{"id":517,"precertRequired":false,"billingCode":"19125","codeType":"CPT"},{"id":518,"precertRequired":false,"billingCode":"19126","codeType":"CPT"},{"id":519,"precertRequired":false,"billingCode":"19260","codeType":"CPT"},{"id":522,"precertRequired":false,"billingCode":"19281","codeType":"CPT"},{"id":523,"precertRequired":false,"billingCode":"19282","codeType":"CPT"},{"id":524,"precertRequired":false,"billingCode":"19283","codeType":"CPT"},{"id":525,"precertRequired":false,"billingCode":"19284","codeType":"CPT"},{"id":526,"precertRequired":false,"billingCode":"19285","codeType":"CPT"},{"id":527,"precertRequired":false,"billingCode":"19286","codeType":"CPT"},{"id":528,"precertRequired":false,"billingCode":"19287","codeType":"CPT"},{"id":529,"precertRequired":false,"billingCode":"19288","codeType":"CPT"},{"id":534,"precertRequired":false,"billingCode":"19300","codeType":"CPT"},{"id":535,"precertRequired":false,"billingCode":"19301","codeType":"CPT"},{"id":536,"precertRequired":false,"billingCode":"19302","codeType":"CPT"},{"id":537,"precertRequired":false,"billingCode":"19303","codeType":"CPT"},{"id":538,"precertRequired":false,"billingCode":"19304","codeType":"CPT"},{"id":539,"precertRequired":false,"billingCode":"19305","codeType":"CPT"},{"id":540,"precertRequired":false,"billingCode":"19306","codeType":"CPT"},{"id":541,"precertRequired":false,"billingCode":"19307","codeType":"CPT"},{"id":543,"precertRequired":false,"billingCode":"20100","codeType":"CPT"},{"id":544,"precertRequired":false,"billingCode":"20101","codeType":"CPT"},{"id":545,"precertRequired":false,"billingCode":"20102","codeType":"CPT"},{"id":546,"precertRequired":false,"billingCode":"20103","codeType":"CPT"},{"id":547,"precertRequired":false,"billingCode":"20150","codeType":"CPT"},{"id":548,"precertRequired":false,"billingCode":"20200","codeType":"CPT"},{"id":549,"precertRequired":false,"billingCode":"20205","codeType":"CPT"},{"id":550,"precertRequired":false,"billingCode":"20206","codeType":"CPT"},{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":552,"precertRequired":false,"billingCode":"20225","codeType":"CPT"},{"id":553,"precertRequired":false,"billingCode":"20240","codeType":"CPT"},{"id":554,"precertRequired":false,"billingCode":"20245","codeType":"CPT"},{"id":555,"precertRequired":true,"billingCode":"20250","codeType":"CPT"},{"id":556,"precertRequired":true,"billingCode":"20251","codeType":"CPT"},{"id":557,"precertRequired":false,"billingCode":"20500","codeType":"CPT"},{"id":558,"precertRequired":false,"billingCode":"20501","codeType":"CPT"},{"id":559,"precertRequired":false,"billingCode":"20520","codeType":"CPT"},{"id":560,"precertRequired":false,"billingCode":"20525","codeType":"CPT"},{"id":562,"precertRequired":true,"billingCode":"20527","codeType":"CPT"},{"id":563,"precertRequired":true,"billingCode":"20550","codeType":"CPT"},{"id":564,"precertRequired":true,"billingCode":"20551","codeType":"CPT"},{"id":567,"precertRequired":false,"billingCode":"20555","codeType":"CPT"},{"id":582,"precertRequired":false,"billingCode":"20665","codeType":"CPT"},{"id":583,"precertRequired":false,"billingCode":"20670","codeType":"CPT"},{"id":584,"precertRequired":false,"billingCode":"20680","codeType":"CPT"},{"id":591,"precertRequired":false,"billingCode":"20900","codeType":"CPT"},{"id":592,"precertRequired":false,"billingCode":"20902","codeType":"CPT"},{"id":593,"precertRequired":false,"billingCode":"20910","codeType":"CPT"},{"id":594,"precertRequired":false,"billingCode":"20912","codeType":"CPT"},{"id":595,"precertRequired":false,"billingCode":"20920","codeType":"CPT"},{"id":596,"precertRequired":false,"billingCode":"20922","codeType":"CPT"},{"id":597,"precertRequired":false,"billingCode":"20924","codeType":"CPT"},{"id":598,"precertRequired":false,"billingCode":"20926","codeType":"CPT"},{"id":600,"precertRequired":false,"billingCode":"20950","codeType":"CPT"},{"id":609,"precertRequired":false,"billingCode":"20982","codeType":"CPT"},{"id":610,"precertRequired":false,"billingCode":"20983","codeType":"CPT"},{"id":611,"precertRequired":false,"billingCode":"20985","codeType":"CPT"},{"id":723,"precertRequired":false,"billingCode":"21501","codeType":"CPT"},{"id":724,"precertRequired":false,"billingCode":"21502","codeType":"CPT"},{"id":725,"precertRequired":false,"billingCode":"21510","codeType":"CPT"},{"id":726,"precertRequired":true,"billingCode":"21550","codeType":"CPT"},{"id":727,"precertRequired":true,"billingCode":"21552","codeType":"CPT"},{"id":728,"precertRequired":true,"billingCode":"21554","codeType":"CPT"},{"id":729,"precertRequired":true,"billingCode":"21555","codeType":"CPT"},{"id":730,"precertRequired":true,"billingCode":"21556","codeType":"CPT"},{"id":731,"precertRequired":true,"billingCode":"21557","codeType":"CPT"},{"id":732,"precertRequired":true,"billingCode":"21558","codeType":"CPT"},{"id":733,"precertRequired":true,"billingCode":"21600","codeType":"CPT"},{"id":734,"precertRequired":true,"billingCode":"21610","codeType":"CPT"},{"id":735,"precertRequired":true,"billingCode":"21615","codeType":"CPT"},{"id":736,"precertRequired":true,"billingCode":"21616","codeType":"CPT"},{"id":737,"precertRequired":true,"billingCode":"21620","codeType":"CPT"},{"id":738,"precertRequired":true,"billingCode":"21627","codeType":"CPT"},{"id":739,"precertRequired":true,"billingCode":"21630","codeType":"CPT"},{"id":740,"precertRequired":true,"billingCode":"21632","codeType":"CPT"},{"id":741,"precertRequired":false,"billingCode":"21685","codeType":"CPT"},{"id":742,"precertRequired":true,"billingCode":"21700","codeType":"CPT"},{"id":743,"precertRequired":true,"billingCode":"21705","codeType":"CPT"},{"id":744,"precertRequired":true,"billingCode":"21720","codeType":"CPT"},{"id":745,"precertRequired":true,"billingCode":"21725","codeType":"CPT"},{"id":749,"precertRequired":true,"billingCode":"21750","codeType":"CPT"},{"id":750,"precertRequired":true,"billingCode":"21811","codeType":"CPT"},{"id":751,"precertRequired":true,"billingCode":"21812","codeType":"CPT"},{"id":752,"precertRequired":true,"billingCode":"21813","codeType":"CPT"},{"id":755,"precertRequired":false,"billingCode":"21920","codeType":"CPT"},{"id":756,"precertRequired":false,"billingCode":"21925","codeType":"CPT"},{"id":757,"precertRequired":false,"billingCode":"21930","codeType":"CPT"},{"id":758,"precertRequired":false,"billingCode":"21931","codeType":"CPT"},{"id":759,"precertRequired":false,"billingCode":"21932","codeType":"CPT"},{"id":760,"precertRequired":false,"billingCode":"21933","codeType":"CPT"},{"id":761,"precertRequired":false,"billingCode":"21935","codeType":"CPT"},{"id":762,"precertRequired":false,"billingCode":"21936","codeType":"CPT"},{"id":763,"precertRequired":true,"billingCode":"22010","codeType":"CPT"},{"id":764,"precertRequired":false,"billingCode":"22015","codeType":"CPT"},{"id":775,"precertRequired":false,"billingCode":"22900","codeType":"CPT"},{"id":776,"precertRequired":false,"billingCode":"22901","codeType":"CPT"},{"id":777,"precertRequired":false,"billingCode":"22902","codeType":"CPT"},{"id":778,"precertRequired":false,"billingCode":"22903","codeType":"CPT"},{"id":779,"precertRequired":false,"billingCode":"22904","codeType":"CPT"},{"id":780,"precertRequired":false,"billingCode":"22905","codeType":"CPT"},{"id":783,"precertRequired":false,"billingCode":"23030","codeType":"CPT"},{"id":784,"precertRequired":false,"billingCode":"23031","codeType":"CPT"},{"id":785,"precertRequired":false,"billingCode":"23035","codeType":"CPT"},{"id":788,"precertRequired":false,"billingCode":"23065","codeType":"CPT"},{"id":789,"precertRequired":false,"billingCode":"23066","codeType":"CPT"},{"id":790,"precertRequired":false,"billingCode":"23071","codeType":"CPT"},{"id":791,"precertRequired":false,"billingCode":"23073","codeType":"CPT"},{"id":792,"precertRequired":false,"billingCode":"23075","codeType":"CPT"},{"id":793,"precertRequired":false,"billingCode":"23076","codeType":"CPT"},{"id":794,"precertRequired":false,"billingCode":"23077","codeType":"CPT"},{"id":795,"precertRequired":false,"billingCode":"23078","codeType":"CPT"},{"id":885,"precertRequired":false,"billingCode":"23930","codeType":"CPT"},{"id":886,"precertRequired":false,"billingCode":"23931","codeType":"CPT"},{"id":887,"precertRequired":false,"billingCode":"23935","codeType":"CPT"},{"id":890,"precertRequired":false,"billingCode":"24065","codeType":"CPT"},{"id":891,"precertRequired":false,"billingCode":"24066","codeType":"CPT"},{"id":892,"precertRequired":false,"billingCode":"24071","codeType":"CPT"},{"id":893,"precertRequired":false,"billingCode":"24073","codeType":"CPT"},{"id":894,"precertRequired":false,"billingCode":"24075","codeType":"CPT"},{"id":895,"precertRequired":false,"billingCode":"24076","codeType":"CPT"},{"id":896,"precertRequired":false,"billingCode":"24077","codeType":"CPT"},{"id":897,"precertRequired":false,"billingCode":"24079","codeType":"CPT"},{"id":921,"precertRequired":false,"billingCode":"24200","codeType":"CPT"},{"id":922,"precertRequired":false,"billingCode":"24201","codeType":"CPT"},{"id":992,"precertRequired":false,"billingCode":"24900","codeType":"CPT"},{"id":993,"precertRequired":false,"billingCode":"24920","codeType":"CPT"},{"id":994,"precertRequired":false,"billingCode":"24925","codeType":"CPT"},{"id":995,"precertRequired":false,"billingCode":"24930","codeType":"CPT"},{"id":996,"precertRequired":false,"billingCode":"24931","codeType":"CPT"},{"id":997,"precertRequired":false,"billingCode":"24935","codeType":"CPT"},{"id":1001,"precertRequired":false,"billingCode":"25020","codeType":"CPT"},{"id":1002,"precertRequired":false,"billingCode":"25023","codeType":"CPT"},{"id":1003,"precertRequired":false,"billingCode":"25024","codeType":"CPT"},{"id":1004,"precertRequired":false,"billingCode":"25025","codeType":"CPT"},{"id":1005,"precertRequired":false,"billingCode":"25028","codeType":"CPT"},{"id":1006,"precertRequired":false,"billingCode":"25031","codeType":"CPT"},{"id":1007,"precertRequired":false,"billingCode":"25035","codeType":"CPT"},{"id":1008,"precertRequired":false,"billingCode":"25040","codeType":"CPT"},{"id":1009,"precertRequired":false,"billingCode":"25065","codeType":"CPT"},{"id":1010,"precertRequired":false,"billingCode":"25066","codeType":"CPT"},{"id":1011,"precertRequired":false,"billingCode":"25071","codeType":"CPT"},{"id":1012,"precertRequired":false,"billingCode":"25073","codeType":"CPT"},{"id":1013,"precertRequired":false,"billingCode":"25075","codeType":"CPT"},{"id":1014,"precertRequired":false,"billingCode":"25076","codeType":"CPT"},{"id":1015,"precertRequired":false,"billingCode":"25077","codeType":"CPT"},{"id":1016,"precertRequired":false,"billingCode":"25078","codeType":"CPT"},{"id":1145,"precertRequired":false,"billingCode":"25900","codeType":"CPT"},{"id":1146,"precertRequired":false,"billingCode":"25905","codeType":"CPT"},{"id":1147,"precertRequired":false,"billingCode":"25907","codeType":"CPT"},{"id":1148,"precertRequired":false,"billingCode":"25909","codeType":"CPT"},{"id":1153,"precertRequired":false,"billingCode":"25927","codeType":"CPT"},{"id":1154,"precertRequired":false,"billingCode":"25929","codeType":"CPT"},{"id":1155,"precertRequired":false,"billingCode":"25931","codeType":"CPT"},{"id":1156,"precertRequired":false,"billingCode":"26010","codeType":"CPT"},{"id":1157,"precertRequired":false,"billingCode":"26011","codeType":"CPT"},{"id":1158,"precertRequired":false,"billingCode":"26020","codeType":"CPT"},{"id":1159,"precertRequired":false,"billingCode":"26025","codeType":"CPT"},{"id":1160,"precertRequired":false,"billingCode":"26030","codeType":"CPT"},{"id":1161,"precertRequired":false,"billingCode":"26034","codeType":"CPT"},{"id":1162,"precertRequired":false,"billingCode":"26035","codeType":"CPT"},{"id":1163,"precertRequired":false,"billingCode":"26037","codeType":"CPT"},{"id":1164,"precertRequired":false,"billingCode":"26040","codeType":"CPT"},{"id":1165,"precertRequired":false,"billingCode":"26045","codeType":"CPT"},{"id":1174,"precertRequired":false,"billingCode":"26111","codeType":"CPT"},{"id":1175,"precertRequired":false,"billingCode":"26113","codeType":"CPT"},{"id":1176,"precertRequired":false,"billingCode":"26115","codeType":"CPT"},{"id":1177,"precertRequired":false,"billingCode":"26116","codeType":"CPT"},{"id":1178,"precertRequired":false,"billingCode":"26117","codeType":"CPT"},{"id":1179,"precertRequired":false,"billingCode":"26118","codeType":"CPT"},{"id":1180,"precertRequired":false,"billingCode":"26121","codeType":"CPT"},{"id":1181,"precertRequired":false,"billingCode":"26123","codeType":"CPT"},{"id":1182,"precertRequired":false,"billingCode":"26125","codeType":"CPT"},{"id":1326,"precertRequired":false,"billingCode":"26910","codeType":"CPT"},{"id":1327,"precertRequired":false,"billingCode":"26951","codeType":"CPT"},{"id":1328,"precertRequired":false,"billingCode":"26952","codeType":"CPT"},{"id":1329,"precertRequired":false,"billingCode":"26990","codeType":"CPT"},{"id":1330,"precertRequired":false,"billingCode":"26991","codeType":"CPT"},{"id":1331,"precertRequired":false,"billingCode":"26992","codeType":"CPT"},{"id":1337,"precertRequired":false,"billingCode":"27025","codeType":"CPT"},{"id":1338,"precertRequired":false,"billingCode":"27027","codeType":"CPT"},{"id":1343,"precertRequired":false,"billingCode":"27040","codeType":"CPT"},{"id":1344,"precertRequired":false,"billingCode":"27041","codeType":"CPT"},{"id":1345,"precertRequired":false,"billingCode":"27043","codeType":"CPT"},{"id":1346,"precertRequired":false,"billingCode":"27045","codeType":"CPT"},{"id":1347,"precertRequired":false,"billingCode":"27047","codeType":"CPT"},{"id":1348,"precertRequired":false,"billingCode":"27048","codeType":"CPT"},{"id":1349,"precertRequired":false,"billingCode":"27049","codeType":"CPT"},{"id":1353,"precertRequired":false,"billingCode":"27057","codeType":"CPT"},{"id":1354,"precertRequired":false,"billingCode":"27059","codeType":"CPT"},{"id":1367,"precertRequired":false,"billingCode":"27086","codeType":"CPT"},{"id":1368,"precertRequired":false,"billingCode":"27087","codeType":"CPT"},{"id":1447,"precertRequired":false,"billingCode":"27290","codeType":"CPT"},{"id":1450,"precertRequired":false,"billingCode":"27301","codeType":"CPT"},{"id":1451,"precertRequired":false,"billingCode":"27303","codeType":"CPT"},{"id":1452,"precertRequired":false,"billingCode":"27305","codeType":"CPT"},{"id":1456,"precertRequired":false,"billingCode":"27323","codeType":"CPT"},{"id":1457,"precertRequired":false,"billingCode":"27324","codeType":"CPT"},{"id":1460,"precertRequired":false,"billingCode":"27327","codeType":"CPT"},{"id":1461,"precertRequired":false,"billingCode":"27328","codeType":"CPT"},{"id":1462,"precertRequired":false,"billingCode":"27329","codeType":"CPT"},{"id":1469,"precertRequired":false,"billingCode":"27337","codeType":"CPT"},{"id":1470,"precertRequired":false,"billingCode":"27339","codeType":"CPT"},{"id":1480,"precertRequired":false,"billingCode":"27364","codeType":"CPT"},{"id":1481,"precertRequired":false,"billingCode":"27365","codeType":"CPT"},{"id":1483,"precertRequired":false,"billingCode":"27372","codeType":"CPT"},{"id":1494,"precertRequired":false,"billingCode":"27396","codeType":"CPT"},{"id":1541,"precertRequired":false,"billingCode":"27496","codeType":"CPT"},{"id":1542,"precertRequired":false,"billingCode":"27497","codeType":"CPT"},{"id":1543,"precertRequired":false,"billingCode":"27498","codeType":"CPT"},{"id":1544,"precertRequired":false,"billingCode":"27499","codeType":"CPT"},{"id":1545,"precertRequired":false,"billingCode":"27500","codeType":"CPT"},{"id":1578,"precertRequired":false,"billingCode":"27590","codeType":"CPT"},{"id":1579,"precertRequired":false,"billingCode":"27591","codeType":"CPT"},{"id":1580,"precertRequired":false,"billingCode":"27592","codeType":"CPT"},{"id":1581,"precertRequired":false,"billingCode":"27594","codeType":"CPT"},{"id":1582,"precertRequired":false,"billingCode":"27596","codeType":"CPT"},{"id":1584,"precertRequired":false,"billingCode":"27600","codeType":"CPT"},{"id":1585,"precertRequired":false,"billingCode":"27601","codeType":"CPT"},{"id":1586,"precertRequired":false,"billingCode":"27602","codeType":"CPT"},{"id":1587,"precertRequired":false,"billingCode":"27603","codeType":"CPT"},{"id":1588,"precertRequired":false,"billingCode":"27604","codeType":"CPT"},{"id":1591,"precertRequired":false,"billingCode":"27607","codeType":"CPT"},{"id":1594,"precertRequired":false,"billingCode":"27613","codeType":"CPT"},{"id":1595,"precertRequired":false,"billingCode":"27614","codeType":"CPT"},{"id":1596,"precertRequired":false,"billingCode":"27615","codeType":"CPT"},{"id":1597,"precertRequired":false,"billingCode":"27616","codeType":"CPT"},{"id":1598,"precertRequired":false,"billingCode":"27618","codeType":"CPT"},{"id":1599,"precertRequired":false,"billingCode":"27619","codeType":"CPT"},{"id":1697,"precertRequired":false,"billingCode":"27880","codeType":"CPT"},{"id":1698,"precertRequired":false,"billingCode":"27881","codeType":"CPT"},{"id":1699,"precertRequired":false,"billingCode":"27882","codeType":"CPT"},{"id":1700,"precertRequired":false,"billingCode":"27884","codeType":"CPT"},{"id":1701,"precertRequired":false,"billingCode":"27886","codeType":"CPT"},{"id":1702,"precertRequired":false,"billingCode":"27888","codeType":"CPT"},{"id":1704,"precertRequired":false,"billingCode":"27892","codeType":"CPT"},{"id":1705,"precertRequired":false,"billingCode":"27893","codeType":"CPT"},{"id":1706,"precertRequired":false,"billingCode":"27894","codeType":"CPT"},{"id":1707,"precertRequired":false,"billingCode":"28001","codeType":"CPT"},{"id":1708,"precertRequired":false,"billingCode":"28002","codeType":"CPT"},{"id":1709,"precertRequired":false,"billingCode":"28003","codeType":"CPT"},{"id":1710,"precertRequired":false,"billingCode":"28005","codeType":"CPT"},{"id":1711,"precertRequired":false,"billingCode":"28008","codeType":"CPT"},{"id":1718,"precertRequired":false,"billingCode":"28039","codeType":"CPT"},{"id":1719,"precertRequired":false,"billingCode":"28041","codeType":"CPT"},{"id":1720,"precertRequired":false,"billingCode":"28043","codeType":"CPT"},{"id":1721,"precertRequired":false,"billingCode":"28045","codeType":"CPT"},{"id":1728,"precertRequired":true,"billingCode":"28060","codeType":"CPT"},{"id":1729,"precertRequired":true,"billingCode":"28062","codeType":"CPT"},{"id":1732,"precertRequired":true,"billingCode":"28080","codeType":"CPT"},{"id":1764,"precertRequired":false,"billingCode":"28190","codeType":"CPT"},{"id":1765,"precertRequired":false,"billingCode":"28192","codeType":"CPT"},{"id":1766,"precertRequired":false,"billingCode":"28193","codeType":"CPT"},{"id":1876,"precertRequired":false,"billingCode":"28800","codeType":"CPT"},{"id":1877,"precertRequired":false,"billingCode":"28805","codeType":"CPT"},{"id":1878,"precertRequired":false,"billingCode":"28810","codeType":"CPT"},{"id":1879,"precertRequired":false,"billingCode":"28820","codeType":"CPT"},{"id":1880,"precertRequired":false,"billingCode":"28825","codeType":"CPT"},{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2567,"precertRequired":false,"billingCode":"36565","codeType":"CPT"},{"id":2568,"precertRequired":false,"billingCode":"36566","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2572,"precertRequired":false,"billingCode":"36571","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2674,"precertRequired":false,"billingCode":"38100","codeType":"CPT"},{"id":2675,"precertRequired":false,"billingCode":"38101","codeType":"CPT"},{"id":2676,"precertRequired":false,"billingCode":"38102","codeType":"CPT"},{"id":2677,"precertRequired":false,"billingCode":"38115","codeType":"CPT"},{"id":2678,"precertRequired":false,"billingCode":"38120","codeType":"CPT"},{"id":2682,"precertRequired":false,"billingCode":"38300","codeType":"CPT"},{"id":2683,"precertRequired":false,"billingCode":"38305","codeType":"CPT"},{"id":2684,"precertRequired":false,"billingCode":"38308","codeType":"CPT"},{"id":2685,"precertRequired":false,"billingCode":"38380","codeType":"CPT"},{"id":2686,"precertRequired":true,"billingCode":"38381","codeType":"CPT"},{"id":2687,"precertRequired":false,"billingCode":"38382","codeType":"CPT"},{"id":2688,"precertRequired":false,"billingCode":"38500","codeType":"CPT"},{"id":2689,"precertRequired":false,"billingCode":"38505","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2691,"precertRequired":false,"billingCode":"38520","codeType":"CPT"},{"id":2692,"precertRequired":false,"billingCode":"38525","codeType":"CPT"},{"id":2693,"precertRequired":false,"billingCode":"38530","codeType":"CPT"},{"id":2694,"precertRequired":false,"billingCode":"38542","codeType":"CPT"},{"id":2695,"precertRequired":false,"billingCode":"38550","codeType":"CPT"},{"id":2696,"precertRequired":false,"billingCode":"38555","codeType":"CPT"},{"id":2697,"precertRequired":false,"billingCode":"38562","codeType":"CPT"},{"id":2698,"precertRequired":false,"billingCode":"38564","codeType":"CPT"},{"id":2699,"precertRequired":false,"billingCode":"38570","codeType":"CPT"},{"id":2700,"precertRequired":false,"billingCode":"38571","codeType":"CPT"},{"id":2701,"precertRequired":false,"billingCode":"38572","codeType":"CPT"},{"id":2702,"precertRequired":false,"billingCode":"38573","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2704,"precertRequired":false,"billingCode":"38720","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2706,"precertRequired":false,"billingCode":"38740","codeType":"CPT"},{"id":2707,"precertRequired":false,"billingCode":"38745","codeType":"CPT"},{"id":2708,"precertRequired":false,"billingCode":"38746","codeType":"CPT"},{"id":2709,"precertRequired":false,"billingCode":"38747","codeType":"CPT"},{"id":2710,"precertRequired":false,"billingCode":"38760","codeType":"CPT"},{"id":2711,"precertRequired":false,"billingCode":"38765","codeType":"CPT"},{"id":2712,"precertRequired":false,"billingCode":"38770","codeType":"CPT"},{"id":2713,"precertRequired":false,"billingCode":"38780","codeType":"CPT"},{"id":2749,"precertRequired":false,"billingCode":"43117","codeType":"CPT"},{"id":2750,"precertRequired":false,"billingCode":"43118","codeType":"CPT"},{"id":2751,"precertRequired":false,"billingCode":"43121","codeType":"CPT"},{"id":2752,"precertRequired":false,"billingCode":"43122","codeType":"CPT"},{"id":2753,"precertRequired":false,"billingCode":"43123","codeType":"CPT"},{"id":2755,"precertRequired":false,"billingCode":"43130","codeType":"CPT"},{"id":2756,"precertRequired":false,"billingCode":"43135","codeType":"CPT"},{"id":2757,"precertRequired":false,"billingCode":"43180","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2819,"precertRequired":false,"billingCode":"43273","codeType":"CPT"},{"id":2825,"precertRequired":false,"billingCode":"43279","codeType":"CPT"},{"id":2826,"precertRequired":false,"billingCode":"43280","codeType":"CPT"},{"id":2827,"precertRequired":false,"billingCode":"43281","codeType":"CPT"},{"id":2828,"precertRequired":false,"billingCode":"43282","codeType":"CPT"},{"id":2829,"precertRequired":false,"billingCode":"43283","codeType":"CPT"},{"id":2830,"precertRequired":false,"billingCode":"43284","codeType":"CPT"},{"id":2831,"precertRequired":false,"billingCode":"43285","codeType":"CPT"},{"id":2832,"precertRequired":false,"billingCode":"43286","codeType":"CPT"},{"id":2833,"precertRequired":false,"billingCode":"43287","codeType":"CPT"},{"id":2834,"precertRequired":false,"billingCode":"43288","codeType":"CPT"},{"id":2836,"precertRequired":false,"billingCode":"43300","codeType":"CPT"},{"id":2837,"precertRequired":false,"billingCode":"43305","codeType":"CPT"},{"id":2838,"precertRequired":false,"billingCode":"43310","codeType":"CPT"},{"id":2839,"precertRequired":false,"billingCode":"43312","codeType":"CPT"},{"id":2840,"precertRequired":false,"billingCode":"43313","codeType":"CPT"},{"id":2841,"precertRequired":false,"billingCode":"43314","codeType":"CPT"},{"id":2842,"precertRequired":false,"billingCode":"43320","codeType":"CPT"},{"id":2843,"precertRequired":false,"billingCode":"43325","codeType":"CPT"},{"id":2844,"precertRequired":false,"billingCode":"43327","codeType":"CPT"},{"id":2845,"precertRequired":false,"billingCode":"43328","codeType":"CPT"},{"id":2846,"precertRequired":false,"billingCode":"43330","codeType":"CPT"},{"id":2847,"precertRequired":false,"billingCode":"43331","codeType":"CPT"},{"id":2854,"precertRequired":false,"billingCode":"43338","codeType":"CPT"},{"id":2855,"precertRequired":false,"billingCode":"43340","codeType":"CPT"},{"id":2856,"precertRequired":false,"billingCode":"43341","codeType":"CPT"},{"id":2857,"precertRequired":false,"billingCode":"43351","codeType":"CPT"},{"id":2858,"precertRequired":false,"billingCode":"43352","codeType":"CPT"},{"id":2859,"precertRequired":false,"billingCode":"43360","codeType":"CPT"},{"id":2860,"precertRequired":false,"billingCode":"43361","codeType":"CPT"},{"id":2861,"precertRequired":false,"billingCode":"43400","codeType":"CPT"},{"id":2862,"precertRequired":false,"billingCode":"43401","codeType":"CPT"},{"id":2863,"precertRequired":false,"billingCode":"43405","codeType":"CPT"},{"id":2864,"precertRequired":false,"billingCode":"43410","codeType":"CPT"},{"id":2865,"precertRequired":false,"billingCode":"43415","codeType":"CPT"},{"id":2866,"precertRequired":false,"billingCode":"43420","codeType":"CPT"},{"id":2867,"precertRequired":false,"billingCode":"43425","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":2869,"precertRequired":false,"billingCode":"43453","codeType":"CPT"},{"id":2870,"precertRequired":false,"billingCode":"43460","codeType":"CPT"},{"id":2871,"precertRequired":false,"billingCode":"43496","codeType":"CPT"},{"id":2873,"precertRequired":false,"billingCode":"43500","codeType":"CPT"},{"id":2874,"precertRequired":false,"billingCode":"43501","codeType":"CPT"},{"id":2875,"precertRequired":false,"billingCode":"43502","codeType":"CPT"},{"id":2876,"precertRequired":false,"billingCode":"43510","codeType":"CPT"},{"id":2877,"precertRequired":false,"billingCode":"43520","codeType":"CPT"},{"id":2878,"precertRequired":false,"billingCode":"43605","codeType":"CPT"},{"id":2879,"precertRequired":false,"billingCode":"43610","codeType":"CPT"},{"id":2880,"precertRequired":false,"billingCode":"43611","codeType":"CPT"},{"id":2881,"precertRequired":false,"billingCode":"43620","codeType":"CPT"},{"id":2882,"precertRequired":false,"billingCode":"43621","codeType":"CPT"},{"id":2883,"precertRequired":false,"billingCode":"43622","codeType":"CPT"},{"id":2884,"precertRequired":false,"billingCode":"43631","codeType":"CPT"},{"id":2885,"precertRequired":false,"billingCode":"43632","codeType":"CPT"},{"id":2886,"precertRequired":false,"billingCode":"43633","codeType":"CPT"},{"id":2887,"precertRequired":false,"billingCode":"43634","codeType":"CPT"},{"id":2888,"precertRequired":false,"billingCode":"43635","codeType":"CPT"},{"id":2889,"precertRequired":false,"billingCode":"43640","codeType":"CPT"},{"id":2890,"precertRequired":false,"billingCode":"43641","codeType":"CPT"},{"id":2891,"precertRequired":false,"billingCode":"43644","codeType":"CPT"},{"id":2892,"precertRequired":false,"billingCode":"43645","codeType":"CPT"},{"id":2893,"precertRequired":false,"billingCode":"43647","codeType":"CPT"},{"id":2894,"precertRequired":false,"billingCode":"43648","codeType":"CPT"},{"id":2895,"precertRequired":false,"billingCode":"43651","codeType":"CPT"},{"id":2896,"precertRequired":false,"billingCode":"43652","codeType":"CPT"},{"id":2897,"precertRequired":false,"billingCode":"43653","codeType":"CPT"},{"id":2898,"precertRequired":false,"billingCode":"43752","codeType":"CPT"},{"id":2899,"precertRequired":false,"billingCode":"43753","codeType":"CPT"},{"id":2900,"precertRequired":false,"billingCode":"43754","codeType":"CPT"},{"id":2901,"precertRequired":false,"billingCode":"43755","codeType":"CPT"},{"id":2902,"precertRequired":false,"billingCode":"43756","codeType":"CPT"},{"id":2903,"precertRequired":false,"billingCode":"43757","codeType":"CPT"},{"id":2905,"precertRequired":false,"billingCode":"43761","codeType":"CPT"},{"id":2912,"precertRequired":false,"billingCode":"43800","codeType":"CPT"},{"id":2913,"precertRequired":false,"billingCode":"43810","codeType":"CPT"},{"id":2914,"precertRequired":false,"billingCode":"43820","codeType":"CPT"},{"id":2915,"precertRequired":false,"billingCode":"43825","codeType":"CPT"},{"id":2916,"precertRequired":false,"billingCode":"43830","codeType":"CPT"},{"id":2917,"precertRequired":false,"billingCode":"43831","codeType":"CPT"},{"id":2918,"precertRequired":false,"billingCode":"43832","codeType":"CPT"},{"id":2919,"precertRequired":false,"billingCode":"43840","codeType":"CPT"},{"id":2926,"precertRequired":false,"billingCode":"43850","codeType":"CPT"},{"id":2927,"precertRequired":false,"billingCode":"43855","codeType":"CPT"},{"id":2928,"precertRequired":false,"billingCode":"43860","codeType":"CPT"},{"id":2929,"precertRequired":false,"billingCode":"43865","codeType":"CPT"},{"id":2930,"precertRequired":false,"billingCode":"43870","codeType":"CPT"},{"id":2931,"precertRequired":false,"billingCode":"43880","codeType":"CPT"},{"id":2934,"precertRequired":false,"billingCode":"43886","codeType":"CPT"},{"id":2935,"precertRequired":false,"billingCode":"43887","codeType":"CPT"},{"id":2936,"precertRequired":false,"billingCode":"43888","codeType":"CPT"},{"id":2937,"precertRequired":false,"billingCode":"44005","codeType":"CPT"},{"id":2938,"precertRequired":false,"billingCode":"44010","codeType":"CPT"},{"id":2939,"precertRequired":false,"billingCode":"44015","codeType":"CPT"},{"id":2940,"precertRequired":false,"billingCode":"44020","codeType":"CPT"},{"id":2941,"precertRequired":false,"billingCode":"44021","codeType":"CPT"},{"id":2942,"precertRequired":false,"billingCode":"44025","codeType":"CPT"},{"id":2943,"precertRequired":false,"billingCode":"44050","codeType":"CPT"},{"id":2944,"precertRequired":false,"billingCode":"44055","codeType":"CPT"},{"id":2945,"precertRequired":false,"billingCode":"44100","codeType":"CPT"},{"id":2946,"precertRequired":false,"billingCode":"44110","codeType":"CPT"},{"id":2947,"precertRequired":false,"billingCode":"44111","codeType":"CPT"},{"id":2948,"precertRequired":false,"billingCode":"44120","codeType":"CPT"},{"id":2949,"precertRequired":false,"billingCode":"44121","codeType":"CPT"},{"id":2950,"precertRequired":false,"billingCode":"44125","codeType":"CPT"},{"id":2951,"precertRequired":false,"billingCode":"44126","codeType":"CPT"},{"id":2952,"precertRequired":false,"billingCode":"44127","codeType":"CPT"},{"id":2953,"precertRequired":false,"billingCode":"44128","codeType":"CPT"},{"id":2954,"precertRequired":false,"billingCode":"44130","codeType":"CPT"},{"id":2960,"precertRequired":false,"billingCode":"44139","codeType":"CPT"},{"id":2961,"precertRequired":false,"billingCode":"44140","codeType":"CPT"},{"id":2962,"precertRequired":false,"billingCode":"44141","codeType":"CPT"},{"id":2963,"precertRequired":false,"billingCode":"44143","codeType":"CPT"},{"id":2964,"precertRequired":false,"billingCode":"44144","codeType":"CPT"},{"id":2965,"precertRequired":false,"billingCode":"44145","codeType":"CPT"},{"id":2966,"precertRequired":false,"billingCode":"44146","codeType":"CPT"},{"id":2967,"precertRequired":false,"billingCode":"44147","codeType":"CPT"},{"id":2968,"precertRequired":false,"billingCode":"44150","codeType":"CPT"},{"id":2969,"precertRequired":false,"billingCode":"44151","codeType":"CPT"},{"id":2970,"precertRequired":false,"billingCode":"44155","codeType":"CPT"},{"id":2971,"precertRequired":false,"billingCode":"44156","codeType":"CPT"},{"id":2972,"precertRequired":false,"billingCode":"44157","codeType":"CPT"},{"id":2973,"precertRequired":false,"billingCode":"44158","codeType":"CPT"},{"id":2974,"precertRequired":false,"billingCode":"44160","codeType":"CPT"},{"id":2975,"precertRequired":false,"billingCode":"44180","codeType":"CPT"},{"id":2976,"precertRequired":false,"billingCode":"44186","codeType":"CPT"},{"id":2977,"precertRequired":false,"billingCode":"44187","codeType":"CPT"},{"id":2978,"precertRequired":false,"billingCode":"44188","codeType":"CPT"},{"id":2979,"precertRequired":false,"billingCode":"44202","codeType":"CPT"},{"id":2980,"precertRequired":false,"billingCode":"44203","codeType":"CPT"},{"id":2981,"precertRequired":false,"billingCode":"44204","codeType":"CPT"},{"id":2982,"precertRequired":false,"billingCode":"44205","codeType":"CPT"},{"id":2983,"precertRequired":false,"billingCode":"44206","codeType":"CPT"},{"id":2984,"precertRequired":false,"billingCode":"44207","codeType":"CPT"},{"id":2985,"precertRequired":false,"billingCode":"44208","codeType":"CPT"},{"id":2986,"precertRequired":false,"billingCode":"44210","codeType":"CPT"},{"id":2987,"precertRequired":false,"billingCode":"44211","codeType":"CPT"},{"id":2988,"precertRequired":false,"billingCode":"44212","codeType":"CPT"},{"id":2989,"precertRequired":false,"billingCode":"44213","codeType":"CPT"},{"id":2990,"precertRequired":false,"billingCode":"44227","codeType":"CPT"},{"id":2991,"precertRequired":false,"billingCode":"44300","codeType":"CPT"},{"id":2992,"precertRequired":false,"billingCode":"44310","codeType":"CPT"},{"id":2993,"precertRequired":false,"billingCode":"44312","codeType":"CPT"},{"id":2994,"precertRequired":false,"billingCode":"44314","codeType":"CPT"},{"id":2995,"precertRequired":false,"billingCode":"44316","codeType":"CPT"},{"id":2996,"precertRequired":false,"billingCode":"44320","codeType":"CPT"},{"id":2997,"precertRequired":false,"billingCode":"44322","codeType":"CPT"},{"id":2998,"precertRequired":false,"billingCode":"44340","codeType":"CPT"},{"id":2999,"precertRequired":false,"billingCode":"44345","codeType":"CPT"},{"id":3000,"precertRequired":false,"billingCode":"44346","codeType":"CPT"},{"id":3015,"precertRequired":false,"billingCode":"44380","codeType":"CPT"},{"id":3016,"precertRequired":false,"billingCode":"44381","codeType":"CPT"},{"id":3017,"precertRequired":false,"billingCode":"44382","codeType":"CPT"},{"id":3018,"precertRequired":false,"billingCode":"44384","codeType":"CPT"},{"id":3019,"precertRequired":false,"billingCode":"44385","codeType":"CPT"},{"id":3020,"precertRequired":false,"billingCode":"44386","codeType":"CPT"},{"id":3035,"precertRequired":false,"billingCode":"44500","codeType":"CPT"},{"id":3036,"precertRequired":false,"billingCode":"44602","codeType":"CPT"},{"id":3037,"precertRequired":false,"billingCode":"44603","codeType":"CPT"},{"id":3038,"precertRequired":false,"billingCode":"44604","codeType":"CPT"},{"id":3039,"precertRequired":false,"billingCode":"44605","codeType":"CPT"},{"id":3040,"precertRequired":false,"billingCode":"44615","codeType":"CPT"},{"id":3041,"precertRequired":false,"billingCode":"44620","codeType":"CPT"},{"id":3042,"precertRequired":false,"billingCode":"44625","codeType":"CPT"},{"id":3043,"precertRequired":false,"billingCode":"44626","codeType":"CPT"},{"id":3044,"precertRequired":false,"billingCode":"44640","codeType":"CPT"},{"id":3045,"precertRequired":false,"billingCode":"44650","codeType":"CPT"},{"id":3046,"precertRequired":false,"billingCode":"44660","codeType":"CPT"},{"id":3047,"precertRequired":false,"billingCode":"44661","codeType":"CPT"},{"id":3048,"precertRequired":false,"billingCode":"44680","codeType":"CPT"},{"id":3049,"precertRequired":false,"billingCode":"44700","codeType":"CPT"},{"id":3050,"precertRequired":false,"billingCode":"44701","codeType":"CPT"},{"id":3056,"precertRequired":false,"billingCode":"44800","codeType":"CPT"},{"id":3057,"precertRequired":false,"billingCode":"44820","codeType":"CPT"},{"id":3058,"precertRequired":false,"billingCode":"44850","codeType":"CPT"},{"id":3059,"precertRequired":false,"billingCode":"44900","codeType":"CPT"},{"id":3060,"precertRequired":false,"billingCode":"44950","codeType":"CPT"},{"id":3061,"precertRequired":false,"billingCode":"44955","codeType":"CPT"},{"id":3062,"precertRequired":false,"billingCode":"44960","codeType":"CPT"},{"id":3063,"precertRequired":false,"billingCode":"44970","codeType":"CPT"},{"id":3064,"precertRequired":false,"billingCode":"45000","codeType":"CPT"},{"id":3065,"precertRequired":false,"billingCode":"45005","codeType":"CPT"},{"id":3066,"precertRequired":false,"billingCode":"45020","codeType":"CPT"},{"id":3067,"precertRequired":false,"billingCode":"45100","codeType":"CPT"},{"id":3068,"precertRequired":false,"billingCode":"45108","codeType":"CPT"},{"id":3080,"precertRequired":false,"billingCode":"45130","codeType":"CPT"},{"id":3081,"precertRequired":false,"billingCode":"45135","codeType":"CPT"},{"id":3082,"precertRequired":false,"billingCode":"45136","codeType":"CPT"},{"id":3083,"precertRequired":false,"billingCode":"45150","codeType":"CPT"},{"id":3084,"precertRequired":false,"billingCode":"45160","codeType":"CPT"},{"id":3085,"precertRequired":false,"billingCode":"45171","codeType":"CPT"},{"id":3086,"precertRequired":false,"billingCode":"45172","codeType":"CPT"},{"id":3087,"precertRequired":false,"billingCode":"45190","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3123,"precertRequired":false,"billingCode":"45388","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3129,"precertRequired":false,"billingCode":"45395","codeType":"CPT"},{"id":3130,"precertRequired":false,"billingCode":"45397","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"},{"id":3132,"precertRequired":false,"billingCode":"45400","codeType":"CPT"},{"id":3133,"precertRequired":false,"billingCode":"45402","codeType":"CPT"},{"id":3134,"precertRequired":false,"billingCode":"45500","codeType":"CPT"},{"id":3135,"precertRequired":false,"billingCode":"45505","codeType":"CPT"},{"id":3136,"precertRequired":false,"billingCode":"45520","codeType":"CPT"},{"id":3137,"precertRequired":false,"billingCode":"45540","codeType":"CPT"},{"id":3138,"precertRequired":false,"billingCode":"45541","codeType":"CPT"},{"id":3139,"precertRequired":false,"billingCode":"45550","codeType":"CPT"},{"id":3140,"precertRequired":false,"billingCode":"45560","codeType":"CPT"},{"id":3141,"precertRequired":false,"billingCode":"45562","codeType":"CPT"},{"id":3142,"precertRequired":false,"billingCode":"45563","codeType":"CPT"},{"id":3143,"precertRequired":false,"billingCode":"45800","codeType":"CPT"},{"id":3144,"precertRequired":false,"billingCode":"45805","codeType":"CPT"},{"id":3145,"precertRequired":false,"billingCode":"45820","codeType":"CPT"},{"id":3146,"precertRequired":false,"billingCode":"45825","codeType":"CPT"},{"id":3147,"precertRequired":false,"billingCode":"45900","codeType":"CPT"},{"id":3148,"precertRequired":false,"billingCode":"45905","codeType":"CPT"},{"id":3149,"precertRequired":false,"billingCode":"45910","codeType":"CPT"},{"id":3150,"precertRequired":false,"billingCode":"45915","codeType":"CPT"},{"id":3151,"precertRequired":false,"billingCode":"45990","codeType":"CPT"},{"id":3152,"precertRequired":false,"billingCode":"46020","codeType":"CPT"},{"id":3153,"precertRequired":false,"billingCode":"46030","codeType":"CPT"},{"id":3154,"precertRequired":false,"billingCode":"46040","codeType":"CPT"},{"id":3155,"precertRequired":false,"billingCode":"46045","codeType":"CPT"},{"id":3156,"precertRequired":false,"billingCode":"46050","codeType":"CPT"},{"id":3157,"precertRequired":false,"billingCode":"46060","codeType":"CPT"},{"id":3158,"precertRequired":false,"billingCode":"46080","codeType":"CPT"},{"id":3159,"precertRequired":false,"billingCode":"46083","codeType":"CPT"},{"id":3160,"precertRequired":false,"billingCode":"46200","codeType":"CPT"},{"id":3161,"precertRequired":false,"billingCode":"46220","codeType":"CPT"},{"id":3162,"precertRequired":false,"billingCode":"46221","codeType":"CPT"},{"id":3163,"precertRequired":false,"billingCode":"46230","codeType":"CPT"},{"id":3164,"precertRequired":false,"billingCode":"46250","codeType":"CPT"},{"id":3165,"precertRequired":false,"billingCode":"46255","codeType":"CPT"},{"id":3166,"precertRequired":false,"billingCode":"46257","codeType":"CPT"},{"id":3167,"precertRequired":false,"billingCode":"46258","codeType":"CPT"},{"id":3168,"precertRequired":false,"billingCode":"46260","codeType":"CPT"},{"id":3169,"precertRequired":false,"billingCode":"46261","codeType":"CPT"},{"id":3170,"precertRequired":false,"billingCode":"46262","codeType":"CPT"},{"id":3171,"precertRequired":false,"billingCode":"46270","codeType":"CPT"},{"id":3172,"precertRequired":false,"billingCode":"46275","codeType":"CPT"},{"id":3173,"precertRequired":false,"billingCode":"46280","codeType":"CPT"},{"id":3174,"precertRequired":false,"billingCode":"46285","codeType":"CPT"},{"id":3175,"precertRequired":false,"billingCode":"46288","codeType":"CPT"},{"id":3176,"precertRequired":false,"billingCode":"46320","codeType":"CPT"},{"id":3177,"precertRequired":false,"billingCode":"46500","codeType":"CPT"},{"id":3178,"precertRequired":false,"billingCode":"46505","codeType":"CPT"},{"id":3179,"precertRequired":false,"billingCode":"46600","codeType":"CPT"},{"id":3180,"precertRequired":false,"billingCode":"46601","codeType":"CPT"},{"id":3181,"precertRequired":false,"billingCode":"46604","codeType":"CPT"},{"id":3182,"precertRequired":false,"billingCode":"46606","codeType":"CPT"},{"id":3183,"precertRequired":false,"billingCode":"46607","codeType":"CPT"},{"id":3184,"precertRequired":false,"billingCode":"46608","codeType":"CPT"},{"id":3185,"precertRequired":false,"billingCode":"46610","codeType":"CPT"},{"id":3186,"precertRequired":false,"billingCode":"46611","codeType":"CPT"},{"id":3187,"precertRequired":false,"billingCode":"46612","codeType":"CPT"},{"id":3188,"precertRequired":false,"billingCode":"46614","codeType":"CPT"},{"id":3189,"precertRequired":false,"billingCode":"46615","codeType":"CPT"},{"id":3190,"precertRequired":false,"billingCode":"46700","codeType":"CPT"},{"id":3191,"precertRequired":false,"billingCode":"46706","codeType":"CPT"},{"id":3192,"precertRequired":false,"billingCode":"46707","codeType":"CPT"},{"id":3193,"precertRequired":false,"billingCode":"46710","codeType":"CPT"},{"id":3194,"precertRequired":false,"billingCode":"46712","codeType":"CPT"},{"id":3195,"precertRequired":false,"billingCode":"46715","codeType":"CPT"},{"id":3196,"precertRequired":false,"billingCode":"46716","codeType":"CPT"},{"id":3197,"precertRequired":false,"billingCode":"46730","codeType":"CPT"},{"id":3198,"precertRequired":false,"billingCode":"46735","codeType":"CPT"},{"id":3199,"precertRequired":false,"billingCode":"46740","codeType":"CPT"},{"id":3200,"precertRequired":false,"billingCode":"46742","codeType":"CPT"},{"id":3201,"precertRequired":false,"billingCode":"46744","codeType":"CPT"},{"id":3202,"precertRequired":false,"billingCode":"46746","codeType":"CPT"},{"id":3204,"precertRequired":false,"billingCode":"46748","codeType":"CPT"},{"id":3205,"precertRequired":false,"billingCode":"46750","codeType":"CPT"},{"id":3207,"precertRequired":false,"billingCode":"46753","codeType":"CPT"},{"id":3208,"precertRequired":false,"billingCode":"46754","codeType":"CPT"},{"id":3209,"precertRequired":false,"billingCode":"46760","codeType":"CPT"},{"id":3210,"precertRequired":false,"billingCode":"46761","codeType":"CPT"},{"id":3212,"precertRequired":false,"billingCode":"46900","codeType":"CPT"},{"id":3213,"precertRequired":false,"billingCode":"46910","codeType":"CPT"},{"id":3214,"precertRequired":false,"billingCode":"46917","codeType":"CPT"},{"id":3215,"precertRequired":false,"billingCode":"46922","codeType":"CPT"},{"id":3216,"precertRequired":false,"billingCode":"46924","codeType":"CPT"},{"id":3217,"precertRequired":false,"billingCode":"46930","codeType":"CPT"},{"id":3218,"precertRequired":false,"billingCode":"46940","codeType":"CPT"},{"id":3219,"precertRequired":false,"billingCode":"46942","codeType":"CPT"},{"id":3220,"precertRequired":false,"billingCode":"46945","codeType":"CPT"},{"id":3221,"precertRequired":false,"billingCode":"46946","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3226,"precertRequired":false,"billingCode":"47010","codeType":"CPT"},{"id":3227,"precertRequired":false,"billingCode":"47015","codeType":"CPT"},{"id":3228,"precertRequired":false,"billingCode":"47100","codeType":"CPT"},{"id":3243,"precertRequired":false,"billingCode":"47300","codeType":"CPT"},{"id":3244,"precertRequired":false,"billingCode":"47350","codeType":"CPT"},{"id":3245,"precertRequired":false,"billingCode":"47360","codeType":"CPT"},{"id":3246,"precertRequired":false,"billingCode":"47361","codeType":"CPT"},{"id":3247,"precertRequired":false,"billingCode":"47362","codeType":"CPT"},{"id":3248,"precertRequired":false,"billingCode":"47371","codeType":"CPT"},{"id":3249,"precertRequired":false,"billingCode":"47381","codeType":"CPT"},{"id":3251,"precertRequired":false,"billingCode":"47383","codeType":"CPT"},{"id":3252,"precertRequired":false,"billingCode":"47400","codeType":"CPT"},{"id":3253,"precertRequired":false,"billingCode":"47420","codeType":"CPT"},{"id":3254,"precertRequired":false,"billingCode":"47425","codeType":"CPT"},{"id":3255,"precertRequired":false,"billingCode":"47460","codeType":"CPT"},{"id":3257,"precertRequired":false,"billingCode":"47490","codeType":"CPT"},{"id":3258,"precertRequired":false,"billingCode":"47531","codeType":"CPT"},{"id":3259,"precertRequired":false,"billingCode":"47532","codeType":"CPT"},{"id":3260,"precertRequired":false,"billingCode":"47533","codeType":"CPT"},{"id":3261,"precertRequired":false,"billingCode":"47534","codeType":"CPT"},{"id":3262,"precertRequired":false,"billingCode":"47535","codeType":"CPT"},{"id":3263,"precertRequired":false,"billingCode":"47536","codeType":"CPT"},{"id":3264,"precertRequired":false,"billingCode":"47537","codeType":"CPT"},{"id":3265,"precertRequired":false,"billingCode":"47538","codeType":"CPT"},{"id":3266,"precertRequired":false,"billingCode":"47539","codeType":"CPT"},{"id":3267,"precertRequired":false,"billingCode":"47540","codeType":"CPT"},{"id":3268,"precertRequired":false,"billingCode":"47541","codeType":"CPT"},{"id":3269,"precertRequired":false,"billingCode":"47542","codeType":"CPT"},{"id":3270,"precertRequired":false,"billingCode":"47543","codeType":"CPT"},{"id":3271,"precertRequired":false,"billingCode":"47544","codeType":"CPT"},{"id":3272,"precertRequired":false,"billingCode":"47550","codeType":"CPT"},{"id":3273,"precertRequired":false,"billingCode":"47552","codeType":"CPT"},{"id":3274,"precertRequired":false,"billingCode":"47553","codeType":"CPT"},{"id":3275,"precertRequired":false,"billingCode":"47554","codeType":"CPT"},{"id":3276,"precertRequired":false,"billingCode":"47555","codeType":"CPT"},{"id":3277,"precertRequired":false,"billingCode":"47556","codeType":"CPT"},{"id":3278,"precertRequired":false,"billingCode":"47562","codeType":"CPT"},{"id":3279,"precertRequired":false,"billingCode":"47563","codeType":"CPT"},{"id":3280,"precertRequired":false,"billingCode":"47564","codeType":"CPT"},{"id":3281,"precertRequired":false,"billingCode":"47570","codeType":"CPT"},{"id":3282,"precertRequired":false,"billingCode":"47600","codeType":"CPT"},{"id":3283,"precertRequired":false,"billingCode":"47605","codeType":"CPT"},{"id":3284,"precertRequired":false,"billingCode":"47610","codeType":"CPT"},{"id":3285,"precertRequired":false,"billingCode":"47612","codeType":"CPT"},{"id":3286,"precertRequired":false,"billingCode":"47620","codeType":"CPT"},{"id":3287,"precertRequired":false,"billingCode":"47700","codeType":"CPT"},{"id":3288,"precertRequired":false,"billingCode":"47701","codeType":"CPT"},{"id":3289,"precertRequired":false,"billingCode":"47711","codeType":"CPT"},{"id":3290,"precertRequired":false,"billingCode":"47712","codeType":"CPT"},{"id":3291,"precertRequired":false,"billingCode":"47715","codeType":"CPT"},{"id":3292,"precertRequired":false,"billingCode":"47720","codeType":"CPT"},{"id":3293,"precertRequired":false,"billingCode":"47721","codeType":"CPT"},{"id":3294,"precertRequired":false,"billingCode":"47740","codeType":"CPT"},{"id":3295,"precertRequired":false,"billingCode":"47741","codeType":"CPT"},{"id":3296,"precertRequired":false,"billingCode":"47760","codeType":"CPT"},{"id":3297,"precertRequired":false,"billingCode":"47765","codeType":"CPT"},{"id":3298,"precertRequired":false,"billingCode":"47780","codeType":"CPT"},{"id":3299,"precertRequired":false,"billingCode":"47785","codeType":"CPT"},{"id":3300,"precertRequired":false,"billingCode":"47800","codeType":"CPT"},{"id":3301,"precertRequired":false,"billingCode":"47801","codeType":"CPT"},{"id":3302,"precertRequired":false,"billingCode":"47802","codeType":"CPT"},{"id":3303,"precertRequired":false,"billingCode":"48000","codeType":"CPT"},{"id":3304,"precertRequired":false,"billingCode":"48001","codeType":"CPT"},{"id":3305,"precertRequired":false,"billingCode":"48020","codeType":"CPT"},{"id":3306,"precertRequired":false,"billingCode":"48100","codeType":"CPT"},{"id":3307,"precertRequired":false,"billingCode":"48102","codeType":"CPT"},{"id":3308,"precertRequired":false,"billingCode":"48105","codeType":"CPT"},{"id":3309,"precertRequired":false,"billingCode":"48120","codeType":"CPT"},{"id":3310,"precertRequired":false,"billingCode":"48148","codeType":"CPT"},{"id":3311,"precertRequired":false,"billingCode":"48150","codeType":"CPT"},{"id":3312,"precertRequired":false,"billingCode":"48152","codeType":"CPT"},{"id":3313,"precertRequired":false,"billingCode":"48153","codeType":"CPT"},{"id":3314,"precertRequired":false,"billingCode":"48154","codeType":"CPT"},{"id":3315,"precertRequired":false,"billingCode":"48155","codeType":"CPT"},{"id":3316,"precertRequired":false,"billingCode":"48160","codeType":"CPT"},{"id":3317,"precertRequired":false,"billingCode":"48400","codeType":"CPT"},{"id":3318,"precertRequired":false,"billingCode":"48500","codeType":"CPT"},{"id":3319,"precertRequired":false,"billingCode":"48510","codeType":"CPT"},{"id":3320,"precertRequired":false,"billingCode":"48520","codeType":"CPT"},{"id":3321,"precertRequired":false,"billingCode":"48540","codeType":"CPT"},{"id":3322,"precertRequired":false,"billingCode":"48545","codeType":"CPT"},{"id":3323,"precertRequired":false,"billingCode":"48547","codeType":"CPT"},{"id":3324,"precertRequired":false,"billingCode":"48548","codeType":"CPT"},{"id":3328,"precertRequired":false,"billingCode":"48554","codeType":"CPT"},{"id":3330,"precertRequired":false,"billingCode":"49002","codeType":"CPT"},{"id":3331,"precertRequired":false,"billingCode":"49010","codeType":"CPT"},{"id":3332,"precertRequired":false,"billingCode":"49020","codeType":"CPT"},{"id":3333,"precertRequired":false,"billingCode":"49040","codeType":"CPT"},{"id":3334,"precertRequired":false,"billingCode":"49060","codeType":"CPT"},{"id":3335,"precertRequired":false,"billingCode":"49062","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3337,"precertRequired":false,"billingCode":"49083","codeType":"CPT"},{"id":3338,"precertRequired":false,"billingCode":"49084","codeType":"CPT"},{"id":3339,"precertRequired":false,"billingCode":"49180","codeType":"CPT"},{"id":3340,"precertRequired":false,"billingCode":"49185","codeType":"CPT"},{"id":3341,"precertRequired":false,"billingCode":"49203","codeType":"CPT"},{"id":3342,"precertRequired":false,"billingCode":"49204","codeType":"CPT"},{"id":3343,"precertRequired":false,"billingCode":"49205","codeType":"CPT"},{"id":3344,"precertRequired":false,"billingCode":"49220","codeType":"CPT"},{"id":3345,"precertRequired":false,"billingCode":"49250","codeType":"CPT"},{"id":3346,"precertRequired":false,"billingCode":"49255","codeType":"CPT"},{"id":3347,"precertRequired":false,"billingCode":"49320","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3350,"precertRequired":false,"billingCode":"49323","codeType":"CPT"},{"id":3351,"precertRequired":false,"billingCode":"49324","codeType":"CPT"},{"id":3352,"precertRequired":false,"billingCode":"49325","codeType":"CPT"},{"id":3353,"precertRequired":false,"billingCode":"49326","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3355,"precertRequired":false,"billingCode":"49329","codeType":"CPT"},{"id":3356,"precertRequired":false,"billingCode":"49400","codeType":"CPT"},{"id":3357,"precertRequired":false,"billingCode":"49402","codeType":"CPT"},{"id":3358,"precertRequired":false,"billingCode":"49405","codeType":"CPT"},{"id":3359,"precertRequired":false,"billingCode":"49406","codeType":"CPT"},{"id":3360,"precertRequired":false,"billingCode":"49407","codeType":"CPT"},{"id":3361,"precertRequired":false,"billingCode":"49411","codeType":"CPT"},{"id":3362,"precertRequired":false,"billingCode":"49412","codeType":"CPT"},{"id":3363,"precertRequired":false,"billingCode":"49418","codeType":"CPT"},{"id":3364,"precertRequired":false,"billingCode":"49419","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"},{"id":3368,"precertRequired":false,"billingCode":"49423","codeType":"CPT"},{"id":3369,"precertRequired":false,"billingCode":"49424","codeType":"CPT"},{"id":3370,"precertRequired":false,"billingCode":"49425","codeType":"CPT"},{"id":3371,"precertRequired":false,"billingCode":"49426","codeType":"CPT"},{"id":3372,"precertRequired":false,"billingCode":"49427","codeType":"CPT"},{"id":3373,"precertRequired":false,"billingCode":"49428","codeType":"CPT"},{"id":3374,"precertRequired":false,"billingCode":"49429","codeType":"CPT"},{"id":3375,"precertRequired":false,"billingCode":"49435","codeType":"CPT"},{"id":3376,"precertRequired":false,"billingCode":"49436","codeType":"CPT"},{"id":3377,"precertRequired":false,"billingCode":"49440","codeType":"CPT"},{"id":3378,"precertRequired":false,"billingCode":"49441","codeType":"CPT"},{"id":3379,"precertRequired":false,"billingCode":"49442","codeType":"CPT"},{"id":3380,"precertRequired":false,"billingCode":"49446","codeType":"CPT"},{"id":3381,"precertRequired":false,"billingCode":"49450","codeType":"CPT"},{"id":3382,"precertRequired":false,"billingCode":"49451","codeType":"CPT"},{"id":3383,"precertRequired":false,"billingCode":"49452","codeType":"CPT"},{"id":3384,"precertRequired":false,"billingCode":"49460","codeType":"CPT"},{"id":3385,"precertRequired":false,"billingCode":"49465","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3847,"precertRequired":false,"billingCode":"60512","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3849,"precertRequired":false,"billingCode":"60521","codeType":"CPT"},{"id":3850,"precertRequired":false,"billingCode":"60522","codeType":"CPT"},{"id":3851,"precertRequired":false,"billingCode":"60540","codeType":"CPT"},{"id":3852,"precertRequired":false,"billingCode":"60545","codeType":"CPT"},{"id":3853,"precertRequired":false,"billingCode":"60600","codeType":"CPT"},{"id":3854,"precertRequired":false,"billingCode":"60605","codeType":"CPT"},{"id":3855,"precertRequired":false,"billingCode":"60650","codeType":"CPT"},{"id":3857,"precertRequired":false,"billingCode":"61576","codeType":"CPT"},{"id":9153,"precertRequired":false,"billingCode":"10004","codeType":"CPT"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9155,"precertRequired":false,"billingCode":"10006","codeType":"CPT"},{"id":9156,"precertRequired":true,"billingCode":"10007","codeType":"CPT"},{"id":9157,"precertRequired":true,"billingCode":"10008","codeType":"CPT"},{"id":9158,"precertRequired":true,"billingCode":"10009","codeType":"CPT"},{"id":9159,"precertRequired":true,"billingCode":"10010","codeType":"CPT"},{"id":9160,"precertRequired":true,"billingCode":"10011","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"},{"id":9527,"precertRequired":true,"billingCode":"47370","codeType":"CPT"},{"id":9556,"precertRequired":true,"billingCode":"50544","codeType":"CPT"},{"id":11876,"precertRequired":false,"billingCode":"49505","codeType":"CPT"},{"id":11877,"precertRequired":false,"billingCode":"49507","codeType":"CPT"},{"id":11878,"precertRequired":false,"billingCode":"49520","codeType":"CPT"},{"id":11879,"precertRequired":false,"billingCode":"49521","codeType":"CPT"},{"id":11880,"precertRequired":false,"billingCode":"49525","codeType":"CPT"},{"id":11881,"precertRequired":false,"billingCode":"49560","codeType":"CPT"},{"id":11882,"precertRequired":false,"billingCode":"49561","codeType":"CPT"},{"id":11883,"precertRequired":false,"billingCode":"49565","codeType":"CPT"},{"id":11884,"precertRequired":false,"billingCode":"49566","codeType":"CPT"},{"id":11885,"precertRequired":false,"billingCode":"49568","codeType":"CPT"},{"id":11886,"precertRequired":false,"billingCode":"49652","codeType":"CPT"},{"id":11887,"precertRequired":false,"billingCode":"49653","codeType":"CPT"},{"id":11888,"precertRequired":false,"billingCode":"49654","codeType":"CPT"},{"id":11889,"precertRequired":false,"billingCode":"49655","codeType":"CPT"},{"id":11890,"precertRequired":false,"billingCode":"49656","codeType":"CPT"},{"id":11891,"precertRequired":false,"billingCode":"49657","codeType":"CPT"},{"id":11892,"precertRequired":false,"billingCode":"50546","codeType":"CPT"},{"id":11893,"precertRequired":false,"billingCode":"50548","codeType":"CPT"},{"id":11894,"precertRequired":false,"billingCode":"50945","codeType":"CPT"},{"id":11895,"precertRequired":false,"billingCode":"54690","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2669,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":22,"precertRequired":false,"billingCode":"00192","codeType":"CPT"},{"id":24,"precertRequired":false,"billingCode":"00211","codeType":"CPT"},{"id":25,"precertRequired":false,"billingCode":"00212","codeType":"CPT"},{"id":26,"precertRequired":false,"billingCode":"00214","codeType":"CPT"},{"id":27,"precertRequired":false,"billingCode":"00215","codeType":"CPT"},{"id":28,"precertRequired":false,"billingCode":"00216","codeType":"CPT"},{"id":29,"precertRequired":false,"billingCode":"00218","codeType":"CPT"},{"id":30,"precertRequired":false,"billingCode":"00220","codeType":"CPT"},{"id":31,"precertRequired":false,"billingCode":"00222","codeType":"CPT"},{"id":37,"precertRequired":false,"billingCode":"00402","codeType":"CPT"},{"id":38,"precertRequired":false,"billingCode":"00404","codeType":"CPT"},{"id":39,"precertRequired":false,"billingCode":"00406","codeType":"CPT"},{"id":40,"precertRequired":false,"billingCode":"00410","codeType":"CPT"},{"id":44,"precertRequired":false,"billingCode":"00472","codeType":"CPT"},{"id":45,"precertRequired":false,"billingCode":"00474","codeType":"CPT"},{"id":46,"precertRequired":false,"billingCode":"00500","codeType":"CPT"},{"id":48,"precertRequired":false,"billingCode":"00522","codeType":"CPT"},{"id":49,"precertRequired":false,"billingCode":"00524","codeType":"CPT"},{"id":50,"precertRequired":false,"billingCode":"00528","codeType":"CPT"},{"id":51,"precertRequired":false,"billingCode":"00529","codeType":"CPT"},{"id":61,"precertRequired":false,"billingCode":"00550","codeType":"CPT"},{"id":70,"precertRequired":false,"billingCode":"00702","codeType":"CPT"},{"id":71,"precertRequired":false,"billingCode":"00730","codeType":"CPT"},{"id":73,"precertRequired":false,"billingCode":"00732","codeType":"CPT"},{"id":75,"precertRequired":false,"billingCode":"00752","codeType":"CPT"},{"id":76,"precertRequired":false,"billingCode":"00754","codeType":"CPT"},{"id":77,"precertRequired":false,"billingCode":"00756","codeType":"CPT"},{"id":78,"precertRequired":false,"billingCode":"00770","codeType":"CPT"},{"id":80,"precertRequired":false,"billingCode":"00792","codeType":"CPT"},{"id":81,"precertRequired":false,"billingCode":"00794","codeType":"CPT"},{"id":88,"precertRequired":false,"billingCode":"00813","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":91,"precertRequired":false,"billingCode":"00832","codeType":"CPT"},{"id":96,"precertRequired":false,"billingCode":"00844","codeType":"CPT"},{"id":104,"precertRequired":false,"billingCode":"00866","codeType":"CPT"},{"id":138,"precertRequired":false,"billingCode":"01120","codeType":"CPT"},{"id":140,"precertRequired":false,"billingCode":"01140","codeType":"CPT"},{"id":141,"precertRequired":false,"billingCode":"01150","codeType":"CPT"},{"id":144,"precertRequired":false,"billingCode":"01173","codeType":"CPT"},{"id":155,"precertRequired":false,"billingCode":"01250","codeType":"CPT"},{"id":156,"precertRequired":false,"billingCode":"01260","codeType":"CPT"},{"id":158,"precertRequired":false,"billingCode":"01272","codeType":"CPT"},{"id":159,"precertRequired":false,"billingCode":"01274","codeType":"CPT"},{"id":160,"precertRequired":false,"billingCode":"01320","codeType":"CPT"},{"id":174,"precertRequired":false,"billingCode":"01442","codeType":"CPT"},{"id":175,"precertRequired":false,"billingCode":"01444","codeType":"CPT"},{"id":8331,"precertRequired":false,"billingCode":"G9654","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":2670,"description":"Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5723,"precertRequired":false,"billingCode":"84445","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2671,"description":"Inpatient or observation admission for surgery/procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2672,"description":"Inpatient admission or observation status for complications related to the surgery/procedure ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2673,"description":"Follow-up visits for this episode of care relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2674,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]}]}},{"Seoc":{"id":438,"seocKey":55,"name":"General Surgery_PRCT","seocId":"SSC_GENERAL SURGERY_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"05-21-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1.   Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.   Diagnostic imaging relevant to the referred condition on the consult  \r\n3.   Diagnostic studies relevant to the referred condition on the consult  \r\n4.   Labs and pathology relevant to the referred condition on the consult \r\n5.   Procedures relevant to the referred condition on the consult including but not limited to:  I&D, biopsy, lesion excision with repair, port placement etc.\r\n6.    Anesthesia consultation related to the procedure\r\n7.    Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)\r\n8.    Inpatient or observation admission for surgery/procedure if indicated\r\n9.    Inpatient admission or observation status for complications related to the surgery/procedure\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure\r\n10.  Follow-up visits for this episode of care relevant to the referred condition on the consult","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be immediately faxed/provided to VA pharmacy to be dispensed timely by VA pharmacy. Non-formulary drug approval process may be required.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"SURGERY GENERAL","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"208600000X"}],"services":[{"id":2367,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4367,"precertRequired":false,"billingCode":"70015","codeType":"CPT"},{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4416,"precertRequired":false,"billingCode":"70545","codeType":"CPT"},{"id":4417,"precertRequired":false,"billingCode":"70546","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4424,"precertRequired":false,"billingCode":"70554","codeType":"CPT"},{"id":4425,"precertRequired":false,"billingCode":"70555","codeType":"CPT"},{"id":4426,"precertRequired":false,"billingCode":"70557","codeType":"CPT"},{"id":4427,"precertRequired":false,"billingCode":"70558","codeType":"CPT"},{"id":4428,"precertRequired":false,"billingCode":"70559","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4584,"precertRequired":false,"billingCode":"74190","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4605,"precertRequired":false,"billingCode":"74300","codeType":"CPT"},{"id":4606,"precertRequired":false,"billingCode":"74301","codeType":"CPT"},{"id":4607,"precertRequired":false,"billingCode":"74328","codeType":"CPT"},{"id":4608,"precertRequired":false,"billingCode":"74329","codeType":"CPT"},{"id":4609,"precertRequired":false,"billingCode":"74330","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4611,"precertRequired":false,"billingCode":"74355","codeType":"CPT"},{"id":4612,"precertRequired":false,"billingCode":"74360","codeType":"CPT"},{"id":4613,"precertRequired":false,"billingCode":"74363","codeType":"CPT"},{"id":4639,"precertRequired":false,"billingCode":"75600","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4661,"precertRequired":false,"billingCode":"75809","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4667,"precertRequired":false,"billingCode":"75831","codeType":"CPT"},{"id":4668,"precertRequired":false,"billingCode":"75833","codeType":"CPT"},{"id":4669,"precertRequired":false,"billingCode":"75840","codeType":"CPT"},{"id":4670,"precertRequired":false,"billingCode":"75842","codeType":"CPT"},{"id":4671,"precertRequired":false,"billingCode":"75860","codeType":"CPT"},{"id":4672,"precertRequired":false,"billingCode":"75870","codeType":"CPT"},{"id":4673,"precertRequired":false,"billingCode":"75872","codeType":"CPT"},{"id":4674,"precertRequired":false,"billingCode":"75880","codeType":"CPT"},{"id":4675,"precertRequired":false,"billingCode":"75885","codeType":"CPT"},{"id":4676,"precertRequired":false,"billingCode":"75887","codeType":"CPT"},{"id":4677,"precertRequired":false,"billingCode":"75889","codeType":"CPT"},{"id":4678,"precertRequired":false,"billingCode":"75891","codeType":"CPT"},{"id":4679,"precertRequired":false,"billingCode":"75893","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4682,"precertRequired":false,"billingCode":"75901","codeType":"CPT"},{"id":4683,"precertRequired":false,"billingCode":"75902","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4691,"precertRequired":false,"billingCode":"75989","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4693,"precertRequired":false,"billingCode":"76001","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4697,"precertRequired":false,"billingCode":"76100","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4700,"precertRequired":false,"billingCode":"76120","codeType":"CPT"},{"id":4701,"precertRequired":false,"billingCode":"76125","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4706,"precertRequired":false,"billingCode":"76390","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4726,"precertRequired":false,"billingCode":"76706","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4770,"precertRequired":false,"billingCode":"76970","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4784,"precertRequired":true,"billingCode":"77058","codeType":"CPT"},{"id":4785,"precertRequired":true,"billingCode":"77059","codeType":"CPT"},{"id":4792,"precertRequired":false,"billingCode":"77071","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4797,"precertRequired":false,"billingCode":"77077","codeType":"CPT"},{"id":4801,"precertRequired":false,"billingCode":"77084","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4910,"precertRequired":false,"billingCode":"78261","codeType":"CPT"},{"id":4918,"precertRequired":false,"billingCode":"78278","codeType":"CPT"},{"id":4919,"precertRequired":false,"billingCode":"78282","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4921,"precertRequired":false,"billingCode":"78291","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4930,"precertRequired":false,"billingCode":"78414","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4932,"precertRequired":false,"billingCode":"78445","codeType":"CPT"},{"id":4937,"precertRequired":false,"billingCode":"78456","codeType":"CPT"},{"id":4938,"precertRequired":false,"billingCode":"78457","codeType":"CPT"},{"id":4939,"precertRequired":false,"billingCode":"78458","codeType":"CPT"},{"id":4969,"precertRequired":false,"billingCode":"78660","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4985,"precertRequired":false,"billingCode":"78804","codeType":"CPT"},{"id":4986,"precertRequired":false,"billingCode":"78805","codeType":"CPT"},{"id":4987,"precertRequired":false,"billingCode":"78806","codeType":"CPT"},{"id":4988,"precertRequired":false,"billingCode":"78807","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"},{"id":4990,"precertRequired":false,"billingCode":"78811","codeType":"CPT"},{"id":4991,"precertRequired":false,"billingCode":"78812","codeType":"CPT"},{"id":4992,"precertRequired":false,"billingCode":"78813","codeType":"CPT"},{"id":4993,"precertRequired":false,"billingCode":"78814","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":4995,"precertRequired":false,"billingCode":"78816","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2368,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4915,"precertRequired":false,"billingCode":"78270","codeType":"CPT"},{"id":4916,"precertRequired":false,"billingCode":"78271","codeType":"CPT"},{"id":4917,"precertRequired":false,"billingCode":"78272","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2369,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5140,"precertRequired":false,"billingCode":"80500","codeType":"CPT"},{"id":5141,"precertRequired":false,"billingCode":"80502","codeType":"CPT"},{"id":5340,"precertRequired":false,"billingCode":"81500","codeType":"CPT"},{"id":5341,"precertRequired":false,"billingCode":"81503","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5382,"precertRequired":false,"billingCode":"82105","codeType":"CPT"},{"id":5383,"precertRequired":false,"billingCode":"82106","codeType":"CPT"},{"id":5384,"precertRequired":false,"billingCode":"82107","codeType":"CPT"},{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5432,"precertRequired":false,"billingCode":"82378","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5586,"precertRequired":false,"billingCode":"83630","codeType":"CPT"},{"id":5587,"precertRequired":false,"billingCode":"83631","codeType":"CPT"},{"id":5668,"precertRequired":false,"billingCode":"84152","codeType":"CPT"},{"id":5669,"precertRequired":false,"billingCode":"84153","codeType":"CPT"},{"id":5670,"precertRequired":false,"billingCode":"84154","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5905,"precertRequired":false,"billingCode":"86300","codeType":"CPT"},{"id":5906,"precertRequired":false,"billingCode":"86301","codeType":"CPT"},{"id":5907,"precertRequired":false,"billingCode":"86304","codeType":"CPT"},{"id":6108,"precertRequired":false,"billingCode":"87045","codeType":"CPT"},{"id":6109,"precertRequired":false,"billingCode":"87046","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6112,"precertRequired":false,"billingCode":"87073","codeType":"CPT"},{"id":6143,"precertRequired":false,"billingCode":"87177","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6236,"precertRequired":false,"billingCode":"87505","codeType":"CPT"},{"id":6237,"precertRequired":false,"billingCode":"87506","codeType":"CPT"},{"id":6238,"precertRequired":false,"billingCode":"87507","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6411,"precertRequired":false,"billingCode":"88314","codeType":"CPT"},{"id":6412,"precertRequired":false,"billingCode":"88319","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6414,"precertRequired":false,"billingCode":"88323","codeType":"CPT"},{"id":6415,"precertRequired":false,"billingCode":"88325","codeType":"CPT"},{"id":6416,"precertRequired":false,"billingCode":"88329","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6419,"precertRequired":false,"billingCode":"88333","codeType":"CPT"},{"id":6420,"precertRequired":false,"billingCode":"88334","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6423,"precertRequired":false,"billingCode":"88344","codeType":"CPT"},{"id":6424,"precertRequired":false,"billingCode":"88346","codeType":"CPT"},{"id":6425,"precertRequired":false,"billingCode":"88348","codeType":"CPT"},{"id":6426,"precertRequired":false,"billingCode":"88350","codeType":"CPT"},{"id":6427,"precertRequired":false,"billingCode":"88355","codeType":"CPT"},{"id":6428,"precertRequired":false,"billingCode":"88356","codeType":"CPT"},{"id":6429,"precertRequired":false,"billingCode":"88358","codeType":"CPT"},{"id":6430,"precertRequired":false,"billingCode":"88360","codeType":"CPT"},{"id":6431,"precertRequired":false,"billingCode":"88361","codeType":"CPT"},{"id":6432,"precertRequired":false,"billingCode":"88362","codeType":"CPT"},{"id":6433,"precertRequired":false,"billingCode":"88363","codeType":"CPT"},{"id":6434,"precertRequired":false,"billingCode":"88364","codeType":"CPT"},{"id":6435,"precertRequired":false,"billingCode":"88365","codeType":"CPT"},{"id":6436,"precertRequired":false,"billingCode":"88366","codeType":"CPT"},{"id":6437,"precertRequired":false,"billingCode":"88367","codeType":"CPT"},{"id":6438,"precertRequired":false,"billingCode":"88368","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"},{"id":6440,"precertRequired":false,"billingCode":"88371","codeType":"CPT"},{"id":6441,"precertRequired":false,"billingCode":"88372","codeType":"CPT"},{"id":6442,"precertRequired":false,"billingCode":"88373","codeType":"CPT"},{"id":6443,"precertRequired":false,"billingCode":"88374","codeType":"CPT"},{"id":6444,"precertRequired":false,"billingCode":"88375","codeType":"CPT"},{"id":6445,"precertRequired":false,"billingCode":"88377","codeType":"CPT"},{"id":6446,"precertRequired":false,"billingCode":"88380","codeType":"CPT"},{"id":6447,"precertRequired":false,"billingCode":"88381","codeType":"CPT"},{"id":6448,"precertRequired":false,"billingCode":"88387","codeType":"CPT"},{"id":6449,"precertRequired":false,"billingCode":"88388","codeType":"CPT"},{"id":6456,"precertRequired":false,"billingCode":"89049","codeType":"CPT"},{"id":6457,"precertRequired":false,"billingCode":"89050","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":8206,"precertRequired":false,"billingCode":"G0416","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":2370,"description":"Procedures relevant to the referred condition on the consult including but not limited to:  I&D, biopsy, lesion excision with repair,port placement etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":222,"precertRequired":false,"billingCode":"10022","codeType":"CPT"},{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":243,"precertRequired":false,"billingCode":"11010","codeType":"CPT"},{"id":244,"precertRequired":false,"billingCode":"11011","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":248,"precertRequired":false,"billingCode":"11044","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":250,"precertRequired":false,"billingCode":"11046","codeType":"CPT"},{"id":251,"precertRequired":false,"billingCode":"11047","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":329,"precertRequired":false,"billingCode":"11960","codeType":"CPT"},{"id":330,"precertRequired":false,"billingCode":"11970","codeType":"CPT"},{"id":331,"precertRequired":false,"billingCode":"11971","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":374,"precertRequired":false,"billingCode":"13120","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":383,"precertRequired":false,"billingCode":"13160","codeType":"CPT"},{"id":384,"precertRequired":false,"billingCode":"14000","codeType":"CPT"},{"id":385,"precertRequired":false,"billingCode":"14001","codeType":"CPT"},{"id":386,"precertRequired":false,"billingCode":"14020","codeType":"CPT"},{"id":387,"precertRequired":false,"billingCode":"14021","codeType":"CPT"},{"id":388,"precertRequired":true,"billingCode":"14040","codeType":"CPT"},{"id":389,"precertRequired":false,"billingCode":"14041","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":392,"precertRequired":true,"billingCode":"14301","codeType":"CPT"},{"id":393,"precertRequired":false,"billingCode":"14302","codeType":"CPT"},{"id":395,"precertRequired":false,"billingCode":"15040","codeType":"CPT"},{"id":396,"precertRequired":false,"billingCode":"15050","codeType":"CPT"},{"id":397,"precertRequired":false,"billingCode":"15150","codeType":"CPT"},{"id":398,"precertRequired":false,"billingCode":"15151","codeType":"CPT"},{"id":399,"precertRequired":false,"billingCode":"15155","codeType":"CPT"},{"id":400,"precertRequired":false,"billingCode":"15156","codeType":"CPT"},{"id":401,"precertRequired":false,"billingCode":"15157","codeType":"CPT"},{"id":402,"precertRequired":false,"billingCode":"15200","codeType":"CPT"},{"id":403,"precertRequired":false,"billingCode":"15201","codeType":"CPT"},{"id":404,"precertRequired":false,"billingCode":"15220","codeType":"CPT"},{"id":405,"precertRequired":false,"billingCode":"15221","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":410,"precertRequired":false,"billingCode":"15271","codeType":"CPT"},{"id":411,"precertRequired":false,"billingCode":"15272","codeType":"CPT"},{"id":412,"precertRequired":false,"billingCode":"15273","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":415,"precertRequired":false,"billingCode":"15570","codeType":"CPT"},{"id":416,"precertRequired":false,"billingCode":"15572","codeType":"CPT"},{"id":417,"precertRequired":false,"billingCode":"15574","codeType":"CPT"},{"id":418,"precertRequired":false,"billingCode":"15576","codeType":"CPT"},{"id":419,"precertRequired":false,"billingCode":"15600","codeType":"CPT"},{"id":420,"precertRequired":false,"billingCode":"15610","codeType":"CPT"},{"id":421,"precertRequired":false,"billingCode":"15620","codeType":"CPT"},{"id":422,"precertRequired":false,"billingCode":"15630","codeType":"CPT"},{"id":423,"precertRequired":false,"billingCode":"15650","codeType":"CPT"},{"id":424,"precertRequired":false,"billingCode":"15730","codeType":"CPT"},{"id":425,"precertRequired":false,"billingCode":"15731","codeType":"CPT"},{"id":426,"precertRequired":false,"billingCode":"15733","codeType":"CPT"},{"id":427,"precertRequired":false,"billingCode":"15734","codeType":"CPT"},{"id":428,"precertRequired":false,"billingCode":"15736","codeType":"CPT"},{"id":429,"precertRequired":false,"billingCode":"15738","codeType":"CPT"},{"id":430,"precertRequired":false,"billingCode":"15740","codeType":"CPT"},{"id":431,"precertRequired":false,"billingCode":"15750","codeType":"CPT"},{"id":432,"precertRequired":false,"billingCode":"15756","codeType":"CPT"},{"id":433,"precertRequired":false,"billingCode":"15757","codeType":"CPT"},{"id":434,"precertRequired":false,"billingCode":"15758","codeType":"CPT"},{"id":435,"precertRequired":false,"billingCode":"15760","codeType":"CPT"},{"id":436,"precertRequired":false,"billingCode":"15770","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":443,"precertRequired":false,"billingCode":"15850","codeType":"CPT"},{"id":444,"precertRequired":false,"billingCode":"15852","codeType":"CPT"},{"id":445,"precertRequired":false,"billingCode":"15860","codeType":"CPT"},{"id":446,"precertRequired":false,"billingCode":"15920","codeType":"CPT"},{"id":447,"precertRequired":false,"billingCode":"15922","codeType":"CPT"},{"id":448,"precertRequired":false,"billingCode":"15931","codeType":"CPT"},{"id":449,"precertRequired":false,"billingCode":"15933","codeType":"CPT"},{"id":450,"precertRequired":false,"billingCode":"15934","codeType":"CPT"},{"id":451,"precertRequired":false,"billingCode":"15935","codeType":"CPT"},{"id":452,"precertRequired":false,"billingCode":"15936","codeType":"CPT"},{"id":453,"precertRequired":false,"billingCode":"15937","codeType":"CPT"},{"id":454,"precertRequired":false,"billingCode":"15940","codeType":"CPT"},{"id":455,"precertRequired":false,"billingCode":"15941","codeType":"CPT"},{"id":456,"precertRequired":false,"billingCode":"15944","codeType":"CPT"},{"id":457,"precertRequired":false,"billingCode":"15945","codeType":"CPT"},{"id":458,"precertRequired":false,"billingCode":"15946","codeType":"CPT"},{"id":459,"precertRequired":false,"billingCode":"15950","codeType":"CPT"},{"id":460,"precertRequired":false,"billingCode":"15951","codeType":"CPT"},{"id":461,"precertRequired":false,"billingCode":"15952","codeType":"CPT"},{"id":462,"precertRequired":false,"billingCode":"15953","codeType":"CPT"},{"id":463,"precertRequired":false,"billingCode":"15956","codeType":"CPT"},{"id":464,"precertRequired":false,"billingCode":"15958","codeType":"CPT"},{"id":465,"precertRequired":false,"billingCode":"16000","codeType":"CPT"},{"id":466,"precertRequired":false,"billingCode":"16020","codeType":"CPT"},{"id":467,"precertRequired":false,"billingCode":"16025","codeType":"CPT"},{"id":468,"precertRequired":false,"billingCode":"16030","codeType":"CPT"},{"id":469,"precertRequired":false,"billingCode":"16035","codeType":"CPT"},{"id":470,"precertRequired":false,"billingCode":"16036","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":474,"precertRequired":false,"billingCode":"17106","codeType":"CPT"},{"id":475,"precertRequired":false,"billingCode":"17107","codeType":"CPT"},{"id":476,"precertRequired":false,"billingCode":"17108","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":503,"precertRequired":false,"billingCode":"19000","codeType":"CPT"},{"id":504,"precertRequired":false,"billingCode":"19001","codeType":"CPT"},{"id":505,"precertRequired":false,"billingCode":"19020","codeType":"CPT"},{"id":506,"precertRequired":false,"billingCode":"19030","codeType":"CPT"},{"id":507,"precertRequired":false,"billingCode":"19081","codeType":"CPT"},{"id":508,"precertRequired":false,"billingCode":"19082","codeType":"CPT"},{"id":509,"precertRequired":false,"billingCode":"19083","codeType":"CPT"},{"id":510,"precertRequired":false,"billingCode":"19084","codeType":"CPT"},{"id":511,"precertRequired":false,"billingCode":"19085","codeType":"CPT"},{"id":512,"precertRequired":false,"billingCode":"19086","codeType":"CPT"},{"id":513,"precertRequired":false,"billingCode":"19100","codeType":"CPT"},{"id":514,"precertRequired":false,"billingCode":"19101","codeType":"CPT"},{"id":515,"precertRequired":false,"billingCode":"19105","codeType":"CPT"},{"id":516,"precertRequired":false,"billingCode":"19120","codeType":"CPT"},{"id":517,"precertRequired":false,"billingCode":"19125","codeType":"CPT"},{"id":518,"precertRequired":false,"billingCode":"19126","codeType":"CPT"},{"id":519,"precertRequired":false,"billingCode":"19260","codeType":"CPT"},{"id":522,"precertRequired":false,"billingCode":"19281","codeType":"CPT"},{"id":523,"precertRequired":false,"billingCode":"19282","codeType":"CPT"},{"id":524,"precertRequired":false,"billingCode":"19283","codeType":"CPT"},{"id":525,"precertRequired":false,"billingCode":"19284","codeType":"CPT"},{"id":526,"precertRequired":false,"billingCode":"19285","codeType":"CPT"},{"id":527,"precertRequired":false,"billingCode":"19286","codeType":"CPT"},{"id":528,"precertRequired":false,"billingCode":"19287","codeType":"CPT"},{"id":529,"precertRequired":false,"billingCode":"19288","codeType":"CPT"},{"id":534,"precertRequired":false,"billingCode":"19300","codeType":"CPT"},{"id":535,"precertRequired":false,"billingCode":"19301","codeType":"CPT"},{"id":536,"precertRequired":false,"billingCode":"19302","codeType":"CPT"},{"id":537,"precertRequired":false,"billingCode":"19303","codeType":"CPT"},{"id":538,"precertRequired":false,"billingCode":"19304","codeType":"CPT"},{"id":539,"precertRequired":false,"billingCode":"19305","codeType":"CPT"},{"id":540,"precertRequired":false,"billingCode":"19306","codeType":"CPT"},{"id":541,"precertRequired":false,"billingCode":"19307","codeType":"CPT"},{"id":542,"precertRequired":false,"billingCode":"20005","codeType":"CPT"},{"id":543,"precertRequired":false,"billingCode":"20100","codeType":"CPT"},{"id":544,"precertRequired":false,"billingCode":"20101","codeType":"CPT"},{"id":545,"precertRequired":false,"billingCode":"20102","codeType":"CPT"},{"id":546,"precertRequired":false,"billingCode":"20103","codeType":"CPT"},{"id":547,"precertRequired":false,"billingCode":"20150","codeType":"CPT"},{"id":548,"precertRequired":false,"billingCode":"20200","codeType":"CPT"},{"id":549,"precertRequired":false,"billingCode":"20205","codeType":"CPT"},{"id":550,"precertRequired":false,"billingCode":"20206","codeType":"CPT"},{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":552,"precertRequired":false,"billingCode":"20225","codeType":"CPT"},{"id":553,"precertRequired":false,"billingCode":"20240","codeType":"CPT"},{"id":554,"precertRequired":false,"billingCode":"20245","codeType":"CPT"},{"id":555,"precertRequired":true,"billingCode":"20250","codeType":"CPT"},{"id":556,"precertRequired":true,"billingCode":"20251","codeType":"CPT"},{"id":557,"precertRequired":false,"billingCode":"20500","codeType":"CPT"},{"id":558,"precertRequired":false,"billingCode":"20501","codeType":"CPT"},{"id":559,"precertRequired":false,"billingCode":"20520","codeType":"CPT"},{"id":560,"precertRequired":false,"billingCode":"20525","codeType":"CPT"},{"id":562,"precertRequired":true,"billingCode":"20527","codeType":"CPT"},{"id":563,"precertRequired":true,"billingCode":"20550","codeType":"CPT"},{"id":564,"precertRequired":true,"billingCode":"20551","codeType":"CPT"},{"id":567,"precertRequired":false,"billingCode":"20555","codeType":"CPT"},{"id":582,"precertRequired":false,"billingCode":"20665","codeType":"CPT"},{"id":583,"precertRequired":false,"billingCode":"20670","codeType":"CPT"},{"id":584,"precertRequired":false,"billingCode":"20680","codeType":"CPT"},{"id":591,"precertRequired":false,"billingCode":"20900","codeType":"CPT"},{"id":592,"precertRequired":false,"billingCode":"20902","codeType":"CPT"},{"id":593,"precertRequired":false,"billingCode":"20910","codeType":"CPT"},{"id":594,"precertRequired":false,"billingCode":"20912","codeType":"CPT"},{"id":595,"precertRequired":false,"billingCode":"20920","codeType":"CPT"},{"id":596,"precertRequired":false,"billingCode":"20922","codeType":"CPT"},{"id":597,"precertRequired":false,"billingCode":"20924","codeType":"CPT"},{"id":598,"precertRequired":false,"billingCode":"20926","codeType":"CPT"},{"id":600,"precertRequired":false,"billingCode":"20950","codeType":"CPT"},{"id":609,"precertRequired":false,"billingCode":"20982","codeType":"CPT"},{"id":610,"precertRequired":false,"billingCode":"20983","codeType":"CPT"},{"id":611,"precertRequired":false,"billingCode":"20985","codeType":"CPT"},{"id":723,"precertRequired":false,"billingCode":"21501","codeType":"CPT"},{"id":724,"precertRequired":false,"billingCode":"21502","codeType":"CPT"},{"id":725,"precertRequired":false,"billingCode":"21510","codeType":"CPT"},{"id":726,"precertRequired":true,"billingCode":"21550","codeType":"CPT"},{"id":727,"precertRequired":true,"billingCode":"21552","codeType":"CPT"},{"id":728,"precertRequired":true,"billingCode":"21554","codeType":"CPT"},{"id":729,"precertRequired":true,"billingCode":"21555","codeType":"CPT"},{"id":730,"precertRequired":true,"billingCode":"21556","codeType":"CPT"},{"id":731,"precertRequired":true,"billingCode":"21557","codeType":"CPT"},{"id":732,"precertRequired":true,"billingCode":"21558","codeType":"CPT"},{"id":733,"precertRequired":true,"billingCode":"21600","codeType":"CPT"},{"id":734,"precertRequired":true,"billingCode":"21610","codeType":"CPT"},{"id":735,"precertRequired":true,"billingCode":"21615","codeType":"CPT"},{"id":736,"precertRequired":true,"billingCode":"21616","codeType":"CPT"},{"id":737,"precertRequired":true,"billingCode":"21620","codeType":"CPT"},{"id":738,"precertRequired":true,"billingCode":"21627","codeType":"CPT"},{"id":739,"precertRequired":true,"billingCode":"21630","codeType":"CPT"},{"id":740,"precertRequired":true,"billingCode":"21632","codeType":"CPT"},{"id":741,"precertRequired":false,"billingCode":"21685","codeType":"CPT"},{"id":742,"precertRequired":true,"billingCode":"21700","codeType":"CPT"},{"id":743,"precertRequired":true,"billingCode":"21705","codeType":"CPT"},{"id":744,"precertRequired":true,"billingCode":"21720","codeType":"CPT"},{"id":745,"precertRequired":true,"billingCode":"21725","codeType":"CPT"},{"id":749,"precertRequired":true,"billingCode":"21750","codeType":"CPT"},{"id":750,"precertRequired":true,"billingCode":"21811","codeType":"CPT"},{"id":751,"precertRequired":true,"billingCode":"21812","codeType":"CPT"},{"id":752,"precertRequired":true,"billingCode":"21813","codeType":"CPT"},{"id":755,"precertRequired":false,"billingCode":"21920","codeType":"CPT"},{"id":756,"precertRequired":false,"billingCode":"21925","codeType":"CPT"},{"id":757,"precertRequired":false,"billingCode":"21930","codeType":"CPT"},{"id":758,"precertRequired":false,"billingCode":"21931","codeType":"CPT"},{"id":759,"precertRequired":false,"billingCode":"21932","codeType":"CPT"},{"id":760,"precertRequired":false,"billingCode":"21933","codeType":"CPT"},{"id":761,"precertRequired":false,"billingCode":"21935","codeType":"CPT"},{"id":762,"precertRequired":false,"billingCode":"21936","codeType":"CPT"},{"id":763,"precertRequired":true,"billingCode":"22010","codeType":"CPT"},{"id":764,"precertRequired":false,"billingCode":"22015","codeType":"CPT"},{"id":775,"precertRequired":false,"billingCode":"22900","codeType":"CPT"},{"id":776,"precertRequired":false,"billingCode":"22901","codeType":"CPT"},{"id":777,"precertRequired":false,"billingCode":"22902","codeType":"CPT"},{"id":778,"precertRequired":false,"billingCode":"22903","codeType":"CPT"},{"id":779,"precertRequired":false,"billingCode":"22904","codeType":"CPT"},{"id":780,"precertRequired":false,"billingCode":"22905","codeType":"CPT"},{"id":783,"precertRequired":false,"billingCode":"23030","codeType":"CPT"},{"id":784,"precertRequired":false,"billingCode":"23031","codeType":"CPT"},{"id":785,"precertRequired":false,"billingCode":"23035","codeType":"CPT"},{"id":788,"precertRequired":false,"billingCode":"23065","codeType":"CPT"},{"id":789,"precertRequired":false,"billingCode":"23066","codeType":"CPT"},{"id":790,"precertRequired":false,"billingCode":"23071","codeType":"CPT"},{"id":791,"precertRequired":false,"billingCode":"23073","codeType":"CPT"},{"id":792,"precertRequired":false,"billingCode":"23075","codeType":"CPT"},{"id":793,"precertRequired":false,"billingCode":"23076","codeType":"CPT"},{"id":794,"precertRequired":false,"billingCode":"23077","codeType":"CPT"},{"id":795,"precertRequired":false,"billingCode":"23078","codeType":"CPT"},{"id":885,"precertRequired":false,"billingCode":"23930","codeType":"CPT"},{"id":886,"precertRequired":false,"billingCode":"23931","codeType":"CPT"},{"id":887,"precertRequired":false,"billingCode":"23935","codeType":"CPT"},{"id":890,"precertRequired":false,"billingCode":"24065","codeType":"CPT"},{"id":891,"precertRequired":false,"billingCode":"24066","codeType":"CPT"},{"id":892,"precertRequired":false,"billingCode":"24071","codeType":"CPT"},{"id":893,"precertRequired":false,"billingCode":"24073","codeType":"CPT"},{"id":894,"precertRequired":false,"billingCode":"24075","codeType":"CPT"},{"id":895,"precertRequired":false,"billingCode":"24076","codeType":"CPT"},{"id":896,"precertRequired":false,"billingCode":"24077","codeType":"CPT"},{"id":897,"precertRequired":false,"billingCode":"24079","codeType":"CPT"},{"id":921,"precertRequired":false,"billingCode":"24200","codeType":"CPT"},{"id":922,"precertRequired":false,"billingCode":"24201","codeType":"CPT"},{"id":992,"precertRequired":false,"billingCode":"24900","codeType":"CPT"},{"id":993,"precertRequired":false,"billingCode":"24920","codeType":"CPT"},{"id":994,"precertRequired":false,"billingCode":"24925","codeType":"CPT"},{"id":995,"precertRequired":false,"billingCode":"24930","codeType":"CPT"},{"id":996,"precertRequired":false,"billingCode":"24931","codeType":"CPT"},{"id":997,"precertRequired":false,"billingCode":"24935","codeType":"CPT"},{"id":1001,"precertRequired":false,"billingCode":"25020","codeType":"CPT"},{"id":1002,"precertRequired":false,"billingCode":"25023","codeType":"CPT"},{"id":1003,"precertRequired":false,"billingCode":"25024","codeType":"CPT"},{"id":1004,"precertRequired":false,"billingCode":"25025","codeType":"CPT"},{"id":1005,"precertRequired":false,"billingCode":"25028","codeType":"CPT"},{"id":1006,"precertRequired":false,"billingCode":"25031","codeType":"CPT"},{"id":1007,"precertRequired":false,"billingCode":"25035","codeType":"CPT"},{"id":1008,"precertRequired":false,"billingCode":"25040","codeType":"CPT"},{"id":1009,"precertRequired":false,"billingCode":"25065","codeType":"CPT"},{"id":1010,"precertRequired":false,"billingCode":"25066","codeType":"CPT"},{"id":1011,"precertRequired":false,"billingCode":"25071","codeType":"CPT"},{"id":1012,"precertRequired":false,"billingCode":"25073","codeType":"CPT"},{"id":1013,"precertRequired":false,"billingCode":"25075","codeType":"CPT"},{"id":1014,"precertRequired":false,"billingCode":"25076","codeType":"CPT"},{"id":1015,"precertRequired":false,"billingCode":"25077","codeType":"CPT"},{"id":1016,"precertRequired":false,"billingCode":"25078","codeType":"CPT"},{"id":1145,"precertRequired":false,"billingCode":"25900","codeType":"CPT"},{"id":1146,"precertRequired":false,"billingCode":"25905","codeType":"CPT"},{"id":1147,"precertRequired":false,"billingCode":"25907","codeType":"CPT"},{"id":1148,"precertRequired":false,"billingCode":"25909","codeType":"CPT"},{"id":1153,"precertRequired":false,"billingCode":"25927","codeType":"CPT"},{"id":1154,"precertRequired":false,"billingCode":"25929","codeType":"CPT"},{"id":1155,"precertRequired":false,"billingCode":"25931","codeType":"CPT"},{"id":1156,"precertRequired":false,"billingCode":"26010","codeType":"CPT"},{"id":1157,"precertRequired":false,"billingCode":"26011","codeType":"CPT"},{"id":1158,"precertRequired":false,"billingCode":"26020","codeType":"CPT"},{"id":1159,"precertRequired":false,"billingCode":"26025","codeType":"CPT"},{"id":1160,"precertRequired":false,"billingCode":"26030","codeType":"CPT"},{"id":1161,"precertRequired":false,"billingCode":"26034","codeType":"CPT"},{"id":1162,"precertRequired":false,"billingCode":"26035","codeType":"CPT"},{"id":1163,"precertRequired":false,"billingCode":"26037","codeType":"CPT"},{"id":1164,"precertRequired":false,"billingCode":"26040","codeType":"CPT"},{"id":1165,"precertRequired":false,"billingCode":"26045","codeType":"CPT"},{"id":1174,"precertRequired":false,"billingCode":"26111","codeType":"CPT"},{"id":1175,"precertRequired":false,"billingCode":"26113","codeType":"CPT"},{"id":1176,"precertRequired":false,"billingCode":"26115","codeType":"CPT"},{"id":1177,"precertRequired":false,"billingCode":"26116","codeType":"CPT"},{"id":1178,"precertRequired":false,"billingCode":"26117","codeType":"CPT"},{"id":1179,"precertRequired":false,"billingCode":"26118","codeType":"CPT"},{"id":1180,"precertRequired":false,"billingCode":"26121","codeType":"CPT"},{"id":1181,"precertRequired":false,"billingCode":"26123","codeType":"CPT"},{"id":1182,"precertRequired":false,"billingCode":"26125","codeType":"CPT"},{"id":1326,"precertRequired":false,"billingCode":"26910","codeType":"CPT"},{"id":1327,"precertRequired":false,"billingCode":"26951","codeType":"CPT"},{"id":1328,"precertRequired":false,"billingCode":"26952","codeType":"CPT"},{"id":1329,"precertRequired":false,"billingCode":"26990","codeType":"CPT"},{"id":1330,"precertRequired":false,"billingCode":"26991","codeType":"CPT"},{"id":1331,"precertRequired":false,"billingCode":"26992","codeType":"CPT"},{"id":1337,"precertRequired":false,"billingCode":"27025","codeType":"CPT"},{"id":1338,"precertRequired":false,"billingCode":"27027","codeType":"CPT"},{"id":1343,"precertRequired":false,"billingCode":"27040","codeType":"CPT"},{"id":1344,"precertRequired":false,"billingCode":"27041","codeType":"CPT"},{"id":1345,"precertRequired":false,"billingCode":"27043","codeType":"CPT"},{"id":1346,"precertRequired":false,"billingCode":"27045","codeType":"CPT"},{"id":1347,"precertRequired":false,"billingCode":"27047","codeType":"CPT"},{"id":1348,"precertRequired":false,"billingCode":"27048","codeType":"CPT"},{"id":1349,"precertRequired":false,"billingCode":"27049","codeType":"CPT"},{"id":1353,"precertRequired":false,"billingCode":"27057","codeType":"CPT"},{"id":1354,"precertRequired":false,"billingCode":"27059","codeType":"CPT"},{"id":1367,"precertRequired":false,"billingCode":"27086","codeType":"CPT"},{"id":1368,"precertRequired":false,"billingCode":"27087","codeType":"CPT"},{"id":1447,"precertRequired":false,"billingCode":"27290","codeType":"CPT"},{"id":1450,"precertRequired":false,"billingCode":"27301","codeType":"CPT"},{"id":1451,"precertRequired":false,"billingCode":"27303","codeType":"CPT"},{"id":1452,"precertRequired":false,"billingCode":"27305","codeType":"CPT"},{"id":1456,"precertRequired":false,"billingCode":"27323","codeType":"CPT"},{"id":1457,"precertRequired":false,"billingCode":"27324","codeType":"CPT"},{"id":1460,"precertRequired":false,"billingCode":"27327","codeType":"CPT"},{"id":1461,"precertRequired":false,"billingCode":"27328","codeType":"CPT"},{"id":1462,"precertRequired":false,"billingCode":"27329","codeType":"CPT"},{"id":1469,"precertRequired":false,"billingCode":"27337","codeType":"CPT"},{"id":1470,"precertRequired":false,"billingCode":"27339","codeType":"CPT"},{"id":1480,"precertRequired":false,"billingCode":"27364","codeType":"CPT"},{"id":1481,"precertRequired":false,"billingCode":"27365","codeType":"CPT"},{"id":1482,"precertRequired":false,"billingCode":"27370","codeType":"CPT"},{"id":1483,"precertRequired":false,"billingCode":"27372","codeType":"CPT"},{"id":1541,"precertRequired":false,"billingCode":"27496","codeType":"CPT"},{"id":1542,"precertRequired":false,"billingCode":"27497","codeType":"CPT"},{"id":1543,"precertRequired":false,"billingCode":"27498","codeType":"CPT"},{"id":1544,"precertRequired":false,"billingCode":"27499","codeType":"CPT"},{"id":1545,"precertRequired":false,"billingCode":"27500","codeType":"CPT"},{"id":1578,"precertRequired":false,"billingCode":"27590","codeType":"CPT"},{"id":1579,"precertRequired":false,"billingCode":"27591","codeType":"CPT"},{"id":1580,"precertRequired":false,"billingCode":"27592","codeType":"CPT"},{"id":1581,"precertRequired":false,"billingCode":"27594","codeType":"CPT"},{"id":1582,"precertRequired":false,"billingCode":"27596","codeType":"CPT"},{"id":1584,"precertRequired":false,"billingCode":"27600","codeType":"CPT"},{"id":1585,"precertRequired":false,"billingCode":"27601","codeType":"CPT"},{"id":1586,"precertRequired":false,"billingCode":"27602","codeType":"CPT"},{"id":1587,"precertRequired":false,"billingCode":"27603","codeType":"CPT"},{"id":1588,"precertRequired":false,"billingCode":"27604","codeType":"CPT"},{"id":1591,"precertRequired":false,"billingCode":"27607","codeType":"CPT"},{"id":1594,"precertRequired":false,"billingCode":"27613","codeType":"CPT"},{"id":1595,"precertRequired":false,"billingCode":"27614","codeType":"CPT"},{"id":1596,"precertRequired":false,"billingCode":"27615","codeType":"CPT"},{"id":1597,"precertRequired":false,"billingCode":"27616","codeType":"CPT"},{"id":1598,"precertRequired":false,"billingCode":"27618","codeType":"CPT"},{"id":1599,"precertRequired":false,"billingCode":"27619","codeType":"CPT"},{"id":1697,"precertRequired":false,"billingCode":"27880","codeType":"CPT"},{"id":1698,"precertRequired":false,"billingCode":"27881","codeType":"CPT"},{"id":1699,"precertRequired":false,"billingCode":"27882","codeType":"CPT"},{"id":1700,"precertRequired":false,"billingCode":"27884","codeType":"CPT"},{"id":1701,"precertRequired":false,"billingCode":"27886","codeType":"CPT"},{"id":1702,"precertRequired":false,"billingCode":"27888","codeType":"CPT"},{"id":1704,"precertRequired":false,"billingCode":"27892","codeType":"CPT"},{"id":1705,"precertRequired":false,"billingCode":"27893","codeType":"CPT"},{"id":1706,"precertRequired":false,"billingCode":"27894","codeType":"CPT"},{"id":1707,"precertRequired":false,"billingCode":"28001","codeType":"CPT"},{"id":1708,"precertRequired":false,"billingCode":"28002","codeType":"CPT"},{"id":1709,"precertRequired":false,"billingCode":"28003","codeType":"CPT"},{"id":1710,"precertRequired":false,"billingCode":"28005","codeType":"CPT"},{"id":1711,"precertRequired":false,"billingCode":"28008","codeType":"CPT"},{"id":1718,"precertRequired":false,"billingCode":"28039","codeType":"CPT"},{"id":1719,"precertRequired":false,"billingCode":"28041","codeType":"CPT"},{"id":1720,"precertRequired":false,"billingCode":"28043","codeType":"CPT"},{"id":1721,"precertRequired":false,"billingCode":"28045","codeType":"CPT"},{"id":1728,"precertRequired":true,"billingCode":"28060","codeType":"CPT"},{"id":1729,"precertRequired":true,"billingCode":"28062","codeType":"CPT"},{"id":1732,"precertRequired":true,"billingCode":"28080","codeType":"CPT"},{"id":1764,"precertRequired":false,"billingCode":"28190","codeType":"CPT"},{"id":1765,"precertRequired":false,"billingCode":"28192","codeType":"CPT"},{"id":1766,"precertRequired":false,"billingCode":"28193","codeType":"CPT"},{"id":1876,"precertRequired":false,"billingCode":"28800","codeType":"CPT"},{"id":1877,"precertRequired":false,"billingCode":"28805","codeType":"CPT"},{"id":1878,"precertRequired":false,"billingCode":"28810","codeType":"CPT"},{"id":1879,"precertRequired":false,"billingCode":"28820","codeType":"CPT"},{"id":1880,"precertRequired":false,"billingCode":"28825","codeType":"CPT"},{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2567,"precertRequired":false,"billingCode":"36565","codeType":"CPT"},{"id":2568,"precertRequired":false,"billingCode":"36566","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2572,"precertRequired":false,"billingCode":"36571","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2674,"precertRequired":false,"billingCode":"38100","codeType":"CPT"},{"id":2675,"precertRequired":false,"billingCode":"38101","codeType":"CPT"},{"id":2676,"precertRequired":false,"billingCode":"38102","codeType":"CPT"},{"id":2677,"precertRequired":false,"billingCode":"38115","codeType":"CPT"},{"id":2678,"precertRequired":false,"billingCode":"38120","codeType":"CPT"},{"id":2682,"precertRequired":false,"billingCode":"38300","codeType":"CPT"},{"id":2683,"precertRequired":false,"billingCode":"38305","codeType":"CPT"},{"id":2684,"precertRequired":false,"billingCode":"38308","codeType":"CPT"},{"id":2685,"precertRequired":false,"billingCode":"38380","codeType":"CPT"},{"id":2686,"precertRequired":true,"billingCode":"38381","codeType":"CPT"},{"id":2687,"precertRequired":false,"billingCode":"38382","codeType":"CPT"},{"id":2688,"precertRequired":false,"billingCode":"38500","codeType":"CPT"},{"id":2689,"precertRequired":false,"billingCode":"38505","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2691,"precertRequired":false,"billingCode":"38520","codeType":"CPT"},{"id":2692,"precertRequired":false,"billingCode":"38525","codeType":"CPT"},{"id":2693,"precertRequired":false,"billingCode":"38530","codeType":"CPT"},{"id":2694,"precertRequired":false,"billingCode":"38542","codeType":"CPT"},{"id":2695,"precertRequired":false,"billingCode":"38550","codeType":"CPT"},{"id":2696,"precertRequired":false,"billingCode":"38555","codeType":"CPT"},{"id":2697,"precertRequired":false,"billingCode":"38562","codeType":"CPT"},{"id":2698,"precertRequired":false,"billingCode":"38564","codeType":"CPT"},{"id":2699,"precertRequired":false,"billingCode":"38570","codeType":"CPT"},{"id":2700,"precertRequired":false,"billingCode":"38571","codeType":"CPT"},{"id":2701,"precertRequired":false,"billingCode":"38572","codeType":"CPT"},{"id":2702,"precertRequired":false,"billingCode":"38573","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2704,"precertRequired":false,"billingCode":"38720","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2706,"precertRequired":false,"billingCode":"38740","codeType":"CPT"},{"id":2707,"precertRequired":false,"billingCode":"38745","codeType":"CPT"},{"id":2708,"precertRequired":false,"billingCode":"38746","codeType":"CPT"},{"id":2709,"precertRequired":false,"billingCode":"38747","codeType":"CPT"},{"id":2710,"precertRequired":false,"billingCode":"38760","codeType":"CPT"},{"id":2711,"precertRequired":false,"billingCode":"38765","codeType":"CPT"},{"id":2712,"precertRequired":false,"billingCode":"38770","codeType":"CPT"},{"id":2713,"precertRequired":false,"billingCode":"38780","codeType":"CPT"},{"id":2749,"precertRequired":false,"billingCode":"43117","codeType":"CPT"},{"id":2750,"precertRequired":false,"billingCode":"43118","codeType":"CPT"},{"id":2751,"precertRequired":false,"billingCode":"43121","codeType":"CPT"},{"id":2752,"precertRequired":false,"billingCode":"43122","codeType":"CPT"},{"id":2753,"precertRequired":false,"billingCode":"43123","codeType":"CPT"},{"id":2755,"precertRequired":false,"billingCode":"43130","codeType":"CPT"},{"id":2756,"precertRequired":false,"billingCode":"43135","codeType":"CPT"},{"id":2757,"precertRequired":false,"billingCode":"43180","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2819,"precertRequired":false,"billingCode":"43273","codeType":"CPT"},{"id":2825,"precertRequired":false,"billingCode":"43279","codeType":"CPT"},{"id":2826,"precertRequired":false,"billingCode":"43280","codeType":"CPT"},{"id":2827,"precertRequired":false,"billingCode":"43281","codeType":"CPT"},{"id":2828,"precertRequired":false,"billingCode":"43282","codeType":"CPT"},{"id":2829,"precertRequired":false,"billingCode":"43283","codeType":"CPT"},{"id":2830,"precertRequired":false,"billingCode":"43284","codeType":"CPT"},{"id":2831,"precertRequired":false,"billingCode":"43285","codeType":"CPT"},{"id":2832,"precertRequired":false,"billingCode":"43286","codeType":"CPT"},{"id":2833,"precertRequired":false,"billingCode":"43287","codeType":"CPT"},{"id":2834,"precertRequired":false,"billingCode":"43288","codeType":"CPT"},{"id":2836,"precertRequired":false,"billingCode":"43300","codeType":"CPT"},{"id":2837,"precertRequired":false,"billingCode":"43305","codeType":"CPT"},{"id":2838,"precertRequired":false,"billingCode":"43310","codeType":"CPT"},{"id":2839,"precertRequired":false,"billingCode":"43312","codeType":"CPT"},{"id":2840,"precertRequired":false,"billingCode":"43313","codeType":"CPT"},{"id":2841,"precertRequired":false,"billingCode":"43314","codeType":"CPT"},{"id":2842,"precertRequired":false,"billingCode":"43320","codeType":"CPT"},{"id":2843,"precertRequired":false,"billingCode":"43325","codeType":"CPT"},{"id":2844,"precertRequired":false,"billingCode":"43327","codeType":"CPT"},{"id":2845,"precertRequired":false,"billingCode":"43328","codeType":"CPT"},{"id":2846,"precertRequired":false,"billingCode":"43330","codeType":"CPT"},{"id":2847,"precertRequired":false,"billingCode":"43331","codeType":"CPT"},{"id":2854,"precertRequired":false,"billingCode":"43338","codeType":"CPT"},{"id":2855,"precertRequired":false,"billingCode":"43340","codeType":"CPT"},{"id":2856,"precertRequired":false,"billingCode":"43341","codeType":"CPT"},{"id":2857,"precertRequired":false,"billingCode":"43351","codeType":"CPT"},{"id":2858,"precertRequired":false,"billingCode":"43352","codeType":"CPT"},{"id":2859,"precertRequired":false,"billingCode":"43360","codeType":"CPT"},{"id":2860,"precertRequired":false,"billingCode":"43361","codeType":"CPT"},{"id":2861,"precertRequired":false,"billingCode":"43400","codeType":"CPT"},{"id":2862,"precertRequired":false,"billingCode":"43401","codeType":"CPT"},{"id":2863,"precertRequired":false,"billingCode":"43405","codeType":"CPT"},{"id":2864,"precertRequired":false,"billingCode":"43410","codeType":"CPT"},{"id":2865,"precertRequired":false,"billingCode":"43415","codeType":"CPT"},{"id":2866,"precertRequired":false,"billingCode":"43420","codeType":"CPT"},{"id":2867,"precertRequired":false,"billingCode":"43425","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":2869,"precertRequired":false,"billingCode":"43453","codeType":"CPT"},{"id":2870,"precertRequired":false,"billingCode":"43460","codeType":"CPT"},{"id":2871,"precertRequired":false,"billingCode":"43496","codeType":"CPT"},{"id":2873,"precertRequired":false,"billingCode":"43500","codeType":"CPT"},{"id":2874,"precertRequired":false,"billingCode":"43501","codeType":"CPT"},{"id":2875,"precertRequired":false,"billingCode":"43502","codeType":"CPT"},{"id":2876,"precertRequired":false,"billingCode":"43510","codeType":"CPT"},{"id":2877,"precertRequired":false,"billingCode":"43520","codeType":"CPT"},{"id":2878,"precertRequired":false,"billingCode":"43605","codeType":"CPT"},{"id":2879,"precertRequired":false,"billingCode":"43610","codeType":"CPT"},{"id":2880,"precertRequired":false,"billingCode":"43611","codeType":"CPT"},{"id":2881,"precertRequired":false,"billingCode":"43620","codeType":"CPT"},{"id":2882,"precertRequired":false,"billingCode":"43621","codeType":"CPT"},{"id":2883,"precertRequired":false,"billingCode":"43622","codeType":"CPT"},{"id":2884,"precertRequired":false,"billingCode":"43631","codeType":"CPT"},{"id":2885,"precertRequired":false,"billingCode":"43632","codeType":"CPT"},{"id":2886,"precertRequired":false,"billingCode":"43633","codeType":"CPT"},{"id":2887,"precertRequired":false,"billingCode":"43634","codeType":"CPT"},{"id":2888,"precertRequired":false,"billingCode":"43635","codeType":"CPT"},{"id":2889,"precertRequired":false,"billingCode":"43640","codeType":"CPT"},{"id":2890,"precertRequired":false,"billingCode":"43641","codeType":"CPT"},{"id":2891,"precertRequired":false,"billingCode":"43644","codeType":"CPT"},{"id":2892,"precertRequired":false,"billingCode":"43645","codeType":"CPT"},{"id":2893,"precertRequired":false,"billingCode":"43647","codeType":"CPT"},{"id":2894,"precertRequired":false,"billingCode":"43648","codeType":"CPT"},{"id":2895,"precertRequired":false,"billingCode":"43651","codeType":"CPT"},{"id":2896,"precertRequired":false,"billingCode":"43652","codeType":"CPT"},{"id":2897,"precertRequired":false,"billingCode":"43653","codeType":"CPT"},{"id":2898,"precertRequired":false,"billingCode":"43752","codeType":"CPT"},{"id":2899,"precertRequired":false,"billingCode":"43753","codeType":"CPT"},{"id":2900,"precertRequired":false,"billingCode":"43754","codeType":"CPT"},{"id":2901,"precertRequired":false,"billingCode":"43755","codeType":"CPT"},{"id":2902,"precertRequired":false,"billingCode":"43756","codeType":"CPT"},{"id":2903,"precertRequired":false,"billingCode":"43757","codeType":"CPT"},{"id":2904,"precertRequired":false,"billingCode":"43760","codeType":"CPT"},{"id":2905,"precertRequired":false,"billingCode":"43761","codeType":"CPT"},{"id":2912,"precertRequired":false,"billingCode":"43800","codeType":"CPT"},{"id":2913,"precertRequired":false,"billingCode":"43810","codeType":"CPT"},{"id":2914,"precertRequired":false,"billingCode":"43820","codeType":"CPT"},{"id":2915,"precertRequired":false,"billingCode":"43825","codeType":"CPT"},{"id":2916,"precertRequired":false,"billingCode":"43830","codeType":"CPT"},{"id":2917,"precertRequired":false,"billingCode":"43831","codeType":"CPT"},{"id":2918,"precertRequired":false,"billingCode":"43832","codeType":"CPT"},{"id":2919,"precertRequired":false,"billingCode":"43840","codeType":"CPT"},{"id":2926,"precertRequired":false,"billingCode":"43850","codeType":"CPT"},{"id":2927,"precertRequired":false,"billingCode":"43855","codeType":"CPT"},{"id":2928,"precertRequired":false,"billingCode":"43860","codeType":"CPT"},{"id":2929,"precertRequired":false,"billingCode":"43865","codeType":"CPT"},{"id":2930,"precertRequired":false,"billingCode":"43870","codeType":"CPT"},{"id":2931,"precertRequired":false,"billingCode":"43880","codeType":"CPT"},{"id":2934,"precertRequired":false,"billingCode":"43886","codeType":"CPT"},{"id":2935,"precertRequired":false,"billingCode":"43887","codeType":"CPT"},{"id":2936,"precertRequired":false,"billingCode":"43888","codeType":"CPT"},{"id":2937,"precertRequired":false,"billingCode":"44005","codeType":"CPT"},{"id":2938,"precertRequired":false,"billingCode":"44010","codeType":"CPT"},{"id":2939,"precertRequired":false,"billingCode":"44015","codeType":"CPT"},{"id":2940,"precertRequired":false,"billingCode":"44020","codeType":"CPT"},{"id":2941,"precertRequired":false,"billingCode":"44021","codeType":"CPT"},{"id":2942,"precertRequired":false,"billingCode":"44025","codeType":"CPT"},{"id":2943,"precertRequired":false,"billingCode":"44050","codeType":"CPT"},{"id":2944,"precertRequired":false,"billingCode":"44055","codeType":"CPT"},{"id":2945,"precertRequired":false,"billingCode":"44100","codeType":"CPT"},{"id":2946,"precertRequired":false,"billingCode":"44110","codeType":"CPT"},{"id":2947,"precertRequired":false,"billingCode":"44111","codeType":"CPT"},{"id":2948,"precertRequired":false,"billingCode":"44120","codeType":"CPT"},{"id":2949,"precertRequired":false,"billingCode":"44121","codeType":"CPT"},{"id":2950,"precertRequired":false,"billingCode":"44125","codeType":"CPT"},{"id":2951,"precertRequired":false,"billingCode":"44126","codeType":"CPT"},{"id":2952,"precertRequired":false,"billingCode":"44127","codeType":"CPT"},{"id":2953,"precertRequired":false,"billingCode":"44128","codeType":"CPT"},{"id":2954,"precertRequired":false,"billingCode":"44130","codeType":"CPT"},{"id":2960,"precertRequired":false,"billingCode":"44139","codeType":"CPT"},{"id":2961,"precertRequired":false,"billingCode":"44140","codeType":"CPT"},{"id":2962,"precertRequired":false,"billingCode":"44141","codeType":"CPT"},{"id":2963,"precertRequired":false,"billingCode":"44143","codeType":"CPT"},{"id":2964,"precertRequired":false,"billingCode":"44144","codeType":"CPT"},{"id":2965,"precertRequired":false,"billingCode":"44145","codeType":"CPT"},{"id":2966,"precertRequired":false,"billingCode":"44146","codeType":"CPT"},{"id":2967,"precertRequired":false,"billingCode":"44147","codeType":"CPT"},{"id":2968,"precertRequired":false,"billingCode":"44150","codeType":"CPT"},{"id":2969,"precertRequired":false,"billingCode":"44151","codeType":"CPT"},{"id":2970,"precertRequired":false,"billingCode":"44155","codeType":"CPT"},{"id":2971,"precertRequired":false,"billingCode":"44156","codeType":"CPT"},{"id":2972,"precertRequired":false,"billingCode":"44157","codeType":"CPT"},{"id":2973,"precertRequired":false,"billingCode":"44158","codeType":"CPT"},{"id":2974,"precertRequired":false,"billingCode":"44160","codeType":"CPT"},{"id":2975,"precertRequired":false,"billingCode":"44180","codeType":"CPT"},{"id":2976,"precertRequired":false,"billingCode":"44186","codeType":"CPT"},{"id":2977,"precertRequired":false,"billingCode":"44187","codeType":"CPT"},{"id":2978,"precertRequired":false,"billingCode":"44188","codeType":"CPT"},{"id":2979,"precertRequired":false,"billingCode":"44202","codeType":"CPT"},{"id":2980,"precertRequired":false,"billingCode":"44203","codeType":"CPT"},{"id":2981,"precertRequired":false,"billingCode":"44204","codeType":"CPT"},{"id":2982,"precertRequired":false,"billingCode":"44205","codeType":"CPT"},{"id":2983,"precertRequired":false,"billingCode":"44206","codeType":"CPT"},{"id":2984,"precertRequired":false,"billingCode":"44207","codeType":"CPT"},{"id":2985,"precertRequired":false,"billingCode":"44208","codeType":"CPT"},{"id":2986,"precertRequired":false,"billingCode":"44210","codeType":"CPT"},{"id":2987,"precertRequired":false,"billingCode":"44211","codeType":"CPT"},{"id":2988,"precertRequired":false,"billingCode":"44212","codeType":"CPT"},{"id":2989,"precertRequired":false,"billingCode":"44213","codeType":"CPT"},{"id":2990,"precertRequired":false,"billingCode":"44227","codeType":"CPT"},{"id":2991,"precertRequired":false,"billingCode":"44300","codeType":"CPT"},{"id":2992,"precertRequired":false,"billingCode":"44310","codeType":"CPT"},{"id":2993,"precertRequired":false,"billingCode":"44312","codeType":"CPT"},{"id":2994,"precertRequired":false,"billingCode":"44314","codeType":"CPT"},{"id":2995,"precertRequired":false,"billingCode":"44316","codeType":"CPT"},{"id":2996,"precertRequired":false,"billingCode":"44320","codeType":"CPT"},{"id":2997,"precertRequired":false,"billingCode":"44322","codeType":"CPT"},{"id":2998,"precertRequired":false,"billingCode":"44340","codeType":"CPT"},{"id":2999,"precertRequired":false,"billingCode":"44345","codeType":"CPT"},{"id":3000,"precertRequired":false,"billingCode":"44346","codeType":"CPT"},{"id":3015,"precertRequired":false,"billingCode":"44380","codeType":"CPT"},{"id":3016,"precertRequired":false,"billingCode":"44381","codeType":"CPT"},{"id":3017,"precertRequired":false,"billingCode":"44382","codeType":"CPT"},{"id":3018,"precertRequired":false,"billingCode":"44384","codeType":"CPT"},{"id":3019,"precertRequired":false,"billingCode":"44385","codeType":"CPT"},{"id":3020,"precertRequired":false,"billingCode":"44386","codeType":"CPT"},{"id":3035,"precertRequired":false,"billingCode":"44500","codeType":"CPT"},{"id":3036,"precertRequired":false,"billingCode":"44602","codeType":"CPT"},{"id":3037,"precertRequired":false,"billingCode":"44603","codeType":"CPT"},{"id":3038,"precertRequired":false,"billingCode":"44604","codeType":"CPT"},{"id":3039,"precertRequired":false,"billingCode":"44605","codeType":"CPT"},{"id":3040,"precertRequired":false,"billingCode":"44615","codeType":"CPT"},{"id":3041,"precertRequired":false,"billingCode":"44620","codeType":"CPT"},{"id":3042,"precertRequired":false,"billingCode":"44625","codeType":"CPT"},{"id":3043,"precertRequired":false,"billingCode":"44626","codeType":"CPT"},{"id":3044,"precertRequired":false,"billingCode":"44640","codeType":"CPT"},{"id":3045,"precertRequired":false,"billingCode":"44650","codeType":"CPT"},{"id":3046,"precertRequired":false,"billingCode":"44660","codeType":"CPT"},{"id":3047,"precertRequired":false,"billingCode":"44661","codeType":"CPT"},{"id":3048,"precertRequired":false,"billingCode":"44680","codeType":"CPT"},{"id":3049,"precertRequired":false,"billingCode":"44700","codeType":"CPT"},{"id":3050,"precertRequired":false,"billingCode":"44701","codeType":"CPT"},{"id":3056,"precertRequired":false,"billingCode":"44800","codeType":"CPT"},{"id":3057,"precertRequired":false,"billingCode":"44820","codeType":"CPT"},{"id":3058,"precertRequired":false,"billingCode":"44850","codeType":"CPT"},{"id":3059,"precertRequired":false,"billingCode":"44900","codeType":"CPT"},{"id":3060,"precertRequired":false,"billingCode":"44950","codeType":"CPT"},{"id":3061,"precertRequired":false,"billingCode":"44955","codeType":"CPT"},{"id":3062,"precertRequired":false,"billingCode":"44960","codeType":"CPT"},{"id":3063,"precertRequired":false,"billingCode":"44970","codeType":"CPT"},{"id":3064,"precertRequired":false,"billingCode":"45000","codeType":"CPT"},{"id":3065,"precertRequired":false,"billingCode":"45005","codeType":"CPT"},{"id":3066,"precertRequired":false,"billingCode":"45020","codeType":"CPT"},{"id":3067,"precertRequired":false,"billingCode":"45100","codeType":"CPT"},{"id":3068,"precertRequired":false,"billingCode":"45108","codeType":"CPT"},{"id":3080,"precertRequired":false,"billingCode":"45130","codeType":"CPT"},{"id":3081,"precertRequired":false,"billingCode":"45135","codeType":"CPT"},{"id":3082,"precertRequired":false,"billingCode":"45136","codeType":"CPT"},{"id":3083,"precertRequired":false,"billingCode":"45150","codeType":"CPT"},{"id":3084,"precertRequired":false,"billingCode":"45160","codeType":"CPT"},{"id":3085,"precertRequired":false,"billingCode":"45171","codeType":"CPT"},{"id":3086,"precertRequired":false,"billingCode":"45172","codeType":"CPT"},{"id":3087,"precertRequired":false,"billingCode":"45190","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3123,"precertRequired":false,"billingCode":"45388","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3129,"precertRequired":false,"billingCode":"45395","codeType":"CPT"},{"id":3130,"precertRequired":false,"billingCode":"45397","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"},{"id":3132,"precertRequired":false,"billingCode":"45400","codeType":"CPT"},{"id":3133,"precertRequired":false,"billingCode":"45402","codeType":"CPT"},{"id":3134,"precertRequired":false,"billingCode":"45500","codeType":"CPT"},{"id":3135,"precertRequired":false,"billingCode":"45505","codeType":"CPT"},{"id":3136,"precertRequired":false,"billingCode":"45520","codeType":"CPT"},{"id":3137,"precertRequired":false,"billingCode":"45540","codeType":"CPT"},{"id":3138,"precertRequired":false,"billingCode":"45541","codeType":"CPT"},{"id":3139,"precertRequired":false,"billingCode":"45550","codeType":"CPT"},{"id":3140,"precertRequired":false,"billingCode":"45560","codeType":"CPT"},{"id":3141,"precertRequired":false,"billingCode":"45562","codeType":"CPT"},{"id":3142,"precertRequired":false,"billingCode":"45563","codeType":"CPT"},{"id":3143,"precertRequired":false,"billingCode":"45800","codeType":"CPT"},{"id":3144,"precertRequired":false,"billingCode":"45805","codeType":"CPT"},{"id":3145,"precertRequired":false,"billingCode":"45820","codeType":"CPT"},{"id":3146,"precertRequired":false,"billingCode":"45825","codeType":"CPT"},{"id":3147,"precertRequired":false,"billingCode":"45900","codeType":"CPT"},{"id":3148,"precertRequired":false,"billingCode":"45905","codeType":"CPT"},{"id":3149,"precertRequired":false,"billingCode":"45910","codeType":"CPT"},{"id":3150,"precertRequired":false,"billingCode":"45915","codeType":"CPT"},{"id":3151,"precertRequired":false,"billingCode":"45990","codeType":"CPT"},{"id":3152,"precertRequired":false,"billingCode":"46020","codeType":"CPT"},{"id":3153,"precertRequired":false,"billingCode":"46030","codeType":"CPT"},{"id":3154,"precertRequired":false,"billingCode":"46040","codeType":"CPT"},{"id":3155,"precertRequired":false,"billingCode":"46045","codeType":"CPT"},{"id":3156,"precertRequired":false,"billingCode":"46050","codeType":"CPT"},{"id":3157,"precertRequired":false,"billingCode":"46060","codeType":"CPT"},{"id":3158,"precertRequired":false,"billingCode":"46080","codeType":"CPT"},{"id":3159,"precertRequired":false,"billingCode":"46083","codeType":"CPT"},{"id":3160,"precertRequired":false,"billingCode":"46200","codeType":"CPT"},{"id":3161,"precertRequired":false,"billingCode":"46220","codeType":"CPT"},{"id":3162,"precertRequired":false,"billingCode":"46221","codeType":"CPT"},{"id":3163,"precertRequired":false,"billingCode":"46230","codeType":"CPT"},{"id":3164,"precertRequired":false,"billingCode":"46250","codeType":"CPT"},{"id":3165,"precertRequired":false,"billingCode":"46255","codeType":"CPT"},{"id":3166,"precertRequired":false,"billingCode":"46257","codeType":"CPT"},{"id":3167,"precertRequired":false,"billingCode":"46258","codeType":"CPT"},{"id":3168,"precertRequired":false,"billingCode":"46260","codeType":"CPT"},{"id":3169,"precertRequired":false,"billingCode":"46261","codeType":"CPT"},{"id":3170,"precertRequired":false,"billingCode":"46262","codeType":"CPT"},{"id":3171,"precertRequired":false,"billingCode":"46270","codeType":"CPT"},{"id":3172,"precertRequired":false,"billingCode":"46275","codeType":"CPT"},{"id":3173,"precertRequired":false,"billingCode":"46280","codeType":"CPT"},{"id":3174,"precertRequired":false,"billingCode":"46285","codeType":"CPT"},{"id":3175,"precertRequired":false,"billingCode":"46288","codeType":"CPT"},{"id":3176,"precertRequired":false,"billingCode":"46320","codeType":"CPT"},{"id":3177,"precertRequired":false,"billingCode":"46500","codeType":"CPT"},{"id":3178,"precertRequired":false,"billingCode":"46505","codeType":"CPT"},{"id":3179,"precertRequired":false,"billingCode":"46600","codeType":"CPT"},{"id":3180,"precertRequired":false,"billingCode":"46601","codeType":"CPT"},{"id":3181,"precertRequired":false,"billingCode":"46604","codeType":"CPT"},{"id":3182,"precertRequired":false,"billingCode":"46606","codeType":"CPT"},{"id":3183,"precertRequired":false,"billingCode":"46607","codeType":"CPT"},{"id":3184,"precertRequired":false,"billingCode":"46608","codeType":"CPT"},{"id":3185,"precertRequired":false,"billingCode":"46610","codeType":"CPT"},{"id":3186,"precertRequired":false,"billingCode":"46611","codeType":"CPT"},{"id":3187,"precertRequired":false,"billingCode":"46612","codeType":"CPT"},{"id":3188,"precertRequired":false,"billingCode":"46614","codeType":"CPT"},{"id":3189,"precertRequired":false,"billingCode":"46615","codeType":"CPT"},{"id":3190,"precertRequired":false,"billingCode":"46700","codeType":"CPT"},{"id":3191,"precertRequired":false,"billingCode":"46706","codeType":"CPT"},{"id":3192,"precertRequired":false,"billingCode":"46707","codeType":"CPT"},{"id":3193,"precertRequired":false,"billingCode":"46710","codeType":"CPT"},{"id":3194,"precertRequired":false,"billingCode":"46712","codeType":"CPT"},{"id":3195,"precertRequired":false,"billingCode":"46715","codeType":"CPT"},{"id":3196,"precertRequired":false,"billingCode":"46716","codeType":"CPT"},{"id":3197,"precertRequired":false,"billingCode":"46730","codeType":"CPT"},{"id":3198,"precertRequired":false,"billingCode":"46735","codeType":"CPT"},{"id":3199,"precertRequired":false,"billingCode":"46740","codeType":"CPT"},{"id":3200,"precertRequired":false,"billingCode":"46742","codeType":"CPT"},{"id":3201,"precertRequired":false,"billingCode":"46744","codeType":"CPT"},{"id":3202,"precertRequired":false,"billingCode":"46746","codeType":"CPT"},{"id":3203,"precertRequired":false,"billingCode":"46747","codeType":"CPT"},{"id":3204,"precertRequired":false,"billingCode":"46748","codeType":"CPT"},{"id":3205,"precertRequired":false,"billingCode":"46750","codeType":"CPT"},{"id":3207,"precertRequired":false,"billingCode":"46753","codeType":"CPT"},{"id":3208,"precertRequired":false,"billingCode":"46754","codeType":"CPT"},{"id":3209,"precertRequired":false,"billingCode":"46760","codeType":"CPT"},{"id":3210,"precertRequired":false,"billingCode":"46761","codeType":"CPT"},{"id":3211,"precertRequired":false,"billingCode":"46762","codeType":"CPT"},{"id":3212,"precertRequired":false,"billingCode":"46900","codeType":"CPT"},{"id":3213,"precertRequired":false,"billingCode":"46910","codeType":"CPT"},{"id":3214,"precertRequired":false,"billingCode":"46917","codeType":"CPT"},{"id":3215,"precertRequired":false,"billingCode":"46922","codeType":"CPT"},{"id":3216,"precertRequired":false,"billingCode":"46924","codeType":"CPT"},{"id":3217,"precertRequired":false,"billingCode":"46930","codeType":"CPT"},{"id":3218,"precertRequired":false,"billingCode":"46940","codeType":"CPT"},{"id":3219,"precertRequired":false,"billingCode":"46942","codeType":"CPT"},{"id":3220,"precertRequired":false,"billingCode":"46945","codeType":"CPT"},{"id":3221,"precertRequired":false,"billingCode":"46946","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3226,"precertRequired":false,"billingCode":"47010","codeType":"CPT"},{"id":3227,"precertRequired":false,"billingCode":"47015","codeType":"CPT"},{"id":3228,"precertRequired":false,"billingCode":"47100","codeType":"CPT"},{"id":3243,"precertRequired":false,"billingCode":"47300","codeType":"CPT"},{"id":3244,"precertRequired":false,"billingCode":"47350","codeType":"CPT"},{"id":3245,"precertRequired":false,"billingCode":"47360","codeType":"CPT"},{"id":3246,"precertRequired":false,"billingCode":"47361","codeType":"CPT"},{"id":3247,"precertRequired":false,"billingCode":"47362","codeType":"CPT"},{"id":3248,"precertRequired":false,"billingCode":"47371","codeType":"CPT"},{"id":3249,"precertRequired":false,"billingCode":"47381","codeType":"CPT"},{"id":3251,"precertRequired":false,"billingCode":"47383","codeType":"CPT"},{"id":3252,"precertRequired":false,"billingCode":"47400","codeType":"CPT"},{"id":3253,"precertRequired":false,"billingCode":"47420","codeType":"CPT"},{"id":3254,"precertRequired":false,"billingCode":"47425","codeType":"CPT"},{"id":3255,"precertRequired":false,"billingCode":"47460","codeType":"CPT"},{"id":3257,"precertRequired":false,"billingCode":"47490","codeType":"CPT"},{"id":3258,"precertRequired":false,"billingCode":"47531","codeType":"CPT"},{"id":3259,"precertRequired":false,"billingCode":"47532","codeType":"CPT"},{"id":3260,"precertRequired":false,"billingCode":"47533","codeType":"CPT"},{"id":3261,"precertRequired":false,"billingCode":"47534","codeType":"CPT"},{"id":3262,"precertRequired":false,"billingCode":"47535","codeType":"CPT"},{"id":3263,"precertRequired":false,"billingCode":"47536","codeType":"CPT"},{"id":3264,"precertRequired":false,"billingCode":"47537","codeType":"CPT"},{"id":3265,"precertRequired":false,"billingCode":"47538","codeType":"CPT"},{"id":3266,"precertRequired":false,"billingCode":"47539","codeType":"CPT"},{"id":3267,"precertRequired":false,"billingCode":"47540","codeType":"CPT"},{"id":3268,"precertRequired":false,"billingCode":"47541","codeType":"CPT"},{"id":3269,"precertRequired":false,"billingCode":"47542","codeType":"CPT"},{"id":3270,"precertRequired":false,"billingCode":"47543","codeType":"CPT"},{"id":3271,"precertRequired":false,"billingCode":"47544","codeType":"CPT"},{"id":3272,"precertRequired":false,"billingCode":"47550","codeType":"CPT"},{"id":3273,"precertRequired":false,"billingCode":"47552","codeType":"CPT"},{"id":3274,"precertRequired":false,"billingCode":"47553","codeType":"CPT"},{"id":3275,"precertRequired":false,"billingCode":"47554","codeType":"CPT"},{"id":3276,"precertRequired":false,"billingCode":"47555","codeType":"CPT"},{"id":3277,"precertRequired":false,"billingCode":"47556","codeType":"CPT"},{"id":3278,"precertRequired":false,"billingCode":"47562","codeType":"CPT"},{"id":3279,"precertRequired":false,"billingCode":"47563","codeType":"CPT"},{"id":3280,"precertRequired":false,"billingCode":"47564","codeType":"CPT"},{"id":3281,"precertRequired":false,"billingCode":"47570","codeType":"CPT"},{"id":3282,"precertRequired":false,"billingCode":"47600","codeType":"CPT"},{"id":3283,"precertRequired":false,"billingCode":"47605","codeType":"CPT"},{"id":3284,"precertRequired":false,"billingCode":"47610","codeType":"CPT"},{"id":3285,"precertRequired":false,"billingCode":"47612","codeType":"CPT"},{"id":3286,"precertRequired":false,"billingCode":"47620","codeType":"CPT"},{"id":3287,"precertRequired":false,"billingCode":"47700","codeType":"CPT"},{"id":3288,"precertRequired":false,"billingCode":"47701","codeType":"CPT"},{"id":3289,"precertRequired":false,"billingCode":"47711","codeType":"CPT"},{"id":3290,"precertRequired":false,"billingCode":"47712","codeType":"CPT"},{"id":3291,"precertRequired":false,"billingCode":"47715","codeType":"CPT"},{"id":3292,"precertRequired":false,"billingCode":"47720","codeType":"CPT"},{"id":3293,"precertRequired":false,"billingCode":"47721","codeType":"CPT"},{"id":3294,"precertRequired":false,"billingCode":"47740","codeType":"CPT"},{"id":3295,"precertRequired":false,"billingCode":"47741","codeType":"CPT"},{"id":3296,"precertRequired":false,"billingCode":"47760","codeType":"CPT"},{"id":3297,"precertRequired":false,"billingCode":"47765","codeType":"CPT"},{"id":3298,"precertRequired":false,"billingCode":"47780","codeType":"CPT"},{"id":3299,"precertRequired":false,"billingCode":"47785","codeType":"CPT"},{"id":3300,"precertRequired":false,"billingCode":"47800","codeType":"CPT"},{"id":3301,"precertRequired":false,"billingCode":"47801","codeType":"CPT"},{"id":3302,"precertRequired":false,"billingCode":"47802","codeType":"CPT"},{"id":3303,"precertRequired":false,"billingCode":"48000","codeType":"CPT"},{"id":3304,"precertRequired":false,"billingCode":"48001","codeType":"CPT"},{"id":3305,"precertRequired":false,"billingCode":"48020","codeType":"CPT"},{"id":3306,"precertRequired":false,"billingCode":"48100","codeType":"CPT"},{"id":3307,"precertRequired":false,"billingCode":"48102","codeType":"CPT"},{"id":3308,"precertRequired":false,"billingCode":"48105","codeType":"CPT"},{"id":3309,"precertRequired":false,"billingCode":"48120","codeType":"CPT"},{"id":3310,"precertRequired":false,"billingCode":"48148","codeType":"CPT"},{"id":3311,"precertRequired":false,"billingCode":"48150","codeType":"CPT"},{"id":3312,"precertRequired":false,"billingCode":"48152","codeType":"CPT"},{"id":3313,"precertRequired":false,"billingCode":"48153","codeType":"CPT"},{"id":3314,"precertRequired":false,"billingCode":"48154","codeType":"CPT"},{"id":3315,"precertRequired":false,"billingCode":"48155","codeType":"CPT"},{"id":3316,"precertRequired":false,"billingCode":"48160","codeType":"CPT"},{"id":3317,"precertRequired":false,"billingCode":"48400","codeType":"CPT"},{"id":3318,"precertRequired":false,"billingCode":"48500","codeType":"CPT"},{"id":3319,"precertRequired":false,"billingCode":"48510","codeType":"CPT"},{"id":3320,"precertRequired":false,"billingCode":"48520","codeType":"CPT"},{"id":3321,"precertRequired":false,"billingCode":"48540","codeType":"CPT"},{"id":3322,"precertRequired":false,"billingCode":"48545","codeType":"CPT"},{"id":3323,"precertRequired":false,"billingCode":"48547","codeType":"CPT"},{"id":3324,"precertRequired":false,"billingCode":"48548","codeType":"CPT"},{"id":3328,"precertRequired":false,"billingCode":"48554","codeType":"CPT"},{"id":3330,"precertRequired":false,"billingCode":"49002","codeType":"CPT"},{"id":3331,"precertRequired":false,"billingCode":"49010","codeType":"CPT"},{"id":3332,"precertRequired":false,"billingCode":"49020","codeType":"CPT"},{"id":3333,"precertRequired":false,"billingCode":"49040","codeType":"CPT"},{"id":3334,"precertRequired":false,"billingCode":"49060","codeType":"CPT"},{"id":3335,"precertRequired":false,"billingCode":"49062","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3337,"precertRequired":false,"billingCode":"49083","codeType":"CPT"},{"id":3338,"precertRequired":false,"billingCode":"49084","codeType":"CPT"},{"id":3339,"precertRequired":false,"billingCode":"49180","codeType":"CPT"},{"id":3340,"precertRequired":false,"billingCode":"49185","codeType":"CPT"},{"id":3341,"precertRequired":false,"billingCode":"49203","codeType":"CPT"},{"id":3342,"precertRequired":false,"billingCode":"49204","codeType":"CPT"},{"id":3343,"precertRequired":false,"billingCode":"49205","codeType":"CPT"},{"id":3344,"precertRequired":false,"billingCode":"49220","codeType":"CPT"},{"id":3345,"precertRequired":false,"billingCode":"49250","codeType":"CPT"},{"id":3346,"precertRequired":false,"billingCode":"49255","codeType":"CPT"},{"id":3347,"precertRequired":false,"billingCode":"49320","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3350,"precertRequired":false,"billingCode":"49323","codeType":"CPT"},{"id":3351,"precertRequired":false,"billingCode":"49324","codeType":"CPT"},{"id":3352,"precertRequired":false,"billingCode":"49325","codeType":"CPT"},{"id":3353,"precertRequired":false,"billingCode":"49326","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3355,"precertRequired":false,"billingCode":"49329","codeType":"CPT"},{"id":3356,"precertRequired":false,"billingCode":"49400","codeType":"CPT"},{"id":3357,"precertRequired":false,"billingCode":"49402","codeType":"CPT"},{"id":3358,"precertRequired":false,"billingCode":"49405","codeType":"CPT"},{"id":3359,"precertRequired":false,"billingCode":"49406","codeType":"CPT"},{"id":3360,"precertRequired":false,"billingCode":"49407","codeType":"CPT"},{"id":3361,"precertRequired":false,"billingCode":"49411","codeType":"CPT"},{"id":3362,"precertRequired":false,"billingCode":"49412","codeType":"CPT"},{"id":3363,"precertRequired":false,"billingCode":"49418","codeType":"CPT"},{"id":3364,"precertRequired":false,"billingCode":"49419","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"},{"id":3368,"precertRequired":false,"billingCode":"49423","codeType":"CPT"},{"id":3369,"precertRequired":false,"billingCode":"49424","codeType":"CPT"},{"id":3370,"precertRequired":false,"billingCode":"49425","codeType":"CPT"},{"id":3371,"precertRequired":false,"billingCode":"49426","codeType":"CPT"},{"id":3372,"precertRequired":false,"billingCode":"49427","codeType":"CPT"},{"id":3373,"precertRequired":false,"billingCode":"49428","codeType":"CPT"},{"id":3374,"precertRequired":false,"billingCode":"49429","codeType":"CPT"},{"id":3375,"precertRequired":false,"billingCode":"49435","codeType":"CPT"},{"id":3376,"precertRequired":false,"billingCode":"49436","codeType":"CPT"},{"id":3377,"precertRequired":false,"billingCode":"49440","codeType":"CPT"},{"id":3378,"precertRequired":false,"billingCode":"49441","codeType":"CPT"},{"id":3379,"precertRequired":false,"billingCode":"49442","codeType":"CPT"},{"id":3380,"precertRequired":false,"billingCode":"49446","codeType":"CPT"},{"id":3381,"precertRequired":false,"billingCode":"49450","codeType":"CPT"},{"id":3382,"precertRequired":false,"billingCode":"49451","codeType":"CPT"},{"id":3383,"precertRequired":false,"billingCode":"49452","codeType":"CPT"},{"id":3384,"precertRequired":false,"billingCode":"49460","codeType":"CPT"},{"id":3385,"precertRequired":false,"billingCode":"49465","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3847,"precertRequired":false,"billingCode":"60512","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3849,"precertRequired":false,"billingCode":"60521","codeType":"CPT"},{"id":3850,"precertRequired":false,"billingCode":"60522","codeType":"CPT"},{"id":3851,"precertRequired":false,"billingCode":"60540","codeType":"CPT"},{"id":3852,"precertRequired":false,"billingCode":"60545","codeType":"CPT"},{"id":3853,"precertRequired":false,"billingCode":"60600","codeType":"CPT"},{"id":3854,"precertRequired":false,"billingCode":"60605","codeType":"CPT"},{"id":3855,"precertRequired":false,"billingCode":"60650","codeType":"CPT"},{"id":3857,"precertRequired":false,"billingCode":"61576","codeType":"CPT"},{"id":9527,"precertRequired":true,"billingCode":"47370","codeType":"CPT"},{"id":9556,"precertRequired":true,"billingCode":"50544","codeType":"CPT"},{"id":11876,"precertRequired":false,"billingCode":"49505","codeType":"CPT"},{"id":11877,"precertRequired":false,"billingCode":"49507","codeType":"CPT"},{"id":11878,"precertRequired":false,"billingCode":"49520","codeType":"CPT"},{"id":11879,"precertRequired":false,"billingCode":"49521","codeType":"CPT"},{"id":11880,"precertRequired":false,"billingCode":"49525","codeType":"CPT"},{"id":11881,"precertRequired":false,"billingCode":"49560","codeType":"CPT"},{"id":11882,"precertRequired":false,"billingCode":"49561","codeType":"CPT"},{"id":11883,"precertRequired":false,"billingCode":"49565","codeType":"CPT"},{"id":11884,"precertRequired":false,"billingCode":"49566","codeType":"CPT"},{"id":11885,"precertRequired":false,"billingCode":"49568","codeType":"CPT"},{"id":11886,"precertRequired":false,"billingCode":"49652","codeType":"CPT"},{"id":11887,"precertRequired":false,"billingCode":"49653","codeType":"CPT"},{"id":11888,"precertRequired":false,"billingCode":"49654","codeType":"CPT"},{"id":11889,"precertRequired":false,"billingCode":"49655","codeType":"CPT"},{"id":11890,"precertRequired":false,"billingCode":"49656","codeType":"CPT"},{"id":11891,"precertRequired":false,"billingCode":"49657","codeType":"CPT"},{"id":11892,"precertRequired":false,"billingCode":"50546","codeType":"CPT"},{"id":11893,"precertRequired":false,"billingCode":"50548","codeType":"CPT"},{"id":11894,"precertRequired":false,"billingCode":"50945","codeType":"CPT"},{"id":11895,"precertRequired":false,"billingCode":"54690","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2371,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":22,"precertRequired":false,"billingCode":"00192","codeType":"CPT"},{"id":24,"precertRequired":false,"billingCode":"00211","codeType":"CPT"},{"id":25,"precertRequired":false,"billingCode":"00212","codeType":"CPT"},{"id":26,"precertRequired":false,"billingCode":"00214","codeType":"CPT"},{"id":27,"precertRequired":false,"billingCode":"00215","codeType":"CPT"},{"id":28,"precertRequired":false,"billingCode":"00216","codeType":"CPT"},{"id":29,"precertRequired":false,"billingCode":"00218","codeType":"CPT"},{"id":30,"precertRequired":false,"billingCode":"00220","codeType":"CPT"},{"id":31,"precertRequired":false,"billingCode":"00222","codeType":"CPT"},{"id":37,"precertRequired":false,"billingCode":"00402","codeType":"CPT"},{"id":38,"precertRequired":false,"billingCode":"00404","codeType":"CPT"},{"id":39,"precertRequired":false,"billingCode":"00406","codeType":"CPT"},{"id":40,"precertRequired":false,"billingCode":"00410","codeType":"CPT"},{"id":44,"precertRequired":false,"billingCode":"00472","codeType":"CPT"},{"id":45,"precertRequired":false,"billingCode":"00474","codeType":"CPT"},{"id":46,"precertRequired":false,"billingCode":"00500","codeType":"CPT"},{"id":48,"precertRequired":false,"billingCode":"00522","codeType":"CPT"},{"id":49,"precertRequired":false,"billingCode":"00524","codeType":"CPT"},{"id":50,"precertRequired":false,"billingCode":"00528","codeType":"CPT"},{"id":51,"precertRequired":false,"billingCode":"00529","codeType":"CPT"},{"id":61,"precertRequired":false,"billingCode":"00550","codeType":"CPT"},{"id":70,"precertRequired":false,"billingCode":"00702","codeType":"CPT"},{"id":71,"precertRequired":false,"billingCode":"00730","codeType":"CPT"},{"id":73,"precertRequired":false,"billingCode":"00732","codeType":"CPT"},{"id":75,"precertRequired":false,"billingCode":"00752","codeType":"CPT"},{"id":76,"precertRequired":false,"billingCode":"00754","codeType":"CPT"},{"id":77,"precertRequired":false,"billingCode":"00756","codeType":"CPT"},{"id":78,"precertRequired":false,"billingCode":"00770","codeType":"CPT"},{"id":80,"precertRequired":false,"billingCode":"00792","codeType":"CPT"},{"id":81,"precertRequired":false,"billingCode":"00794","codeType":"CPT"},{"id":88,"precertRequired":false,"billingCode":"00813","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":91,"precertRequired":false,"billingCode":"00832","codeType":"CPT"},{"id":96,"precertRequired":false,"billingCode":"00844","codeType":"CPT"},{"id":104,"precertRequired":false,"billingCode":"00866","codeType":"CPT"},{"id":138,"precertRequired":false,"billingCode":"01120","codeType":"CPT"},{"id":140,"precertRequired":false,"billingCode":"01140","codeType":"CPT"},{"id":141,"precertRequired":false,"billingCode":"01150","codeType":"CPT"},{"id":144,"precertRequired":false,"billingCode":"01173","codeType":"CPT"},{"id":155,"precertRequired":false,"billingCode":"01250","codeType":"CPT"},{"id":156,"precertRequired":false,"billingCode":"01260","codeType":"CPT"},{"id":158,"precertRequired":false,"billingCode":"01272","codeType":"CPT"},{"id":159,"precertRequired":false,"billingCode":"01274","codeType":"CPT"},{"id":160,"precertRequired":false,"billingCode":"01320","codeType":"CPT"},{"id":174,"precertRequired":false,"billingCode":"01442","codeType":"CPT"},{"id":175,"precertRequired":false,"billingCode":"01444","codeType":"CPT"},{"id":8331,"precertRequired":false,"billingCode":"G9654","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":2372,"description":"Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5723,"precertRequired":false,"billingCode":"84445","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2373,"description":"Inpatient or observation admission for surgery/procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2374,"description":"Inpatient admission or observation status for complications related to the surgery/procedure ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2375,"description":"Follow-up visits for this episode of care relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":2431,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]}]}},{"Seoc":{"id":278,"seocKey":55,"name":"General Surgery PRCT_PRCT","seocId":"SSC_GENERAL SURGERY PRCT_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-03-2019","endDate":"05-21-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. Labs and pathology relevant to the referred condition on the consult\r\n5. Procedures relevant to the referred condition on the consult including but not limited to:  I&D, biopsy, lesion excision with repair, etc\r\n6. Anesthesia consultation related to the procedure\r\n7. Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)\r\n8. Inpatient or observation admission for surgery/procedure if indicated\r\n9. Inpatient admission or observation status for complications related to the surgery/procedure\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure\r\n10. Follow-up visits for this episode of care relevant to the referred condition on the consult\r\n11. Follow-up imaging as clinically indicated relevant to the referred condition on the consult\r\n12. Follow-up studies as clinically indicated relevant to the referred condition on the consult","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a  reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"SURGERY GENERAL","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"208600000X"}],"services":[{"id":1159,"description":" Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":1160,"description":"Diagnostic imaging relevant to the referred condition on the consult  ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4367,"precertRequired":false,"billingCode":"70015","codeType":"CPT"},{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4416,"precertRequired":false,"billingCode":"70545","codeType":"CPT"},{"id":4417,"precertRequired":false,"billingCode":"70546","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4424,"precertRequired":false,"billingCode":"70554","codeType":"CPT"},{"id":4425,"precertRequired":false,"billingCode":"70555","codeType":"CPT"},{"id":4426,"precertRequired":false,"billingCode":"70557","codeType":"CPT"},{"id":4427,"precertRequired":false,"billingCode":"70558","codeType":"CPT"},{"id":4428,"precertRequired":false,"billingCode":"70559","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4584,"precertRequired":false,"billingCode":"74190","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4605,"precertRequired":false,"billingCode":"74300","codeType":"CPT"},{"id":4606,"precertRequired":false,"billingCode":"74301","codeType":"CPT"},{"id":4607,"precertRequired":false,"billingCode":"74328","codeType":"CPT"},{"id":4608,"precertRequired":false,"billingCode":"74329","codeType":"CPT"},{"id":4609,"precertRequired":false,"billingCode":"74330","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4611,"precertRequired":false,"billingCode":"74355","codeType":"CPT"},{"id":4612,"precertRequired":false,"billingCode":"74360","codeType":"CPT"},{"id":4613,"precertRequired":false,"billingCode":"74363","codeType":"CPT"},{"id":4639,"precertRequired":false,"billingCode":"75600","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4661,"precertRequired":false,"billingCode":"75809","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4667,"precertRequired":false,"billingCode":"75831","codeType":"CPT"},{"id":4668,"precertRequired":false,"billingCode":"75833","codeType":"CPT"},{"id":4669,"precertRequired":false,"billingCode":"75840","codeType":"CPT"},{"id":4670,"precertRequired":false,"billingCode":"75842","codeType":"CPT"},{"id":4671,"precertRequired":false,"billingCode":"75860","codeType":"CPT"},{"id":4672,"precertRequired":false,"billingCode":"75870","codeType":"CPT"},{"id":4673,"precertRequired":false,"billingCode":"75872","codeType":"CPT"},{"id":4674,"precertRequired":false,"billingCode":"75880","codeType":"CPT"},{"id":4675,"precertRequired":false,"billingCode":"75885","codeType":"CPT"},{"id":4676,"precertRequired":false,"billingCode":"75887","codeType":"CPT"},{"id":4677,"precertRequired":false,"billingCode":"75889","codeType":"CPT"},{"id":4678,"precertRequired":false,"billingCode":"75891","codeType":"CPT"},{"id":4679,"precertRequired":false,"billingCode":"75893","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4682,"precertRequired":false,"billingCode":"75901","codeType":"CPT"},{"id":4683,"precertRequired":false,"billingCode":"75902","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4691,"precertRequired":false,"billingCode":"75989","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4693,"precertRequired":false,"billingCode":"76001","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4697,"precertRequired":false,"billingCode":"76100","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4700,"precertRequired":false,"billingCode":"76120","codeType":"CPT"},{"id":4701,"precertRequired":false,"billingCode":"76125","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4706,"precertRequired":false,"billingCode":"76390","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4726,"precertRequired":false,"billingCode":"76706","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4770,"precertRequired":false,"billingCode":"76970","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4784,"precertRequired":true,"billingCode":"77058","codeType":"CPT"},{"id":4785,"precertRequired":true,"billingCode":"77059","codeType":"CPT"},{"id":4792,"precertRequired":false,"billingCode":"77071","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4797,"precertRequired":false,"billingCode":"77077","codeType":"CPT"},{"id":4801,"precertRequired":false,"billingCode":"77084","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4910,"precertRequired":false,"billingCode":"78261","codeType":"CPT"},{"id":4918,"precertRequired":false,"billingCode":"78278","codeType":"CPT"},{"id":4919,"precertRequired":false,"billingCode":"78282","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4921,"precertRequired":false,"billingCode":"78291","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4930,"precertRequired":false,"billingCode":"78414","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4932,"precertRequired":false,"billingCode":"78445","codeType":"CPT"},{"id":4937,"precertRequired":false,"billingCode":"78456","codeType":"CPT"},{"id":4938,"precertRequired":false,"billingCode":"78457","codeType":"CPT"},{"id":4939,"precertRequired":false,"billingCode":"78458","codeType":"CPT"},{"id":4969,"precertRequired":false,"billingCode":"78660","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4986,"precertRequired":false,"billingCode":"78805","codeType":"CPT"},{"id":4987,"precertRequired":false,"billingCode":"78806","codeType":"CPT"},{"id":4988,"precertRequired":false,"billingCode":"78807","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"},{"id":4990,"precertRequired":false,"billingCode":"78811","codeType":"CPT"},{"id":4991,"precertRequired":false,"billingCode":"78812","codeType":"CPT"},{"id":4992,"precertRequired":false,"billingCode":"78813","codeType":"CPT"},{"id":4993,"precertRequired":false,"billingCode":"78814","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":4995,"precertRequired":false,"billingCode":"78816","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1161,"description":"Diagnostic studies relevant to the referred condition on the consult  ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4915,"precertRequired":false,"billingCode":"78270","codeType":"CPT"},{"id":4916,"precertRequired":false,"billingCode":"78271","codeType":"CPT"},{"id":4917,"precertRequired":false,"billingCode":"78272","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":1162,"description":"Labs and pathology relevant to the referred condition on the consult ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5140,"precertRequired":false,"billingCode":"80500","codeType":"CPT"},{"id":5141,"precertRequired":false,"billingCode":"80502","codeType":"CPT"},{"id":5340,"precertRequired":false,"billingCode":"81500","codeType":"CPT"},{"id":5341,"precertRequired":false,"billingCode":"81503","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5382,"precertRequired":false,"billingCode":"82105","codeType":"CPT"},{"id":5383,"precertRequired":false,"billingCode":"82106","codeType":"CPT"},{"id":5384,"precertRequired":false,"billingCode":"82107","codeType":"CPT"},{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5432,"precertRequired":false,"billingCode":"82378","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5586,"precertRequired":false,"billingCode":"83630","codeType":"CPT"},{"id":5587,"precertRequired":false,"billingCode":"83631","codeType":"CPT"},{"id":5668,"precertRequired":false,"billingCode":"84152","codeType":"CPT"},{"id":5669,"precertRequired":false,"billingCode":"84153","codeType":"CPT"},{"id":5670,"precertRequired":false,"billingCode":"84154","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5905,"precertRequired":false,"billingCode":"86300","codeType":"CPT"},{"id":5906,"precertRequired":false,"billingCode":"86301","codeType":"CPT"},{"id":5907,"precertRequired":false,"billingCode":"86304","codeType":"CPT"},{"id":6108,"precertRequired":false,"billingCode":"87045","codeType":"CPT"},{"id":6109,"precertRequired":false,"billingCode":"87046","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6112,"precertRequired":false,"billingCode":"87073","codeType":"CPT"},{"id":6143,"precertRequired":false,"billingCode":"87177","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6236,"precertRequired":false,"billingCode":"87505","codeType":"CPT"},{"id":6237,"precertRequired":false,"billingCode":"87506","codeType":"CPT"},{"id":6238,"precertRequired":false,"billingCode":"87507","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6411,"precertRequired":false,"billingCode":"88314","codeType":"CPT"},{"id":6412,"precertRequired":false,"billingCode":"88319","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6414,"precertRequired":false,"billingCode":"88323","codeType":"CPT"},{"id":6415,"precertRequired":false,"billingCode":"88325","codeType":"CPT"},{"id":6416,"precertRequired":false,"billingCode":"88329","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6419,"precertRequired":false,"billingCode":"88333","codeType":"CPT"},{"id":6420,"precertRequired":false,"billingCode":"88334","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6423,"precertRequired":false,"billingCode":"88344","codeType":"CPT"},{"id":6424,"precertRequired":false,"billingCode":"88346","codeType":"CPT"},{"id":6425,"precertRequired":false,"billingCode":"88348","codeType":"CPT"},{"id":6426,"precertRequired":false,"billingCode":"88350","codeType":"CPT"},{"id":6427,"precertRequired":false,"billingCode":"88355","codeType":"CPT"},{"id":6428,"precertRequired":false,"billingCode":"88356","codeType":"CPT"},{"id":6429,"precertRequired":false,"billingCode":"88358","codeType":"CPT"},{"id":6430,"precertRequired":false,"billingCode":"88360","codeType":"CPT"},{"id":6431,"precertRequired":false,"billingCode":"88361","codeType":"CPT"},{"id":6432,"precertRequired":false,"billingCode":"88362","codeType":"CPT"},{"id":6433,"precertRequired":false,"billingCode":"88363","codeType":"CPT"},{"id":6434,"precertRequired":false,"billingCode":"88364","codeType":"CPT"},{"id":6435,"precertRequired":false,"billingCode":"88365","codeType":"CPT"},{"id":6436,"precertRequired":false,"billingCode":"88366","codeType":"CPT"},{"id":6437,"precertRequired":false,"billingCode":"88367","codeType":"CPT"},{"id":6438,"precertRequired":false,"billingCode":"88368","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"},{"id":6440,"precertRequired":false,"billingCode":"88371","codeType":"CPT"},{"id":6441,"precertRequired":false,"billingCode":"88372","codeType":"CPT"},{"id":6442,"precertRequired":false,"billingCode":"88373","codeType":"CPT"},{"id":6443,"precertRequired":false,"billingCode":"88374","codeType":"CPT"},{"id":6444,"precertRequired":false,"billingCode":"88375","codeType":"CPT"},{"id":6445,"precertRequired":false,"billingCode":"88377","codeType":"CPT"},{"id":6446,"precertRequired":false,"billingCode":"88380","codeType":"CPT"},{"id":6447,"precertRequired":false,"billingCode":"88381","codeType":"CPT"},{"id":6448,"precertRequired":false,"billingCode":"88387","codeType":"CPT"},{"id":6449,"precertRequired":false,"billingCode":"88388","codeType":"CPT"},{"id":6456,"precertRequired":false,"billingCode":"89049","codeType":"CPT"},{"id":6457,"precertRequired":false,"billingCode":"89050","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":8206,"precertRequired":false,"billingCode":"G0416","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1163,"description":"Procedures relevant to the referred condition on the consult including but not limited to:  I&D, biopsy, lesion excision with repair, etc.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":222,"precertRequired":false,"billingCode":"10022","codeType":"CPT"},{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":243,"precertRequired":false,"billingCode":"11010","codeType":"CPT"},{"id":244,"precertRequired":false,"billingCode":"11011","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":248,"precertRequired":false,"billingCode":"11044","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":250,"precertRequired":false,"billingCode":"11046","codeType":"CPT"},{"id":251,"precertRequired":false,"billingCode":"11047","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":329,"precertRequired":false,"billingCode":"11960","codeType":"CPT"},{"id":330,"precertRequired":false,"billingCode":"11970","codeType":"CPT"},{"id":331,"precertRequired":false,"billingCode":"11971","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":374,"precertRequired":false,"billingCode":"13120","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":383,"precertRequired":false,"billingCode":"13160","codeType":"CPT"},{"id":384,"precertRequired":false,"billingCode":"14000","codeType":"CPT"},{"id":385,"precertRequired":false,"billingCode":"14001","codeType":"CPT"},{"id":386,"precertRequired":false,"billingCode":"14020","codeType":"CPT"},{"id":387,"precertRequired":false,"billingCode":"14021","codeType":"CPT"},{"id":388,"precertRequired":true,"billingCode":"14040","codeType":"CPT"},{"id":389,"precertRequired":false,"billingCode":"14041","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":392,"precertRequired":true,"billingCode":"14301","codeType":"CPT"},{"id":393,"precertRequired":false,"billingCode":"14302","codeType":"CPT"},{"id":395,"precertRequired":false,"billingCode":"15040","codeType":"CPT"},{"id":396,"precertRequired":false,"billingCode":"15050","codeType":"CPT"},{"id":397,"precertRequired":false,"billingCode":"15150","codeType":"CPT"},{"id":398,"precertRequired":false,"billingCode":"15151","codeType":"CPT"},{"id":399,"precertRequired":false,"billingCode":"15155","codeType":"CPT"},{"id":400,"precertRequired":false,"billingCode":"15156","codeType":"CPT"},{"id":401,"precertRequired":false,"billingCode":"15157","codeType":"CPT"},{"id":402,"precertRequired":false,"billingCode":"15200","codeType":"CPT"},{"id":403,"precertRequired":false,"billingCode":"15201","codeType":"CPT"},{"id":404,"precertRequired":false,"billingCode":"15220","codeType":"CPT"},{"id":405,"precertRequired":false,"billingCode":"15221","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":410,"precertRequired":false,"billingCode":"15271","codeType":"CPT"},{"id":411,"precertRequired":false,"billingCode":"15272","codeType":"CPT"},{"id":412,"precertRequired":false,"billingCode":"15273","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":415,"precertRequired":false,"billingCode":"15570","codeType":"CPT"},{"id":416,"precertRequired":false,"billingCode":"15572","codeType":"CPT"},{"id":417,"precertRequired":false,"billingCode":"15574","codeType":"CPT"},{"id":418,"precertRequired":false,"billingCode":"15576","codeType":"CPT"},{"id":419,"precertRequired":false,"billingCode":"15600","codeType":"CPT"},{"id":420,"precertRequired":false,"billingCode":"15610","codeType":"CPT"},{"id":421,"precertRequired":false,"billingCode":"15620","codeType":"CPT"},{"id":422,"precertRequired":false,"billingCode":"15630","codeType":"CPT"},{"id":423,"precertRequired":false,"billingCode":"15650","codeType":"CPT"},{"id":424,"precertRequired":false,"billingCode":"15730","codeType":"CPT"},{"id":425,"precertRequired":false,"billingCode":"15731","codeType":"CPT"},{"id":426,"precertRequired":false,"billingCode":"15733","codeType":"CPT"},{"id":427,"precertRequired":false,"billingCode":"15734","codeType":"CPT"},{"id":428,"precertRequired":false,"billingCode":"15736","codeType":"CPT"},{"id":429,"precertRequired":false,"billingCode":"15738","codeType":"CPT"},{"id":430,"precertRequired":false,"billingCode":"15740","codeType":"CPT"},{"id":431,"precertRequired":false,"billingCode":"15750","codeType":"CPT"},{"id":432,"precertRequired":false,"billingCode":"15756","codeType":"CPT"},{"id":433,"precertRequired":false,"billingCode":"15757","codeType":"CPT"},{"id":434,"precertRequired":false,"billingCode":"15758","codeType":"CPT"},{"id":435,"precertRequired":false,"billingCode":"15760","codeType":"CPT"},{"id":436,"precertRequired":false,"billingCode":"15770","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":443,"precertRequired":false,"billingCode":"15850","codeType":"CPT"},{"id":444,"precertRequired":false,"billingCode":"15852","codeType":"CPT"},{"id":445,"precertRequired":false,"billingCode":"15860","codeType":"CPT"},{"id":446,"precertRequired":false,"billingCode":"15920","codeType":"CPT"},{"id":447,"precertRequired":false,"billingCode":"15922","codeType":"CPT"},{"id":448,"precertRequired":false,"billingCode":"15931","codeType":"CPT"},{"id":449,"precertRequired":false,"billingCode":"15933","codeType":"CPT"},{"id":450,"precertRequired":false,"billingCode":"15934","codeType":"CPT"},{"id":451,"precertRequired":false,"billingCode":"15935","codeType":"CPT"},{"id":452,"precertRequired":false,"billingCode":"15936","codeType":"CPT"},{"id":453,"precertRequired":false,"billingCode":"15937","codeType":"CPT"},{"id":454,"precertRequired":false,"billingCode":"15940","codeType":"CPT"},{"id":455,"precertRequired":false,"billingCode":"15941","codeType":"CPT"},{"id":456,"precertRequired":false,"billingCode":"15944","codeType":"CPT"},{"id":457,"precertRequired":false,"billingCode":"15945","codeType":"CPT"},{"id":458,"precertRequired":false,"billingCode":"15946","codeType":"CPT"},{"id":459,"precertRequired":false,"billingCode":"15950","codeType":"CPT"},{"id":460,"precertRequired":false,"billingCode":"15951","codeType":"CPT"},{"id":461,"precertRequired":false,"billingCode":"15952","codeType":"CPT"},{"id":462,"precertRequired":false,"billingCode":"15953","codeType":"CPT"},{"id":463,"precertRequired":false,"billingCode":"15956","codeType":"CPT"},{"id":464,"precertRequired":false,"billingCode":"15958","codeType":"CPT"},{"id":465,"precertRequired":false,"billingCode":"16000","codeType":"CPT"},{"id":466,"precertRequired":false,"billingCode":"16020","codeType":"CPT"},{"id":467,"precertRequired":false,"billingCode":"16025","codeType":"CPT"},{"id":468,"precertRequired":false,"billingCode":"16030","codeType":"CPT"},{"id":469,"precertRequired":false,"billingCode":"16035","codeType":"CPT"},{"id":470,"precertRequired":false,"billingCode":"16036","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":474,"precertRequired":false,"billingCode":"17106","codeType":"CPT"},{"id":475,"precertRequired":false,"billingCode":"17107","codeType":"CPT"},{"id":476,"precertRequired":false,"billingCode":"17108","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":503,"precertRequired":false,"billingCode":"19000","codeType":"CPT"},{"id":504,"precertRequired":false,"billingCode":"19001","codeType":"CPT"},{"id":505,"precertRequired":false,"billingCode":"19020","codeType":"CPT"},{"id":506,"precertRequired":false,"billingCode":"19030","codeType":"CPT"},{"id":507,"precertRequired":false,"billingCode":"19081","codeType":"CPT"},{"id":508,"precertRequired":false,"billingCode":"19082","codeType":"CPT"},{"id":509,"precertRequired":false,"billingCode":"19083","codeType":"CPT"},{"id":510,"precertRequired":false,"billingCode":"19084","codeType":"CPT"},{"id":511,"precertRequired":false,"billingCode":"19085","codeType":"CPT"},{"id":512,"precertRequired":false,"billingCode":"19086","codeType":"CPT"},{"id":513,"precertRequired":false,"billingCode":"19100","codeType":"CPT"},{"id":514,"precertRequired":false,"billingCode":"19101","codeType":"CPT"},{"id":515,"precertRequired":false,"billingCode":"19105","codeType":"CPT"},{"id":516,"precertRequired":false,"billingCode":"19120","codeType":"CPT"},{"id":517,"precertRequired":false,"billingCode":"19125","codeType":"CPT"},{"id":518,"precertRequired":false,"billingCode":"19126","codeType":"CPT"},{"id":519,"precertRequired":false,"billingCode":"19260","codeType":"CPT"},{"id":522,"precertRequired":false,"billingCode":"19281","codeType":"CPT"},{"id":523,"precertRequired":false,"billingCode":"19282","codeType":"CPT"},{"id":524,"precertRequired":false,"billingCode":"19283","codeType":"CPT"},{"id":525,"precertRequired":false,"billingCode":"19284","codeType":"CPT"},{"id":526,"precertRequired":false,"billingCode":"19285","codeType":"CPT"},{"id":527,"precertRequired":false,"billingCode":"19286","codeType":"CPT"},{"id":528,"precertRequired":false,"billingCode":"19287","codeType":"CPT"},{"id":529,"precertRequired":false,"billingCode":"19288","codeType":"CPT"},{"id":542,"precertRequired":false,"billingCode":"20005","codeType":"CPT"},{"id":543,"precertRequired":false,"billingCode":"20100","codeType":"CPT"},{"id":544,"precertRequired":false,"billingCode":"20101","codeType":"CPT"},{"id":545,"precertRequired":false,"billingCode":"20102","codeType":"CPT"},{"id":546,"precertRequired":false,"billingCode":"20103","codeType":"CPT"},{"id":547,"precertRequired":false,"billingCode":"20150","codeType":"CPT"},{"id":548,"precertRequired":false,"billingCode":"20200","codeType":"CPT"},{"id":549,"precertRequired":false,"billingCode":"20205","codeType":"CPT"},{"id":550,"precertRequired":false,"billingCode":"20206","codeType":"CPT"},{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":552,"precertRequired":false,"billingCode":"20225","codeType":"CPT"},{"id":553,"precertRequired":false,"billingCode":"20240","codeType":"CPT"},{"id":554,"precertRequired":false,"billingCode":"20245","codeType":"CPT"},{"id":555,"precertRequired":true,"billingCode":"20250","codeType":"CPT"},{"id":556,"precertRequired":true,"billingCode":"20251","codeType":"CPT"},{"id":557,"precertRequired":false,"billingCode":"20500","codeType":"CPT"},{"id":558,"precertRequired":false,"billingCode":"20501","codeType":"CPT"},{"id":559,"precertRequired":false,"billingCode":"20520","codeType":"CPT"},{"id":560,"precertRequired":false,"billingCode":"20525","codeType":"CPT"},{"id":562,"precertRequired":true,"billingCode":"20527","codeType":"CPT"},{"id":563,"precertRequired":true,"billingCode":"20550","codeType":"CPT"},{"id":564,"precertRequired":true,"billingCode":"20551","codeType":"CPT"},{"id":567,"precertRequired":false,"billingCode":"20555","codeType":"CPT"},{"id":582,"precertRequired":false,"billingCode":"20665","codeType":"CPT"},{"id":583,"precertRequired":false,"billingCode":"20670","codeType":"CPT"},{"id":584,"precertRequired":false,"billingCode":"20680","codeType":"CPT"},{"id":591,"precertRequired":false,"billingCode":"20900","codeType":"CPT"},{"id":592,"precertRequired":false,"billingCode":"20902","codeType":"CPT"},{"id":593,"precertRequired":false,"billingCode":"20910","codeType":"CPT"},{"id":594,"precertRequired":false,"billingCode":"20912","codeType":"CPT"},{"id":595,"precertRequired":false,"billingCode":"20920","codeType":"CPT"},{"id":596,"precertRequired":false,"billingCode":"20922","codeType":"CPT"},{"id":597,"precertRequired":false,"billingCode":"20924","codeType":"CPT"},{"id":598,"precertRequired":false,"billingCode":"20926","codeType":"CPT"},{"id":600,"precertRequired":false,"billingCode":"20950","codeType":"CPT"},{"id":609,"precertRequired":false,"billingCode":"20982","codeType":"CPT"},{"id":610,"precertRequired":false,"billingCode":"20983","codeType":"CPT"},{"id":611,"precertRequired":false,"billingCode":"20985","codeType":"CPT"},{"id":723,"precertRequired":false,"billingCode":"21501","codeType":"CPT"},{"id":724,"precertRequired":false,"billingCode":"21502","codeType":"CPT"},{"id":725,"precertRequired":false,"billingCode":"21510","codeType":"CPT"},{"id":726,"precertRequired":true,"billingCode":"21550","codeType":"CPT"},{"id":727,"precertRequired":true,"billingCode":"21552","codeType":"CPT"},{"id":728,"precertRequired":true,"billingCode":"21554","codeType":"CPT"},{"id":729,"precertRequired":true,"billingCode":"21555","codeType":"CPT"},{"id":730,"precertRequired":true,"billingCode":"21556","codeType":"CPT"},{"id":731,"precertRequired":true,"billingCode":"21557","codeType":"CPT"},{"id":732,"precertRequired":true,"billingCode":"21558","codeType":"CPT"},{"id":733,"precertRequired":true,"billingCode":"21600","codeType":"CPT"},{"id":734,"precertRequired":true,"billingCode":"21610","codeType":"CPT"},{"id":735,"precertRequired":true,"billingCode":"21615","codeType":"CPT"},{"id":736,"precertRequired":true,"billingCode":"21616","codeType":"CPT"},{"id":737,"precertRequired":true,"billingCode":"21620","codeType":"CPT"},{"id":738,"precertRequired":true,"billingCode":"21627","codeType":"CPT"},{"id":739,"precertRequired":true,"billingCode":"21630","codeType":"CPT"},{"id":740,"precertRequired":true,"billingCode":"21632","codeType":"CPT"},{"id":741,"precertRequired":false,"billingCode":"21685","codeType":"CPT"},{"id":742,"precertRequired":true,"billingCode":"21700","codeType":"CPT"},{"id":743,"precertRequired":true,"billingCode":"21705","codeType":"CPT"},{"id":744,"precertRequired":true,"billingCode":"21720","codeType":"CPT"},{"id":745,"precertRequired":true,"billingCode":"21725","codeType":"CPT"},{"id":749,"precertRequired":true,"billingCode":"21750","codeType":"CPT"},{"id":750,"precertRequired":true,"billingCode":"21811","codeType":"CPT"},{"id":751,"precertRequired":true,"billingCode":"21812","codeType":"CPT"},{"id":752,"precertRequired":true,"billingCode":"21813","codeType":"CPT"},{"id":755,"precertRequired":false,"billingCode":"21920","codeType":"CPT"},{"id":756,"precertRequired":false,"billingCode":"21925","codeType":"CPT"},{"id":757,"precertRequired":false,"billingCode":"21930","codeType":"CPT"},{"id":758,"precertRequired":false,"billingCode":"21931","codeType":"CPT"},{"id":759,"precertRequired":false,"billingCode":"21932","codeType":"CPT"},{"id":760,"precertRequired":false,"billingCode":"21933","codeType":"CPT"},{"id":761,"precertRequired":false,"billingCode":"21935","codeType":"CPT"},{"id":762,"precertRequired":false,"billingCode":"21936","codeType":"CPT"},{"id":763,"precertRequired":true,"billingCode":"22010","codeType":"CPT"},{"id":764,"precertRequired":false,"billingCode":"22015","codeType":"CPT"},{"id":775,"precertRequired":false,"billingCode":"22900","codeType":"CPT"},{"id":776,"precertRequired":false,"billingCode":"22901","codeType":"CPT"},{"id":777,"precertRequired":false,"billingCode":"22902","codeType":"CPT"},{"id":778,"precertRequired":false,"billingCode":"22903","codeType":"CPT"},{"id":779,"precertRequired":false,"billingCode":"22904","codeType":"CPT"},{"id":780,"precertRequired":false,"billingCode":"22905","codeType":"CPT"},{"id":783,"precertRequired":false,"billingCode":"23030","codeType":"CPT"},{"id":784,"precertRequired":false,"billingCode":"23031","codeType":"CPT"},{"id":785,"precertRequired":false,"billingCode":"23035","codeType":"CPT"},{"id":788,"precertRequired":false,"billingCode":"23065","codeType":"CPT"},{"id":789,"precertRequired":false,"billingCode":"23066","codeType":"CPT"},{"id":790,"precertRequired":false,"billingCode":"23071","codeType":"CPT"},{"id":791,"precertRequired":false,"billingCode":"23073","codeType":"CPT"},{"id":792,"precertRequired":false,"billingCode":"23075","codeType":"CPT"},{"id":793,"precertRequired":false,"billingCode":"23076","codeType":"CPT"},{"id":794,"precertRequired":false,"billingCode":"23077","codeType":"CPT"},{"id":795,"precertRequired":false,"billingCode":"23078","codeType":"CPT"},{"id":885,"precertRequired":false,"billingCode":"23930","codeType":"CPT"},{"id":886,"precertRequired":false,"billingCode":"23931","codeType":"CPT"},{"id":887,"precertRequired":false,"billingCode":"23935","codeType":"CPT"},{"id":890,"precertRequired":false,"billingCode":"24065","codeType":"CPT"},{"id":891,"precertRequired":false,"billingCode":"24066","codeType":"CPT"},{"id":892,"precertRequired":false,"billingCode":"24071","codeType":"CPT"},{"id":893,"precertRequired":false,"billingCode":"24073","codeType":"CPT"},{"id":894,"precertRequired":false,"billingCode":"24075","codeType":"CPT"},{"id":895,"precertRequired":false,"billingCode":"24076","codeType":"CPT"},{"id":896,"precertRequired":false,"billingCode":"24077","codeType":"CPT"},{"id":897,"precertRequired":false,"billingCode":"24079","codeType":"CPT"},{"id":921,"precertRequired":false,"billingCode":"24200","codeType":"CPT"},{"id":922,"precertRequired":false,"billingCode":"24201","codeType":"CPT"},{"id":992,"precertRequired":false,"billingCode":"24900","codeType":"CPT"},{"id":993,"precertRequired":false,"billingCode":"24920","codeType":"CPT"},{"id":994,"precertRequired":false,"billingCode":"24925","codeType":"CPT"},{"id":995,"precertRequired":false,"billingCode":"24930","codeType":"CPT"},{"id":996,"precertRequired":false,"billingCode":"24931","codeType":"CPT"},{"id":997,"precertRequired":false,"billingCode":"24935","codeType":"CPT"},{"id":1001,"precertRequired":false,"billingCode":"25020","codeType":"CPT"},{"id":1002,"precertRequired":false,"billingCode":"25023","codeType":"CPT"},{"id":1003,"precertRequired":false,"billingCode":"25024","codeType":"CPT"},{"id":1004,"precertRequired":false,"billingCode":"25025","codeType":"CPT"},{"id":1005,"precertRequired":false,"billingCode":"25028","codeType":"CPT"},{"id":1006,"precertRequired":false,"billingCode":"25031","codeType":"CPT"},{"id":1007,"precertRequired":false,"billingCode":"25035","codeType":"CPT"},{"id":1008,"precertRequired":false,"billingCode":"25040","codeType":"CPT"},{"id":1009,"precertRequired":false,"billingCode":"25065","codeType":"CPT"},{"id":1010,"precertRequired":false,"billingCode":"25066","codeType":"CPT"},{"id":1011,"precertRequired":false,"billingCode":"25071","codeType":"CPT"},{"id":1012,"precertRequired":false,"billingCode":"25073","codeType":"CPT"},{"id":1013,"precertRequired":false,"billingCode":"25075","codeType":"CPT"},{"id":1014,"precertRequired":false,"billingCode":"25076","codeType":"CPT"},{"id":1015,"precertRequired":false,"billingCode":"25077","codeType":"CPT"},{"id":1016,"precertRequired":false,"billingCode":"25078","codeType":"CPT"},{"id":1145,"precertRequired":false,"billingCode":"25900","codeType":"CPT"},{"id":1146,"precertRequired":false,"billingCode":"25905","codeType":"CPT"},{"id":1147,"precertRequired":false,"billingCode":"25907","codeType":"CPT"},{"id":1148,"precertRequired":false,"billingCode":"25909","codeType":"CPT"},{"id":1153,"precertRequired":false,"billingCode":"25927","codeType":"CPT"},{"id":1154,"precertRequired":false,"billingCode":"25929","codeType":"CPT"},{"id":1155,"precertRequired":false,"billingCode":"25931","codeType":"CPT"},{"id":1156,"precertRequired":false,"billingCode":"26010","codeType":"CPT"},{"id":1157,"precertRequired":false,"billingCode":"26011","codeType":"CPT"},{"id":1158,"precertRequired":false,"billingCode":"26020","codeType":"CPT"},{"id":1159,"precertRequired":false,"billingCode":"26025","codeType":"CPT"},{"id":1160,"precertRequired":false,"billingCode":"26030","codeType":"CPT"},{"id":1161,"precertRequired":false,"billingCode":"26034","codeType":"CPT"},{"id":1162,"precertRequired":false,"billingCode":"26035","codeType":"CPT"},{"id":1163,"precertRequired":false,"billingCode":"26037","codeType":"CPT"},{"id":1164,"precertRequired":false,"billingCode":"26040","codeType":"CPT"},{"id":1165,"precertRequired":false,"billingCode":"26045","codeType":"CPT"},{"id":1174,"precertRequired":false,"billingCode":"26111","codeType":"CPT"},{"id":1175,"precertRequired":false,"billingCode":"26113","codeType":"CPT"},{"id":1176,"precertRequired":false,"billingCode":"26115","codeType":"CPT"},{"id":1177,"precertRequired":false,"billingCode":"26116","codeType":"CPT"},{"id":1178,"precertRequired":false,"billingCode":"26117","codeType":"CPT"},{"id":1179,"precertRequired":false,"billingCode":"26118","codeType":"CPT"},{"id":1180,"precertRequired":false,"billingCode":"26121","codeType":"CPT"},{"id":1181,"precertRequired":false,"billingCode":"26123","codeType":"CPT"},{"id":1182,"precertRequired":false,"billingCode":"26125","codeType":"CPT"},{"id":1326,"precertRequired":false,"billingCode":"26910","codeType":"CPT"},{"id":1327,"precertRequired":false,"billingCode":"26951","codeType":"CPT"},{"id":1328,"precertRequired":false,"billingCode":"26952","codeType":"CPT"},{"id":1329,"precertRequired":false,"billingCode":"26990","codeType":"CPT"},{"id":1330,"precertRequired":false,"billingCode":"26991","codeType":"CPT"},{"id":1331,"precertRequired":false,"billingCode":"26992","codeType":"CPT"},{"id":1337,"precertRequired":false,"billingCode":"27025","codeType":"CPT"},{"id":1338,"precertRequired":false,"billingCode":"27027","codeType":"CPT"},{"id":1343,"precertRequired":false,"billingCode":"27040","codeType":"CPT"},{"id":1344,"precertRequired":false,"billingCode":"27041","codeType":"CPT"},{"id":1345,"precertRequired":false,"billingCode":"27043","codeType":"CPT"},{"id":1346,"precertRequired":false,"billingCode":"27045","codeType":"CPT"},{"id":1347,"precertRequired":false,"billingCode":"27047","codeType":"CPT"},{"id":1348,"precertRequired":false,"billingCode":"27048","codeType":"CPT"},{"id":1349,"precertRequired":false,"billingCode":"27049","codeType":"CPT"},{"id":1353,"precertRequired":false,"billingCode":"27057","codeType":"CPT"},{"id":1354,"precertRequired":false,"billingCode":"27059","codeType":"CPT"},{"id":1367,"precertRequired":false,"billingCode":"27086","codeType":"CPT"},{"id":1368,"precertRequired":false,"billingCode":"27087","codeType":"CPT"},{"id":1447,"precertRequired":false,"billingCode":"27290","codeType":"CPT"},{"id":1450,"precertRequired":false,"billingCode":"27301","codeType":"CPT"},{"id":1451,"precertRequired":false,"billingCode":"27303","codeType":"CPT"},{"id":1452,"precertRequired":false,"billingCode":"27305","codeType":"CPT"},{"id":1456,"precertRequired":false,"billingCode":"27323","codeType":"CPT"},{"id":1457,"precertRequired":false,"billingCode":"27324","codeType":"CPT"},{"id":1460,"precertRequired":false,"billingCode":"27327","codeType":"CPT"},{"id":1461,"precertRequired":false,"billingCode":"27328","codeType":"CPT"},{"id":1462,"precertRequired":false,"billingCode":"27329","codeType":"CPT"},{"id":1469,"precertRequired":false,"billingCode":"27337","codeType":"CPT"},{"id":1470,"precertRequired":false,"billingCode":"27339","codeType":"CPT"},{"id":1480,"precertRequired":false,"billingCode":"27364","codeType":"CPT"},{"id":1481,"precertRequired":false,"billingCode":"27365","codeType":"CPT"},{"id":1482,"precertRequired":false,"billingCode":"27370","codeType":"CPT"},{"id":1483,"precertRequired":false,"billingCode":"27372","codeType":"CPT"},{"id":1541,"precertRequired":false,"billingCode":"27496","codeType":"CPT"},{"id":1542,"precertRequired":false,"billingCode":"27497","codeType":"CPT"},{"id":1543,"precertRequired":false,"billingCode":"27498","codeType":"CPT"},{"id":1544,"precertRequired":false,"billingCode":"27499","codeType":"CPT"},{"id":1545,"precertRequired":false,"billingCode":"27500","codeType":"CPT"},{"id":1578,"precertRequired":false,"billingCode":"27590","codeType":"CPT"},{"id":1579,"precertRequired":false,"billingCode":"27591","codeType":"CPT"},{"id":1580,"precertRequired":false,"billingCode":"27592","codeType":"CPT"},{"id":1581,"precertRequired":false,"billingCode":"27594","codeType":"CPT"},{"id":1582,"precertRequired":false,"billingCode":"27596","codeType":"CPT"},{"id":1584,"precertRequired":false,"billingCode":"27600","codeType":"CPT"},{"id":1585,"precertRequired":false,"billingCode":"27601","codeType":"CPT"},{"id":1586,"precertRequired":false,"billingCode":"27602","codeType":"CPT"},{"id":1587,"precertRequired":false,"billingCode":"27603","codeType":"CPT"},{"id":1588,"precertRequired":false,"billingCode":"27604","codeType":"CPT"},{"id":1591,"precertRequired":false,"billingCode":"27607","codeType":"CPT"},{"id":1594,"precertRequired":false,"billingCode":"27613","codeType":"CPT"},{"id":1595,"precertRequired":false,"billingCode":"27614","codeType":"CPT"},{"id":1596,"precertRequired":false,"billingCode":"27615","codeType":"CPT"},{"id":1597,"precertRequired":false,"billingCode":"27616","codeType":"CPT"},{"id":1598,"precertRequired":false,"billingCode":"27618","codeType":"CPT"},{"id":1599,"precertRequired":false,"billingCode":"27619","codeType":"CPT"},{"id":1697,"precertRequired":false,"billingCode":"27880","codeType":"CPT"},{"id":1698,"precertRequired":false,"billingCode":"27881","codeType":"CPT"},{"id":1699,"precertRequired":false,"billingCode":"27882","codeType":"CPT"},{"id":1700,"precertRequired":false,"billingCode":"27884","codeType":"CPT"},{"id":1701,"precertRequired":false,"billingCode":"27886","codeType":"CPT"},{"id":1702,"precertRequired":false,"billingCode":"27888","codeType":"CPT"},{"id":1704,"precertRequired":false,"billingCode":"27892","codeType":"CPT"},{"id":1705,"precertRequired":false,"billingCode":"27893","codeType":"CPT"},{"id":1706,"precertRequired":false,"billingCode":"27894","codeType":"CPT"},{"id":1707,"precertRequired":false,"billingCode":"28001","codeType":"CPT"},{"id":1708,"precertRequired":false,"billingCode":"28002","codeType":"CPT"},{"id":1709,"precertRequired":false,"billingCode":"28003","codeType":"CPT"},{"id":1710,"precertRequired":false,"billingCode":"28005","codeType":"CPT"},{"id":1711,"precertRequired":false,"billingCode":"28008","codeType":"CPT"},{"id":1718,"precertRequired":false,"billingCode":"28039","codeType":"CPT"},{"id":1719,"precertRequired":false,"billingCode":"28041","codeType":"CPT"},{"id":1720,"precertRequired":false,"billingCode":"28043","codeType":"CPT"},{"id":1721,"precertRequired":false,"billingCode":"28045","codeType":"CPT"},{"id":1728,"precertRequired":true,"billingCode":"28060","codeType":"CPT"},{"id":1729,"precertRequired":true,"billingCode":"28062","codeType":"CPT"},{"id":1732,"precertRequired":true,"billingCode":"28080","codeType":"CPT"},{"id":1764,"precertRequired":false,"billingCode":"28190","codeType":"CPT"},{"id":1765,"precertRequired":false,"billingCode":"28192","codeType":"CPT"},{"id":1766,"precertRequired":false,"billingCode":"28193","codeType":"CPT"},{"id":1876,"precertRequired":false,"billingCode":"28800","codeType":"CPT"},{"id":1877,"precertRequired":false,"billingCode":"28805","codeType":"CPT"},{"id":1878,"precertRequired":false,"billingCode":"28810","codeType":"CPT"},{"id":1879,"precertRequired":false,"billingCode":"28820","codeType":"CPT"},{"id":1880,"precertRequired":false,"billingCode":"28825","codeType":"CPT"},{"id":2674,"precertRequired":false,"billingCode":"38100","codeType":"CPT"},{"id":2675,"precertRequired":false,"billingCode":"38101","codeType":"CPT"},{"id":2676,"precertRequired":false,"billingCode":"38102","codeType":"CPT"},{"id":2677,"precertRequired":false,"billingCode":"38115","codeType":"CPT"},{"id":2678,"precertRequired":false,"billingCode":"38120","codeType":"CPT"},{"id":2682,"precertRequired":false,"billingCode":"38300","codeType":"CPT"},{"id":2683,"precertRequired":false,"billingCode":"38305","codeType":"CPT"},{"id":2684,"precertRequired":false,"billingCode":"38308","codeType":"CPT"},{"id":2685,"precertRequired":false,"billingCode":"38380","codeType":"CPT"},{"id":2686,"precertRequired":true,"billingCode":"38381","codeType":"CPT"},{"id":2687,"precertRequired":false,"billingCode":"38382","codeType":"CPT"},{"id":2688,"precertRequired":false,"billingCode":"38500","codeType":"CPT"},{"id":2689,"precertRequired":false,"billingCode":"38505","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2691,"precertRequired":false,"billingCode":"38520","codeType":"CPT"},{"id":2692,"precertRequired":false,"billingCode":"38525","codeType":"CPT"},{"id":2693,"precertRequired":false,"billingCode":"38530","codeType":"CPT"},{"id":2694,"precertRequired":false,"billingCode":"38542","codeType":"CPT"},{"id":2695,"precertRequired":false,"billingCode":"38550","codeType":"CPT"},{"id":2696,"precertRequired":false,"billingCode":"38555","codeType":"CPT"},{"id":2697,"precertRequired":false,"billingCode":"38562","codeType":"CPT"},{"id":2698,"precertRequired":false,"billingCode":"38564","codeType":"CPT"},{"id":2699,"precertRequired":false,"billingCode":"38570","codeType":"CPT"},{"id":2700,"precertRequired":false,"billingCode":"38571","codeType":"CPT"},{"id":2701,"precertRequired":false,"billingCode":"38572","codeType":"CPT"},{"id":2702,"precertRequired":false,"billingCode":"38573","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2704,"precertRequired":false,"billingCode":"38720","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2706,"precertRequired":false,"billingCode":"38740","codeType":"CPT"},{"id":2707,"precertRequired":false,"billingCode":"38745","codeType":"CPT"},{"id":2708,"precertRequired":false,"billingCode":"38746","codeType":"CPT"},{"id":2709,"precertRequired":false,"billingCode":"38747","codeType":"CPT"},{"id":2710,"precertRequired":false,"billingCode":"38760","codeType":"CPT"},{"id":2711,"precertRequired":false,"billingCode":"38765","codeType":"CPT"},{"id":2712,"precertRequired":false,"billingCode":"38770","codeType":"CPT"},{"id":2713,"precertRequired":false,"billingCode":"38780","codeType":"CPT"},{"id":2749,"precertRequired":false,"billingCode":"43117","codeType":"CPT"},{"id":2750,"precertRequired":false,"billingCode":"43118","codeType":"CPT"},{"id":2751,"precertRequired":false,"billingCode":"43121","codeType":"CPT"},{"id":2752,"precertRequired":false,"billingCode":"43122","codeType":"CPT"},{"id":2753,"precertRequired":false,"billingCode":"43123","codeType":"CPT"},{"id":2755,"precertRequired":false,"billingCode":"43130","codeType":"CPT"},{"id":2756,"precertRequired":false,"billingCode":"43135","codeType":"CPT"},{"id":2757,"precertRequired":false,"billingCode":"43180","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2819,"precertRequired":false,"billingCode":"43273","codeType":"CPT"},{"id":2825,"precertRequired":false,"billingCode":"43279","codeType":"CPT"},{"id":2826,"precertRequired":false,"billingCode":"43280","codeType":"CPT"},{"id":2827,"precertRequired":false,"billingCode":"43281","codeType":"CPT"},{"id":2828,"precertRequired":false,"billingCode":"43282","codeType":"CPT"},{"id":2829,"precertRequired":false,"billingCode":"43283","codeType":"CPT"},{"id":2830,"precertRequired":false,"billingCode":"43284","codeType":"CPT"},{"id":2831,"precertRequired":false,"billingCode":"43285","codeType":"CPT"},{"id":2832,"precertRequired":false,"billingCode":"43286","codeType":"CPT"},{"id":2833,"precertRequired":false,"billingCode":"43287","codeType":"CPT"},{"id":2834,"precertRequired":false,"billingCode":"43288","codeType":"CPT"},{"id":2836,"precertRequired":false,"billingCode":"43300","codeType":"CPT"},{"id":2837,"precertRequired":false,"billingCode":"43305","codeType":"CPT"},{"id":2838,"precertRequired":false,"billingCode":"43310","codeType":"CPT"},{"id":2839,"precertRequired":false,"billingCode":"43312","codeType":"CPT"},{"id":2840,"precertRequired":false,"billingCode":"43313","codeType":"CPT"},{"id":2841,"precertRequired":false,"billingCode":"43314","codeType":"CPT"},{"id":2842,"precertRequired":false,"billingCode":"43320","codeType":"CPT"},{"id":2843,"precertRequired":false,"billingCode":"43325","codeType":"CPT"},{"id":2844,"precertRequired":false,"billingCode":"43327","codeType":"CPT"},{"id":2845,"precertRequired":false,"billingCode":"43328","codeType":"CPT"},{"id":2846,"precertRequired":false,"billingCode":"43330","codeType":"CPT"},{"id":2847,"precertRequired":false,"billingCode":"43331","codeType":"CPT"},{"id":2854,"precertRequired":false,"billingCode":"43338","codeType":"CPT"},{"id":2855,"precertRequired":false,"billingCode":"43340","codeType":"CPT"},{"id":2856,"precertRequired":false,"billingCode":"43341","codeType":"CPT"},{"id":2857,"precertRequired":false,"billingCode":"43351","codeType":"CPT"},{"id":2858,"precertRequired":false,"billingCode":"43352","codeType":"CPT"},{"id":2859,"precertRequired":false,"billingCode":"43360","codeType":"CPT"},{"id":2860,"precertRequired":false,"billingCode":"43361","codeType":"CPT"},{"id":2861,"precertRequired":false,"billingCode":"43400","codeType":"CPT"},{"id":2862,"precertRequired":false,"billingCode":"43401","codeType":"CPT"},{"id":2863,"precertRequired":false,"billingCode":"43405","codeType":"CPT"},{"id":2864,"precertRequired":false,"billingCode":"43410","codeType":"CPT"},{"id":2865,"precertRequired":false,"billingCode":"43415","codeType":"CPT"},{"id":2866,"precertRequired":false,"billingCode":"43420","codeType":"CPT"},{"id":2867,"precertRequired":false,"billingCode":"43425","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":2869,"precertRequired":false,"billingCode":"43453","codeType":"CPT"},{"id":2870,"precertRequired":false,"billingCode":"43460","codeType":"CPT"},{"id":2871,"precertRequired":false,"billingCode":"43496","codeType":"CPT"},{"id":2873,"precertRequired":false,"billingCode":"43500","codeType":"CPT"},{"id":2874,"precertRequired":false,"billingCode":"43501","codeType":"CPT"},{"id":2875,"precertRequired":false,"billingCode":"43502","codeType":"CPT"},{"id":2876,"precertRequired":false,"billingCode":"43510","codeType":"CPT"},{"id":2877,"precertRequired":false,"billingCode":"43520","codeType":"CPT"},{"id":2878,"precertRequired":false,"billingCode":"43605","codeType":"CPT"},{"id":2879,"precertRequired":false,"billingCode":"43610","codeType":"CPT"},{"id":2880,"precertRequired":false,"billingCode":"43611","codeType":"CPT"},{"id":2881,"precertRequired":false,"billingCode":"43620","codeType":"CPT"},{"id":2882,"precertRequired":false,"billingCode":"43621","codeType":"CPT"},{"id":2883,"precertRequired":false,"billingCode":"43622","codeType":"CPT"},{"id":2884,"precertRequired":false,"billingCode":"43631","codeType":"CPT"},{"id":2885,"precertRequired":false,"billingCode":"43632","codeType":"CPT"},{"id":2886,"precertRequired":false,"billingCode":"43633","codeType":"CPT"},{"id":2887,"precertRequired":false,"billingCode":"43634","codeType":"CPT"},{"id":2888,"precertRequired":false,"billingCode":"43635","codeType":"CPT"},{"id":2889,"precertRequired":false,"billingCode":"43640","codeType":"CPT"},{"id":2890,"precertRequired":false,"billingCode":"43641","codeType":"CPT"},{"id":2891,"precertRequired":false,"billingCode":"43644","codeType":"CPT"},{"id":2892,"precertRequired":false,"billingCode":"43645","codeType":"CPT"},{"id":2893,"precertRequired":false,"billingCode":"43647","codeType":"CPT"},{"id":2894,"precertRequired":false,"billingCode":"43648","codeType":"CPT"},{"id":2895,"precertRequired":false,"billingCode":"43651","codeType":"CPT"},{"id":2896,"precertRequired":false,"billingCode":"43652","codeType":"CPT"},{"id":2897,"precertRequired":false,"billingCode":"43653","codeType":"CPT"},{"id":2898,"precertRequired":false,"billingCode":"43752","codeType":"CPT"},{"id":2899,"precertRequired":false,"billingCode":"43753","codeType":"CPT"},{"id":2900,"precertRequired":false,"billingCode":"43754","codeType":"CPT"},{"id":2901,"precertRequired":false,"billingCode":"43755","codeType":"CPT"},{"id":2902,"precertRequired":false,"billingCode":"43756","codeType":"CPT"},{"id":2903,"precertRequired":false,"billingCode":"43757","codeType":"CPT"},{"id":2904,"precertRequired":false,"billingCode":"43760","codeType":"CPT"},{"id":2905,"precertRequired":false,"billingCode":"43761","codeType":"CPT"},{"id":2912,"precertRequired":false,"billingCode":"43800","codeType":"CPT"},{"id":2913,"precertRequired":false,"billingCode":"43810","codeType":"CPT"},{"id":2914,"precertRequired":false,"billingCode":"43820","codeType":"CPT"},{"id":2915,"precertRequired":false,"billingCode":"43825","codeType":"CPT"},{"id":2916,"precertRequired":false,"billingCode":"43830","codeType":"CPT"},{"id":2917,"precertRequired":false,"billingCode":"43831","codeType":"CPT"},{"id":2918,"precertRequired":false,"billingCode":"43832","codeType":"CPT"},{"id":2919,"precertRequired":false,"billingCode":"43840","codeType":"CPT"},{"id":2926,"precertRequired":false,"billingCode":"43850","codeType":"CPT"},{"id":2927,"precertRequired":false,"billingCode":"43855","codeType":"CPT"},{"id":2928,"precertRequired":false,"billingCode":"43860","codeType":"CPT"},{"id":2929,"precertRequired":false,"billingCode":"43865","codeType":"CPT"},{"id":2930,"precertRequired":false,"billingCode":"43870","codeType":"CPT"},{"id":2931,"precertRequired":false,"billingCode":"43880","codeType":"CPT"},{"id":2934,"precertRequired":false,"billingCode":"43886","codeType":"CPT"},{"id":2935,"precertRequired":false,"billingCode":"43887","codeType":"CPT"},{"id":2936,"precertRequired":false,"billingCode":"43888","codeType":"CPT"},{"id":2937,"precertRequired":false,"billingCode":"44005","codeType":"CPT"},{"id":2938,"precertRequired":false,"billingCode":"44010","codeType":"CPT"},{"id":2939,"precertRequired":false,"billingCode":"44015","codeType":"CPT"},{"id":2940,"precertRequired":false,"billingCode":"44020","codeType":"CPT"},{"id":2941,"precertRequired":false,"billingCode":"44021","codeType":"CPT"},{"id":2942,"precertRequired":false,"billingCode":"44025","codeType":"CPT"},{"id":2943,"precertRequired":false,"billingCode":"44050","codeType":"CPT"},{"id":2944,"precertRequired":false,"billingCode":"44055","codeType":"CPT"},{"id":2945,"precertRequired":false,"billingCode":"44100","codeType":"CPT"},{"id":2946,"precertRequired":false,"billingCode":"44110","codeType":"CPT"},{"id":2947,"precertRequired":false,"billingCode":"44111","codeType":"CPT"},{"id":2948,"precertRequired":false,"billingCode":"44120","codeType":"CPT"},{"id":2949,"precertRequired":false,"billingCode":"44121","codeType":"CPT"},{"id":2950,"precertRequired":false,"billingCode":"44125","codeType":"CPT"},{"id":2951,"precertRequired":false,"billingCode":"44126","codeType":"CPT"},{"id":2952,"precertRequired":false,"billingCode":"44127","codeType":"CPT"},{"id":2953,"precertRequired":false,"billingCode":"44128","codeType":"CPT"},{"id":2954,"precertRequired":false,"billingCode":"44130","codeType":"CPT"},{"id":2960,"precertRequired":false,"billingCode":"44139","codeType":"CPT"},{"id":2961,"precertRequired":false,"billingCode":"44140","codeType":"CPT"},{"id":2962,"precertRequired":false,"billingCode":"44141","codeType":"CPT"},{"id":2963,"precertRequired":false,"billingCode":"44143","codeType":"CPT"},{"id":2964,"precertRequired":false,"billingCode":"44144","codeType":"CPT"},{"id":2965,"precertRequired":false,"billingCode":"44145","codeType":"CPT"},{"id":2966,"precertRequired":false,"billingCode":"44146","codeType":"CPT"},{"id":2967,"precertRequired":false,"billingCode":"44147","codeType":"CPT"},{"id":2968,"precertRequired":false,"billingCode":"44150","codeType":"CPT"},{"id":2969,"precertRequired":false,"billingCode":"44151","codeType":"CPT"},{"id":2970,"precertRequired":false,"billingCode":"44155","codeType":"CPT"},{"id":2971,"precertRequired":false,"billingCode":"44156","codeType":"CPT"},{"id":2972,"precertRequired":false,"billingCode":"44157","codeType":"CPT"},{"id":2973,"precertRequired":false,"billingCode":"44158","codeType":"CPT"},{"id":2974,"precertRequired":false,"billingCode":"44160","codeType":"CPT"},{"id":2975,"precertRequired":false,"billingCode":"44180","codeType":"CPT"},{"id":2976,"precertRequired":false,"billingCode":"44186","codeType":"CPT"},{"id":2977,"precertRequired":false,"billingCode":"44187","codeType":"CPT"},{"id":2978,"precertRequired":false,"billingCode":"44188","codeType":"CPT"},{"id":2979,"precertRequired":false,"billingCode":"44202","codeType":"CPT"},{"id":2980,"precertRequired":false,"billingCode":"44203","codeType":"CPT"},{"id":2981,"precertRequired":false,"billingCode":"44204","codeType":"CPT"},{"id":2982,"precertRequired":false,"billingCode":"44205","codeType":"CPT"},{"id":2983,"precertRequired":false,"billingCode":"44206","codeType":"CPT"},{"id":2984,"precertRequired":false,"billingCode":"44207","codeType":"CPT"},{"id":2985,"precertRequired":false,"billingCode":"44208","codeType":"CPT"},{"id":2986,"precertRequired":false,"billingCode":"44210","codeType":"CPT"},{"id":2987,"precertRequired":false,"billingCode":"44211","codeType":"CPT"},{"id":2988,"precertRequired":false,"billingCode":"44212","codeType":"CPT"},{"id":2989,"precertRequired":false,"billingCode":"44213","codeType":"CPT"},{"id":2990,"precertRequired":false,"billingCode":"44227","codeType":"CPT"},{"id":2991,"precertRequired":false,"billingCode":"44300","codeType":"CPT"},{"id":2992,"precertRequired":false,"billingCode":"44310","codeType":"CPT"},{"id":2993,"precertRequired":false,"billingCode":"44312","codeType":"CPT"},{"id":2994,"precertRequired":false,"billingCode":"44314","codeType":"CPT"},{"id":2995,"precertRequired":false,"billingCode":"44316","codeType":"CPT"},{"id":2996,"precertRequired":false,"billingCode":"44320","codeType":"CPT"},{"id":2997,"precertRequired":false,"billingCode":"44322","codeType":"CPT"},{"id":2998,"precertRequired":false,"billingCode":"44340","codeType":"CPT"},{"id":2999,"precertRequired":false,"billingCode":"44345","codeType":"CPT"},{"id":3000,"precertRequired":false,"billingCode":"44346","codeType":"CPT"},{"id":3015,"precertRequired":false,"billingCode":"44380","codeType":"CPT"},{"id":3016,"precertRequired":false,"billingCode":"44381","codeType":"CPT"},{"id":3017,"precertRequired":false,"billingCode":"44382","codeType":"CPT"},{"id":3018,"precertRequired":false,"billingCode":"44384","codeType":"CPT"},{"id":3019,"precertRequired":false,"billingCode":"44385","codeType":"CPT"},{"id":3020,"precertRequired":false,"billingCode":"44386","codeType":"CPT"},{"id":3035,"precertRequired":false,"billingCode":"44500","codeType":"CPT"},{"id":3036,"precertRequired":false,"billingCode":"44602","codeType":"CPT"},{"id":3037,"precertRequired":false,"billingCode":"44603","codeType":"CPT"},{"id":3038,"precertRequired":false,"billingCode":"44604","codeType":"CPT"},{"id":3039,"precertRequired":false,"billingCode":"44605","codeType":"CPT"},{"id":3040,"precertRequired":false,"billingCode":"44615","codeType":"CPT"},{"id":3041,"precertRequired":false,"billingCode":"44620","codeType":"CPT"},{"id":3042,"precertRequired":false,"billingCode":"44625","codeType":"CPT"},{"id":3043,"precertRequired":false,"billingCode":"44626","codeType":"CPT"},{"id":3044,"precertRequired":false,"billingCode":"44640","codeType":"CPT"},{"id":3045,"precertRequired":false,"billingCode":"44650","codeType":"CPT"},{"id":3046,"precertRequired":false,"billingCode":"44660","codeType":"CPT"},{"id":3047,"precertRequired":false,"billingCode":"44661","codeType":"CPT"},{"id":3048,"precertRequired":false,"billingCode":"44680","codeType":"CPT"},{"id":3049,"precertRequired":false,"billingCode":"44700","codeType":"CPT"},{"id":3050,"precertRequired":false,"billingCode":"44701","codeType":"CPT"},{"id":3056,"precertRequired":false,"billingCode":"44800","codeType":"CPT"},{"id":3057,"precertRequired":false,"billingCode":"44820","codeType":"CPT"},{"id":3058,"precertRequired":false,"billingCode":"44850","codeType":"CPT"},{"id":3059,"precertRequired":false,"billingCode":"44900","codeType":"CPT"},{"id":3060,"precertRequired":false,"billingCode":"44950","codeType":"CPT"},{"id":3061,"precertRequired":false,"billingCode":"44955","codeType":"CPT"},{"id":3062,"precertRequired":false,"billingCode":"44960","codeType":"CPT"},{"id":3063,"precertRequired":false,"billingCode":"44970","codeType":"CPT"},{"id":3064,"precertRequired":false,"billingCode":"45000","codeType":"CPT"},{"id":3065,"precertRequired":false,"billingCode":"45005","codeType":"CPT"},{"id":3066,"precertRequired":false,"billingCode":"45020","codeType":"CPT"},{"id":3067,"precertRequired":false,"billingCode":"45100","codeType":"CPT"},{"id":3068,"precertRequired":false,"billingCode":"45108","codeType":"CPT"},{"id":3080,"precertRequired":false,"billingCode":"45130","codeType":"CPT"},{"id":3081,"precertRequired":false,"billingCode":"45135","codeType":"CPT"},{"id":3082,"precertRequired":false,"billingCode":"45136","codeType":"CPT"},{"id":3083,"precertRequired":false,"billingCode":"45150","codeType":"CPT"},{"id":3084,"precertRequired":false,"billingCode":"45160","codeType":"CPT"},{"id":3085,"precertRequired":false,"billingCode":"45171","codeType":"CPT"},{"id":3086,"precertRequired":false,"billingCode":"45172","codeType":"CPT"},{"id":3087,"precertRequired":false,"billingCode":"45190","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3123,"precertRequired":false,"billingCode":"45388","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3129,"precertRequired":false,"billingCode":"45395","codeType":"CPT"},{"id":3130,"precertRequired":false,"billingCode":"45397","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"},{"id":3132,"precertRequired":false,"billingCode":"45400","codeType":"CPT"},{"id":3133,"precertRequired":false,"billingCode":"45402","codeType":"CPT"},{"id":3134,"precertRequired":false,"billingCode":"45500","codeType":"CPT"},{"id":3135,"precertRequired":false,"billingCode":"45505","codeType":"CPT"},{"id":3136,"precertRequired":false,"billingCode":"45520","codeType":"CPT"},{"id":3137,"precertRequired":false,"billingCode":"45540","codeType":"CPT"},{"id":3138,"precertRequired":false,"billingCode":"45541","codeType":"CPT"},{"id":3139,"precertRequired":false,"billingCode":"45550","codeType":"CPT"},{"id":3140,"precertRequired":false,"billingCode":"45560","codeType":"CPT"},{"id":3141,"precertRequired":false,"billingCode":"45562","codeType":"CPT"},{"id":3142,"precertRequired":false,"billingCode":"45563","codeType":"CPT"},{"id":3143,"precertRequired":false,"billingCode":"45800","codeType":"CPT"},{"id":3144,"precertRequired":false,"billingCode":"45805","codeType":"CPT"},{"id":3145,"precertRequired":false,"billingCode":"45820","codeType":"CPT"},{"id":3146,"precertRequired":false,"billingCode":"45825","codeType":"CPT"},{"id":3147,"precertRequired":false,"billingCode":"45900","codeType":"CPT"},{"id":3148,"precertRequired":false,"billingCode":"45905","codeType":"CPT"},{"id":3149,"precertRequired":false,"billingCode":"45910","codeType":"CPT"},{"id":3150,"precertRequired":false,"billingCode":"45915","codeType":"CPT"},{"id":3151,"precertRequired":false,"billingCode":"45990","codeType":"CPT"},{"id":3152,"precertRequired":false,"billingCode":"46020","codeType":"CPT"},{"id":3153,"precertRequired":false,"billingCode":"46030","codeType":"CPT"},{"id":3154,"precertRequired":false,"billingCode":"46040","codeType":"CPT"},{"id":3155,"precertRequired":false,"billingCode":"46045","codeType":"CPT"},{"id":3156,"precertRequired":false,"billingCode":"46050","codeType":"CPT"},{"id":3157,"precertRequired":false,"billingCode":"46060","codeType":"CPT"},{"id":3158,"precertRequired":false,"billingCode":"46080","codeType":"CPT"},{"id":3159,"precertRequired":false,"billingCode":"46083","codeType":"CPT"},{"id":3160,"precertRequired":false,"billingCode":"46200","codeType":"CPT"},{"id":3161,"precertRequired":false,"billingCode":"46220","codeType":"CPT"},{"id":3162,"precertRequired":false,"billingCode":"46221","codeType":"CPT"},{"id":3163,"precertRequired":false,"billingCode":"46230","codeType":"CPT"},{"id":3164,"precertRequired":false,"billingCode":"46250","codeType":"CPT"},{"id":3165,"precertRequired":false,"billingCode":"46255","codeType":"CPT"},{"id":3166,"precertRequired":false,"billingCode":"46257","codeType":"CPT"},{"id":3167,"precertRequired":false,"billingCode":"46258","codeType":"CPT"},{"id":3168,"precertRequired":false,"billingCode":"46260","codeType":"CPT"},{"id":3169,"precertRequired":false,"billingCode":"46261","codeType":"CPT"},{"id":3170,"precertRequired":false,"billingCode":"46262","codeType":"CPT"},{"id":3171,"precertRequired":false,"billingCode":"46270","codeType":"CPT"},{"id":3172,"precertRequired":false,"billingCode":"46275","codeType":"CPT"},{"id":3173,"precertRequired":false,"billingCode":"46280","codeType":"CPT"},{"id":3174,"precertRequired":false,"billingCode":"46285","codeType":"CPT"},{"id":3175,"precertRequired":false,"billingCode":"46288","codeType":"CPT"},{"id":3176,"precertRequired":false,"billingCode":"46320","codeType":"CPT"},{"id":3177,"precertRequired":false,"billingCode":"46500","codeType":"CPT"},{"id":3178,"precertRequired":false,"billingCode":"46505","codeType":"CPT"},{"id":3179,"precertRequired":false,"billingCode":"46600","codeType":"CPT"},{"id":3180,"precertRequired":false,"billingCode":"46601","codeType":"CPT"},{"id":3181,"precertRequired":false,"billingCode":"46604","codeType":"CPT"},{"id":3182,"precertRequired":false,"billingCode":"46606","codeType":"CPT"},{"id":3183,"precertRequired":false,"billingCode":"46607","codeType":"CPT"},{"id":3184,"precertRequired":false,"billingCode":"46608","codeType":"CPT"},{"id":3185,"precertRequired":false,"billingCode":"46610","codeType":"CPT"},{"id":3186,"precertRequired":false,"billingCode":"46611","codeType":"CPT"},{"id":3187,"precertRequired":false,"billingCode":"46612","codeType":"CPT"},{"id":3188,"precertRequired":false,"billingCode":"46614","codeType":"CPT"},{"id":3189,"precertRequired":false,"billingCode":"46615","codeType":"CPT"},{"id":3190,"precertRequired":false,"billingCode":"46700","codeType":"CPT"},{"id":3191,"precertRequired":false,"billingCode":"46706","codeType":"CPT"},{"id":3192,"precertRequired":false,"billingCode":"46707","codeType":"CPT"},{"id":3193,"precertRequired":false,"billingCode":"46710","codeType":"CPT"},{"id":3194,"precertRequired":false,"billingCode":"46712","codeType":"CPT"},{"id":3195,"precertRequired":false,"billingCode":"46715","codeType":"CPT"},{"id":3196,"precertRequired":false,"billingCode":"46716","codeType":"CPT"},{"id":3197,"precertRequired":false,"billingCode":"46730","codeType":"CPT"},{"id":3198,"precertRequired":false,"billingCode":"46735","codeType":"CPT"},{"id":3199,"precertRequired":false,"billingCode":"46740","codeType":"CPT"},{"id":3200,"precertRequired":false,"billingCode":"46742","codeType":"CPT"},{"id":3201,"precertRequired":false,"billingCode":"46744","codeType":"CPT"},{"id":3202,"precertRequired":false,"billingCode":"46746","codeType":"CPT"},{"id":3203,"precertRequired":false,"billingCode":"46747","codeType":"CPT"},{"id":3204,"precertRequired":false,"billingCode":"46748","codeType":"CPT"},{"id":3205,"precertRequired":false,"billingCode":"46750","codeType":"CPT"},{"id":3207,"precertRequired":false,"billingCode":"46753","codeType":"CPT"},{"id":3208,"precertRequired":false,"billingCode":"46754","codeType":"CPT"},{"id":3209,"precertRequired":false,"billingCode":"46760","codeType":"CPT"},{"id":3210,"precertRequired":false,"billingCode":"46761","codeType":"CPT"},{"id":3211,"precertRequired":false,"billingCode":"46762","codeType":"CPT"},{"id":3212,"precertRequired":false,"billingCode":"46900","codeType":"CPT"},{"id":3213,"precertRequired":false,"billingCode":"46910","codeType":"CPT"},{"id":3214,"precertRequired":false,"billingCode":"46917","codeType":"CPT"},{"id":3215,"precertRequired":false,"billingCode":"46922","codeType":"CPT"},{"id":3216,"precertRequired":false,"billingCode":"46924","codeType":"CPT"},{"id":3217,"precertRequired":false,"billingCode":"46930","codeType":"CPT"},{"id":3218,"precertRequired":false,"billingCode":"46940","codeType":"CPT"},{"id":3219,"precertRequired":false,"billingCode":"46942","codeType":"CPT"},{"id":3220,"precertRequired":false,"billingCode":"46945","codeType":"CPT"},{"id":3221,"precertRequired":false,"billingCode":"46946","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3226,"precertRequired":false,"billingCode":"47010","codeType":"CPT"},{"id":3227,"precertRequired":false,"billingCode":"47015","codeType":"CPT"},{"id":3228,"precertRequired":false,"billingCode":"47100","codeType":"CPT"},{"id":3243,"precertRequired":false,"billingCode":"47300","codeType":"CPT"},{"id":3244,"precertRequired":false,"billingCode":"47350","codeType":"CPT"},{"id":3245,"precertRequired":false,"billingCode":"47360","codeType":"CPT"},{"id":3246,"precertRequired":false,"billingCode":"47361","codeType":"CPT"},{"id":3247,"precertRequired":false,"billingCode":"47362","codeType":"CPT"},{"id":3248,"precertRequired":false,"billingCode":"47371","codeType":"CPT"},{"id":3249,"precertRequired":false,"billingCode":"47381","codeType":"CPT"},{"id":3251,"precertRequired":false,"billingCode":"47383","codeType":"CPT"},{"id":3252,"precertRequired":false,"billingCode":"47400","codeType":"CPT"},{"id":3253,"precertRequired":false,"billingCode":"47420","codeType":"CPT"},{"id":3254,"precertRequired":false,"billingCode":"47425","codeType":"CPT"},{"id":3255,"precertRequired":false,"billingCode":"47460","codeType":"CPT"},{"id":3257,"precertRequired":false,"billingCode":"47490","codeType":"CPT"},{"id":3258,"precertRequired":false,"billingCode":"47531","codeType":"CPT"},{"id":3259,"precertRequired":false,"billingCode":"47532","codeType":"CPT"},{"id":3260,"precertRequired":false,"billingCode":"47533","codeType":"CPT"},{"id":3261,"precertRequired":false,"billingCode":"47534","codeType":"CPT"},{"id":3262,"precertRequired":false,"billingCode":"47535","codeType":"CPT"},{"id":3263,"precertRequired":false,"billingCode":"47536","codeType":"CPT"},{"id":3264,"precertRequired":false,"billingCode":"47537","codeType":"CPT"},{"id":3265,"precertRequired":false,"billingCode":"47538","codeType":"CPT"},{"id":3266,"precertRequired":false,"billingCode":"47539","codeType":"CPT"},{"id":3267,"precertRequired":false,"billingCode":"47540","codeType":"CPT"},{"id":3268,"precertRequired":false,"billingCode":"47541","codeType":"CPT"},{"id":3269,"precertRequired":false,"billingCode":"47542","codeType":"CPT"},{"id":3270,"precertRequired":false,"billingCode":"47543","codeType":"CPT"},{"id":3271,"precertRequired":false,"billingCode":"47544","codeType":"CPT"},{"id":3272,"precertRequired":false,"billingCode":"47550","codeType":"CPT"},{"id":3273,"precertRequired":false,"billingCode":"47552","codeType":"CPT"},{"id":3274,"precertRequired":false,"billingCode":"47553","codeType":"CPT"},{"id":3275,"precertRequired":false,"billingCode":"47554","codeType":"CPT"},{"id":3276,"precertRequired":false,"billingCode":"47555","codeType":"CPT"},{"id":3277,"precertRequired":false,"billingCode":"47556","codeType":"CPT"},{"id":3278,"precertRequired":false,"billingCode":"47562","codeType":"CPT"},{"id":3279,"precertRequired":false,"billingCode":"47563","codeType":"CPT"},{"id":3280,"precertRequired":false,"billingCode":"47564","codeType":"CPT"},{"id":3281,"precertRequired":false,"billingCode":"47570","codeType":"CPT"},{"id":3282,"precertRequired":false,"billingCode":"47600","codeType":"CPT"},{"id":3283,"precertRequired":false,"billingCode":"47605","codeType":"CPT"},{"id":3284,"precertRequired":false,"billingCode":"47610","codeType":"CPT"},{"id":3285,"precertRequired":false,"billingCode":"47612","codeType":"CPT"},{"id":3286,"precertRequired":false,"billingCode":"47620","codeType":"CPT"},{"id":3287,"precertRequired":false,"billingCode":"47700","codeType":"CPT"},{"id":3288,"precertRequired":false,"billingCode":"47701","codeType":"CPT"},{"id":3289,"precertRequired":false,"billingCode":"47711","codeType":"CPT"},{"id":3290,"precertRequired":false,"billingCode":"47712","codeType":"CPT"},{"id":3291,"precertRequired":false,"billingCode":"47715","codeType":"CPT"},{"id":3292,"precertRequired":false,"billingCode":"47720","codeType":"CPT"},{"id":3293,"precertRequired":false,"billingCode":"47721","codeType":"CPT"},{"id":3294,"precertRequired":false,"billingCode":"47740","codeType":"CPT"},{"id":3295,"precertRequired":false,"billingCode":"47741","codeType":"CPT"},{"id":3296,"precertRequired":false,"billingCode":"47760","codeType":"CPT"},{"id":3297,"precertRequired":false,"billingCode":"47765","codeType":"CPT"},{"id":3298,"precertRequired":false,"billingCode":"47780","codeType":"CPT"},{"id":3299,"precertRequired":false,"billingCode":"47785","codeType":"CPT"},{"id":3300,"precertRequired":false,"billingCode":"47800","codeType":"CPT"},{"id":3301,"precertRequired":false,"billingCode":"47801","codeType":"CPT"},{"id":3302,"precertRequired":false,"billingCode":"47802","codeType":"CPT"},{"id":3303,"precertRequired":false,"billingCode":"48000","codeType":"CPT"},{"id":3304,"precertRequired":false,"billingCode":"48001","codeType":"CPT"},{"id":3305,"precertRequired":false,"billingCode":"48020","codeType":"CPT"},{"id":3306,"precertRequired":false,"billingCode":"48100","codeType":"CPT"},{"id":3307,"precertRequired":false,"billingCode":"48102","codeType":"CPT"},{"id":3308,"precertRequired":false,"billingCode":"48105","codeType":"CPT"},{"id":3309,"precertRequired":false,"billingCode":"48120","codeType":"CPT"},{"id":3310,"precertRequired":false,"billingCode":"48148","codeType":"CPT"},{"id":3311,"precertRequired":false,"billingCode":"48150","codeType":"CPT"},{"id":3312,"precertRequired":false,"billingCode":"48152","codeType":"CPT"},{"id":3313,"precertRequired":false,"billingCode":"48153","codeType":"CPT"},{"id":3314,"precertRequired":false,"billingCode":"48154","codeType":"CPT"},{"id":3315,"precertRequired":false,"billingCode":"48155","codeType":"CPT"},{"id":3316,"precertRequired":false,"billingCode":"48160","codeType":"CPT"},{"id":3317,"precertRequired":false,"billingCode":"48400","codeType":"CPT"},{"id":3318,"precertRequired":false,"billingCode":"48500","codeType":"CPT"},{"id":3319,"precertRequired":false,"billingCode":"48510","codeType":"CPT"},{"id":3320,"precertRequired":false,"billingCode":"48520","codeType":"CPT"},{"id":3321,"precertRequired":false,"billingCode":"48540","codeType":"CPT"},{"id":3322,"precertRequired":false,"billingCode":"48545","codeType":"CPT"},{"id":3323,"precertRequired":false,"billingCode":"48547","codeType":"CPT"},{"id":3324,"precertRequired":false,"billingCode":"48548","codeType":"CPT"},{"id":3328,"precertRequired":false,"billingCode":"48554","codeType":"CPT"},{"id":3330,"precertRequired":false,"billingCode":"49002","codeType":"CPT"},{"id":3331,"precertRequired":false,"billingCode":"49010","codeType":"CPT"},{"id":3332,"precertRequired":false,"billingCode":"49020","codeType":"CPT"},{"id":3333,"precertRequired":false,"billingCode":"49040","codeType":"CPT"},{"id":3334,"precertRequired":false,"billingCode":"49060","codeType":"CPT"},{"id":3335,"precertRequired":false,"billingCode":"49062","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3337,"precertRequired":false,"billingCode":"49083","codeType":"CPT"},{"id":3338,"precertRequired":false,"billingCode":"49084","codeType":"CPT"},{"id":3339,"precertRequired":false,"billingCode":"49180","codeType":"CPT"},{"id":3340,"precertRequired":false,"billingCode":"49185","codeType":"CPT"},{"id":3341,"precertRequired":false,"billingCode":"49203","codeType":"CPT"},{"id":3342,"precertRequired":false,"billingCode":"49204","codeType":"CPT"},{"id":3343,"precertRequired":false,"billingCode":"49205","codeType":"CPT"},{"id":3344,"precertRequired":false,"billingCode":"49220","codeType":"CPT"},{"id":3345,"precertRequired":false,"billingCode":"49250","codeType":"CPT"},{"id":3346,"precertRequired":false,"billingCode":"49255","codeType":"CPT"},{"id":3347,"precertRequired":false,"billingCode":"49320","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3350,"precertRequired":false,"billingCode":"49323","codeType":"CPT"},{"id":3351,"precertRequired":false,"billingCode":"49324","codeType":"CPT"},{"id":3352,"precertRequired":false,"billingCode":"49325","codeType":"CPT"},{"id":3353,"precertRequired":false,"billingCode":"49326","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3355,"precertRequired":false,"billingCode":"49329","codeType":"CPT"},{"id":3356,"precertRequired":false,"billingCode":"49400","codeType":"CPT"},{"id":3357,"precertRequired":false,"billingCode":"49402","codeType":"CPT"},{"id":3358,"precertRequired":false,"billingCode":"49405","codeType":"CPT"},{"id":3359,"precertRequired":false,"billingCode":"49406","codeType":"CPT"},{"id":3360,"precertRequired":false,"billingCode":"49407","codeType":"CPT"},{"id":3361,"precertRequired":false,"billingCode":"49411","codeType":"CPT"},{"id":3362,"precertRequired":false,"billingCode":"49412","codeType":"CPT"},{"id":3363,"precertRequired":false,"billingCode":"49418","codeType":"CPT"},{"id":3364,"precertRequired":false,"billingCode":"49419","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"},{"id":3368,"precertRequired":false,"billingCode":"49423","codeType":"CPT"},{"id":3369,"precertRequired":false,"billingCode":"49424","codeType":"CPT"},{"id":3370,"precertRequired":false,"billingCode":"49425","codeType":"CPT"},{"id":3371,"precertRequired":false,"billingCode":"49426","codeType":"CPT"},{"id":3372,"precertRequired":false,"billingCode":"49427","codeType":"CPT"},{"id":3373,"precertRequired":false,"billingCode":"49428","codeType":"CPT"},{"id":3374,"precertRequired":false,"billingCode":"49429","codeType":"CPT"},{"id":3375,"precertRequired":false,"billingCode":"49435","codeType":"CPT"},{"id":3376,"precertRequired":false,"billingCode":"49436","codeType":"CPT"},{"id":3377,"precertRequired":false,"billingCode":"49440","codeType":"CPT"},{"id":3378,"precertRequired":false,"billingCode":"49441","codeType":"CPT"},{"id":3379,"precertRequired":false,"billingCode":"49442","codeType":"CPT"},{"id":3380,"precertRequired":false,"billingCode":"49446","codeType":"CPT"},{"id":3381,"precertRequired":false,"billingCode":"49450","codeType":"CPT"},{"id":3382,"precertRequired":false,"billingCode":"49451","codeType":"CPT"},{"id":3383,"precertRequired":false,"billingCode":"49452","codeType":"CPT"},{"id":3384,"precertRequired":false,"billingCode":"49460","codeType":"CPT"},{"id":3385,"precertRequired":false,"billingCode":"49465","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3847,"precertRequired":false,"billingCode":"60512","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3849,"precertRequired":false,"billingCode":"60521","codeType":"CPT"},{"id":3850,"precertRequired":false,"billingCode":"60522","codeType":"CPT"},{"id":3851,"precertRequired":false,"billingCode":"60540","codeType":"CPT"},{"id":3852,"precertRequired":false,"billingCode":"60545","codeType":"CPT"},{"id":3853,"precertRequired":false,"billingCode":"60600","codeType":"CPT"},{"id":3854,"precertRequired":false,"billingCode":"60605","codeType":"CPT"},{"id":3855,"precertRequired":false,"billingCode":"60650","codeType":"CPT"},{"id":3857,"precertRequired":false,"billingCode":"61576","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":1164,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":1,"precertRequired":false,"billingCode":"00100","codeType":"CPT"},{"id":2,"precertRequired":false,"billingCode":"00102","codeType":"CPT"},{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"},{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":8,"precertRequired":false,"billingCode":"00140","codeType":"CPT"},{"id":9,"precertRequired":false,"billingCode":"00142","codeType":"CPT"},{"id":10,"precertRequired":false,"billingCode":"00144","codeType":"CPT"},{"id":11,"precertRequired":false,"billingCode":"00145","codeType":"CPT"},{"id":12,"precertRequired":false,"billingCode":"00147","codeType":"CPT"},{"id":13,"precertRequired":false,"billingCode":"00148","codeType":"CPT"},{"id":14,"precertRequired":false,"billingCode":"00160","codeType":"CPT"},{"id":15,"precertRequired":false,"billingCode":"00162","codeType":"CPT"},{"id":16,"precertRequired":false,"billingCode":"00164","codeType":"CPT"},{"id":17,"precertRequired":false,"billingCode":"00170","codeType":"CPT"},{"id":18,"precertRequired":false,"billingCode":"00172","codeType":"CPT"},{"id":19,"precertRequired":false,"billingCode":"00174","codeType":"CPT"},{"id":20,"precertRequired":false,"billingCode":"00176","codeType":"CPT"},{"id":21,"precertRequired":false,"billingCode":"00190","codeType":"CPT"},{"id":22,"precertRequired":false,"billingCode":"00192","codeType":"CPT"},{"id":23,"precertRequired":false,"billingCode":"00210","codeType":"CPT"},{"id":24,"precertRequired":false,"billingCode":"00211","codeType":"CPT"},{"id":25,"precertRequired":false,"billingCode":"00212","codeType":"CPT"},{"id":26,"precertRequired":false,"billingCode":"00214","codeType":"CPT"},{"id":27,"precertRequired":false,"billingCode":"00215","codeType":"CPT"},{"id":28,"precertRequired":false,"billingCode":"00216","codeType":"CPT"},{"id":29,"precertRequired":false,"billingCode":"00218","codeType":"CPT"},{"id":30,"precertRequired":false,"billingCode":"00220","codeType":"CPT"},{"id":31,"precertRequired":false,"billingCode":"00222","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":33,"precertRequired":false,"billingCode":"00320","codeType":"CPT"},{"id":34,"precertRequired":false,"billingCode":"00322","codeType":"CPT"},{"id":35,"precertRequired":false,"billingCode":"00326","codeType":"CPT"},{"id":36,"precertRequired":false,"billingCode":"00400","codeType":"CPT"},{"id":37,"precertRequired":false,"billingCode":"00402","codeType":"CPT"},{"id":38,"precertRequired":false,"billingCode":"00404","codeType":"CPT"},{"id":39,"precertRequired":false,"billingCode":"00406","codeType":"CPT"},{"id":40,"precertRequired":false,"billingCode":"00410","codeType":"CPT"},{"id":41,"precertRequired":false,"billingCode":"00450","codeType":"CPT"},{"id":42,"precertRequired":false,"billingCode":"00454","codeType":"CPT"},{"id":43,"precertRequired":false,"billingCode":"00470","codeType":"CPT"},{"id":44,"precertRequired":false,"billingCode":"00472","codeType":"CPT"},{"id":45,"precertRequired":false,"billingCode":"00474","codeType":"CPT"},{"id":46,"precertRequired":false,"billingCode":"00500","codeType":"CPT"},{"id":47,"precertRequired":false,"billingCode":"00520","codeType":"CPT"},{"id":48,"precertRequired":false,"billingCode":"00522","codeType":"CPT"},{"id":49,"precertRequired":false,"billingCode":"00524","codeType":"CPT"},{"id":50,"precertRequired":false,"billingCode":"00528","codeType":"CPT"},{"id":51,"precertRequired":false,"billingCode":"00529","codeType":"CPT"},{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":53,"precertRequired":false,"billingCode":"00534","codeType":"CPT"},{"id":54,"precertRequired":false,"billingCode":"00537","codeType":"CPT"},{"id":55,"precertRequired":false,"billingCode":"00539","codeType":"CPT"},{"id":57,"precertRequired":false,"billingCode":"00541","codeType":"CPT"},{"id":58,"precertRequired":false,"billingCode":"00542","codeType":"CPT"},{"id":59,"precertRequired":false,"billingCode":"00546","codeType":"CPT"},{"id":60,"precertRequired":false,"billingCode":"00548","codeType":"CPT"},{"id":61,"precertRequired":false,"billingCode":"00550","codeType":"CPT"},{"id":69,"precertRequired":false,"billingCode":"00700","codeType":"CPT"},{"id":70,"precertRequired":false,"billingCode":"00702","codeType":"CPT"},{"id":71,"precertRequired":false,"billingCode":"00730","codeType":"CPT"},{"id":72,"precertRequired":false,"billingCode":"00731","codeType":"CPT"},{"id":73,"precertRequired":false,"billingCode":"00732","codeType":"CPT"},{"id":74,"precertRequired":false,"billingCode":"00750","codeType":"CPT"},{"id":75,"precertRequired":false,"billingCode":"00752","codeType":"CPT"},{"id":76,"precertRequired":false,"billingCode":"00754","codeType":"CPT"},{"id":77,"precertRequired":false,"billingCode":"00756","codeType":"CPT"},{"id":78,"precertRequired":false,"billingCode":"00770","codeType":"CPT"},{"id":79,"precertRequired":false,"billingCode":"00790","codeType":"CPT"},{"id":80,"precertRequired":false,"billingCode":"00792","codeType":"CPT"},{"id":81,"precertRequired":false,"billingCode":"00794","codeType":"CPT"},{"id":82,"precertRequired":false,"billingCode":"00796","codeType":"CPT"},{"id":83,"precertRequired":false,"billingCode":"00797","codeType":"CPT"},{"id":84,"precertRequired":false,"billingCode":"00800","codeType":"CPT"},{"id":85,"precertRequired":false,"billingCode":"00802","codeType":"CPT"},{"id":86,"precertRequired":false,"billingCode":"00811","codeType":"CPT"},{"id":87,"precertRequired":false,"billingCode":"00812","codeType":"CPT"},{"id":88,"precertRequired":false,"billingCode":"00813","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":90,"precertRequired":false,"billingCode":"00830","codeType":"CPT"},{"id":91,"precertRequired":false,"billingCode":"00832","codeType":"CPT"},{"id":92,"precertRequired":false,"billingCode":"00834","codeType":"CPT"},{"id":93,"precertRequired":false,"billingCode":"00836","codeType":"CPT"},{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":95,"precertRequired":false,"billingCode":"00842","codeType":"CPT"},{"id":96,"precertRequired":false,"billingCode":"00844","codeType":"CPT"},{"id":97,"precertRequired":false,"billingCode":"00846","codeType":"CPT"},{"id":99,"precertRequired":false,"billingCode":"00851","codeType":"CPT"},{"id":100,"precertRequired":false,"billingCode":"00860","codeType":"CPT"},{"id":101,"precertRequired":false,"billingCode":"00862","codeType":"CPT"},{"id":102,"precertRequired":false,"billingCode":"00864","codeType":"CPT"},{"id":103,"precertRequired":false,"billingCode":"00865","codeType":"CPT"},{"id":104,"precertRequired":false,"billingCode":"00866","codeType":"CPT"},{"id":105,"precertRequired":false,"billingCode":"00868","codeType":"CPT"},{"id":106,"precertRequired":false,"billingCode":"00870","codeType":"CPT"},{"id":107,"precertRequired":false,"billingCode":"00872","codeType":"CPT"},{"id":108,"precertRequired":false,"billingCode":"00873","codeType":"CPT"},{"id":109,"precertRequired":false,"billingCode":"00880","codeType":"CPT"},{"id":110,"precertRequired":false,"billingCode":"00882","codeType":"CPT"},{"id":111,"precertRequired":false,"billingCode":"00902","codeType":"CPT"},{"id":112,"precertRequired":false,"billingCode":"00904","codeType":"CPT"},{"id":113,"precertRequired":false,"billingCode":"00906","codeType":"CPT"},{"id":114,"precertRequired":false,"billingCode":"00908","codeType":"CPT"},{"id":115,"precertRequired":false,"billingCode":"00910","codeType":"CPT"},{"id":116,"precertRequired":false,"billingCode":"00912","codeType":"CPT"},{"id":117,"precertRequired":false,"billingCode":"00914","codeType":"CPT"},{"id":118,"precertRequired":false,"billingCode":"00916","codeType":"CPT"},{"id":119,"precertRequired":false,"billingCode":"00918","codeType":"CPT"},{"id":120,"precertRequired":false,"billingCode":"00920","codeType":"CPT"},{"id":121,"precertRequired":false,"billingCode":"00921","codeType":"CPT"},{"id":122,"precertRequired":false,"billingCode":"00922","codeType":"CPT"},{"id":123,"precertRequired":false,"billingCode":"00924","codeType":"CPT"},{"id":124,"precertRequired":false,"billingCode":"00926","codeType":"CPT"},{"id":125,"precertRequired":false,"billingCode":"00928","codeType":"CPT"},{"id":126,"precertRequired":false,"billingCode":"00930","codeType":"CPT"},{"id":127,"precertRequired":false,"billingCode":"00932","codeType":"CPT"},{"id":128,"precertRequired":false,"billingCode":"00934","codeType":"CPT"},{"id":129,"precertRequired":false,"billingCode":"00936","codeType":"CPT"},{"id":130,"precertRequired":false,"billingCode":"00938","codeType":"CPT"},{"id":131,"precertRequired":false,"billingCode":"00940","codeType":"CPT"},{"id":132,"precertRequired":false,"billingCode":"00942","codeType":"CPT"},{"id":133,"precertRequired":false,"billingCode":"00944","codeType":"CPT"},{"id":134,"precertRequired":false,"billingCode":"00948","codeType":"CPT"},{"id":135,"precertRequired":false,"billingCode":"00950","codeType":"CPT"},{"id":136,"precertRequired":false,"billingCode":"00952","codeType":"CPT"},{"id":137,"precertRequired":false,"billingCode":"01112","codeType":"CPT"},{"id":138,"precertRequired":false,"billingCode":"01120","codeType":"CPT"},{"id":139,"precertRequired":false,"billingCode":"01130","codeType":"CPT"},{"id":140,"precertRequired":false,"billingCode":"01140","codeType":"CPT"},{"id":141,"precertRequired":false,"billingCode":"01150","codeType":"CPT"},{"id":142,"precertRequired":false,"billingCode":"01160","codeType":"CPT"},{"id":143,"precertRequired":false,"billingCode":"01170","codeType":"CPT"},{"id":144,"precertRequired":false,"billingCode":"01173","codeType":"CPT"},{"id":145,"precertRequired":false,"billingCode":"01200","codeType":"CPT"},{"id":146,"precertRequired":false,"billingCode":"01202","codeType":"CPT"},{"id":147,"precertRequired":false,"billingCode":"01210","codeType":"CPT"},{"id":148,"precertRequired":false,"billingCode":"01212","codeType":"CPT"},{"id":149,"precertRequired":false,"billingCode":"01214","codeType":"CPT"},{"id":150,"precertRequired":false,"billingCode":"01215","codeType":"CPT"},{"id":151,"precertRequired":false,"billingCode":"01220","codeType":"CPT"},{"id":152,"precertRequired":false,"billingCode":"01230","codeType":"CPT"},{"id":153,"precertRequired":false,"billingCode":"01232","codeType":"CPT"},{"id":154,"precertRequired":false,"billingCode":"01234","codeType":"CPT"},{"id":155,"precertRequired":false,"billingCode":"01250","codeType":"CPT"},{"id":156,"precertRequired":false,"billingCode":"01260","codeType":"CPT"},{"id":157,"precertRequired":false,"billingCode":"01270","codeType":"CPT"},{"id":158,"precertRequired":false,"billingCode":"01272","codeType":"CPT"},{"id":159,"precertRequired":false,"billingCode":"01274","codeType":"CPT"},{"id":160,"precertRequired":false,"billingCode":"01320","codeType":"CPT"},{"id":161,"precertRequired":false,"billingCode":"01340","codeType":"CPT"},{"id":162,"precertRequired":false,"billingCode":"01360","codeType":"CPT"},{"id":163,"precertRequired":false,"billingCode":"01380","codeType":"CPT"},{"id":164,"precertRequired":false,"billingCode":"01382","codeType":"CPT"},{"id":165,"precertRequired":false,"billingCode":"01390","codeType":"CPT"},{"id":166,"precertRequired":false,"billingCode":"01392","codeType":"CPT"},{"id":167,"precertRequired":false,"billingCode":"01400","codeType":"CPT"},{"id":168,"precertRequired":false,"billingCode":"01402","codeType":"CPT"},{"id":169,"precertRequired":false,"billingCode":"01404","codeType":"CPT"},{"id":170,"precertRequired":false,"billingCode":"01420","codeType":"CPT"},{"id":171,"precertRequired":false,"billingCode":"01430","codeType":"CPT"},{"id":172,"precertRequired":false,"billingCode":"01432","codeType":"CPT"},{"id":173,"precertRequired":false,"billingCode":"01440","codeType":"CPT"},{"id":174,"precertRequired":false,"billingCode":"01442","codeType":"CPT"},{"id":175,"precertRequired":false,"billingCode":"01444","codeType":"CPT"},{"id":176,"precertRequired":false,"billingCode":"01462","codeType":"CPT"},{"id":177,"precertRequired":false,"billingCode":"01464","codeType":"CPT"},{"id":178,"precertRequired":false,"billingCode":"01470","codeType":"CPT"},{"id":179,"precertRequired":false,"billingCode":"01472","codeType":"CPT"},{"id":180,"precertRequired":false,"billingCode":"01474","codeType":"CPT"},{"id":181,"precertRequired":false,"billingCode":"01480","codeType":"CPT"},{"id":182,"precertRequired":false,"billingCode":"01482","codeType":"CPT"},{"id":183,"precertRequired":false,"billingCode":"01484","codeType":"CPT"},{"id":184,"precertRequired":false,"billingCode":"01486","codeType":"CPT"},{"id":185,"precertRequired":false,"billingCode":"01490","codeType":"CPT"},{"id":186,"precertRequired":false,"billingCode":"01500","codeType":"CPT"},{"id":187,"precertRequired":false,"billingCode":"01502","codeType":"CPT"},{"id":188,"precertRequired":false,"billingCode":"01520","codeType":"CPT"},{"id":189,"precertRequired":false,"billingCode":"01522","codeType":"CPT"},{"id":204,"precertRequired":false,"billingCode":"01951","codeType":"CPT"},{"id":205,"precertRequired":false,"billingCode":"01952","codeType":"CPT"},{"id":206,"precertRequired":false,"billingCode":"01953","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1165,"description":"Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5723,"precertRequired":false,"billingCode":"84445","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":1166,"description":"Inpatient or observation admission for surgery/procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":1167,"description":"Inpatient admission or observation status for complications related to the surgery/procedure ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":1168,"description":"Follow-up visits for this episode of care relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":1169,"description":"Follow-up imaging as clinically indicated relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4367,"precertRequired":false,"billingCode":"70015","codeType":"CPT"},{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4416,"precertRequired":false,"billingCode":"70545","codeType":"CPT"},{"id":4417,"precertRequired":false,"billingCode":"70546","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4424,"precertRequired":false,"billingCode":"70554","codeType":"CPT"},{"id":4425,"precertRequired":false,"billingCode":"70555","codeType":"CPT"},{"id":4426,"precertRequired":false,"billingCode":"70557","codeType":"CPT"},{"id":4427,"precertRequired":false,"billingCode":"70558","codeType":"CPT"},{"id":4428,"precertRequired":false,"billingCode":"70559","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4584,"precertRequired":false,"billingCode":"74190","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4605,"precertRequired":false,"billingCode":"74300","codeType":"CPT"},{"id":4606,"precertRequired":false,"billingCode":"74301","codeType":"CPT"},{"id":4607,"precertRequired":false,"billingCode":"74328","codeType":"CPT"},{"id":4608,"precertRequired":false,"billingCode":"74329","codeType":"CPT"},{"id":4609,"precertRequired":false,"billingCode":"74330","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4611,"precertRequired":false,"billingCode":"74355","codeType":"CPT"},{"id":4612,"precertRequired":false,"billingCode":"74360","codeType":"CPT"},{"id":4613,"precertRequired":false,"billingCode":"74363","codeType":"CPT"},{"id":4639,"precertRequired":false,"billingCode":"75600","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4661,"precertRequired":false,"billingCode":"75809","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4667,"precertRequired":false,"billingCode":"75831","codeType":"CPT"},{"id":4668,"precertRequired":false,"billingCode":"75833","codeType":"CPT"},{"id":4669,"precertRequired":false,"billingCode":"75840","codeType":"CPT"},{"id":4670,"precertRequired":false,"billingCode":"75842","codeType":"CPT"},{"id":4671,"precertRequired":false,"billingCode":"75860","codeType":"CPT"},{"id":4672,"precertRequired":false,"billingCode":"75870","codeType":"CPT"},{"id":4673,"precertRequired":false,"billingCode":"75872","codeType":"CPT"},{"id":4674,"precertRequired":false,"billingCode":"75880","codeType":"CPT"},{"id":4675,"precertRequired":false,"billingCode":"75885","codeType":"CPT"},{"id":4676,"precertRequired":false,"billingCode":"75887","codeType":"CPT"},{"id":4677,"precertRequired":false,"billingCode":"75889","codeType":"CPT"},{"id":4678,"precertRequired":false,"billingCode":"75891","codeType":"CPT"},{"id":4679,"precertRequired":false,"billingCode":"75893","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4682,"precertRequired":false,"billingCode":"75901","codeType":"CPT"},{"id":4683,"precertRequired":false,"billingCode":"75902","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4691,"precertRequired":false,"billingCode":"75989","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4693,"precertRequired":false,"billingCode":"76001","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4697,"precertRequired":false,"billingCode":"76100","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4700,"precertRequired":false,"billingCode":"76120","codeType":"CPT"},{"id":4701,"precertRequired":false,"billingCode":"76125","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4706,"precertRequired":false,"billingCode":"76390","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4726,"precertRequired":false,"billingCode":"76706","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4770,"precertRequired":false,"billingCode":"76970","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4784,"precertRequired":true,"billingCode":"77058","codeType":"CPT"},{"id":4785,"precertRequired":true,"billingCode":"77059","codeType":"CPT"},{"id":4792,"precertRequired":false,"billingCode":"77071","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4797,"precertRequired":false,"billingCode":"77077","codeType":"CPT"},{"id":4801,"precertRequired":false,"billingCode":"77084","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4910,"precertRequired":false,"billingCode":"78261","codeType":"CPT"},{"id":4918,"precertRequired":false,"billingCode":"78278","codeType":"CPT"},{"id":4919,"precertRequired":false,"billingCode":"78282","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4921,"precertRequired":false,"billingCode":"78291","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4930,"precertRequired":false,"billingCode":"78414","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4932,"precertRequired":false,"billingCode":"78445","codeType":"CPT"},{"id":4937,"precertRequired":false,"billingCode":"78456","codeType":"CPT"},{"id":4938,"precertRequired":false,"billingCode":"78457","codeType":"CPT"},{"id":4939,"precertRequired":false,"billingCode":"78458","codeType":"CPT"},{"id":4969,"precertRequired":false,"billingCode":"78660","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4986,"precertRequired":false,"billingCode":"78805","codeType":"CPT"},{"id":4987,"precertRequired":false,"billingCode":"78806","codeType":"CPT"},{"id":4988,"precertRequired":false,"billingCode":"78807","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"},{"id":4990,"precertRequired":false,"billingCode":"78811","codeType":"CPT"},{"id":4991,"precertRequired":false,"billingCode":"78812","codeType":"CPT"},{"id":4992,"precertRequired":false,"billingCode":"78813","codeType":"CPT"},{"id":4993,"precertRequired":false,"billingCode":"78814","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":4995,"precertRequired":false,"billingCode":"78816","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1170,"description":"Follow-up studies as clinically indicated relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4915,"precertRequired":false,"billingCode":"78270","codeType":"CPT"},{"id":4916,"precertRequired":false,"billingCode":"78271","codeType":"CPT"},{"id":4917,"precertRequired":false,"billingCode":"78272","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]}]}},{"Seoc":{"id":149,"seocKey":55,"name":"General Surgery PRCT_PRCT","seocId":"SSC_GENERAL SURGERY PRCT_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-03-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Diagnostic studies relevant to the referred condition on the consult\r\n4. Labs and pathology relevant to the referred condition on the consult\r\n5. Procedures relevant to the referred condition on the consult including but not limited to:  I&D, biopsy, lesion excision with repair, etc\r\n6. Anesthesia consultation related to the procedure\r\n7. Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)\r\n8. Inpatient or observation admission for surgery/procedure if indicated\r\n9. Inpatient admission or observation status for complications related to the surgery/procedure\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure\r\n10. Follow-up visits for this episode of care relevant to the referred condition on the consult\r\n11. Follow-up imaging as clinically indicated relevant to the referred condition on the consult\r\n12. Follow-up studies as clinically indicated relevant to the referred condition on the consult","maxAllowableVisits":999,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a  reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"SURGERY GENERAL","serviceLine":"Surgical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":592,"description":" Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":593,"description":"Diagnostic imaging relevant to the referred condition on the consult  ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4367,"precertRequired":false,"billingCode":"70015","codeType":"CPT"},{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4416,"precertRequired":false,"billingCode":"70545","codeType":"CPT"},{"id":4417,"precertRequired":false,"billingCode":"70546","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4424,"precertRequired":false,"billingCode":"70554","codeType":"CPT"},{"id":4425,"precertRequired":false,"billingCode":"70555","codeType":"CPT"},{"id":4426,"precertRequired":false,"billingCode":"70557","codeType":"CPT"},{"id":4427,"precertRequired":false,"billingCode":"70558","codeType":"CPT"},{"id":4428,"precertRequired":false,"billingCode":"70559","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4584,"precertRequired":false,"billingCode":"74190","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4605,"precertRequired":false,"billingCode":"74300","codeType":"CPT"},{"id":4606,"precertRequired":false,"billingCode":"74301","codeType":"CPT"},{"id":4607,"precertRequired":false,"billingCode":"74328","codeType":"CPT"},{"id":4608,"precertRequired":false,"billingCode":"74329","codeType":"CPT"},{"id":4609,"precertRequired":false,"billingCode":"74330","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4611,"precertRequired":false,"billingCode":"74355","codeType":"CPT"},{"id":4612,"precertRequired":false,"billingCode":"74360","codeType":"CPT"},{"id":4613,"precertRequired":false,"billingCode":"74363","codeType":"CPT"},{"id":4639,"precertRequired":false,"billingCode":"75600","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4661,"precertRequired":false,"billingCode":"75809","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4667,"precertRequired":false,"billingCode":"75831","codeType":"CPT"},{"id":4668,"precertRequired":false,"billingCode":"75833","codeType":"CPT"},{"id":4669,"precertRequired":false,"billingCode":"75840","codeType":"CPT"},{"id":4670,"precertRequired":false,"billingCode":"75842","codeType":"CPT"},{"id":4671,"precertRequired":false,"billingCode":"75860","codeType":"CPT"},{"id":4672,"precertRequired":false,"billingCode":"75870","codeType":"CPT"},{"id":4673,"precertRequired":false,"billingCode":"75872","codeType":"CPT"},{"id":4674,"precertRequired":false,"billingCode":"75880","codeType":"CPT"},{"id":4675,"precertRequired":false,"billingCode":"75885","codeType":"CPT"},{"id":4676,"precertRequired":false,"billingCode":"75887","codeType":"CPT"},{"id":4677,"precertRequired":false,"billingCode":"75889","codeType":"CPT"},{"id":4678,"precertRequired":false,"billingCode":"75891","codeType":"CPT"},{"id":4679,"precertRequired":false,"billingCode":"75893","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4682,"precertRequired":false,"billingCode":"75901","codeType":"CPT"},{"id":4683,"precertRequired":false,"billingCode":"75902","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4691,"precertRequired":false,"billingCode":"75989","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4693,"precertRequired":false,"billingCode":"76001","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4697,"precertRequired":false,"billingCode":"76100","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4700,"precertRequired":false,"billingCode":"76120","codeType":"CPT"},{"id":4701,"precertRequired":false,"billingCode":"76125","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4706,"precertRequired":false,"billingCode":"76390","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4726,"precertRequired":false,"billingCode":"76706","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4770,"precertRequired":false,"billingCode":"76970","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4784,"precertRequired":true,"billingCode":"77058","codeType":"CPT"},{"id":4785,"precertRequired":true,"billingCode":"77059","codeType":"CPT"},{"id":4792,"precertRequired":false,"billingCode":"77071","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4797,"precertRequired":false,"billingCode":"77077","codeType":"CPT"},{"id":4801,"precertRequired":false,"billingCode":"77084","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4910,"precertRequired":false,"billingCode":"78261","codeType":"CPT"},{"id":4918,"precertRequired":false,"billingCode":"78278","codeType":"CPT"},{"id":4919,"precertRequired":false,"billingCode":"78282","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4921,"precertRequired":false,"billingCode":"78291","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4930,"precertRequired":false,"billingCode":"78414","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4932,"precertRequired":false,"billingCode":"78445","codeType":"CPT"},{"id":4937,"precertRequired":false,"billingCode":"78456","codeType":"CPT"},{"id":4938,"precertRequired":false,"billingCode":"78457","codeType":"CPT"},{"id":4939,"precertRequired":false,"billingCode":"78458","codeType":"CPT"},{"id":4969,"precertRequired":false,"billingCode":"78660","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4986,"precertRequired":false,"billingCode":"78805","codeType":"CPT"},{"id":4987,"precertRequired":false,"billingCode":"78806","codeType":"CPT"},{"id":4988,"precertRequired":false,"billingCode":"78807","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"},{"id":4990,"precertRequired":false,"billingCode":"78811","codeType":"CPT"},{"id":4991,"precertRequired":false,"billingCode":"78812","codeType":"CPT"},{"id":4992,"precertRequired":false,"billingCode":"78813","codeType":"CPT"},{"id":4993,"precertRequired":false,"billingCode":"78814","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":4995,"precertRequired":false,"billingCode":"78816","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":594,"description":"Diagnostic studies relevant to the referred condition on the consult  ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4915,"precertRequired":false,"billingCode":"78270","codeType":"CPT"},{"id":4916,"precertRequired":false,"billingCode":"78271","codeType":"CPT"},{"id":4917,"precertRequired":false,"billingCode":"78272","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":595,"description":"Labs and pathology relevant to the referred condition on the consult ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5138,"precertRequired":false,"billingCode":"80438","codeType":"CPT"},{"id":5139,"precertRequired":false,"billingCode":"80439","codeType":"CPT"},{"id":5140,"precertRequired":false,"billingCode":"80500","codeType":"CPT"},{"id":5141,"precertRequired":false,"billingCode":"80502","codeType":"CPT"},{"id":5340,"precertRequired":false,"billingCode":"81500","codeType":"CPT"},{"id":5341,"precertRequired":false,"billingCode":"81503","codeType":"CPT"},{"id":5375,"precertRequired":false,"billingCode":"82044","codeType":"CPT"},{"id":5382,"precertRequired":false,"billingCode":"82105","codeType":"CPT"},{"id":5383,"precertRequired":false,"billingCode":"82106","codeType":"CPT"},{"id":5384,"precertRequired":false,"billingCode":"82107","codeType":"CPT"},{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5432,"precertRequired":false,"billingCode":"82378","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5586,"precertRequired":false,"billingCode":"83630","codeType":"CPT"},{"id":5587,"precertRequired":false,"billingCode":"83631","codeType":"CPT"},{"id":5668,"precertRequired":false,"billingCode":"84152","codeType":"CPT"},{"id":5669,"precertRequired":false,"billingCode":"84153","codeType":"CPT"},{"id":5670,"precertRequired":false,"billingCode":"84154","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5905,"precertRequired":false,"billingCode":"86300","codeType":"CPT"},{"id":5906,"precertRequired":false,"billingCode":"86301","codeType":"CPT"},{"id":5907,"precertRequired":false,"billingCode":"86304","codeType":"CPT"},{"id":6108,"precertRequired":false,"billingCode":"87045","codeType":"CPT"},{"id":6109,"precertRequired":false,"billingCode":"87046","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6112,"precertRequired":false,"billingCode":"87073","codeType":"CPT"},{"id":6143,"precertRequired":false,"billingCode":"87177","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6236,"precertRequired":false,"billingCode":"87505","codeType":"CPT"},{"id":6237,"precertRequired":false,"billingCode":"87506","codeType":"CPT"},{"id":6238,"precertRequired":false,"billingCode":"87507","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":6411,"precertRequired":false,"billingCode":"88314","codeType":"CPT"},{"id":6412,"precertRequired":false,"billingCode":"88319","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6414,"precertRequired":false,"billingCode":"88323","codeType":"CPT"},{"id":6415,"precertRequired":false,"billingCode":"88325","codeType":"CPT"},{"id":6416,"precertRequired":false,"billingCode":"88329","codeType":"CPT"},{"id":6417,"precertRequired":false,"billingCode":"88331","codeType":"CPT"},{"id":6418,"precertRequired":false,"billingCode":"88332","codeType":"CPT"},{"id":6419,"precertRequired":false,"billingCode":"88333","codeType":"CPT"},{"id":6420,"precertRequired":false,"billingCode":"88334","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6423,"precertRequired":false,"billingCode":"88344","codeType":"CPT"},{"id":6424,"precertRequired":false,"billingCode":"88346","codeType":"CPT"},{"id":6425,"precertRequired":false,"billingCode":"88348","codeType":"CPT"},{"id":6426,"precertRequired":false,"billingCode":"88350","codeType":"CPT"},{"id":6427,"precertRequired":false,"billingCode":"88355","codeType":"CPT"},{"id":6428,"precertRequired":false,"billingCode":"88356","codeType":"CPT"},{"id":6429,"precertRequired":false,"billingCode":"88358","codeType":"CPT"},{"id":6430,"precertRequired":false,"billingCode":"88360","codeType":"CPT"},{"id":6431,"precertRequired":false,"billingCode":"88361","codeType":"CPT"},{"id":6432,"precertRequired":false,"billingCode":"88362","codeType":"CPT"},{"id":6433,"precertRequired":false,"billingCode":"88363","codeType":"CPT"},{"id":6434,"precertRequired":false,"billingCode":"88364","codeType":"CPT"},{"id":6435,"precertRequired":false,"billingCode":"88365","codeType":"CPT"},{"id":6436,"precertRequired":false,"billingCode":"88366","codeType":"CPT"},{"id":6437,"precertRequired":false,"billingCode":"88367","codeType":"CPT"},{"id":6438,"precertRequired":false,"billingCode":"88368","codeType":"CPT"},{"id":6439,"precertRequired":false,"billingCode":"88369","codeType":"CPT"},{"id":6440,"precertRequired":false,"billingCode":"88371","codeType":"CPT"},{"id":6441,"precertRequired":false,"billingCode":"88372","codeType":"CPT"},{"id":6442,"precertRequired":false,"billingCode":"88373","codeType":"CPT"},{"id":6443,"precertRequired":false,"billingCode":"88374","codeType":"CPT"},{"id":6444,"precertRequired":false,"billingCode":"88375","codeType":"CPT"},{"id":6445,"precertRequired":false,"billingCode":"88377","codeType":"CPT"},{"id":6446,"precertRequired":false,"billingCode":"88380","codeType":"CPT"},{"id":6447,"precertRequired":false,"billingCode":"88381","codeType":"CPT"},{"id":6448,"precertRequired":false,"billingCode":"88387","codeType":"CPT"},{"id":6449,"precertRequired":false,"billingCode":"88388","codeType":"CPT"},{"id":6456,"precertRequired":false,"billingCode":"89049","codeType":"CPT"},{"id":6457,"precertRequired":false,"billingCode":"89050","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":8206,"precertRequired":false,"billingCode":"G0416","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":596,"description":"Procedures relevant to the referred condition on the consult including but not limited to:  I&D, biopsy, lesion excision with repair, etc.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":222,"precertRequired":false,"billingCode":"10022","codeType":"CPT"},{"id":223,"precertRequired":false,"billingCode":"10030","codeType":"CPT"},{"id":224,"precertRequired":false,"billingCode":"10035","codeType":"CPT"},{"id":225,"precertRequired":false,"billingCode":"10036","codeType":"CPT"},{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":229,"precertRequired":false,"billingCode":"10080","codeType":"CPT"},{"id":230,"precertRequired":false,"billingCode":"10081","codeType":"CPT"},{"id":231,"precertRequired":false,"billingCode":"10120","codeType":"CPT"},{"id":232,"precertRequired":false,"billingCode":"10121","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":235,"precertRequired":false,"billingCode":"10160","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":237,"precertRequired":false,"billingCode":"11000","codeType":"CPT"},{"id":238,"precertRequired":false,"billingCode":"11001","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":243,"precertRequired":false,"billingCode":"11010","codeType":"CPT"},{"id":244,"precertRequired":false,"billingCode":"11011","codeType":"CPT"},{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":248,"precertRequired":false,"billingCode":"11044","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":250,"precertRequired":false,"billingCode":"11046","codeType":"CPT"},{"id":251,"precertRequired":false,"billingCode":"11047","codeType":"CPT"},{"id":271,"precertRequired":false,"billingCode":"11400","codeType":"CPT"},{"id":272,"precertRequired":false,"billingCode":"11401","codeType":"CPT"},{"id":273,"precertRequired":false,"billingCode":"11402","codeType":"CPT"},{"id":274,"precertRequired":false,"billingCode":"11403","codeType":"CPT"},{"id":275,"precertRequired":false,"billingCode":"11404","codeType":"CPT"},{"id":276,"precertRequired":false,"billingCode":"11406","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":283,"precertRequired":false,"billingCode":"11440","codeType":"CPT"},{"id":284,"precertRequired":false,"billingCode":"11441","codeType":"CPT"},{"id":285,"precertRequired":false,"billingCode":"11442","codeType":"CPT"},{"id":286,"precertRequired":false,"billingCode":"11443","codeType":"CPT"},{"id":287,"precertRequired":false,"billingCode":"11444","codeType":"CPT"},{"id":288,"precertRequired":false,"billingCode":"11446","codeType":"CPT"},{"id":289,"precertRequired":false,"billingCode":"11450","codeType":"CPT"},{"id":290,"precertRequired":false,"billingCode":"11451","codeType":"CPT"},{"id":291,"precertRequired":false,"billingCode":"11462","codeType":"CPT"},{"id":292,"precertRequired":false,"billingCode":"11463","codeType":"CPT"},{"id":293,"precertRequired":false,"billingCode":"11470","codeType":"CPT"},{"id":294,"precertRequired":false,"billingCode":"11471","codeType":"CPT"},{"id":295,"precertRequired":false,"billingCode":"11600","codeType":"CPT"},{"id":296,"precertRequired":false,"billingCode":"11601","codeType":"CPT"},{"id":297,"precertRequired":false,"billingCode":"11602","codeType":"CPT"},{"id":298,"precertRequired":false,"billingCode":"11603","codeType":"CPT"},{"id":299,"precertRequired":false,"billingCode":"11604","codeType":"CPT"},{"id":300,"precertRequired":false,"billingCode":"11606","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":307,"precertRequired":false,"billingCode":"11640","codeType":"CPT"},{"id":308,"precertRequired":false,"billingCode":"11641","codeType":"CPT"},{"id":309,"precertRequired":false,"billingCode":"11642","codeType":"CPT"},{"id":310,"precertRequired":false,"billingCode":"11643","codeType":"CPT"},{"id":311,"precertRequired":false,"billingCode":"11644","codeType":"CPT"},{"id":312,"precertRequired":false,"billingCode":"11646","codeType":"CPT"},{"id":318,"precertRequired":false,"billingCode":"11740","codeType":"CPT"},{"id":324,"precertRequired":false,"billingCode":"11770","codeType":"CPT"},{"id":325,"precertRequired":false,"billingCode":"11771","codeType":"CPT"},{"id":326,"precertRequired":false,"billingCode":"11772","codeType":"CPT"},{"id":327,"precertRequired":false,"billingCode":"11900","codeType":"CPT"},{"id":328,"precertRequired":false,"billingCode":"11901","codeType":"CPT"},{"id":329,"precertRequired":false,"billingCode":"11960","codeType":"CPT"},{"id":330,"precertRequired":false,"billingCode":"11970","codeType":"CPT"},{"id":331,"precertRequired":false,"billingCode":"11971","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":343,"precertRequired":false,"billingCode":"12011","codeType":"CPT"},{"id":344,"precertRequired":false,"billingCode":"12013","codeType":"CPT"},{"id":345,"precertRequired":false,"billingCode":"12014","codeType":"CPT"},{"id":346,"precertRequired":false,"billingCode":"12015","codeType":"CPT"},{"id":347,"precertRequired":false,"billingCode":"12016","codeType":"CPT"},{"id":348,"precertRequired":false,"billingCode":"12017","codeType":"CPT"},{"id":349,"precertRequired":false,"billingCode":"12018","codeType":"CPT"},{"id":350,"precertRequired":false,"billingCode":"12020","codeType":"CPT"},{"id":351,"precertRequired":false,"billingCode":"12021","codeType":"CPT"},{"id":352,"precertRequired":false,"billingCode":"12031","codeType":"CPT"},{"id":353,"precertRequired":false,"billingCode":"12032","codeType":"CPT"},{"id":354,"precertRequired":false,"billingCode":"12034","codeType":"CPT"},{"id":355,"precertRequired":false,"billingCode":"12035","codeType":"CPT"},{"id":356,"precertRequired":false,"billingCode":"12036","codeType":"CPT"},{"id":357,"precertRequired":false,"billingCode":"12037","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":364,"precertRequired":false,"billingCode":"12051","codeType":"CPT"},{"id":365,"precertRequired":false,"billingCode":"12052","codeType":"CPT"},{"id":366,"precertRequired":false,"billingCode":"12053","codeType":"CPT"},{"id":367,"precertRequired":false,"billingCode":"12054","codeType":"CPT"},{"id":368,"precertRequired":false,"billingCode":"12055","codeType":"CPT"},{"id":369,"precertRequired":false,"billingCode":"12056","codeType":"CPT"},{"id":370,"precertRequired":false,"billingCode":"12057","codeType":"CPT"},{"id":371,"precertRequired":false,"billingCode":"13100","codeType":"CPT"},{"id":372,"precertRequired":false,"billingCode":"13101","codeType":"CPT"},{"id":373,"precertRequired":false,"billingCode":"13102","codeType":"CPT"},{"id":374,"precertRequired":false,"billingCode":"13120","codeType":"CPT"},{"id":375,"precertRequired":false,"billingCode":"13121","codeType":"CPT"},{"id":376,"precertRequired":false,"billingCode":"13122","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":380,"precertRequired":false,"billingCode":"13151","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":383,"precertRequired":false,"billingCode":"13160","codeType":"CPT"},{"id":384,"precertRequired":false,"billingCode":"14000","codeType":"CPT"},{"id":385,"precertRequired":false,"billingCode":"14001","codeType":"CPT"},{"id":386,"precertRequired":false,"billingCode":"14020","codeType":"CPT"},{"id":387,"precertRequired":false,"billingCode":"14021","codeType":"CPT"},{"id":388,"precertRequired":true,"billingCode":"14040","codeType":"CPT"},{"id":389,"precertRequired":false,"billingCode":"14041","codeType":"CPT"},{"id":390,"precertRequired":true,"billingCode":"14060","codeType":"CPT"},{"id":391,"precertRequired":false,"billingCode":"14061","codeType":"CPT"},{"id":392,"precertRequired":true,"billingCode":"14301","codeType":"CPT"},{"id":393,"precertRequired":false,"billingCode":"14302","codeType":"CPT"},{"id":395,"precertRequired":false,"billingCode":"15040","codeType":"CPT"},{"id":396,"precertRequired":false,"billingCode":"15050","codeType":"CPT"},{"id":397,"precertRequired":false,"billingCode":"15150","codeType":"CPT"},{"id":398,"precertRequired":false,"billingCode":"15151","codeType":"CPT"},{"id":399,"precertRequired":false,"billingCode":"15155","codeType":"CPT"},{"id":400,"precertRequired":false,"billingCode":"15156","codeType":"CPT"},{"id":401,"precertRequired":false,"billingCode":"15157","codeType":"CPT"},{"id":402,"precertRequired":false,"billingCode":"15200","codeType":"CPT"},{"id":403,"precertRequired":false,"billingCode":"15201","codeType":"CPT"},{"id":404,"precertRequired":false,"billingCode":"15220","codeType":"CPT"},{"id":405,"precertRequired":false,"billingCode":"15221","codeType":"CPT"},{"id":406,"precertRequired":false,"billingCode":"15240","codeType":"CPT"},{"id":407,"precertRequired":false,"billingCode":"15241","codeType":"CPT"},{"id":408,"precertRequired":false,"billingCode":"15260","codeType":"CPT"},{"id":409,"precertRequired":false,"billingCode":"15261","codeType":"CPT"},{"id":410,"precertRequired":false,"billingCode":"15271","codeType":"CPT"},{"id":411,"precertRequired":false,"billingCode":"15272","codeType":"CPT"},{"id":412,"precertRequired":false,"billingCode":"15273","codeType":"CPT"},{"id":413,"precertRequired":false,"billingCode":"15275","codeType":"CPT"},{"id":414,"precertRequired":false,"billingCode":"15276","codeType":"CPT"},{"id":415,"precertRequired":false,"billingCode":"15570","codeType":"CPT"},{"id":416,"precertRequired":false,"billingCode":"15572","codeType":"CPT"},{"id":417,"precertRequired":false,"billingCode":"15574","codeType":"CPT"},{"id":418,"precertRequired":false,"billingCode":"15576","codeType":"CPT"},{"id":419,"precertRequired":false,"billingCode":"15600","codeType":"CPT"},{"id":420,"precertRequired":false,"billingCode":"15610","codeType":"CPT"},{"id":421,"precertRequired":false,"billingCode":"15620","codeType":"CPT"},{"id":422,"precertRequired":false,"billingCode":"15630","codeType":"CPT"},{"id":423,"precertRequired":false,"billingCode":"15650","codeType":"CPT"},{"id":424,"precertRequired":false,"billingCode":"15730","codeType":"CPT"},{"id":425,"precertRequired":false,"billingCode":"15731","codeType":"CPT"},{"id":426,"precertRequired":false,"billingCode":"15733","codeType":"CPT"},{"id":427,"precertRequired":false,"billingCode":"15734","codeType":"CPT"},{"id":428,"precertRequired":false,"billingCode":"15736","codeType":"CPT"},{"id":429,"precertRequired":false,"billingCode":"15738","codeType":"CPT"},{"id":430,"precertRequired":false,"billingCode":"15740","codeType":"CPT"},{"id":431,"precertRequired":false,"billingCode":"15750","codeType":"CPT"},{"id":432,"precertRequired":false,"billingCode":"15756","codeType":"CPT"},{"id":433,"precertRequired":false,"billingCode":"15757","codeType":"CPT"},{"id":434,"precertRequired":false,"billingCode":"15758","codeType":"CPT"},{"id":435,"precertRequired":false,"billingCode":"15760","codeType":"CPT"},{"id":436,"precertRequired":false,"billingCode":"15770","codeType":"CPT"},{"id":441,"precertRequired":false,"billingCode":"15786","codeType":"CPT"},{"id":442,"precertRequired":false,"billingCode":"15787","codeType":"CPT"},{"id":443,"precertRequired":false,"billingCode":"15850","codeType":"CPT"},{"id":444,"precertRequired":false,"billingCode":"15852","codeType":"CPT"},{"id":445,"precertRequired":false,"billingCode":"15860","codeType":"CPT"},{"id":446,"precertRequired":false,"billingCode":"15920","codeType":"CPT"},{"id":447,"precertRequired":false,"billingCode":"15922","codeType":"CPT"},{"id":448,"precertRequired":false,"billingCode":"15931","codeType":"CPT"},{"id":449,"precertRequired":false,"billingCode":"15933","codeType":"CPT"},{"id":450,"precertRequired":false,"billingCode":"15934","codeType":"CPT"},{"id":451,"precertRequired":false,"billingCode":"15935","codeType":"CPT"},{"id":452,"precertRequired":false,"billingCode":"15936","codeType":"CPT"},{"id":453,"precertRequired":false,"billingCode":"15937","codeType":"CPT"},{"id":454,"precertRequired":false,"billingCode":"15940","codeType":"CPT"},{"id":455,"precertRequired":false,"billingCode":"15941","codeType":"CPT"},{"id":456,"precertRequired":false,"billingCode":"15944","codeType":"CPT"},{"id":457,"precertRequired":false,"billingCode":"15945","codeType":"CPT"},{"id":458,"precertRequired":false,"billingCode":"15946","codeType":"CPT"},{"id":459,"precertRequired":false,"billingCode":"15950","codeType":"CPT"},{"id":460,"precertRequired":false,"billingCode":"15951","codeType":"CPT"},{"id":461,"precertRequired":false,"billingCode":"15952","codeType":"CPT"},{"id":462,"precertRequired":false,"billingCode":"15953","codeType":"CPT"},{"id":463,"precertRequired":false,"billingCode":"15956","codeType":"CPT"},{"id":464,"precertRequired":false,"billingCode":"15958","codeType":"CPT"},{"id":465,"precertRequired":false,"billingCode":"16000","codeType":"CPT"},{"id":466,"precertRequired":false,"billingCode":"16020","codeType":"CPT"},{"id":467,"precertRequired":false,"billingCode":"16025","codeType":"CPT"},{"id":468,"precertRequired":false,"billingCode":"16030","codeType":"CPT"},{"id":469,"precertRequired":false,"billingCode":"16035","codeType":"CPT"},{"id":470,"precertRequired":false,"billingCode":"16036","codeType":"CPT"},{"id":471,"precertRequired":false,"billingCode":"17000","codeType":"CPT"},{"id":472,"precertRequired":false,"billingCode":"17003","codeType":"CPT"},{"id":473,"precertRequired":false,"billingCode":"17004","codeType":"CPT"},{"id":474,"precertRequired":false,"billingCode":"17106","codeType":"CPT"},{"id":475,"precertRequired":false,"billingCode":"17107","codeType":"CPT"},{"id":476,"precertRequired":false,"billingCode":"17108","codeType":"CPT"},{"id":477,"precertRequired":false,"billingCode":"17110","codeType":"CPT"},{"id":478,"precertRequired":false,"billingCode":"17111","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":480,"precertRequired":false,"billingCode":"17260","codeType":"CPT"},{"id":481,"precertRequired":false,"billingCode":"17261","codeType":"CPT"},{"id":482,"precertRequired":false,"billingCode":"17262","codeType":"CPT"},{"id":483,"precertRequired":false,"billingCode":"17263","codeType":"CPT"},{"id":484,"precertRequired":false,"billingCode":"17264","codeType":"CPT"},{"id":485,"precertRequired":false,"billingCode":"17266","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":492,"precertRequired":false,"billingCode":"17280","codeType":"CPT"},{"id":493,"precertRequired":false,"billingCode":"17281","codeType":"CPT"},{"id":494,"precertRequired":false,"billingCode":"17282","codeType":"CPT"},{"id":495,"precertRequired":false,"billingCode":"17283","codeType":"CPT"},{"id":496,"precertRequired":false,"billingCode":"17284","codeType":"CPT"},{"id":497,"precertRequired":false,"billingCode":"17286","codeType":"CPT"},{"id":503,"precertRequired":false,"billingCode":"19000","codeType":"CPT"},{"id":504,"precertRequired":false,"billingCode":"19001","codeType":"CPT"},{"id":505,"precertRequired":false,"billingCode":"19020","codeType":"CPT"},{"id":506,"precertRequired":false,"billingCode":"19030","codeType":"CPT"},{"id":507,"precertRequired":false,"billingCode":"19081","codeType":"CPT"},{"id":508,"precertRequired":false,"billingCode":"19082","codeType":"CPT"},{"id":509,"precertRequired":false,"billingCode":"19083","codeType":"CPT"},{"id":510,"precertRequired":false,"billingCode":"19084","codeType":"CPT"},{"id":511,"precertRequired":false,"billingCode":"19085","codeType":"CPT"},{"id":512,"precertRequired":false,"billingCode":"19086","codeType":"CPT"},{"id":513,"precertRequired":false,"billingCode":"19100","codeType":"CPT"},{"id":514,"precertRequired":false,"billingCode":"19101","codeType":"CPT"},{"id":515,"precertRequired":false,"billingCode":"19105","codeType":"CPT"},{"id":516,"precertRequired":false,"billingCode":"19120","codeType":"CPT"},{"id":517,"precertRequired":false,"billingCode":"19125","codeType":"CPT"},{"id":518,"precertRequired":false,"billingCode":"19126","codeType":"CPT"},{"id":519,"precertRequired":false,"billingCode":"19260","codeType":"CPT"},{"id":522,"precertRequired":false,"billingCode":"19281","codeType":"CPT"},{"id":523,"precertRequired":false,"billingCode":"19282","codeType":"CPT"},{"id":524,"precertRequired":false,"billingCode":"19283","codeType":"CPT"},{"id":525,"precertRequired":false,"billingCode":"19284","codeType":"CPT"},{"id":526,"precertRequired":false,"billingCode":"19285","codeType":"CPT"},{"id":527,"precertRequired":false,"billingCode":"19286","codeType":"CPT"},{"id":528,"precertRequired":false,"billingCode":"19287","codeType":"CPT"},{"id":529,"precertRequired":false,"billingCode":"19288","codeType":"CPT"},{"id":542,"precertRequired":false,"billingCode":"20005","codeType":"CPT"},{"id":543,"precertRequired":false,"billingCode":"20100","codeType":"CPT"},{"id":544,"precertRequired":false,"billingCode":"20101","codeType":"CPT"},{"id":545,"precertRequired":false,"billingCode":"20102","codeType":"CPT"},{"id":546,"precertRequired":false,"billingCode":"20103","codeType":"CPT"},{"id":547,"precertRequired":false,"billingCode":"20150","codeType":"CPT"},{"id":548,"precertRequired":false,"billingCode":"20200","codeType":"CPT"},{"id":549,"precertRequired":false,"billingCode":"20205","codeType":"CPT"},{"id":550,"precertRequired":false,"billingCode":"20206","codeType":"CPT"},{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":552,"precertRequired":false,"billingCode":"20225","codeType":"CPT"},{"id":553,"precertRequired":false,"billingCode":"20240","codeType":"CPT"},{"id":554,"precertRequired":false,"billingCode":"20245","codeType":"CPT"},{"id":555,"precertRequired":true,"billingCode":"20250","codeType":"CPT"},{"id":556,"precertRequired":true,"billingCode":"20251","codeType":"CPT"},{"id":557,"precertRequired":false,"billingCode":"20500","codeType":"CPT"},{"id":558,"precertRequired":false,"billingCode":"20501","codeType":"CPT"},{"id":559,"precertRequired":false,"billingCode":"20520","codeType":"CPT"},{"id":560,"precertRequired":false,"billingCode":"20525","codeType":"CPT"},{"id":562,"precertRequired":true,"billingCode":"20527","codeType":"CPT"},{"id":563,"precertRequired":true,"billingCode":"20550","codeType":"CPT"},{"id":564,"precertRequired":true,"billingCode":"20551","codeType":"CPT"},{"id":567,"precertRequired":false,"billingCode":"20555","codeType":"CPT"},{"id":582,"precertRequired":false,"billingCode":"20665","codeType":"CPT"},{"id":583,"precertRequired":false,"billingCode":"20670","codeType":"CPT"},{"id":584,"precertRequired":false,"billingCode":"20680","codeType":"CPT"},{"id":591,"precertRequired":false,"billingCode":"20900","codeType":"CPT"},{"id":592,"precertRequired":false,"billingCode":"20902","codeType":"CPT"},{"id":593,"precertRequired":false,"billingCode":"20910","codeType":"CPT"},{"id":594,"precertRequired":false,"billingCode":"20912","codeType":"CPT"},{"id":595,"precertRequired":false,"billingCode":"20920","codeType":"CPT"},{"id":596,"precertRequired":false,"billingCode":"20922","codeType":"CPT"},{"id":597,"precertRequired":false,"billingCode":"20924","codeType":"CPT"},{"id":598,"precertRequired":false,"billingCode":"20926","codeType":"CPT"},{"id":600,"precertRequired":false,"billingCode":"20950","codeType":"CPT"},{"id":609,"precertRequired":false,"billingCode":"20982","codeType":"CPT"},{"id":610,"precertRequired":false,"billingCode":"20983","codeType":"CPT"},{"id":611,"precertRequired":false,"billingCode":"20985","codeType":"CPT"},{"id":723,"precertRequired":false,"billingCode":"21501","codeType":"CPT"},{"id":724,"precertRequired":false,"billingCode":"21502","codeType":"CPT"},{"id":725,"precertRequired":false,"billingCode":"21510","codeType":"CPT"},{"id":726,"precertRequired":true,"billingCode":"21550","codeType":"CPT"},{"id":727,"precertRequired":true,"billingCode":"21552","codeType":"CPT"},{"id":728,"precertRequired":true,"billingCode":"21554","codeType":"CPT"},{"id":729,"precertRequired":true,"billingCode":"21555","codeType":"CPT"},{"id":730,"precertRequired":true,"billingCode":"21556","codeType":"CPT"},{"id":731,"precertRequired":true,"billingCode":"21557","codeType":"CPT"},{"id":732,"precertRequired":true,"billingCode":"21558","codeType":"CPT"},{"id":733,"precertRequired":true,"billingCode":"21600","codeType":"CPT"},{"id":734,"precertRequired":true,"billingCode":"21610","codeType":"CPT"},{"id":735,"precertRequired":true,"billingCode":"21615","codeType":"CPT"},{"id":736,"precertRequired":true,"billingCode":"21616","codeType":"CPT"},{"id":737,"precertRequired":true,"billingCode":"21620","codeType":"CPT"},{"id":738,"precertRequired":true,"billingCode":"21627","codeType":"CPT"},{"id":739,"precertRequired":true,"billingCode":"21630","codeType":"CPT"},{"id":740,"precertRequired":true,"billingCode":"21632","codeType":"CPT"},{"id":741,"precertRequired":false,"billingCode":"21685","codeType":"CPT"},{"id":742,"precertRequired":true,"billingCode":"21700","codeType":"CPT"},{"id":743,"precertRequired":true,"billingCode":"21705","codeType":"CPT"},{"id":744,"precertRequired":true,"billingCode":"21720","codeType":"CPT"},{"id":745,"precertRequired":true,"billingCode":"21725","codeType":"CPT"},{"id":749,"precertRequired":true,"billingCode":"21750","codeType":"CPT"},{"id":750,"precertRequired":true,"billingCode":"21811","codeType":"CPT"},{"id":751,"precertRequired":true,"billingCode":"21812","codeType":"CPT"},{"id":752,"precertRequired":true,"billingCode":"21813","codeType":"CPT"},{"id":755,"precertRequired":false,"billingCode":"21920","codeType":"CPT"},{"id":756,"precertRequired":false,"billingCode":"21925","codeType":"CPT"},{"id":757,"precertRequired":false,"billingCode":"21930","codeType":"CPT"},{"id":758,"precertRequired":false,"billingCode":"21931","codeType":"CPT"},{"id":759,"precertRequired":false,"billingCode":"21932","codeType":"CPT"},{"id":760,"precertRequired":false,"billingCode":"21933","codeType":"CPT"},{"id":761,"precertRequired":false,"billingCode":"21935","codeType":"CPT"},{"id":762,"precertRequired":false,"billingCode":"21936","codeType":"CPT"},{"id":763,"precertRequired":true,"billingCode":"22010","codeType":"CPT"},{"id":764,"precertRequired":false,"billingCode":"22015","codeType":"CPT"},{"id":775,"precertRequired":false,"billingCode":"22900","codeType":"CPT"},{"id":776,"precertRequired":false,"billingCode":"22901","codeType":"CPT"},{"id":777,"precertRequired":false,"billingCode":"22902","codeType":"CPT"},{"id":778,"precertRequired":false,"billingCode":"22903","codeType":"CPT"},{"id":779,"precertRequired":false,"billingCode":"22904","codeType":"CPT"},{"id":780,"precertRequired":false,"billingCode":"22905","codeType":"CPT"},{"id":783,"precertRequired":false,"billingCode":"23030","codeType":"CPT"},{"id":784,"precertRequired":false,"billingCode":"23031","codeType":"CPT"},{"id":785,"precertRequired":false,"billingCode":"23035","codeType":"CPT"},{"id":788,"precertRequired":false,"billingCode":"23065","codeType":"CPT"},{"id":789,"precertRequired":false,"billingCode":"23066","codeType":"CPT"},{"id":790,"precertRequired":false,"billingCode":"23071","codeType":"CPT"},{"id":791,"precertRequired":false,"billingCode":"23073","codeType":"CPT"},{"id":792,"precertRequired":false,"billingCode":"23075","codeType":"CPT"},{"id":793,"precertRequired":false,"billingCode":"23076","codeType":"CPT"},{"id":794,"precertRequired":false,"billingCode":"23077","codeType":"CPT"},{"id":795,"precertRequired":false,"billingCode":"23078","codeType":"CPT"},{"id":885,"precertRequired":false,"billingCode":"23930","codeType":"CPT"},{"id":886,"precertRequired":false,"billingCode":"23931","codeType":"CPT"},{"id":887,"precertRequired":false,"billingCode":"23935","codeType":"CPT"},{"id":890,"precertRequired":false,"billingCode":"24065","codeType":"CPT"},{"id":891,"precertRequired":false,"billingCode":"24066","codeType":"CPT"},{"id":892,"precertRequired":false,"billingCode":"24071","codeType":"CPT"},{"id":893,"precertRequired":false,"billingCode":"24073","codeType":"CPT"},{"id":894,"precertRequired":false,"billingCode":"24075","codeType":"CPT"},{"id":895,"precertRequired":false,"billingCode":"24076","codeType":"CPT"},{"id":896,"precertRequired":false,"billingCode":"24077","codeType":"CPT"},{"id":897,"precertRequired":false,"billingCode":"24079","codeType":"CPT"},{"id":921,"precertRequired":false,"billingCode":"24200","codeType":"CPT"},{"id":922,"precertRequired":false,"billingCode":"24201","codeType":"CPT"},{"id":992,"precertRequired":false,"billingCode":"24900","codeType":"CPT"},{"id":993,"precertRequired":false,"billingCode":"24920","codeType":"CPT"},{"id":994,"precertRequired":false,"billingCode":"24925","codeType":"CPT"},{"id":995,"precertRequired":false,"billingCode":"24930","codeType":"CPT"},{"id":996,"precertRequired":false,"billingCode":"24931","codeType":"CPT"},{"id":997,"precertRequired":false,"billingCode":"24935","codeType":"CPT"},{"id":1001,"precertRequired":false,"billingCode":"25020","codeType":"CPT"},{"id":1002,"precertRequired":false,"billingCode":"25023","codeType":"CPT"},{"id":1003,"precertRequired":false,"billingCode":"25024","codeType":"CPT"},{"id":1004,"precertRequired":false,"billingCode":"25025","codeType":"CPT"},{"id":1005,"precertRequired":false,"billingCode":"25028","codeType":"CPT"},{"id":1006,"precertRequired":false,"billingCode":"25031","codeType":"CPT"},{"id":1007,"precertRequired":false,"billingCode":"25035","codeType":"CPT"},{"id":1008,"precertRequired":false,"billingCode":"25040","codeType":"CPT"},{"id":1009,"precertRequired":false,"billingCode":"25065","codeType":"CPT"},{"id":1010,"precertRequired":false,"billingCode":"25066","codeType":"CPT"},{"id":1011,"precertRequired":false,"billingCode":"25071","codeType":"CPT"},{"id":1012,"precertRequired":false,"billingCode":"25073","codeType":"CPT"},{"id":1013,"precertRequired":false,"billingCode":"25075","codeType":"CPT"},{"id":1014,"precertRequired":false,"billingCode":"25076","codeType":"CPT"},{"id":1015,"precertRequired":false,"billingCode":"25077","codeType":"CPT"},{"id":1016,"precertRequired":false,"billingCode":"25078","codeType":"CPT"},{"id":1145,"precertRequired":false,"billingCode":"25900","codeType":"CPT"},{"id":1146,"precertRequired":false,"billingCode":"25905","codeType":"CPT"},{"id":1147,"precertRequired":false,"billingCode":"25907","codeType":"CPT"},{"id":1148,"precertRequired":false,"billingCode":"25909","codeType":"CPT"},{"id":1153,"precertRequired":false,"billingCode":"25927","codeType":"CPT"},{"id":1154,"precertRequired":false,"billingCode":"25929","codeType":"CPT"},{"id":1155,"precertRequired":false,"billingCode":"25931","codeType":"CPT"},{"id":1156,"precertRequired":false,"billingCode":"26010","codeType":"CPT"},{"id":1157,"precertRequired":false,"billingCode":"26011","codeType":"CPT"},{"id":1158,"precertRequired":false,"billingCode":"26020","codeType":"CPT"},{"id":1159,"precertRequired":false,"billingCode":"26025","codeType":"CPT"},{"id":1160,"precertRequired":false,"billingCode":"26030","codeType":"CPT"},{"id":1161,"precertRequired":false,"billingCode":"26034","codeType":"CPT"},{"id":1162,"precertRequired":false,"billingCode":"26035","codeType":"CPT"},{"id":1163,"precertRequired":false,"billingCode":"26037","codeType":"CPT"},{"id":1164,"precertRequired":false,"billingCode":"26040","codeType":"CPT"},{"id":1165,"precertRequired":false,"billingCode":"26045","codeType":"CPT"},{"id":1174,"precertRequired":false,"billingCode":"26111","codeType":"CPT"},{"id":1175,"precertRequired":false,"billingCode":"26113","codeType":"CPT"},{"id":1176,"precertRequired":false,"billingCode":"26115","codeType":"CPT"},{"id":1177,"precertRequired":false,"billingCode":"26116","codeType":"CPT"},{"id":1178,"precertRequired":false,"billingCode":"26117","codeType":"CPT"},{"id":1179,"precertRequired":false,"billingCode":"26118","codeType":"CPT"},{"id":1180,"precertRequired":false,"billingCode":"26121","codeType":"CPT"},{"id":1181,"precertRequired":false,"billingCode":"26123","codeType":"CPT"},{"id":1182,"precertRequired":false,"billingCode":"26125","codeType":"CPT"},{"id":1326,"precertRequired":false,"billingCode":"26910","codeType":"CPT"},{"id":1327,"precertRequired":false,"billingCode":"26951","codeType":"CPT"},{"id":1328,"precertRequired":false,"billingCode":"26952","codeType":"CPT"},{"id":1329,"precertRequired":false,"billingCode":"26990","codeType":"CPT"},{"id":1330,"precertRequired":false,"billingCode":"26991","codeType":"CPT"},{"id":1331,"precertRequired":false,"billingCode":"26992","codeType":"CPT"},{"id":1337,"precertRequired":false,"billingCode":"27025","codeType":"CPT"},{"id":1338,"precertRequired":false,"billingCode":"27027","codeType":"CPT"},{"id":1343,"precertRequired":false,"billingCode":"27040","codeType":"CPT"},{"id":1344,"precertRequired":false,"billingCode":"27041","codeType":"CPT"},{"id":1345,"precertRequired":false,"billingCode":"27043","codeType":"CPT"},{"id":1346,"precertRequired":false,"billingCode":"27045","codeType":"CPT"},{"id":1347,"precertRequired":false,"billingCode":"27047","codeType":"CPT"},{"id":1348,"precertRequired":false,"billingCode":"27048","codeType":"CPT"},{"id":1349,"precertRequired":false,"billingCode":"27049","codeType":"CPT"},{"id":1353,"precertRequired":false,"billingCode":"27057","codeType":"CPT"},{"id":1354,"precertRequired":false,"billingCode":"27059","codeType":"CPT"},{"id":1367,"precertRequired":false,"billingCode":"27086","codeType":"CPT"},{"id":1368,"precertRequired":false,"billingCode":"27087","codeType":"CPT"},{"id":1447,"precertRequired":false,"billingCode":"27290","codeType":"CPT"},{"id":1450,"precertRequired":false,"billingCode":"27301","codeType":"CPT"},{"id":1451,"precertRequired":false,"billingCode":"27303","codeType":"CPT"},{"id":1452,"precertRequired":false,"billingCode":"27305","codeType":"CPT"},{"id":1456,"precertRequired":false,"billingCode":"27323","codeType":"CPT"},{"id":1457,"precertRequired":false,"billingCode":"27324","codeType":"CPT"},{"id":1460,"precertRequired":false,"billingCode":"27327","codeType":"CPT"},{"id":1461,"precertRequired":false,"billingCode":"27328","codeType":"CPT"},{"id":1462,"precertRequired":false,"billingCode":"27329","codeType":"CPT"},{"id":1469,"precertRequired":false,"billingCode":"27337","codeType":"CPT"},{"id":1470,"precertRequired":false,"billingCode":"27339","codeType":"CPT"},{"id":1480,"precertRequired":false,"billingCode":"27364","codeType":"CPT"},{"id":1481,"precertRequired":false,"billingCode":"27365","codeType":"CPT"},{"id":1482,"precertRequired":false,"billingCode":"27370","codeType":"CPT"},{"id":1483,"precertRequired":false,"billingCode":"27372","codeType":"CPT"},{"id":1541,"precertRequired":false,"billingCode":"27496","codeType":"CPT"},{"id":1542,"precertRequired":false,"billingCode":"27497","codeType":"CPT"},{"id":1543,"precertRequired":false,"billingCode":"27498","codeType":"CPT"},{"id":1544,"precertRequired":false,"billingCode":"27499","codeType":"CPT"},{"id":1545,"precertRequired":false,"billingCode":"27500","codeType":"CPT"},{"id":1578,"precertRequired":false,"billingCode":"27590","codeType":"CPT"},{"id":1579,"precertRequired":false,"billingCode":"27591","codeType":"CPT"},{"id":1580,"precertRequired":false,"billingCode":"27592","codeType":"CPT"},{"id":1581,"precertRequired":false,"billingCode":"27594","codeType":"CPT"},{"id":1582,"precertRequired":false,"billingCode":"27596","codeType":"CPT"},{"id":1584,"precertRequired":false,"billingCode":"27600","codeType":"CPT"},{"id":1585,"precertRequired":false,"billingCode":"27601","codeType":"CPT"},{"id":1586,"precertRequired":false,"billingCode":"27602","codeType":"CPT"},{"id":1587,"precertRequired":false,"billingCode":"27603","codeType":"CPT"},{"id":1588,"precertRequired":false,"billingCode":"27604","codeType":"CPT"},{"id":1591,"precertRequired":false,"billingCode":"27607","codeType":"CPT"},{"id":1594,"precertRequired":false,"billingCode":"27613","codeType":"CPT"},{"id":1595,"precertRequired":false,"billingCode":"27614","codeType":"CPT"},{"id":1596,"precertRequired":false,"billingCode":"27615","codeType":"CPT"},{"id":1597,"precertRequired":false,"billingCode":"27616","codeType":"CPT"},{"id":1598,"precertRequired":false,"billingCode":"27618","codeType":"CPT"},{"id":1599,"precertRequired":false,"billingCode":"27619","codeType":"CPT"},{"id":1697,"precertRequired":false,"billingCode":"27880","codeType":"CPT"},{"id":1698,"precertRequired":false,"billingCode":"27881","codeType":"CPT"},{"id":1699,"precertRequired":false,"billingCode":"27882","codeType":"CPT"},{"id":1700,"precertRequired":false,"billingCode":"27884","codeType":"CPT"},{"id":1701,"precertRequired":false,"billingCode":"27886","codeType":"CPT"},{"id":1702,"precertRequired":false,"billingCode":"27888","codeType":"CPT"},{"id":1704,"precertRequired":false,"billingCode":"27892","codeType":"CPT"},{"id":1705,"precertRequired":false,"billingCode":"27893","codeType":"CPT"},{"id":1706,"precertRequired":false,"billingCode":"27894","codeType":"CPT"},{"id":1707,"precertRequired":false,"billingCode":"28001","codeType":"CPT"},{"id":1708,"precertRequired":false,"billingCode":"28002","codeType":"CPT"},{"id":1709,"precertRequired":false,"billingCode":"28003","codeType":"CPT"},{"id":1710,"precertRequired":false,"billingCode":"28005","codeType":"CPT"},{"id":1711,"precertRequired":false,"billingCode":"28008","codeType":"CPT"},{"id":1718,"precertRequired":false,"billingCode":"28039","codeType":"CPT"},{"id":1719,"precertRequired":false,"billingCode":"28041","codeType":"CPT"},{"id":1720,"precertRequired":false,"billingCode":"28043","codeType":"CPT"},{"id":1721,"precertRequired":false,"billingCode":"28045","codeType":"CPT"},{"id":1728,"precertRequired":true,"billingCode":"28060","codeType":"CPT"},{"id":1729,"precertRequired":true,"billingCode":"28062","codeType":"CPT"},{"id":1732,"precertRequired":true,"billingCode":"28080","codeType":"CPT"},{"id":1764,"precertRequired":false,"billingCode":"28190","codeType":"CPT"},{"id":1765,"precertRequired":false,"billingCode":"28192","codeType":"CPT"},{"id":1766,"precertRequired":false,"billingCode":"28193","codeType":"CPT"},{"id":1876,"precertRequired":false,"billingCode":"28800","codeType":"CPT"},{"id":1877,"precertRequired":false,"billingCode":"28805","codeType":"CPT"},{"id":1878,"precertRequired":false,"billingCode":"28810","codeType":"CPT"},{"id":1879,"precertRequired":false,"billingCode":"28820","codeType":"CPT"},{"id":1880,"precertRequired":false,"billingCode":"28825","codeType":"CPT"},{"id":2674,"precertRequired":false,"billingCode":"38100","codeType":"CPT"},{"id":2675,"precertRequired":false,"billingCode":"38101","codeType":"CPT"},{"id":2676,"precertRequired":false,"billingCode":"38102","codeType":"CPT"},{"id":2677,"precertRequired":false,"billingCode":"38115","codeType":"CPT"},{"id":2678,"precertRequired":false,"billingCode":"38120","codeType":"CPT"},{"id":2682,"precertRequired":false,"billingCode":"38300","codeType":"CPT"},{"id":2683,"precertRequired":false,"billingCode":"38305","codeType":"CPT"},{"id":2684,"precertRequired":false,"billingCode":"38308","codeType":"CPT"},{"id":2685,"precertRequired":false,"billingCode":"38380","codeType":"CPT"},{"id":2686,"precertRequired":true,"billingCode":"38381","codeType":"CPT"},{"id":2687,"precertRequired":false,"billingCode":"38382","codeType":"CPT"},{"id":2688,"precertRequired":false,"billingCode":"38500","codeType":"CPT"},{"id":2689,"precertRequired":false,"billingCode":"38505","codeType":"CPT"},{"id":2690,"precertRequired":false,"billingCode":"38510","codeType":"CPT"},{"id":2691,"precertRequired":false,"billingCode":"38520","codeType":"CPT"},{"id":2692,"precertRequired":false,"billingCode":"38525","codeType":"CPT"},{"id":2693,"precertRequired":false,"billingCode":"38530","codeType":"CPT"},{"id":2694,"precertRequired":false,"billingCode":"38542","codeType":"CPT"},{"id":2695,"precertRequired":false,"billingCode":"38550","codeType":"CPT"},{"id":2696,"precertRequired":false,"billingCode":"38555","codeType":"CPT"},{"id":2697,"precertRequired":false,"billingCode":"38562","codeType":"CPT"},{"id":2698,"precertRequired":false,"billingCode":"38564","codeType":"CPT"},{"id":2699,"precertRequired":false,"billingCode":"38570","codeType":"CPT"},{"id":2700,"precertRequired":false,"billingCode":"38571","codeType":"CPT"},{"id":2701,"precertRequired":false,"billingCode":"38572","codeType":"CPT"},{"id":2702,"precertRequired":false,"billingCode":"38573","codeType":"CPT"},{"id":2703,"precertRequired":false,"billingCode":"38700","codeType":"CPT"},{"id":2704,"precertRequired":false,"billingCode":"38720","codeType":"CPT"},{"id":2705,"precertRequired":false,"billingCode":"38724","codeType":"CPT"},{"id":2706,"precertRequired":false,"billingCode":"38740","codeType":"CPT"},{"id":2707,"precertRequired":false,"billingCode":"38745","codeType":"CPT"},{"id":2708,"precertRequired":false,"billingCode":"38746","codeType":"CPT"},{"id":2709,"precertRequired":false,"billingCode":"38747","codeType":"CPT"},{"id":2710,"precertRequired":false,"billingCode":"38760","codeType":"CPT"},{"id":2711,"precertRequired":false,"billingCode":"38765","codeType":"CPT"},{"id":2712,"precertRequired":false,"billingCode":"38770","codeType":"CPT"},{"id":2713,"precertRequired":false,"billingCode":"38780","codeType":"CPT"},{"id":2749,"precertRequired":false,"billingCode":"43117","codeType":"CPT"},{"id":2750,"precertRequired":false,"billingCode":"43118","codeType":"CPT"},{"id":2751,"precertRequired":false,"billingCode":"43121","codeType":"CPT"},{"id":2752,"precertRequired":false,"billingCode":"43122","codeType":"CPT"},{"id":2753,"precertRequired":false,"billingCode":"43123","codeType":"CPT"},{"id":2755,"precertRequired":false,"billingCode":"43130","codeType":"CPT"},{"id":2756,"precertRequired":false,"billingCode":"43135","codeType":"CPT"},{"id":2757,"precertRequired":false,"billingCode":"43180","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2819,"precertRequired":false,"billingCode":"43273","codeType":"CPT"},{"id":2825,"precertRequired":false,"billingCode":"43279","codeType":"CPT"},{"id":2826,"precertRequired":false,"billingCode":"43280","codeType":"CPT"},{"id":2827,"precertRequired":false,"billingCode":"43281","codeType":"CPT"},{"id":2828,"precertRequired":false,"billingCode":"43282","codeType":"CPT"},{"id":2829,"precertRequired":false,"billingCode":"43283","codeType":"CPT"},{"id":2830,"precertRequired":false,"billingCode":"43284","codeType":"CPT"},{"id":2831,"precertRequired":false,"billingCode":"43285","codeType":"CPT"},{"id":2832,"precertRequired":false,"billingCode":"43286","codeType":"CPT"},{"id":2833,"precertRequired":false,"billingCode":"43287","codeType":"CPT"},{"id":2834,"precertRequired":false,"billingCode":"43288","codeType":"CPT"},{"id":2836,"precertRequired":false,"billingCode":"43300","codeType":"CPT"},{"id":2837,"precertRequired":false,"billingCode":"43305","codeType":"CPT"},{"id":2838,"precertRequired":false,"billingCode":"43310","codeType":"CPT"},{"id":2839,"precertRequired":false,"billingCode":"43312","codeType":"CPT"},{"id":2840,"precertRequired":false,"billingCode":"43313","codeType":"CPT"},{"id":2841,"precertRequired":false,"billingCode":"43314","codeType":"CPT"},{"id":2842,"precertRequired":false,"billingCode":"43320","codeType":"CPT"},{"id":2843,"precertRequired":false,"billingCode":"43325","codeType":"CPT"},{"id":2844,"precertRequired":false,"billingCode":"43327","codeType":"CPT"},{"id":2845,"precertRequired":false,"billingCode":"43328","codeType":"CPT"},{"id":2846,"precertRequired":false,"billingCode":"43330","codeType":"CPT"},{"id":2847,"precertRequired":false,"billingCode":"43331","codeType":"CPT"},{"id":2854,"precertRequired":false,"billingCode":"43338","codeType":"CPT"},{"id":2855,"precertRequired":false,"billingCode":"43340","codeType":"CPT"},{"id":2856,"precertRequired":false,"billingCode":"43341","codeType":"CPT"},{"id":2857,"precertRequired":false,"billingCode":"43351","codeType":"CPT"},{"id":2858,"precertRequired":false,"billingCode":"43352","codeType":"CPT"},{"id":2859,"precertRequired":false,"billingCode":"43360","codeType":"CPT"},{"id":2860,"precertRequired":false,"billingCode":"43361","codeType":"CPT"},{"id":2861,"precertRequired":false,"billingCode":"43400","codeType":"CPT"},{"id":2862,"precertRequired":false,"billingCode":"43401","codeType":"CPT"},{"id":2863,"precertRequired":false,"billingCode":"43405","codeType":"CPT"},{"id":2864,"precertRequired":false,"billingCode":"43410","codeType":"CPT"},{"id":2865,"precertRequired":false,"billingCode":"43415","codeType":"CPT"},{"id":2866,"precertRequired":false,"billingCode":"43420","codeType":"CPT"},{"id":2867,"precertRequired":false,"billingCode":"43425","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":2869,"precertRequired":false,"billingCode":"43453","codeType":"CPT"},{"id":2870,"precertRequired":false,"billingCode":"43460","codeType":"CPT"},{"id":2871,"precertRequired":false,"billingCode":"43496","codeType":"CPT"},{"id":2873,"precertRequired":false,"billingCode":"43500","codeType":"CPT"},{"id":2874,"precertRequired":false,"billingCode":"43501","codeType":"CPT"},{"id":2875,"precertRequired":false,"billingCode":"43502","codeType":"CPT"},{"id":2876,"precertRequired":false,"billingCode":"43510","codeType":"CPT"},{"id":2877,"precertRequired":false,"billingCode":"43520","codeType":"CPT"},{"id":2878,"precertRequired":false,"billingCode":"43605","codeType":"CPT"},{"id":2879,"precertRequired":false,"billingCode":"43610","codeType":"CPT"},{"id":2880,"precertRequired":false,"billingCode":"43611","codeType":"CPT"},{"id":2881,"precertRequired":false,"billingCode":"43620","codeType":"CPT"},{"id":2882,"precertRequired":false,"billingCode":"43621","codeType":"CPT"},{"id":2883,"precertRequired":false,"billingCode":"43622","codeType":"CPT"},{"id":2884,"precertRequired":false,"billingCode":"43631","codeType":"CPT"},{"id":2885,"precertRequired":false,"billingCode":"43632","codeType":"CPT"},{"id":2886,"precertRequired":false,"billingCode":"43633","codeType":"CPT"},{"id":2887,"precertRequired":false,"billingCode":"43634","codeType":"CPT"},{"id":2888,"precertRequired":false,"billingCode":"43635","codeType":"CPT"},{"id":2889,"precertRequired":false,"billingCode":"43640","codeType":"CPT"},{"id":2890,"precertRequired":false,"billingCode":"43641","codeType":"CPT"},{"id":2891,"precertRequired":false,"billingCode":"43644","codeType":"CPT"},{"id":2892,"precertRequired":false,"billingCode":"43645","codeType":"CPT"},{"id":2893,"precertRequired":false,"billingCode":"43647","codeType":"CPT"},{"id":2894,"precertRequired":false,"billingCode":"43648","codeType":"CPT"},{"id":2895,"precertRequired":false,"billingCode":"43651","codeType":"CPT"},{"id":2896,"precertRequired":false,"billingCode":"43652","codeType":"CPT"},{"id":2897,"precertRequired":false,"billingCode":"43653","codeType":"CPT"},{"id":2898,"precertRequired":false,"billingCode":"43752","codeType":"CPT"},{"id":2899,"precertRequired":false,"billingCode":"43753","codeType":"CPT"},{"id":2900,"precertRequired":false,"billingCode":"43754","codeType":"CPT"},{"id":2901,"precertRequired":false,"billingCode":"43755","codeType":"CPT"},{"id":2902,"precertRequired":false,"billingCode":"43756","codeType":"CPT"},{"id":2903,"precertRequired":false,"billingCode":"43757","codeType":"CPT"},{"id":2904,"precertRequired":false,"billingCode":"43760","codeType":"CPT"},{"id":2905,"precertRequired":false,"billingCode":"43761","codeType":"CPT"},{"id":2912,"precertRequired":false,"billingCode":"43800","codeType":"CPT"},{"id":2913,"precertRequired":false,"billingCode":"43810","codeType":"CPT"},{"id":2914,"precertRequired":false,"billingCode":"43820","codeType":"CPT"},{"id":2915,"precertRequired":false,"billingCode":"43825","codeType":"CPT"},{"id":2916,"precertRequired":false,"billingCode":"43830","codeType":"CPT"},{"id":2917,"precertRequired":false,"billingCode":"43831","codeType":"CPT"},{"id":2918,"precertRequired":false,"billingCode":"43832","codeType":"CPT"},{"id":2919,"precertRequired":false,"billingCode":"43840","codeType":"CPT"},{"id":2926,"precertRequired":false,"billingCode":"43850","codeType":"CPT"},{"id":2927,"precertRequired":false,"billingCode":"43855","codeType":"CPT"},{"id":2928,"precertRequired":false,"billingCode":"43860","codeType":"CPT"},{"id":2929,"precertRequired":false,"billingCode":"43865","codeType":"CPT"},{"id":2930,"precertRequired":false,"billingCode":"43870","codeType":"CPT"},{"id":2931,"precertRequired":false,"billingCode":"43880","codeType":"CPT"},{"id":2934,"precertRequired":false,"billingCode":"43886","codeType":"CPT"},{"id":2935,"precertRequired":false,"billingCode":"43887","codeType":"CPT"},{"id":2936,"precertRequired":false,"billingCode":"43888","codeType":"CPT"},{"id":2937,"precertRequired":false,"billingCode":"44005","codeType":"CPT"},{"id":2938,"precertRequired":false,"billingCode":"44010","codeType":"CPT"},{"id":2939,"precertRequired":false,"billingCode":"44015","codeType":"CPT"},{"id":2940,"precertRequired":false,"billingCode":"44020","codeType":"CPT"},{"id":2941,"precertRequired":false,"billingCode":"44021","codeType":"CPT"},{"id":2942,"precertRequired":false,"billingCode":"44025","codeType":"CPT"},{"id":2943,"precertRequired":false,"billingCode":"44050","codeType":"CPT"},{"id":2944,"precertRequired":false,"billingCode":"44055","codeType":"CPT"},{"id":2945,"precertRequired":false,"billingCode":"44100","codeType":"CPT"},{"id":2946,"precertRequired":false,"billingCode":"44110","codeType":"CPT"},{"id":2947,"precertRequired":false,"billingCode":"44111","codeType":"CPT"},{"id":2948,"precertRequired":false,"billingCode":"44120","codeType":"CPT"},{"id":2949,"precertRequired":false,"billingCode":"44121","codeType":"CPT"},{"id":2950,"precertRequired":false,"billingCode":"44125","codeType":"CPT"},{"id":2951,"precertRequired":false,"billingCode":"44126","codeType":"CPT"},{"id":2952,"precertRequired":false,"billingCode":"44127","codeType":"CPT"},{"id":2953,"precertRequired":false,"billingCode":"44128","codeType":"CPT"},{"id":2954,"precertRequired":false,"billingCode":"44130","codeType":"CPT"},{"id":2960,"precertRequired":false,"billingCode":"44139","codeType":"CPT"},{"id":2961,"precertRequired":false,"billingCode":"44140","codeType":"CPT"},{"id":2962,"precertRequired":false,"billingCode":"44141","codeType":"CPT"},{"id":2963,"precertRequired":false,"billingCode":"44143","codeType":"CPT"},{"id":2964,"precertRequired":false,"billingCode":"44144","codeType":"CPT"},{"id":2965,"precertRequired":false,"billingCode":"44145","codeType":"CPT"},{"id":2966,"precertRequired":false,"billingCode":"44146","codeType":"CPT"},{"id":2967,"precertRequired":false,"billingCode":"44147","codeType":"CPT"},{"id":2968,"precertRequired":false,"billingCode":"44150","codeType":"CPT"},{"id":2969,"precertRequired":false,"billingCode":"44151","codeType":"CPT"},{"id":2970,"precertRequired":false,"billingCode":"44155","codeType":"CPT"},{"id":2971,"precertRequired":false,"billingCode":"44156","codeType":"CPT"},{"id":2972,"precertRequired":false,"billingCode":"44157","codeType":"CPT"},{"id":2973,"precertRequired":false,"billingCode":"44158","codeType":"CPT"},{"id":2974,"precertRequired":false,"billingCode":"44160","codeType":"CPT"},{"id":2975,"precertRequired":false,"billingCode":"44180","codeType":"CPT"},{"id":2976,"precertRequired":false,"billingCode":"44186","codeType":"CPT"},{"id":2977,"precertRequired":false,"billingCode":"44187","codeType":"CPT"},{"id":2978,"precertRequired":false,"billingCode":"44188","codeType":"CPT"},{"id":2979,"precertRequired":false,"billingCode":"44202","codeType":"CPT"},{"id":2980,"precertRequired":false,"billingCode":"44203","codeType":"CPT"},{"id":2981,"precertRequired":false,"billingCode":"44204","codeType":"CPT"},{"id":2982,"precertRequired":false,"billingCode":"44205","codeType":"CPT"},{"id":2983,"precertRequired":false,"billingCode":"44206","codeType":"CPT"},{"id":2984,"precertRequired":false,"billingCode":"44207","codeType":"CPT"},{"id":2985,"precertRequired":false,"billingCode":"44208","codeType":"CPT"},{"id":2986,"precertRequired":false,"billingCode":"44210","codeType":"CPT"},{"id":2987,"precertRequired":false,"billingCode":"44211","codeType":"CPT"},{"id":2988,"precertRequired":false,"billingCode":"44212","codeType":"CPT"},{"id":2989,"precertRequired":false,"billingCode":"44213","codeType":"CPT"},{"id":2990,"precertRequired":false,"billingCode":"44227","codeType":"CPT"},{"id":2991,"precertRequired":false,"billingCode":"44300","codeType":"CPT"},{"id":2992,"precertRequired":false,"billingCode":"44310","codeType":"CPT"},{"id":2993,"precertRequired":false,"billingCode":"44312","codeType":"CPT"},{"id":2994,"precertRequired":false,"billingCode":"44314","codeType":"CPT"},{"id":2995,"precertRequired":false,"billingCode":"44316","codeType":"CPT"},{"id":2996,"precertRequired":false,"billingCode":"44320","codeType":"CPT"},{"id":2997,"precertRequired":false,"billingCode":"44322","codeType":"CPT"},{"id":2998,"precertRequired":false,"billingCode":"44340","codeType":"CPT"},{"id":2999,"precertRequired":false,"billingCode":"44345","codeType":"CPT"},{"id":3000,"precertRequired":false,"billingCode":"44346","codeType":"CPT"},{"id":3015,"precertRequired":false,"billingCode":"44380","codeType":"CPT"},{"id":3016,"precertRequired":false,"billingCode":"44381","codeType":"CPT"},{"id":3017,"precertRequired":false,"billingCode":"44382","codeType":"CPT"},{"id":3018,"precertRequired":false,"billingCode":"44384","codeType":"CPT"},{"id":3019,"precertRequired":false,"billingCode":"44385","codeType":"CPT"},{"id":3020,"precertRequired":false,"billingCode":"44386","codeType":"CPT"},{"id":3035,"precertRequired":false,"billingCode":"44500","codeType":"CPT"},{"id":3036,"precertRequired":false,"billingCode":"44602","codeType":"CPT"},{"id":3037,"precertRequired":false,"billingCode":"44603","codeType":"CPT"},{"id":3038,"precertRequired":false,"billingCode":"44604","codeType":"CPT"},{"id":3039,"precertRequired":false,"billingCode":"44605","codeType":"CPT"},{"id":3040,"precertRequired":false,"billingCode":"44615","codeType":"CPT"},{"id":3041,"precertRequired":false,"billingCode":"44620","codeType":"CPT"},{"id":3042,"precertRequired":false,"billingCode":"44625","codeType":"CPT"},{"id":3043,"precertRequired":false,"billingCode":"44626","codeType":"CPT"},{"id":3044,"precertRequired":false,"billingCode":"44640","codeType":"CPT"},{"id":3045,"precertRequired":false,"billingCode":"44650","codeType":"CPT"},{"id":3046,"precertRequired":false,"billingCode":"44660","codeType":"CPT"},{"id":3047,"precertRequired":false,"billingCode":"44661","codeType":"CPT"},{"id":3048,"precertRequired":false,"billingCode":"44680","codeType":"CPT"},{"id":3049,"precertRequired":false,"billingCode":"44700","codeType":"CPT"},{"id":3050,"precertRequired":false,"billingCode":"44701","codeType":"CPT"},{"id":3056,"precertRequired":false,"billingCode":"44800","codeType":"CPT"},{"id":3057,"precertRequired":false,"billingCode":"44820","codeType":"CPT"},{"id":3058,"precertRequired":false,"billingCode":"44850","codeType":"CPT"},{"id":3059,"precertRequired":false,"billingCode":"44900","codeType":"CPT"},{"id":3060,"precertRequired":false,"billingCode":"44950","codeType":"CPT"},{"id":3061,"precertRequired":false,"billingCode":"44955","codeType":"CPT"},{"id":3062,"precertRequired":false,"billingCode":"44960","codeType":"CPT"},{"id":3063,"precertRequired":false,"billingCode":"44970","codeType":"CPT"},{"id":3064,"precertRequired":false,"billingCode":"45000","codeType":"CPT"},{"id":3065,"precertRequired":false,"billingCode":"45005","codeType":"CPT"},{"id":3066,"precertRequired":false,"billingCode":"45020","codeType":"CPT"},{"id":3067,"precertRequired":false,"billingCode":"45100","codeType":"CPT"},{"id":3068,"precertRequired":false,"billingCode":"45108","codeType":"CPT"},{"id":3080,"precertRequired":false,"billingCode":"45130","codeType":"CPT"},{"id":3081,"precertRequired":false,"billingCode":"45135","codeType":"CPT"},{"id":3082,"precertRequired":false,"billingCode":"45136","codeType":"CPT"},{"id":3083,"precertRequired":false,"billingCode":"45150","codeType":"CPT"},{"id":3084,"precertRequired":false,"billingCode":"45160","codeType":"CPT"},{"id":3085,"precertRequired":false,"billingCode":"45171","codeType":"CPT"},{"id":3086,"precertRequired":false,"billingCode":"45172","codeType":"CPT"},{"id":3087,"precertRequired":false,"billingCode":"45190","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3123,"precertRequired":false,"billingCode":"45388","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3129,"precertRequired":false,"billingCode":"45395","codeType":"CPT"},{"id":3130,"precertRequired":false,"billingCode":"45397","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"},{"id":3132,"precertRequired":false,"billingCode":"45400","codeType":"CPT"},{"id":3133,"precertRequired":false,"billingCode":"45402","codeType":"CPT"},{"id":3134,"precertRequired":false,"billingCode":"45500","codeType":"CPT"},{"id":3135,"precertRequired":false,"billingCode":"45505","codeType":"CPT"},{"id":3136,"precertRequired":false,"billingCode":"45520","codeType":"CPT"},{"id":3137,"precertRequired":false,"billingCode":"45540","codeType":"CPT"},{"id":3138,"precertRequired":false,"billingCode":"45541","codeType":"CPT"},{"id":3139,"precertRequired":false,"billingCode":"45550","codeType":"CPT"},{"id":3140,"precertRequired":false,"billingCode":"45560","codeType":"CPT"},{"id":3141,"precertRequired":false,"billingCode":"45562","codeType":"CPT"},{"id":3142,"precertRequired":false,"billingCode":"45563","codeType":"CPT"},{"id":3143,"precertRequired":false,"billingCode":"45800","codeType":"CPT"},{"id":3144,"precertRequired":false,"billingCode":"45805","codeType":"CPT"},{"id":3145,"precertRequired":false,"billingCode":"45820","codeType":"CPT"},{"id":3146,"precertRequired":false,"billingCode":"45825","codeType":"CPT"},{"id":3147,"precertRequired":false,"billingCode":"45900","codeType":"CPT"},{"id":3148,"precertRequired":false,"billingCode":"45905","codeType":"CPT"},{"id":3149,"precertRequired":false,"billingCode":"45910","codeType":"CPT"},{"id":3150,"precertRequired":false,"billingCode":"45915","codeType":"CPT"},{"id":3151,"precertRequired":false,"billingCode":"45990","codeType":"CPT"},{"id":3152,"precertRequired":false,"billingCode":"46020","codeType":"CPT"},{"id":3153,"precertRequired":false,"billingCode":"46030","codeType":"CPT"},{"id":3154,"precertRequired":false,"billingCode":"46040","codeType":"CPT"},{"id":3155,"precertRequired":false,"billingCode":"46045","codeType":"CPT"},{"id":3156,"precertRequired":false,"billingCode":"46050","codeType":"CPT"},{"id":3157,"precertRequired":false,"billingCode":"46060","codeType":"CPT"},{"id":3158,"precertRequired":false,"billingCode":"46080","codeType":"CPT"},{"id":3159,"precertRequired":false,"billingCode":"46083","codeType":"CPT"},{"id":3160,"precertRequired":false,"billingCode":"46200","codeType":"CPT"},{"id":3161,"precertRequired":false,"billingCode":"46220","codeType":"CPT"},{"id":3162,"precertRequired":false,"billingCode":"46221","codeType":"CPT"},{"id":3163,"precertRequired":false,"billingCode":"46230","codeType":"CPT"},{"id":3164,"precertRequired":false,"billingCode":"46250","codeType":"CPT"},{"id":3165,"precertRequired":false,"billingCode":"46255","codeType":"CPT"},{"id":3166,"precertRequired":false,"billingCode":"46257","codeType":"CPT"},{"id":3167,"precertRequired":false,"billingCode":"46258","codeType":"CPT"},{"id":3168,"precertRequired":false,"billingCode":"46260","codeType":"CPT"},{"id":3169,"precertRequired":false,"billingCode":"46261","codeType":"CPT"},{"id":3170,"precertRequired":false,"billingCode":"46262","codeType":"CPT"},{"id":3171,"precertRequired":false,"billingCode":"46270","codeType":"CPT"},{"id":3172,"precertRequired":false,"billingCode":"46275","codeType":"CPT"},{"id":3173,"precertRequired":false,"billingCode":"46280","codeType":"CPT"},{"id":3174,"precertRequired":false,"billingCode":"46285","codeType":"CPT"},{"id":3175,"precertRequired":false,"billingCode":"46288","codeType":"CPT"},{"id":3176,"precertRequired":false,"billingCode":"46320","codeType":"CPT"},{"id":3177,"precertRequired":false,"billingCode":"46500","codeType":"CPT"},{"id":3178,"precertRequired":false,"billingCode":"46505","codeType":"CPT"},{"id":3179,"precertRequired":false,"billingCode":"46600","codeType":"CPT"},{"id":3180,"precertRequired":false,"billingCode":"46601","codeType":"CPT"},{"id":3181,"precertRequired":false,"billingCode":"46604","codeType":"CPT"},{"id":3182,"precertRequired":false,"billingCode":"46606","codeType":"CPT"},{"id":3183,"precertRequired":false,"billingCode":"46607","codeType":"CPT"},{"id":3184,"precertRequired":false,"billingCode":"46608","codeType":"CPT"},{"id":3185,"precertRequired":false,"billingCode":"46610","codeType":"CPT"},{"id":3186,"precertRequired":false,"billingCode":"46611","codeType":"CPT"},{"id":3187,"precertRequired":false,"billingCode":"46612","codeType":"CPT"},{"id":3188,"precertRequired":false,"billingCode":"46614","codeType":"CPT"},{"id":3189,"precertRequired":false,"billingCode":"46615","codeType":"CPT"},{"id":3190,"precertRequired":false,"billingCode":"46700","codeType":"CPT"},{"id":3191,"precertRequired":false,"billingCode":"46706","codeType":"CPT"},{"id":3192,"precertRequired":false,"billingCode":"46707","codeType":"CPT"},{"id":3193,"precertRequired":false,"billingCode":"46710","codeType":"CPT"},{"id":3194,"precertRequired":false,"billingCode":"46712","codeType":"CPT"},{"id":3195,"precertRequired":false,"billingCode":"46715","codeType":"CPT"},{"id":3196,"precertRequired":false,"billingCode":"46716","codeType":"CPT"},{"id":3197,"precertRequired":false,"billingCode":"46730","codeType":"CPT"},{"id":3198,"precertRequired":false,"billingCode":"46735","codeType":"CPT"},{"id":3199,"precertRequired":false,"billingCode":"46740","codeType":"CPT"},{"id":3200,"precertRequired":false,"billingCode":"46742","codeType":"CPT"},{"id":3201,"precertRequired":false,"billingCode":"46744","codeType":"CPT"},{"id":3202,"precertRequired":false,"billingCode":"46746","codeType":"CPT"},{"id":3203,"precertRequired":false,"billingCode":"46747","codeType":"CPT"},{"id":3204,"precertRequired":false,"billingCode":"46748","codeType":"CPT"},{"id":3205,"precertRequired":false,"billingCode":"46750","codeType":"CPT"},{"id":3207,"precertRequired":false,"billingCode":"46753","codeType":"CPT"},{"id":3208,"precertRequired":false,"billingCode":"46754","codeType":"CPT"},{"id":3209,"precertRequired":false,"billingCode":"46760","codeType":"CPT"},{"id":3210,"precertRequired":false,"billingCode":"46761","codeType":"CPT"},{"id":3211,"precertRequired":false,"billingCode":"46762","codeType":"CPT"},{"id":3212,"precertRequired":false,"billingCode":"46900","codeType":"CPT"},{"id":3213,"precertRequired":false,"billingCode":"46910","codeType":"CPT"},{"id":3214,"precertRequired":false,"billingCode":"46917","codeType":"CPT"},{"id":3215,"precertRequired":false,"billingCode":"46922","codeType":"CPT"},{"id":3216,"precertRequired":false,"billingCode":"46924","codeType":"CPT"},{"id":3217,"precertRequired":false,"billingCode":"46930","codeType":"CPT"},{"id":3218,"precertRequired":false,"billingCode":"46940","codeType":"CPT"},{"id":3219,"precertRequired":false,"billingCode":"46942","codeType":"CPT"},{"id":3220,"precertRequired":false,"billingCode":"46945","codeType":"CPT"},{"id":3221,"precertRequired":false,"billingCode":"46946","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3226,"precertRequired":false,"billingCode":"47010","codeType":"CPT"},{"id":3227,"precertRequired":false,"billingCode":"47015","codeType":"CPT"},{"id":3228,"precertRequired":false,"billingCode":"47100","codeType":"CPT"},{"id":3243,"precertRequired":false,"billingCode":"47300","codeType":"CPT"},{"id":3244,"precertRequired":false,"billingCode":"47350","codeType":"CPT"},{"id":3245,"precertRequired":false,"billingCode":"47360","codeType":"CPT"},{"id":3246,"precertRequired":false,"billingCode":"47361","codeType":"CPT"},{"id":3247,"precertRequired":false,"billingCode":"47362","codeType":"CPT"},{"id":3248,"precertRequired":false,"billingCode":"47371","codeType":"CPT"},{"id":3249,"precertRequired":false,"billingCode":"47381","codeType":"CPT"},{"id":3251,"precertRequired":false,"billingCode":"47383","codeType":"CPT"},{"id":3252,"precertRequired":false,"billingCode":"47400","codeType":"CPT"},{"id":3253,"precertRequired":false,"billingCode":"47420","codeType":"CPT"},{"id":3254,"precertRequired":false,"billingCode":"47425","codeType":"CPT"},{"id":3255,"precertRequired":false,"billingCode":"47460","codeType":"CPT"},{"id":3257,"precertRequired":false,"billingCode":"47490","codeType":"CPT"},{"id":3258,"precertRequired":false,"billingCode":"47531","codeType":"CPT"},{"id":3259,"precertRequired":false,"billingCode":"47532","codeType":"CPT"},{"id":3260,"precertRequired":false,"billingCode":"47533","codeType":"CPT"},{"id":3261,"precertRequired":false,"billingCode":"47534","codeType":"CPT"},{"id":3262,"precertRequired":false,"billingCode":"47535","codeType":"CPT"},{"id":3263,"precertRequired":false,"billingCode":"47536","codeType":"CPT"},{"id":3264,"precertRequired":false,"billingCode":"47537","codeType":"CPT"},{"id":3265,"precertRequired":false,"billingCode":"47538","codeType":"CPT"},{"id":3266,"precertRequired":false,"billingCode":"47539","codeType":"CPT"},{"id":3267,"precertRequired":false,"billingCode":"47540","codeType":"CPT"},{"id":3268,"precertRequired":false,"billingCode":"47541","codeType":"CPT"},{"id":3269,"precertRequired":false,"billingCode":"47542","codeType":"CPT"},{"id":3270,"precertRequired":false,"billingCode":"47543","codeType":"CPT"},{"id":3271,"precertRequired":false,"billingCode":"47544","codeType":"CPT"},{"id":3272,"precertRequired":false,"billingCode":"47550","codeType":"CPT"},{"id":3273,"precertRequired":false,"billingCode":"47552","codeType":"CPT"},{"id":3274,"precertRequired":false,"billingCode":"47553","codeType":"CPT"},{"id":3275,"precertRequired":false,"billingCode":"47554","codeType":"CPT"},{"id":3276,"precertRequired":false,"billingCode":"47555","codeType":"CPT"},{"id":3277,"precertRequired":false,"billingCode":"47556","codeType":"CPT"},{"id":3278,"precertRequired":false,"billingCode":"47562","codeType":"CPT"},{"id":3279,"precertRequired":false,"billingCode":"47563","codeType":"CPT"},{"id":3280,"precertRequired":false,"billingCode":"47564","codeType":"CPT"},{"id":3281,"precertRequired":false,"billingCode":"47570","codeType":"CPT"},{"id":3282,"precertRequired":false,"billingCode":"47600","codeType":"CPT"},{"id":3283,"precertRequired":false,"billingCode":"47605","codeType":"CPT"},{"id":3284,"precertRequired":false,"billingCode":"47610","codeType":"CPT"},{"id":3285,"precertRequired":false,"billingCode":"47612","codeType":"CPT"},{"id":3286,"precertRequired":false,"billingCode":"47620","codeType":"CPT"},{"id":3287,"precertRequired":false,"billingCode":"47700","codeType":"CPT"},{"id":3288,"precertRequired":false,"billingCode":"47701","codeType":"CPT"},{"id":3289,"precertRequired":false,"billingCode":"47711","codeType":"CPT"},{"id":3290,"precertRequired":false,"billingCode":"47712","codeType":"CPT"},{"id":3291,"precertRequired":false,"billingCode":"47715","codeType":"CPT"},{"id":3292,"precertRequired":false,"billingCode":"47720","codeType":"CPT"},{"id":3293,"precertRequired":false,"billingCode":"47721","codeType":"CPT"},{"id":3294,"precertRequired":false,"billingCode":"47740","codeType":"CPT"},{"id":3295,"precertRequired":false,"billingCode":"47741","codeType":"CPT"},{"id":3296,"precertRequired":false,"billingCode":"47760","codeType":"CPT"},{"id":3297,"precertRequired":false,"billingCode":"47765","codeType":"CPT"},{"id":3298,"precertRequired":false,"billingCode":"47780","codeType":"CPT"},{"id":3299,"precertRequired":false,"billingCode":"47785","codeType":"CPT"},{"id":3300,"precertRequired":false,"billingCode":"47800","codeType":"CPT"},{"id":3301,"precertRequired":false,"billingCode":"47801","codeType":"CPT"},{"id":3302,"precertRequired":false,"billingCode":"47802","codeType":"CPT"},{"id":3303,"precertRequired":false,"billingCode":"48000","codeType":"CPT"},{"id":3304,"precertRequired":false,"billingCode":"48001","codeType":"CPT"},{"id":3305,"precertRequired":false,"billingCode":"48020","codeType":"CPT"},{"id":3306,"precertRequired":false,"billingCode":"48100","codeType":"CPT"},{"id":3307,"precertRequired":false,"billingCode":"48102","codeType":"CPT"},{"id":3308,"precertRequired":false,"billingCode":"48105","codeType":"CPT"},{"id":3309,"precertRequired":false,"billingCode":"48120","codeType":"CPT"},{"id":3310,"precertRequired":false,"billingCode":"48148","codeType":"CPT"},{"id":3311,"precertRequired":false,"billingCode":"48150","codeType":"CPT"},{"id":3312,"precertRequired":false,"billingCode":"48152","codeType":"CPT"},{"id":3313,"precertRequired":false,"billingCode":"48153","codeType":"CPT"},{"id":3314,"precertRequired":false,"billingCode":"48154","codeType":"CPT"},{"id":3315,"precertRequired":false,"billingCode":"48155","codeType":"CPT"},{"id":3316,"precertRequired":false,"billingCode":"48160","codeType":"CPT"},{"id":3317,"precertRequired":false,"billingCode":"48400","codeType":"CPT"},{"id":3318,"precertRequired":false,"billingCode":"48500","codeType":"CPT"},{"id":3319,"precertRequired":false,"billingCode":"48510","codeType":"CPT"},{"id":3320,"precertRequired":false,"billingCode":"48520","codeType":"CPT"},{"id":3321,"precertRequired":false,"billingCode":"48540","codeType":"CPT"},{"id":3322,"precertRequired":false,"billingCode":"48545","codeType":"CPT"},{"id":3323,"precertRequired":false,"billingCode":"48547","codeType":"CPT"},{"id":3324,"precertRequired":false,"billingCode":"48548","codeType":"CPT"},{"id":3328,"precertRequired":false,"billingCode":"48554","codeType":"CPT"},{"id":3330,"precertRequired":false,"billingCode":"49002","codeType":"CPT"},{"id":3331,"precertRequired":false,"billingCode":"49010","codeType":"CPT"},{"id":3332,"precertRequired":false,"billingCode":"49020","codeType":"CPT"},{"id":3333,"precertRequired":false,"billingCode":"49040","codeType":"CPT"},{"id":3334,"precertRequired":false,"billingCode":"49060","codeType":"CPT"},{"id":3335,"precertRequired":false,"billingCode":"49062","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3337,"precertRequired":false,"billingCode":"49083","codeType":"CPT"},{"id":3338,"precertRequired":false,"billingCode":"49084","codeType":"CPT"},{"id":3339,"precertRequired":false,"billingCode":"49180","codeType":"CPT"},{"id":3340,"precertRequired":false,"billingCode":"49185","codeType":"CPT"},{"id":3341,"precertRequired":false,"billingCode":"49203","codeType":"CPT"},{"id":3342,"precertRequired":false,"billingCode":"49204","codeType":"CPT"},{"id":3343,"precertRequired":false,"billingCode":"49205","codeType":"CPT"},{"id":3344,"precertRequired":false,"billingCode":"49220","codeType":"CPT"},{"id":3345,"precertRequired":false,"billingCode":"49250","codeType":"CPT"},{"id":3346,"precertRequired":false,"billingCode":"49255","codeType":"CPT"},{"id":3347,"precertRequired":false,"billingCode":"49320","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3350,"precertRequired":false,"billingCode":"49323","codeType":"CPT"},{"id":3351,"precertRequired":false,"billingCode":"49324","codeType":"CPT"},{"id":3352,"precertRequired":false,"billingCode":"49325","codeType":"CPT"},{"id":3353,"precertRequired":false,"billingCode":"49326","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3355,"precertRequired":false,"billingCode":"49329","codeType":"CPT"},{"id":3356,"precertRequired":false,"billingCode":"49400","codeType":"CPT"},{"id":3357,"precertRequired":false,"billingCode":"49402","codeType":"CPT"},{"id":3358,"precertRequired":false,"billingCode":"49405","codeType":"CPT"},{"id":3359,"precertRequired":false,"billingCode":"49406","codeType":"CPT"},{"id":3360,"precertRequired":false,"billingCode":"49407","codeType":"CPT"},{"id":3361,"precertRequired":false,"billingCode":"49411","codeType":"CPT"},{"id":3362,"precertRequired":false,"billingCode":"49412","codeType":"CPT"},{"id":3363,"precertRequired":false,"billingCode":"49418","codeType":"CPT"},{"id":3364,"precertRequired":false,"billingCode":"49419","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"},{"id":3368,"precertRequired":false,"billingCode":"49423","codeType":"CPT"},{"id":3369,"precertRequired":false,"billingCode":"49424","codeType":"CPT"},{"id":3370,"precertRequired":false,"billingCode":"49425","codeType":"CPT"},{"id":3371,"precertRequired":false,"billingCode":"49426","codeType":"CPT"},{"id":3372,"precertRequired":false,"billingCode":"49427","codeType":"CPT"},{"id":3373,"precertRequired":false,"billingCode":"49428","codeType":"CPT"},{"id":3374,"precertRequired":false,"billingCode":"49429","codeType":"CPT"},{"id":3375,"precertRequired":false,"billingCode":"49435","codeType":"CPT"},{"id":3376,"precertRequired":false,"billingCode":"49436","codeType":"CPT"},{"id":3377,"precertRequired":false,"billingCode":"49440","codeType":"CPT"},{"id":3378,"precertRequired":false,"billingCode":"49441","codeType":"CPT"},{"id":3379,"precertRequired":false,"billingCode":"49442","codeType":"CPT"},{"id":3380,"precertRequired":false,"billingCode":"49446","codeType":"CPT"},{"id":3381,"precertRequired":false,"billingCode":"49450","codeType":"CPT"},{"id":3382,"precertRequired":false,"billingCode":"49451","codeType":"CPT"},{"id":3383,"precertRequired":false,"billingCode":"49452","codeType":"CPT"},{"id":3384,"precertRequired":false,"billingCode":"49460","codeType":"CPT"},{"id":3385,"precertRequired":false,"billingCode":"49465","codeType":"CPT"},{"id":3828,"precertRequired":false,"billingCode":"60000","codeType":"CPT"},{"id":3829,"precertRequired":false,"billingCode":"60100","codeType":"CPT"},{"id":3830,"precertRequired":false,"billingCode":"60200","codeType":"CPT"},{"id":3831,"precertRequired":false,"billingCode":"60210","codeType":"CPT"},{"id":3832,"precertRequired":false,"billingCode":"60212","codeType":"CPT"},{"id":3833,"precertRequired":false,"billingCode":"60220","codeType":"CPT"},{"id":3834,"precertRequired":false,"billingCode":"60225","codeType":"CPT"},{"id":3835,"precertRequired":false,"billingCode":"60240","codeType":"CPT"},{"id":3836,"precertRequired":false,"billingCode":"60252","codeType":"CPT"},{"id":3837,"precertRequired":false,"billingCode":"60254","codeType":"CPT"},{"id":3838,"precertRequired":false,"billingCode":"60260","codeType":"CPT"},{"id":3839,"precertRequired":false,"billingCode":"60270","codeType":"CPT"},{"id":3840,"precertRequired":false,"billingCode":"60271","codeType":"CPT"},{"id":3841,"precertRequired":false,"billingCode":"60280","codeType":"CPT"},{"id":3842,"precertRequired":false,"billingCode":"60281","codeType":"CPT"},{"id":3843,"precertRequired":false,"billingCode":"60300","codeType":"CPT"},{"id":3844,"precertRequired":false,"billingCode":"60500","codeType":"CPT"},{"id":3845,"precertRequired":false,"billingCode":"60502","codeType":"CPT"},{"id":3846,"precertRequired":false,"billingCode":"60505","codeType":"CPT"},{"id":3847,"precertRequired":false,"billingCode":"60512","codeType":"CPT"},{"id":3848,"precertRequired":false,"billingCode":"60520","codeType":"CPT"},{"id":3849,"precertRequired":false,"billingCode":"60521","codeType":"CPT"},{"id":3850,"precertRequired":false,"billingCode":"60522","codeType":"CPT"},{"id":3851,"precertRequired":false,"billingCode":"60540","codeType":"CPT"},{"id":3852,"precertRequired":false,"billingCode":"60545","codeType":"CPT"},{"id":3853,"precertRequired":false,"billingCode":"60600","codeType":"CPT"},{"id":3854,"precertRequired":false,"billingCode":"60605","codeType":"CPT"},{"id":3855,"precertRequired":false,"billingCode":"60650","codeType":"CPT"},{"id":3857,"precertRequired":false,"billingCode":"61576","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":597,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":1,"precertRequired":false,"billingCode":"00100","codeType":"CPT"},{"id":2,"precertRequired":false,"billingCode":"00102","codeType":"CPT"},{"id":3,"precertRequired":false,"billingCode":"00103","codeType":"CPT"},{"id":4,"precertRequired":false,"billingCode":"00104","codeType":"CPT"},{"id":5,"precertRequired":false,"billingCode":"00120","codeType":"CPT"},{"id":6,"precertRequired":false,"billingCode":"00124","codeType":"CPT"},{"id":7,"precertRequired":false,"billingCode":"00126","codeType":"CPT"},{"id":8,"precertRequired":false,"billingCode":"00140","codeType":"CPT"},{"id":9,"precertRequired":false,"billingCode":"00142","codeType":"CPT"},{"id":10,"precertRequired":false,"billingCode":"00144","codeType":"CPT"},{"id":11,"precertRequired":false,"billingCode":"00145","codeType":"CPT"},{"id":12,"precertRequired":false,"billingCode":"00147","codeType":"CPT"},{"id":13,"precertRequired":false,"billingCode":"00148","codeType":"CPT"},{"id":14,"precertRequired":false,"billingCode":"00160","codeType":"CPT"},{"id":15,"precertRequired":false,"billingCode":"00162","codeType":"CPT"},{"id":16,"precertRequired":false,"billingCode":"00164","codeType":"CPT"},{"id":17,"precertRequired":false,"billingCode":"00170","codeType":"CPT"},{"id":18,"precertRequired":false,"billingCode":"00172","codeType":"CPT"},{"id":19,"precertRequired":false,"billingCode":"00174","codeType":"CPT"},{"id":20,"precertRequired":false,"billingCode":"00176","codeType":"CPT"},{"id":21,"precertRequired":false,"billingCode":"00190","codeType":"CPT"},{"id":22,"precertRequired":false,"billingCode":"00192","codeType":"CPT"},{"id":23,"precertRequired":false,"billingCode":"00210","codeType":"CPT"},{"id":24,"precertRequired":false,"billingCode":"00211","codeType":"CPT"},{"id":25,"precertRequired":false,"billingCode":"00212","codeType":"CPT"},{"id":26,"precertRequired":false,"billingCode":"00214","codeType":"CPT"},{"id":27,"precertRequired":false,"billingCode":"00215","codeType":"CPT"},{"id":28,"precertRequired":false,"billingCode":"00216","codeType":"CPT"},{"id":29,"precertRequired":false,"billingCode":"00218","codeType":"CPT"},{"id":30,"precertRequired":false,"billingCode":"00220","codeType":"CPT"},{"id":31,"precertRequired":false,"billingCode":"00222","codeType":"CPT"},{"id":32,"precertRequired":false,"billingCode":"00300","codeType":"CPT"},{"id":33,"precertRequired":false,"billingCode":"00320","codeType":"CPT"},{"id":34,"precertRequired":false,"billingCode":"00322","codeType":"CPT"},{"id":35,"precertRequired":false,"billingCode":"00326","codeType":"CPT"},{"id":36,"precertRequired":false,"billingCode":"00400","codeType":"CPT"},{"id":37,"precertRequired":false,"billingCode":"00402","codeType":"CPT"},{"id":38,"precertRequired":false,"billingCode":"00404","codeType":"CPT"},{"id":39,"precertRequired":false,"billingCode":"00406","codeType":"CPT"},{"id":40,"precertRequired":false,"billingCode":"00410","codeType":"CPT"},{"id":41,"precertRequired":false,"billingCode":"00450","codeType":"CPT"},{"id":42,"precertRequired":false,"billingCode":"00454","codeType":"CPT"},{"id":43,"precertRequired":false,"billingCode":"00470","codeType":"CPT"},{"id":44,"precertRequired":false,"billingCode":"00472","codeType":"CPT"},{"id":45,"precertRequired":false,"billingCode":"00474","codeType":"CPT"},{"id":46,"precertRequired":false,"billingCode":"00500","codeType":"CPT"},{"id":47,"precertRequired":false,"billingCode":"00520","codeType":"CPT"},{"id":48,"precertRequired":false,"billingCode":"00522","codeType":"CPT"},{"id":49,"precertRequired":false,"billingCode":"00524","codeType":"CPT"},{"id":50,"precertRequired":false,"billingCode":"00528","codeType":"CPT"},{"id":51,"precertRequired":false,"billingCode":"00529","codeType":"CPT"},{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":53,"precertRequired":false,"billingCode":"00534","codeType":"CPT"},{"id":54,"precertRequired":false,"billingCode":"00537","codeType":"CPT"},{"id":55,"precertRequired":false,"billingCode":"00539","codeType":"CPT"},{"id":57,"precertRequired":false,"billingCode":"00541","codeType":"CPT"},{"id":58,"precertRequired":false,"billingCode":"00542","codeType":"CPT"},{"id":59,"precertRequired":false,"billingCode":"00546","codeType":"CPT"},{"id":60,"precertRequired":false,"billingCode":"00548","codeType":"CPT"},{"id":61,"precertRequired":false,"billingCode":"00550","codeType":"CPT"},{"id":69,"precertRequired":false,"billingCode":"00700","codeType":"CPT"},{"id":70,"precertRequired":false,"billingCode":"00702","codeType":"CPT"},{"id":71,"precertRequired":false,"billingCode":"00730","codeType":"CPT"},{"id":72,"precertRequired":false,"billingCode":"00731","codeType":"CPT"},{"id":73,"precertRequired":false,"billingCode":"00732","codeType":"CPT"},{"id":74,"precertRequired":false,"billingCode":"00750","codeType":"CPT"},{"id":75,"precertRequired":false,"billingCode":"00752","codeType":"CPT"},{"id":76,"precertRequired":false,"billingCode":"00754","codeType":"CPT"},{"id":77,"precertRequired":false,"billingCode":"00756","codeType":"CPT"},{"id":78,"precertRequired":false,"billingCode":"00770","codeType":"CPT"},{"id":79,"precertRequired":false,"billingCode":"00790","codeType":"CPT"},{"id":80,"precertRequired":false,"billingCode":"00792","codeType":"CPT"},{"id":81,"precertRequired":false,"billingCode":"00794","codeType":"CPT"},{"id":82,"precertRequired":false,"billingCode":"00796","codeType":"CPT"},{"id":83,"precertRequired":false,"billingCode":"00797","codeType":"CPT"},{"id":84,"precertRequired":false,"billingCode":"00800","codeType":"CPT"},{"id":85,"precertRequired":false,"billingCode":"00802","codeType":"CPT"},{"id":86,"precertRequired":false,"billingCode":"00811","codeType":"CPT"},{"id":87,"precertRequired":false,"billingCode":"00812","codeType":"CPT"},{"id":88,"precertRequired":false,"billingCode":"00813","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":90,"precertRequired":false,"billingCode":"00830","codeType":"CPT"},{"id":91,"precertRequired":false,"billingCode":"00832","codeType":"CPT"},{"id":92,"precertRequired":false,"billingCode":"00834","codeType":"CPT"},{"id":93,"precertRequired":false,"billingCode":"00836","codeType":"CPT"},{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":95,"precertRequired":false,"billingCode":"00842","codeType":"CPT"},{"id":96,"precertRequired":false,"billingCode":"00844","codeType":"CPT"},{"id":97,"precertRequired":false,"billingCode":"00846","codeType":"CPT"},{"id":99,"precertRequired":false,"billingCode":"00851","codeType":"CPT"},{"id":100,"precertRequired":false,"billingCode":"00860","codeType":"CPT"},{"id":101,"precertRequired":false,"billingCode":"00862","codeType":"CPT"},{"id":102,"precertRequired":false,"billingCode":"00864","codeType":"CPT"},{"id":103,"precertRequired":false,"billingCode":"00865","codeType":"CPT"},{"id":104,"precertRequired":false,"billingCode":"00866","codeType":"CPT"},{"id":105,"precertRequired":false,"billingCode":"00868","codeType":"CPT"},{"id":106,"precertRequired":false,"billingCode":"00870","codeType":"CPT"},{"id":107,"precertRequired":false,"billingCode":"00872","codeType":"CPT"},{"id":108,"precertRequired":false,"billingCode":"00873","codeType":"CPT"},{"id":109,"precertRequired":false,"billingCode":"00880","codeType":"CPT"},{"id":110,"precertRequired":false,"billingCode":"00882","codeType":"CPT"},{"id":111,"precertRequired":false,"billingCode":"00902","codeType":"CPT"},{"id":112,"precertRequired":false,"billingCode":"00904","codeType":"CPT"},{"id":113,"precertRequired":false,"billingCode":"00906","codeType":"CPT"},{"id":114,"precertRequired":false,"billingCode":"00908","codeType":"CPT"},{"id":115,"precertRequired":false,"billingCode":"00910","codeType":"CPT"},{"id":116,"precertRequired":false,"billingCode":"00912","codeType":"CPT"},{"id":117,"precertRequired":false,"billingCode":"00914","codeType":"CPT"},{"id":118,"precertRequired":false,"billingCode":"00916","codeType":"CPT"},{"id":119,"precertRequired":false,"billingCode":"00918","codeType":"CPT"},{"id":120,"precertRequired":false,"billingCode":"00920","codeType":"CPT"},{"id":121,"precertRequired":false,"billingCode":"00921","codeType":"CPT"},{"id":122,"precertRequired":false,"billingCode":"00922","codeType":"CPT"},{"id":123,"precertRequired":false,"billingCode":"00924","codeType":"CPT"},{"id":124,"precertRequired":false,"billingCode":"00926","codeType":"CPT"},{"id":125,"precertRequired":false,"billingCode":"00928","codeType":"CPT"},{"id":126,"precertRequired":false,"billingCode":"00930","codeType":"CPT"},{"id":127,"precertRequired":false,"billingCode":"00932","codeType":"CPT"},{"id":128,"precertRequired":false,"billingCode":"00934","codeType":"CPT"},{"id":129,"precertRequired":false,"billingCode":"00936","codeType":"CPT"},{"id":130,"precertRequired":false,"billingCode":"00938","codeType":"CPT"},{"id":131,"precertRequired":false,"billingCode":"00940","codeType":"CPT"},{"id":132,"precertRequired":false,"billingCode":"00942","codeType":"CPT"},{"id":133,"precertRequired":false,"billingCode":"00944","codeType":"CPT"},{"id":134,"precertRequired":false,"billingCode":"00948","codeType":"CPT"},{"id":135,"precertRequired":false,"billingCode":"00950","codeType":"CPT"},{"id":136,"precertRequired":false,"billingCode":"00952","codeType":"CPT"},{"id":137,"precertRequired":false,"billingCode":"01112","codeType":"CPT"},{"id":138,"precertRequired":false,"billingCode":"01120","codeType":"CPT"},{"id":139,"precertRequired":false,"billingCode":"01130","codeType":"CPT"},{"id":140,"precertRequired":false,"billingCode":"01140","codeType":"CPT"},{"id":141,"precertRequired":false,"billingCode":"01150","codeType":"CPT"},{"id":142,"precertRequired":false,"billingCode":"01160","codeType":"CPT"},{"id":143,"precertRequired":false,"billingCode":"01170","codeType":"CPT"},{"id":144,"precertRequired":false,"billingCode":"01173","codeType":"CPT"},{"id":145,"precertRequired":false,"billingCode":"01200","codeType":"CPT"},{"id":146,"precertRequired":false,"billingCode":"01202","codeType":"CPT"},{"id":147,"precertRequired":false,"billingCode":"01210","codeType":"CPT"},{"id":148,"precertRequired":false,"billingCode":"01212","codeType":"CPT"},{"id":149,"precertRequired":false,"billingCode":"01214","codeType":"CPT"},{"id":150,"precertRequired":false,"billingCode":"01215","codeType":"CPT"},{"id":151,"precertRequired":false,"billingCode":"01220","codeType":"CPT"},{"id":152,"precertRequired":false,"billingCode":"01230","codeType":"CPT"},{"id":153,"precertRequired":false,"billingCode":"01232","codeType":"CPT"},{"id":154,"precertRequired":false,"billingCode":"01234","codeType":"CPT"},{"id":155,"precertRequired":false,"billingCode":"01250","codeType":"CPT"},{"id":156,"precertRequired":false,"billingCode":"01260","codeType":"CPT"},{"id":157,"precertRequired":false,"billingCode":"01270","codeType":"CPT"},{"id":158,"precertRequired":false,"billingCode":"01272","codeType":"CPT"},{"id":159,"precertRequired":false,"billingCode":"01274","codeType":"CPT"},{"id":160,"precertRequired":false,"billingCode":"01320","codeType":"CPT"},{"id":161,"precertRequired":false,"billingCode":"01340","codeType":"CPT"},{"id":162,"precertRequired":false,"billingCode":"01360","codeType":"CPT"},{"id":163,"precertRequired":false,"billingCode":"01380","codeType":"CPT"},{"id":164,"precertRequired":false,"billingCode":"01382","codeType":"CPT"},{"id":165,"precertRequired":false,"billingCode":"01390","codeType":"CPT"},{"id":166,"precertRequired":false,"billingCode":"01392","codeType":"CPT"},{"id":167,"precertRequired":false,"billingCode":"01400","codeType":"CPT"},{"id":168,"precertRequired":false,"billingCode":"01402","codeType":"CPT"},{"id":169,"precertRequired":false,"billingCode":"01404","codeType":"CPT"},{"id":170,"precertRequired":false,"billingCode":"01420","codeType":"CPT"},{"id":171,"precertRequired":false,"billingCode":"01430","codeType":"CPT"},{"id":172,"precertRequired":false,"billingCode":"01432","codeType":"CPT"},{"id":173,"precertRequired":false,"billingCode":"01440","codeType":"CPT"},{"id":174,"precertRequired":false,"billingCode":"01442","codeType":"CPT"},{"id":175,"precertRequired":false,"billingCode":"01444","codeType":"CPT"},{"id":176,"precertRequired":false,"billingCode":"01462","codeType":"CPT"},{"id":177,"precertRequired":false,"billingCode":"01464","codeType":"CPT"},{"id":178,"precertRequired":false,"billingCode":"01470","codeType":"CPT"},{"id":179,"precertRequired":false,"billingCode":"01472","codeType":"CPT"},{"id":180,"precertRequired":false,"billingCode":"01474","codeType":"CPT"},{"id":181,"precertRequired":false,"billingCode":"01480","codeType":"CPT"},{"id":182,"precertRequired":false,"billingCode":"01482","codeType":"CPT"},{"id":183,"precertRequired":false,"billingCode":"01484","codeType":"CPT"},{"id":184,"precertRequired":false,"billingCode":"01486","codeType":"CPT"},{"id":185,"precertRequired":false,"billingCode":"01490","codeType":"CPT"},{"id":186,"precertRequired":false,"billingCode":"01500","codeType":"CPT"},{"id":187,"precertRequired":false,"billingCode":"01502","codeType":"CPT"},{"id":188,"precertRequired":false,"billingCode":"01520","codeType":"CPT"},{"id":189,"precertRequired":false,"billingCode":"01522","codeType":"CPT"},{"id":204,"precertRequired":false,"billingCode":"01951","codeType":"CPT"},{"id":205,"precertRequired":false,"billingCode":"01952","codeType":"CPT"},{"id":206,"precertRequired":false,"billingCode":"01953","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":598,"description":"Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5723,"precertRequired":false,"billingCode":"84445","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":599,"description":"Inpatient or observation admission for surgery/procedure if indicated","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":600,"description":"Inpatient admission or observation status for complications related to the surgery/procedure ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":601,"description":"Follow-up visits for this episode of care relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]},{"id":602,"description":"Follow-up imaging as clinically indicated relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4367,"precertRequired":false,"billingCode":"70015","codeType":"CPT"},{"id":4368,"precertRequired":false,"billingCode":"70030","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4407,"precertRequired":false,"billingCode":"70490","codeType":"CPT"},{"id":4408,"precertRequired":false,"billingCode":"70491","codeType":"CPT"},{"id":4409,"precertRequired":false,"billingCode":"70492","codeType":"CPT"},{"id":4410,"precertRequired":false,"billingCode":"70496","codeType":"CPT"},{"id":4411,"precertRequired":false,"billingCode":"70498","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4416,"precertRequired":false,"billingCode":"70545","codeType":"CPT"},{"id":4417,"precertRequired":false,"billingCode":"70546","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4424,"precertRequired":false,"billingCode":"70554","codeType":"CPT"},{"id":4425,"precertRequired":false,"billingCode":"70555","codeType":"CPT"},{"id":4426,"precertRequired":false,"billingCode":"70557","codeType":"CPT"},{"id":4427,"precertRequired":false,"billingCode":"70558","codeType":"CPT"},{"id":4428,"precertRequired":false,"billingCode":"70559","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4465,"precertRequired":false,"billingCode":"72125","codeType":"CPT"},{"id":4466,"precertRequired":false,"billingCode":"72126","codeType":"CPT"},{"id":4467,"precertRequired":false,"billingCode":"72127","codeType":"CPT"},{"id":4468,"precertRequired":true,"billingCode":"72128","codeType":"CPT"},{"id":4469,"precertRequired":true,"billingCode":"72129","codeType":"CPT"},{"id":4470,"precertRequired":false,"billingCode":"72130","codeType":"CPT"},{"id":4471,"precertRequired":false,"billingCode":"72131","codeType":"CPT"},{"id":4472,"precertRequired":false,"billingCode":"72132","codeType":"CPT"},{"id":4473,"precertRequired":false,"billingCode":"72133","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4584,"precertRequired":false,"billingCode":"74190","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4605,"precertRequired":false,"billingCode":"74300","codeType":"CPT"},{"id":4606,"precertRequired":false,"billingCode":"74301","codeType":"CPT"},{"id":4607,"precertRequired":false,"billingCode":"74328","codeType":"CPT"},{"id":4608,"precertRequired":false,"billingCode":"74329","codeType":"CPT"},{"id":4609,"precertRequired":false,"billingCode":"74330","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4611,"precertRequired":false,"billingCode":"74355","codeType":"CPT"},{"id":4612,"precertRequired":false,"billingCode":"74360","codeType":"CPT"},{"id":4613,"precertRequired":false,"billingCode":"74363","codeType":"CPT"},{"id":4639,"precertRequired":false,"billingCode":"75600","codeType":"CPT"},{"id":4640,"precertRequired":false,"billingCode":"75605","codeType":"CPT"},{"id":4641,"precertRequired":false,"billingCode":"75625","codeType":"CPT"},{"id":4642,"precertRequired":false,"billingCode":"75630","codeType":"CPT"},{"id":4643,"precertRequired":false,"billingCode":"75635","codeType":"CPT"},{"id":4648,"precertRequired":false,"billingCode":"75726","codeType":"CPT"},{"id":4649,"precertRequired":false,"billingCode":"75731","codeType":"CPT"},{"id":4650,"precertRequired":false,"billingCode":"75733","codeType":"CPT"},{"id":4651,"precertRequired":false,"billingCode":"75736","codeType":"CPT"},{"id":4652,"precertRequired":false,"billingCode":"75741","codeType":"CPT"},{"id":4653,"precertRequired":false,"billingCode":"75743","codeType":"CPT"},{"id":4654,"precertRequired":false,"billingCode":"75746","codeType":"CPT"},{"id":4655,"precertRequired":false,"billingCode":"75756","codeType":"CPT"},{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4661,"precertRequired":false,"billingCode":"75809","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4663,"precertRequired":false,"billingCode":"75820","codeType":"CPT"},{"id":4664,"precertRequired":false,"billingCode":"75822","codeType":"CPT"},{"id":4665,"precertRequired":false,"billingCode":"75825","codeType":"CPT"},{"id":4666,"precertRequired":false,"billingCode":"75827","codeType":"CPT"},{"id":4667,"precertRequired":false,"billingCode":"75831","codeType":"CPT"},{"id":4668,"precertRequired":false,"billingCode":"75833","codeType":"CPT"},{"id":4669,"precertRequired":false,"billingCode":"75840","codeType":"CPT"},{"id":4670,"precertRequired":false,"billingCode":"75842","codeType":"CPT"},{"id":4671,"precertRequired":false,"billingCode":"75860","codeType":"CPT"},{"id":4672,"precertRequired":false,"billingCode":"75870","codeType":"CPT"},{"id":4673,"precertRequired":false,"billingCode":"75872","codeType":"CPT"},{"id":4674,"precertRequired":false,"billingCode":"75880","codeType":"CPT"},{"id":4675,"precertRequired":false,"billingCode":"75885","codeType":"CPT"},{"id":4676,"precertRequired":false,"billingCode":"75887","codeType":"CPT"},{"id":4677,"precertRequired":false,"billingCode":"75889","codeType":"CPT"},{"id":4678,"precertRequired":false,"billingCode":"75891","codeType":"CPT"},{"id":4679,"precertRequired":false,"billingCode":"75893","codeType":"CPT"},{"id":4680,"precertRequired":false,"billingCode":"75894","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4682,"precertRequired":false,"billingCode":"75901","codeType":"CPT"},{"id":4683,"precertRequired":false,"billingCode":"75902","codeType":"CPT"},{"id":4689,"precertRequired":false,"billingCode":"75970","codeType":"CPT"},{"id":4690,"precertRequired":false,"billingCode":"75984","codeType":"CPT"},{"id":4691,"precertRequired":false,"billingCode":"75989","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4693,"precertRequired":false,"billingCode":"76001","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4696,"precertRequired":false,"billingCode":"76098","codeType":"CPT"},{"id":4697,"precertRequired":false,"billingCode":"76100","codeType":"CPT"},{"id":4698,"precertRequired":false,"billingCode":"76101","codeType":"CPT"},{"id":4699,"precertRequired":false,"billingCode":"76102","codeType":"CPT"},{"id":4700,"precertRequired":false,"billingCode":"76120","codeType":"CPT"},{"id":4701,"precertRequired":false,"billingCode":"76125","codeType":"CPT"},{"id":4702,"precertRequired":false,"billingCode":"76140","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4705,"precertRequired":false,"billingCode":"76380","codeType":"CPT"},{"id":4706,"precertRequired":false,"billingCode":"76390","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4726,"precertRequired":false,"billingCode":"76706","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4770,"precertRequired":false,"billingCode":"76970","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4784,"precertRequired":true,"billingCode":"77058","codeType":"CPT"},{"id":4785,"precertRequired":true,"billingCode":"77059","codeType":"CPT"},{"id":4792,"precertRequired":false,"billingCode":"77071","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4797,"precertRequired":false,"billingCode":"77077","codeType":"CPT"},{"id":4801,"precertRequired":false,"billingCode":"77084","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4910,"precertRequired":false,"billingCode":"78261","codeType":"CPT"},{"id":4918,"precertRequired":false,"billingCode":"78278","codeType":"CPT"},{"id":4919,"precertRequired":false,"billingCode":"78282","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4921,"precertRequired":false,"billingCode":"78291","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4930,"precertRequired":false,"billingCode":"78414","codeType":"CPT"},{"id":4931,"precertRequired":false,"billingCode":"78428","codeType":"CPT"},{"id":4932,"precertRequired":false,"billingCode":"78445","codeType":"CPT"},{"id":4937,"precertRequired":false,"billingCode":"78456","codeType":"CPT"},{"id":4938,"precertRequired":false,"billingCode":"78457","codeType":"CPT"},{"id":4939,"precertRequired":false,"billingCode":"78458","codeType":"CPT"},{"id":4969,"precertRequired":false,"billingCode":"78660","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4986,"precertRequired":false,"billingCode":"78805","codeType":"CPT"},{"id":4987,"precertRequired":false,"billingCode":"78806","codeType":"CPT"},{"id":4988,"precertRequired":false,"billingCode":"78807","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"},{"id":4990,"precertRequired":false,"billingCode":"78811","codeType":"CPT"},{"id":4991,"precertRequired":false,"billingCode":"78812","codeType":"CPT"},{"id":4992,"precertRequired":false,"billingCode":"78813","codeType":"CPT"},{"id":4993,"precertRequired":false,"billingCode":"78814","codeType":"CPT"},{"id":4994,"precertRequired":false,"billingCode":"78815","codeType":"CPT"},{"id":4995,"precertRequired":false,"billingCode":"78816","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":603,"description":"Follow-up studies as clinically indicated relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"02-General surgery"}],"billingCodes":[{"id":4656,"precertRequired":false,"billingCode":"75774","codeType":"CPT"},{"id":4681,"precertRequired":false,"billingCode":"75898","codeType":"CPT"},{"id":4695,"precertRequired":false,"billingCode":"76080","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4915,"precertRequired":false,"billingCode":"78270","codeType":"CPT"},{"id":4916,"precertRequired":false,"billingCode":"78271","codeType":"CPT"},{"id":4917,"precertRequired":false,"billingCode":"78272","codeType":"CPT"},{"id":4989,"precertRequired":false,"billingCode":"78808","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2086S0129X"},{"HPTC":"208600000X"},{"HPTC":"2086S0105X"},{"HPTC":"2086S0127X"},{"HPTC":"207XX0801X"},{"HPTC":"207XX0005X"},{"HPTC":"207XS0114X"},{"HPTC":"2086X0206X"},{"HPTC":"207XS0117X"},{"HPTC":"2082S0105X"},{"HPTC":"208G00000X"},{"HPTC":"2086S0122X"},{"HPTC":"2086H0002X"},{"HPTC":"2086S0120X"},{"HPTC":"207T00000X"},{"HPTC":"2086S0102X"},{"HPTC":"208C00000X"},{"HPTC":"208200000X"},{"HPTC":"204E00000X"},{"HPTC":"207XX0004X"},{"HPTC":"207X00000X"},{"HPTC":"207XP3100X"},{"HPTC":"207XS0106X"},{"HPTC":"204F00000X"},{"HPTC":"2082S0099X"}]}]}},{"Seoc":{"id":1779,"seocKey":56,"name":"GI Upper Endoscopy (EGD) and - or Colonoscopy_REV_PRCT","seocId":"MSC_GI UPPER ENDOSCOPY (EGD) AND - OR COLONOSCOPY_1.0.5_REV_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":180,"REV":true,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition on consult order\r\n2.    Diagnostic imaging relevant to the referred condition on the consult order\r\n3.    Labs and pathology relevant to the referred condition on the consult order\r\n4.    Procedures to include: Colonoscopy (screening or diagnostic) and/or EGD.  Appropriate interventions as clinically necessary (examples: banding and sclerosing, polyp removal, tumor ablation, dilatation)\r\n5.    Anesthesia consultation related to the procedure\r\n6.    Pre-procedure medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)\r\n7.    Follow up visits as clinically indicated for this episode of care\r\n8.    Follow-up imaging as clinically indicated during this episode of care","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"COLONOSCOPY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RG0100X"}],"services":[{"id":5474,"description":"Initial outpatient evaluation and treatment for the referred condition on consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":5475,"description":"Diagnostic imaging relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4598,"precertRequired":false,"billingCode":"74261","codeType":"CPT"},{"id":4599,"precertRequired":false,"billingCode":"74262","codeType":"CPT"},{"id":4600,"precertRequired":false,"billingCode":"74263","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4771,"precertRequired":false,"billingCode":"76975","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":6630,"precertRequired":false,"billingCode":"91110","codeType":"CPT"},{"id":6631,"precertRequired":false,"billingCode":"91111","codeType":"CPT"},{"id":13411,"precertRequired":false,"billingCode":"74248","codeType":"CPT"},{"id":13443,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":13444,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":13445,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":13656,"precertRequired":true,"billingCode":"71260","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5476,"description":"Labs and pathology relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5413,"precertRequired":false,"billingCode":"82271","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5477,"description":"Procedures to include: Colonoscopy (screening or diagnostic) and/or EGD.  Appropriate interventions as clinically necessary (examples: banding and sclerosing, polyp removal, tumor ablation, dilatation)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":2758,"precertRequired":false,"billingCode":"43191","codeType":"CPT"},{"id":2759,"precertRequired":false,"billingCode":"43192","codeType":"CPT"},{"id":2760,"precertRequired":false,"billingCode":"43193","codeType":"CPT"},{"id":2761,"precertRequired":false,"billingCode":"43194","codeType":"CPT"},{"id":2762,"precertRequired":false,"billingCode":"43195","codeType":"CPT"},{"id":2763,"precertRequired":false,"billingCode":"43196","codeType":"CPT"},{"id":2764,"precertRequired":false,"billingCode":"43197","codeType":"CPT"},{"id":2765,"precertRequired":false,"billingCode":"43198","codeType":"CPT"},{"id":2766,"precertRequired":false,"billingCode":"43200","codeType":"CPT"},{"id":2767,"precertRequired":false,"billingCode":"43201","codeType":"CPT"},{"id":2768,"precertRequired":false,"billingCode":"43202","codeType":"CPT"},{"id":2769,"precertRequired":false,"billingCode":"43204","codeType":"CPT"},{"id":2770,"precertRequired":false,"billingCode":"43205","codeType":"CPT"},{"id":2771,"precertRequired":false,"billingCode":"43206","codeType":"CPT"},{"id":2772,"precertRequired":false,"billingCode":"43210","codeType":"CPT"},{"id":2773,"precertRequired":false,"billingCode":"43211","codeType":"CPT"},{"id":2774,"precertRequired":false,"billingCode":"43212","codeType":"CPT"},{"id":2775,"precertRequired":false,"billingCode":"43213","codeType":"CPT"},{"id":2776,"precertRequired":false,"billingCode":"43214","codeType":"CPT"},{"id":2777,"precertRequired":false,"billingCode":"43215","codeType":"CPT"},{"id":2778,"precertRequired":false,"billingCode":"43216","codeType":"CPT"},{"id":2779,"precertRequired":false,"billingCode":"43217","codeType":"CPT"},{"id":2781,"precertRequired":false,"billingCode":"43220","codeType":"CPT"},{"id":2782,"precertRequired":false,"billingCode":"43226","codeType":"CPT"},{"id":2783,"precertRequired":false,"billingCode":"43227","codeType":"CPT"},{"id":2784,"precertRequired":false,"billingCode":"43229","codeType":"CPT"},{"id":2785,"precertRequired":false,"billingCode":"43231","codeType":"CPT"},{"id":2786,"precertRequired":false,"billingCode":"43232","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2790,"precertRequired":false,"billingCode":"43237","codeType":"CPT"},{"id":2791,"precertRequired":false,"billingCode":"43238","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2795,"precertRequired":false,"billingCode":"43242","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2810,"precertRequired":false,"billingCode":"43259","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":2869,"precertRequired":false,"billingCode":"43453","codeType":"CPT"},{"id":3021,"precertRequired":false,"billingCode":"44388","codeType":"CPT"},{"id":3022,"precertRequired":false,"billingCode":"44389","codeType":"CPT"},{"id":3023,"precertRequired":false,"billingCode":"44390","codeType":"CPT"},{"id":3024,"precertRequired":false,"billingCode":"44391","codeType":"CPT"},{"id":3025,"precertRequired":false,"billingCode":"44392","codeType":"CPT"},{"id":3026,"precertRequired":false,"billingCode":"44394","codeType":"CPT"},{"id":3027,"precertRequired":false,"billingCode":"44401","codeType":"CPT"},{"id":3028,"precertRequired":false,"billingCode":"44402","codeType":"CPT"},{"id":3029,"precertRequired":false,"billingCode":"44403","codeType":"CPT"},{"id":3030,"precertRequired":false,"billingCode":"44404","codeType":"CPT"},{"id":3031,"precertRequired":false,"billingCode":"44405","codeType":"CPT"},{"id":3032,"precertRequired":false,"billingCode":"44406","codeType":"CPT"},{"id":3033,"precertRequired":false,"billingCode":"44407","codeType":"CPT"},{"id":3034,"precertRequired":false,"billingCode":"44408","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3123,"precertRequired":false,"billingCode":"45388","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"},{"id":8118,"precertRequired":false,"billingCode":"G0104","codeType":"HCPCS"},{"id":8119,"precertRequired":false,"billingCode":"G0105","codeType":"HCPCS"},{"id":8120,"precertRequired":false,"billingCode":"G0106","codeType":"HCPCS"},{"id":8125,"precertRequired":false,"billingCode":"G0120","codeType":"HCPCS"},{"id":8126,"precertRequired":false,"billingCode":"G0121","codeType":"HCPCS"},{"id":11449,"precertRequired":false,"billingCode":"G0122","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":5478,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":72,"precertRequired":false,"billingCode":"00731","codeType":"CPT"},{"id":73,"precertRequired":false,"billingCode":"00732","codeType":"CPT"},{"id":88,"precertRequired":false,"billingCode":"00813","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":5479,"description":"Pre-procedure medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":5480,"description":"Follow up visits as clinically indicated for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":5481,"description":"Follow-up imaging as clinically indicated during this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4598,"precertRequired":false,"billingCode":"74261","codeType":"CPT"},{"id":4599,"precertRequired":false,"billingCode":"74262","codeType":"CPT"},{"id":4600,"precertRequired":false,"billingCode":"74263","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4771,"precertRequired":false,"billingCode":"76975","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":6630,"precertRequired":false,"billingCode":"91110","codeType":"CPT"},{"id":6631,"precertRequired":false,"billingCode":"91111","codeType":"CPT"},{"id":13411,"precertRequired":false,"billingCode":"74248","codeType":"CPT"},{"id":13443,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":13444,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":13445,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":13656,"precertRequired":true,"billingCode":"71260","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":488,"seocKey":56,"name":"GI Upper Endoscopy (EGD) and/or Colonoscopy_PRCT","seocId":"MSC_GI UPPER ENDOSCOPY (EGD) AND/OR COLONOSCOPY_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Labs and pathology relevant to the referred condition on the consult\r\n4. Procedures to include: Colonoscopy (screening or diagnostic) and/or EGD.  Appropriate interventions as clinically necessary (examples: banding and sclerosing, polyp removal, tumor ablation, dilatation)\r\n5. Anesthesia consultation related to the procedure\r\n6. Pre-procedure medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)\r\n7. Follow up visits as clinically indicated for this episode of care\r\n8. Follow-up imaging as clinically indicated during this episode of care","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"COLONOSCOPY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RG0100X"}],"services":[{"id":2811,"description":"Initial outpatient evaluation and treatment for the referred condition on consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7320,"precertRequired":false,"billingCode":"99024","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":2812,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4597,"precertRequired":false,"billingCode":"74260","codeType":"CPT"},{"id":4598,"precertRequired":false,"billingCode":"74261","codeType":"CPT"},{"id":4599,"precertRequired":false,"billingCode":"74262","codeType":"CPT"},{"id":4600,"precertRequired":false,"billingCode":"74263","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4771,"precertRequired":false,"billingCode":"76975","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":6630,"precertRequired":false,"billingCode":"91110","codeType":"CPT"},{"id":6631,"precertRequired":false,"billingCode":"91111","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2813,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5413,"precertRequired":false,"billingCode":"82271","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":2814,"description":"Procedures to include: Colonoscopy (screening or diagnostic) and/or EGD.  Appropriate interventions as clinically necessary (examples: banding and sclerosing, polyp removal, tumor ablation, dilatation)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":2758,"precertRequired":false,"billingCode":"43191","codeType":"CPT"},{"id":2759,"precertRequired":false,"billingCode":"43192","codeType":"CPT"},{"id":2760,"precertRequired":false,"billingCode":"43193","codeType":"CPT"},{"id":2761,"precertRequired":false,"billingCode":"43194","codeType":"CPT"},{"id":2762,"precertRequired":false,"billingCode":"43195","codeType":"CPT"},{"id":2763,"precertRequired":false,"billingCode":"43196","codeType":"CPT"},{"id":2764,"precertRequired":false,"billingCode":"43197","codeType":"CPT"},{"id":2765,"precertRequired":false,"billingCode":"43198","codeType":"CPT"},{"id":2766,"precertRequired":false,"billingCode":"43200","codeType":"CPT"},{"id":2767,"precertRequired":false,"billingCode":"43201","codeType":"CPT"},{"id":2768,"precertRequired":false,"billingCode":"43202","codeType":"CPT"},{"id":2769,"precertRequired":false,"billingCode":"43204","codeType":"CPT"},{"id":2770,"precertRequired":false,"billingCode":"43205","codeType":"CPT"},{"id":2771,"precertRequired":false,"billingCode":"43206","codeType":"CPT"},{"id":2772,"precertRequired":false,"billingCode":"43210","codeType":"CPT"},{"id":2773,"precertRequired":false,"billingCode":"43211","codeType":"CPT"},{"id":2774,"precertRequired":false,"billingCode":"43212","codeType":"CPT"},{"id":2775,"precertRequired":false,"billingCode":"43213","codeType":"CPT"},{"id":2776,"precertRequired":false,"billingCode":"43214","codeType":"CPT"},{"id":2777,"precertRequired":false,"billingCode":"43215","codeType":"CPT"},{"id":2778,"precertRequired":false,"billingCode":"43216","codeType":"CPT"},{"id":2779,"precertRequired":false,"billingCode":"43217","codeType":"CPT"},{"id":2781,"precertRequired":false,"billingCode":"43220","codeType":"CPT"},{"id":2782,"precertRequired":false,"billingCode":"43226","codeType":"CPT"},{"id":2783,"precertRequired":false,"billingCode":"43227","codeType":"CPT"},{"id":2784,"precertRequired":false,"billingCode":"43229","codeType":"CPT"},{"id":2785,"precertRequired":false,"billingCode":"43231","codeType":"CPT"},{"id":2786,"precertRequired":false,"billingCode":"43232","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2790,"precertRequired":false,"billingCode":"43237","codeType":"CPT"},{"id":2791,"precertRequired":false,"billingCode":"43238","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2795,"precertRequired":false,"billingCode":"43242","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2810,"precertRequired":false,"billingCode":"43259","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":2869,"precertRequired":false,"billingCode":"43453","codeType":"CPT"},{"id":3021,"precertRequired":false,"billingCode":"44388","codeType":"CPT"},{"id":3022,"precertRequired":false,"billingCode":"44389","codeType":"CPT"},{"id":3023,"precertRequired":false,"billingCode":"44390","codeType":"CPT"},{"id":3024,"precertRequired":false,"billingCode":"44391","codeType":"CPT"},{"id":3025,"precertRequired":false,"billingCode":"44392","codeType":"CPT"},{"id":3026,"precertRequired":false,"billingCode":"44394","codeType":"CPT"},{"id":3027,"precertRequired":false,"billingCode":"44401","codeType":"CPT"},{"id":3028,"precertRequired":false,"billingCode":"44402","codeType":"CPT"},{"id":3029,"precertRequired":false,"billingCode":"44403","codeType":"CPT"},{"id":3030,"precertRequired":false,"billingCode":"44404","codeType":"CPT"},{"id":3031,"precertRequired":false,"billingCode":"44405","codeType":"CPT"},{"id":3032,"precertRequired":false,"billingCode":"44406","codeType":"CPT"},{"id":3033,"precertRequired":false,"billingCode":"44407","codeType":"CPT"},{"id":3034,"precertRequired":false,"billingCode":"44408","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":2815,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":72,"precertRequired":false,"billingCode":"00731","codeType":"CPT"},{"id":73,"precertRequired":false,"billingCode":"00732","codeType":"CPT"},{"id":88,"precertRequired":false,"billingCode":"00813","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":2816,"description":"Pre-procedure medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":2817,"description":"Follow up visits as clinically indicated for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7320,"precertRequired":false,"billingCode":"99024","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":2818,"description":"Follow-up imaging as clinically indicated during this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":277,"seocKey":56,"name":"GI Upper Endoscopy (EGD) and/or Colonoscopy_PRCT","seocId":"MSC_GI UPPER ENDOSCOPY (EGD) AND/OR COLONOSCOPY_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Labs and pathology relevant to the referred condition on the consult\r\n4. Procedures to include: Colonoscopy (screening or diagnostic) and/or EGD.  Appropriate interventions as clinically necessary (examples: banding and sclerosing, polyp removal, tumor ablation, dilatation)\r\n5. Anesthesia consultation related to the procedure\r\n6. Pre-procedure medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)\r\n7. Follow up visits as clinically indicated for this episode of care\r\n8. Follow-up imaging as clinically indicated during this episode of care","maxAllowableVisits":null,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"COLONOSCOPY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RG0100X"}],"services":[{"id":1151,"description":"Initial outpatient evaluation and treatment for the referred condition on consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7320,"precertRequired":false,"billingCode":"99024","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":1152,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4597,"precertRequired":false,"billingCode":"74260","codeType":"CPT"},{"id":4598,"precertRequired":false,"billingCode":"74261","codeType":"CPT"},{"id":4599,"precertRequired":false,"billingCode":"74262","codeType":"CPT"},{"id":4600,"precertRequired":false,"billingCode":"74263","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4693,"precertRequired":false,"billingCode":"76001","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4771,"precertRequired":false,"billingCode":"76975","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":6630,"precertRequired":false,"billingCode":"91110","codeType":"CPT"},{"id":6631,"precertRequired":false,"billingCode":"91111","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1153,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5413,"precertRequired":false,"billingCode":"82271","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1154,"description":"Procedures to include: Colonoscopy (screening or diagnostic) and/or EGD.  Appropriate interventions as clinically necessary (examples: banding and sclerosing, polyp removal, tumor ablation, dilatation)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":2758,"precertRequired":false,"billingCode":"43191","codeType":"CPT"},{"id":2759,"precertRequired":false,"billingCode":"43192","codeType":"CPT"},{"id":2760,"precertRequired":false,"billingCode":"43193","codeType":"CPT"},{"id":2761,"precertRequired":false,"billingCode":"43194","codeType":"CPT"},{"id":2762,"precertRequired":false,"billingCode":"43195","codeType":"CPT"},{"id":2763,"precertRequired":false,"billingCode":"43196","codeType":"CPT"},{"id":2764,"precertRequired":false,"billingCode":"43197","codeType":"CPT"},{"id":2765,"precertRequired":false,"billingCode":"43198","codeType":"CPT"},{"id":2766,"precertRequired":false,"billingCode":"43200","codeType":"CPT"},{"id":2767,"precertRequired":false,"billingCode":"43201","codeType":"CPT"},{"id":2768,"precertRequired":false,"billingCode":"43202","codeType":"CPT"},{"id":2769,"precertRequired":false,"billingCode":"43204","codeType":"CPT"},{"id":2770,"precertRequired":false,"billingCode":"43205","codeType":"CPT"},{"id":2771,"precertRequired":false,"billingCode":"43206","codeType":"CPT"},{"id":2772,"precertRequired":false,"billingCode":"43210","codeType":"CPT"},{"id":2773,"precertRequired":false,"billingCode":"43211","codeType":"CPT"},{"id":2774,"precertRequired":false,"billingCode":"43212","codeType":"CPT"},{"id":2775,"precertRequired":false,"billingCode":"43213","codeType":"CPT"},{"id":2776,"precertRequired":false,"billingCode":"43214","codeType":"CPT"},{"id":2777,"precertRequired":false,"billingCode":"43215","codeType":"CPT"},{"id":2778,"precertRequired":false,"billingCode":"43216","codeType":"CPT"},{"id":2779,"precertRequired":false,"billingCode":"43217","codeType":"CPT"},{"id":2781,"precertRequired":false,"billingCode":"43220","codeType":"CPT"},{"id":2782,"precertRequired":false,"billingCode":"43226","codeType":"CPT"},{"id":2783,"precertRequired":false,"billingCode":"43227","codeType":"CPT"},{"id":2784,"precertRequired":false,"billingCode":"43229","codeType":"CPT"},{"id":2785,"precertRequired":false,"billingCode":"43231","codeType":"CPT"},{"id":2786,"precertRequired":false,"billingCode":"43232","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2790,"precertRequired":false,"billingCode":"43237","codeType":"CPT"},{"id":2791,"precertRequired":false,"billingCode":"43238","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2795,"precertRequired":false,"billingCode":"43242","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2810,"precertRequired":false,"billingCode":"43259","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":2869,"precertRequired":false,"billingCode":"43453","codeType":"CPT"},{"id":3021,"precertRequired":false,"billingCode":"44388","codeType":"CPT"},{"id":3022,"precertRequired":false,"billingCode":"44389","codeType":"CPT"},{"id":3023,"precertRequired":false,"billingCode":"44390","codeType":"CPT"},{"id":3024,"precertRequired":false,"billingCode":"44391","codeType":"CPT"},{"id":3025,"precertRequired":false,"billingCode":"44392","codeType":"CPT"},{"id":3026,"precertRequired":false,"billingCode":"44394","codeType":"CPT"},{"id":3027,"precertRequired":false,"billingCode":"44401","codeType":"CPT"},{"id":3028,"precertRequired":false,"billingCode":"44402","codeType":"CPT"},{"id":3029,"precertRequired":false,"billingCode":"44403","codeType":"CPT"},{"id":3030,"precertRequired":false,"billingCode":"44404","codeType":"CPT"},{"id":3031,"precertRequired":false,"billingCode":"44405","codeType":"CPT"},{"id":3032,"precertRequired":false,"billingCode":"44406","codeType":"CPT"},{"id":3033,"precertRequired":false,"billingCode":"44407","codeType":"CPT"},{"id":3034,"precertRequired":false,"billingCode":"44408","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":1155,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":72,"precertRequired":false,"billingCode":"00731","codeType":"CPT"},{"id":73,"precertRequired":false,"billingCode":"00732","codeType":"CPT"},{"id":88,"precertRequired":false,"billingCode":"00813","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1156,"description":"Pre-procedure medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":1157,"description":"Follow up visits as clinically indicated for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7320,"precertRequired":false,"billingCode":"99024","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":1158,"description":"Follow-up imaging as clinically indicated during this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":150,"seocKey":56,"name":"GI Upper Endoscopy (EGD) and/or Colonoscopy_PRCT","seocId":"MSC_GI UPPER ENDOSCOPY (EGD) AND/OR COLONOSCOPY_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"12-07-2018","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on consult\r\n2. Diagnostic imaging relevant to the referred condition on the consult\r\n3. Labs and pathology relevant to the referred condition on the consult\r\n4. Procedures to include: Colonoscopy (screening or diagnostic) and/or EGD.  Appropriate interventions as clinically necessary (examples: banding and sclerosing, polyp removal, tumor ablation, dilatation)\r\n5. Anesthesia consultation related to the procedure\r\n6. Pre-procedure medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)\r\n7. Follow up visits as clinically indicated for this episode of care\r\n8. Follow-up imaging as clinically indicated during this episode of care","maxAllowableVisits":999,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.\r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"COLONOSCOPY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":179,"description":"Initial outpatient evaluation and treatment for the referred condition on consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7320,"precertRequired":false,"billingCode":"99024","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":180,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4576,"precertRequired":false,"billingCode":"74175","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4597,"precertRequired":false,"billingCode":"74260","codeType":"CPT"},{"id":4598,"precertRequired":false,"billingCode":"74261","codeType":"CPT"},{"id":4599,"precertRequired":false,"billingCode":"74262","codeType":"CPT"},{"id":4600,"precertRequired":false,"billingCode":"74263","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4693,"precertRequired":false,"billingCode":"76001","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4771,"precertRequired":false,"billingCode":"76975","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":6630,"precertRequired":false,"billingCode":"91110","codeType":"CPT"},{"id":6631,"precertRequired":false,"billingCode":"91111","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":181,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5413,"precertRequired":false,"billingCode":"82271","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":182,"description":"Procedures to include: Colonoscopy (screening or diagnostic) and/or EGD.  Appropriate interventions as clinically necessary (examples: banding and sclerosing, polyp removal, tumor ablation, dilatation)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":2758,"precertRequired":false,"billingCode":"43191","codeType":"CPT"},{"id":2759,"precertRequired":false,"billingCode":"43192","codeType":"CPT"},{"id":2760,"precertRequired":false,"billingCode":"43193","codeType":"CPT"},{"id":2761,"precertRequired":false,"billingCode":"43194","codeType":"CPT"},{"id":2762,"precertRequired":false,"billingCode":"43195","codeType":"CPT"},{"id":2763,"precertRequired":false,"billingCode":"43196","codeType":"CPT"},{"id":2764,"precertRequired":false,"billingCode":"43197","codeType":"CPT"},{"id":2765,"precertRequired":false,"billingCode":"43198","codeType":"CPT"},{"id":2766,"precertRequired":false,"billingCode":"43200","codeType":"CPT"},{"id":2767,"precertRequired":false,"billingCode":"43201","codeType":"CPT"},{"id":2768,"precertRequired":false,"billingCode":"43202","codeType":"CPT"},{"id":2769,"precertRequired":false,"billingCode":"43204","codeType":"CPT"},{"id":2770,"precertRequired":false,"billingCode":"43205","codeType":"CPT"},{"id":2771,"precertRequired":false,"billingCode":"43206","codeType":"CPT"},{"id":2772,"precertRequired":false,"billingCode":"43210","codeType":"CPT"},{"id":2773,"precertRequired":false,"billingCode":"43211","codeType":"CPT"},{"id":2774,"precertRequired":false,"billingCode":"43212","codeType":"CPT"},{"id":2775,"precertRequired":false,"billingCode":"43213","codeType":"CPT"},{"id":2776,"precertRequired":false,"billingCode":"43214","codeType":"CPT"},{"id":2777,"precertRequired":false,"billingCode":"43215","codeType":"CPT"},{"id":2778,"precertRequired":false,"billingCode":"43216","codeType":"CPT"},{"id":2779,"precertRequired":false,"billingCode":"43217","codeType":"CPT"},{"id":2781,"precertRequired":false,"billingCode":"43220","codeType":"CPT"},{"id":2782,"precertRequired":false,"billingCode":"43226","codeType":"CPT"},{"id":2783,"precertRequired":false,"billingCode":"43227","codeType":"CPT"},{"id":2784,"precertRequired":false,"billingCode":"43229","codeType":"CPT"},{"id":2785,"precertRequired":false,"billingCode":"43231","codeType":"CPT"},{"id":2786,"precertRequired":false,"billingCode":"43232","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2790,"precertRequired":false,"billingCode":"43237","codeType":"CPT"},{"id":2791,"precertRequired":false,"billingCode":"43238","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2795,"precertRequired":false,"billingCode":"43242","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2810,"precertRequired":false,"billingCode":"43259","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2868,"precertRequired":false,"billingCode":"43450","codeType":"CPT"},{"id":2869,"precertRequired":false,"billingCode":"43453","codeType":"CPT"},{"id":3021,"precertRequired":false,"billingCode":"44388","codeType":"CPT"},{"id":3022,"precertRequired":false,"billingCode":"44389","codeType":"CPT"},{"id":3023,"precertRequired":false,"billingCode":"44390","codeType":"CPT"},{"id":3024,"precertRequired":false,"billingCode":"44391","codeType":"CPT"},{"id":3025,"precertRequired":false,"billingCode":"44392","codeType":"CPT"},{"id":3026,"precertRequired":false,"billingCode":"44394","codeType":"CPT"},{"id":3027,"precertRequired":false,"billingCode":"44401","codeType":"CPT"},{"id":3028,"precertRequired":false,"billingCode":"44402","codeType":"CPT"},{"id":3029,"precertRequired":false,"billingCode":"44403","codeType":"CPT"},{"id":3030,"precertRequired":false,"billingCode":"44404","codeType":"CPT"},{"id":3031,"precertRequired":false,"billingCode":"44405","codeType":"CPT"},{"id":3032,"precertRequired":false,"billingCode":"44406","codeType":"CPT"},{"id":3033,"precertRequired":false,"billingCode":"44407","codeType":"CPT"},{"id":3034,"precertRequired":false,"billingCode":"44408","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":183,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":72,"precertRequired":false,"billingCode":"00731","codeType":"CPT"},{"id":73,"precertRequired":false,"billingCode":"00732","codeType":"CPT"},{"id":88,"precertRequired":false,"billingCode":"00813","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":184,"description":"Pre-procedure medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":185,"description":"Follow up visits as clinically indicated for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7320,"precertRequired":false,"billingCode":"99024","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":186,"description":"Follow-up imaging as clinically indicated during this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4375,"precertRequired":false,"billingCode":"70145","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":17,"seocKey":56,"name":"Upper and lower GI routine procedure_PRCT","seocId":"MSC_UPPER AND LOWER GI ROUTINE PROCEDURE_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"05-15-2017","endDate":"12-07-2018","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition on consult\r\n2. Diagnostic images, laboratories and procedures relevant to the patient complaint/condition\r\n3. Procedures to include: Colonoscopy (screening or diagnostic), EGD, Endoscopic Ultrasound. Appropriate interventions as clinically necessary (examples: banding and sclerosing, polyp removal, tumor ablation, dilatation)\r\n4. Pathology services relevant to the findings\r\n5. Anesthesia consultation related to the procedure\r\n6. Pre-operative medical clearance as indicated (including H+P/labs, EKG, CXR)\r\n7. One (1) follow-up visit, unless procedure included esophageal dilatation. Three (3) follow-up visits are approved for esophageal dilatation\r\n8. Follow-up images/laboratories/procedures as indicated during this episode of care","maxAllowableVisits":999,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"GASTROENTEROLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":556,"description":"Initial outpatient evaluation and treatment for the referred condition on consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":557,"description":"Diagnostic images, laboratories and procedures relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":2758,"precertRequired":false,"billingCode":"43191","codeType":"CPT"},{"id":2760,"precertRequired":false,"billingCode":"43193","codeType":"CPT"},{"id":2764,"precertRequired":false,"billingCode":"43197","codeType":"CPT"},{"id":2765,"precertRequired":false,"billingCode":"43198","codeType":"CPT"},{"id":2766,"precertRequired":false,"billingCode":"43200","codeType":"CPT"},{"id":2768,"precertRequired":false,"billingCode":"43202","codeType":"CPT"},{"id":2785,"precertRequired":false,"billingCode":"43231","codeType":"CPT"},{"id":2786,"precertRequired":false,"billingCode":"43232","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2791,"precertRequired":false,"billingCode":"43238","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2795,"precertRequired":false,"billingCode":"43242","codeType":"CPT"},{"id":2811,"precertRequired":false,"billingCode":"43260","codeType":"CPT"},{"id":2812,"precertRequired":false,"billingCode":"43261","codeType":"CPT"},{"id":3001,"precertRequired":false,"billingCode":"44360","codeType":"CPT"},{"id":3002,"precertRequired":false,"billingCode":"44361","codeType":"CPT"},{"id":3011,"precertRequired":false,"billingCode":"44376","codeType":"CPT"},{"id":3012,"precertRequired":false,"billingCode":"44377","codeType":"CPT"},{"id":3015,"precertRequired":false,"billingCode":"44380","codeType":"CPT"},{"id":3019,"precertRequired":false,"billingCode":"44385","codeType":"CPT"},{"id":3020,"precertRequired":false,"billingCode":"44386","codeType":"CPT"},{"id":3021,"precertRequired":false,"billingCode":"44388","codeType":"CPT"},{"id":3022,"precertRequired":false,"billingCode":"44389","codeType":"CPT"},{"id":3067,"precertRequired":false,"billingCode":"45100","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3090,"precertRequired":false,"billingCode":"45305","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4587,"precertRequired":false,"billingCode":"74230","codeType":"CPT"},{"id":4588,"precertRequired":false,"billingCode":"74235","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4610,"precertRequired":false,"billingCode":"74340","codeType":"CPT"},{"id":4612,"precertRequired":false,"billingCode":"74360","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4911,"precertRequired":false,"billingCode":"78262","codeType":"CPT"},{"id":4912,"precertRequired":false,"billingCode":"78264","codeType":"CPT"},{"id":5066,"precertRequired":false,"billingCode":"80327","codeType":"CPT"},{"id":5140,"precertRequired":false,"billingCode":"80500","codeType":"CPT"},{"id":5141,"precertRequired":false,"billingCode":"80502","codeType":"CPT"},{"id":5381,"precertRequired":false,"billingCode":"82104","codeType":"CPT"},{"id":5412,"precertRequired":false,"billingCode":"82270","codeType":"CPT"},{"id":5413,"precertRequired":false,"billingCode":"82271","codeType":"CPT"},{"id":5414,"precertRequired":false,"billingCode":"82272","codeType":"CPT"},{"id":5415,"precertRequired":false,"billingCode":"82274","codeType":"CPT"},{"id":5416,"precertRequired":false,"billingCode":"82286","codeType":"CPT"},{"id":5417,"precertRequired":false,"billingCode":"82300","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5419,"precertRequired":false,"billingCode":"82308","codeType":"CPT"},{"id":5420,"precertRequired":false,"billingCode":"82310","codeType":"CPT"},{"id":5421,"precertRequired":false,"billingCode":"82330","codeType":"CPT"},{"id":5422,"precertRequired":false,"billingCode":"82331","codeType":"CPT"},{"id":5423,"precertRequired":false,"billingCode":"82340","codeType":"CPT"},{"id":5424,"precertRequired":false,"billingCode":"82355","codeType":"CPT"},{"id":5425,"precertRequired":false,"billingCode":"82360","codeType":"CPT"},{"id":5426,"precertRequired":false,"billingCode":"82365","codeType":"CPT"},{"id":5427,"precertRequired":false,"billingCode":"82370","codeType":"CPT"},{"id":5428,"precertRequired":false,"billingCode":"82373","codeType":"CPT"},{"id":5429,"precertRequired":false,"billingCode":"82374","codeType":"CPT"},{"id":5430,"precertRequired":false,"billingCode":"82375","codeType":"CPT"},{"id":5431,"precertRequired":false,"billingCode":"82376","codeType":"CPT"},{"id":5432,"precertRequired":false,"billingCode":"82378","codeType":"CPT"},{"id":5433,"precertRequired":false,"billingCode":"82379","codeType":"CPT"},{"id":5434,"precertRequired":false,"billingCode":"82380","codeType":"CPT"},{"id":5435,"precertRequired":false,"billingCode":"82382","codeType":"CPT"},{"id":5436,"precertRequired":false,"billingCode":"82383","codeType":"CPT"},{"id":5437,"precertRequired":false,"billingCode":"82384","codeType":"CPT"},{"id":5438,"precertRequired":false,"billingCode":"82387","codeType":"CPT"},{"id":5439,"precertRequired":false,"billingCode":"82390","codeType":"CPT"},{"id":5440,"precertRequired":false,"billingCode":"82397","codeType":"CPT"},{"id":5441,"precertRequired":false,"billingCode":"82415","codeType":"CPT"},{"id":5442,"precertRequired":false,"billingCode":"82435","codeType":"CPT"},{"id":5443,"precertRequired":false,"billingCode":"82436","codeType":"CPT"},{"id":5444,"precertRequired":false,"billingCode":"82438","codeType":"CPT"},{"id":5445,"precertRequired":false,"billingCode":"82441","codeType":"CPT"},{"id":5446,"precertRequired":false,"billingCode":"82465","codeType":"CPT"},{"id":5447,"precertRequired":false,"billingCode":"82480","codeType":"CPT"},{"id":5448,"precertRequired":false,"billingCode":"82482","codeType":"CPT"},{"id":5449,"precertRequired":false,"billingCode":"82485","codeType":"CPT"},{"id":5450,"precertRequired":false,"billingCode":"82495","codeType":"CPT"},{"id":5451,"precertRequired":false,"billingCode":"82507","codeType":"CPT"},{"id":5452,"precertRequired":false,"billingCode":"82523","codeType":"CPT"},{"id":5453,"precertRequired":false,"billingCode":"82525","codeType":"CPT"},{"id":5454,"precertRequired":false,"billingCode":"82528","codeType":"CPT"},{"id":5455,"precertRequired":false,"billingCode":"82530","codeType":"CPT"},{"id":5456,"precertRequired":false,"billingCode":"82533","codeType":"CPT"},{"id":5457,"precertRequired":false,"billingCode":"82540","codeType":"CPT"},{"id":5458,"precertRequired":false,"billingCode":"82542","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5460,"precertRequired":false,"billingCode":"82552","codeType":"CPT"},{"id":5461,"precertRequired":false,"billingCode":"82553","codeType":"CPT"},{"id":5462,"precertRequired":false,"billingCode":"82554","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5464,"precertRequired":false,"billingCode":"82570","codeType":"CPT"},{"id":5465,"precertRequired":false,"billingCode":"82575","codeType":"CPT"},{"id":5466,"precertRequired":false,"billingCode":"82585","codeType":"CPT"},{"id":5467,"precertRequired":false,"billingCode":"82595","codeType":"CPT"},{"id":5468,"precertRequired":false,"billingCode":"82600","codeType":"CPT"},{"id":5469,"precertRequired":false,"billingCode":"82607","codeType":"CPT"},{"id":5470,"precertRequired":false,"billingCode":"82608","codeType":"CPT"},{"id":5471,"precertRequired":false,"billingCode":"82610","codeType":"CPT"},{"id":5472,"precertRequired":false,"billingCode":"82615","codeType":"CPT"},{"id":5473,"precertRequired":false,"billingCode":"82626","codeType":"CPT"},{"id":5474,"precertRequired":false,"billingCode":"82627","codeType":"CPT"},{"id":5475,"precertRequired":false,"billingCode":"82633","codeType":"CPT"},{"id":5476,"precertRequired":false,"billingCode":"82634","codeType":"CPT"},{"id":5477,"precertRequired":false,"billingCode":"82638","codeType":"CPT"},{"id":5478,"precertRequired":false,"billingCode":"82652","codeType":"CPT"},{"id":5479,"precertRequired":false,"billingCode":"82656","codeType":"CPT"},{"id":5480,"precertRequired":false,"billingCode":"82657","codeType":"CPT"},{"id":5481,"precertRequired":false,"billingCode":"82658","codeType":"CPT"},{"id":5482,"precertRequired":false,"billingCode":"82664","codeType":"CPT"},{"id":5483,"precertRequired":false,"billingCode":"82668","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5485,"precertRequired":false,"billingCode":"82671","codeType":"CPT"},{"id":5486,"precertRequired":false,"billingCode":"82672","codeType":"CPT"},{"id":5487,"precertRequired":false,"billingCode":"82677","codeType":"CPT"},{"id":5488,"precertRequired":false,"billingCode":"82679","codeType":"CPT"},{"id":5489,"precertRequired":false,"billingCode":"82693","codeType":"CPT"},{"id":5490,"precertRequired":false,"billingCode":"82696","codeType":"CPT"},{"id":5491,"precertRequired":false,"billingCode":"82705","codeType":"CPT"},{"id":5492,"precertRequired":false,"billingCode":"82710","codeType":"CPT"},{"id":5493,"precertRequired":false,"billingCode":"82715","codeType":"CPT"},{"id":5494,"precertRequired":false,"billingCode":"82725","codeType":"CPT"},{"id":5495,"precertRequired":false,"billingCode":"82726","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5497,"precertRequired":false,"billingCode":"82731","codeType":"CPT"},{"id":5498,"precertRequired":false,"billingCode":"82735","codeType":"CPT"},{"id":5499,"precertRequired":false,"billingCode":"82746","codeType":"CPT"},{"id":5500,"precertRequired":false,"billingCode":"82747","codeType":"CPT"},{"id":5501,"precertRequired":false,"billingCode":"82757","codeType":"CPT"},{"id":5502,"precertRequired":false,"billingCode":"82759","codeType":"CPT"},{"id":5503,"precertRequired":false,"billingCode":"82760","codeType":"CPT"},{"id":5504,"precertRequired":false,"billingCode":"82775","codeType":"CPT"},{"id":5505,"precertRequired":false,"billingCode":"82776","codeType":"CPT"},{"id":5506,"precertRequired":false,"billingCode":"82777","codeType":"CPT"},{"id":5507,"precertRequired":false,"billingCode":"82784","codeType":"CPT"},{"id":5508,"precertRequired":false,"billingCode":"82785","codeType":"CPT"},{"id":5509,"precertRequired":false,"billingCode":"82787","codeType":"CPT"},{"id":5510,"precertRequired":false,"billingCode":"82800","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5514,"precertRequired":false,"billingCode":"82820","codeType":"CPT"},{"id":5515,"precertRequired":false,"billingCode":"82930","codeType":"CPT"},{"id":5516,"precertRequired":false,"billingCode":"82938","codeType":"CPT"},{"id":5517,"precertRequired":false,"billingCode":"82941","codeType":"CPT"},{"id":5518,"precertRequired":false,"billingCode":"82943","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5520,"precertRequired":false,"billingCode":"82946","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5522,"precertRequired":false,"billingCode":"82948","codeType":"CPT"},{"id":5523,"precertRequired":false,"billingCode":"82950","codeType":"CPT"},{"id":5524,"precertRequired":false,"billingCode":"82951","codeType":"CPT"},{"id":5525,"precertRequired":false,"billingCode":"82952","codeType":"CPT"},{"id":5526,"precertRequired":false,"billingCode":"82955","codeType":"CPT"},{"id":5527,"precertRequired":false,"billingCode":"82960","codeType":"CPT"},{"id":5528,"precertRequired":false,"billingCode":"82962","codeType":"CPT"},{"id":5529,"precertRequired":false,"billingCode":"82963","codeType":"CPT"},{"id":5530,"precertRequired":false,"billingCode":"82965","codeType":"CPT"},{"id":5531,"precertRequired":false,"billingCode":"82977","codeType":"CPT"},{"id":5532,"precertRequired":false,"billingCode":"82978","codeType":"CPT"},{"id":5533,"precertRequired":false,"billingCode":"82979","codeType":"CPT"},{"id":5534,"precertRequired":false,"billingCode":"82985","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5537,"precertRequired":false,"billingCode":"83003","codeType":"CPT"},{"id":5538,"precertRequired":false,"billingCode":"83006","codeType":"CPT"},{"id":5539,"precertRequired":false,"billingCode":"83009","codeType":"CPT"},{"id":5541,"precertRequired":false,"billingCode":"83012","codeType":"CPT"},{"id":5542,"precertRequired":false,"billingCode":"83013","codeType":"CPT"},{"id":5543,"precertRequired":false,"billingCode":"83014","codeType":"CPT"},{"id":5544,"precertRequired":false,"billingCode":"83015","codeType":"CPT"},{"id":5546,"precertRequired":false,"billingCode":"83020","codeType":"CPT"},{"id":5547,"precertRequired":false,"billingCode":"83021","codeType":"CPT"},{"id":5548,"precertRequired":false,"billingCode":"83026","codeType":"CPT"},{"id":5549,"precertRequired":false,"billingCode":"83030","codeType":"CPT"},{"id":5550,"precertRequired":false,"billingCode":"83033","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5552,"precertRequired":false,"billingCode":"83037","codeType":"CPT"},{"id":5553,"precertRequired":false,"billingCode":"83045","codeType":"CPT"},{"id":5554,"precertRequired":false,"billingCode":"83050","codeType":"CPT"},{"id":5555,"precertRequired":false,"billingCode":"83051","codeType":"CPT"},{"id":5556,"precertRequired":false,"billingCode":"83060","codeType":"CPT"},{"id":5557,"precertRequired":false,"billingCode":"83065","codeType":"CPT"},{"id":5558,"precertRequired":false,"billingCode":"83068","codeType":"CPT"},{"id":5559,"precertRequired":false,"billingCode":"83069","codeType":"CPT"},{"id":5560,"precertRequired":false,"billingCode":"83070","codeType":"CPT"},{"id":5561,"precertRequired":false,"billingCode":"83080","codeType":"CPT"},{"id":5562,"precertRequired":false,"billingCode":"83088","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5564,"precertRequired":false,"billingCode":"83150","codeType":"CPT"},{"id":5565,"precertRequired":false,"billingCode":"83491","codeType":"CPT"},{"id":5566,"precertRequired":false,"billingCode":"83497","codeType":"CPT"},{"id":5567,"precertRequired":false,"billingCode":"83498","codeType":"CPT"},{"id":5568,"precertRequired":false,"billingCode":"83500","codeType":"CPT"},{"id":5569,"precertRequired":false,"billingCode":"83505","codeType":"CPT"},{"id":5570,"precertRequired":false,"billingCode":"83516","codeType":"CPT"},{"id":5571,"precertRequired":false,"billingCode":"83518","codeType":"CPT"},{"id":5572,"precertRequired":false,"billingCode":"83519","codeType":"CPT"},{"id":5573,"precertRequired":false,"billingCode":"83520","codeType":"CPT"},{"id":5574,"precertRequired":false,"billingCode":"83525","codeType":"CPT"},{"id":5575,"precertRequired":false,"billingCode":"83527","codeType":"CPT"},{"id":5576,"precertRequired":false,"billingCode":"83528","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5578,"precertRequired":false,"billingCode":"83550","codeType":"CPT"},{"id":5579,"precertRequired":false,"billingCode":"83570","codeType":"CPT"},{"id":5580,"precertRequired":false,"billingCode":"83582","codeType":"CPT"},{"id":5581,"precertRequired":false,"billingCode":"83586","codeType":"CPT"},{"id":5582,"precertRequired":false,"billingCode":"83593","codeType":"CPT"},{"id":5583,"precertRequired":false,"billingCode":"83605","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5585,"precertRequired":false,"billingCode":"83625","codeType":"CPT"},{"id":5586,"precertRequired":false,"billingCode":"83630","codeType":"CPT"},{"id":5587,"precertRequired":false,"billingCode":"83631","codeType":"CPT"},{"id":5588,"precertRequired":false,"billingCode":"83632","codeType":"CPT"},{"id":5589,"precertRequired":false,"billingCode":"83633","codeType":"CPT"},{"id":5590,"precertRequired":false,"billingCode":"83655","codeType":"CPT"},{"id":5591,"precertRequired":false,"billingCode":"83658","codeType":"CPT"},{"id":5592,"precertRequired":false,"billingCode":"83661","codeType":"CPT"},{"id":5593,"precertRequired":false,"billingCode":"83662","codeType":"CPT"},{"id":5594,"precertRequired":false,"billingCode":"83663","codeType":"CPT"},{"id":5595,"precertRequired":false,"billingCode":"83664","codeType":"CPT"},{"id":5596,"precertRequired":false,"billingCode":"83670","codeType":"CPT"},{"id":5597,"precertRequired":false,"billingCode":"83690","codeType":"CPT"},{"id":5598,"precertRequired":false,"billingCode":"83695","codeType":"CPT"},{"id":5599,"precertRequired":false,"billingCode":"83698","codeType":"CPT"},{"id":5600,"precertRequired":false,"billingCode":"83700","codeType":"CPT"},{"id":5601,"precertRequired":false,"billingCode":"83701","codeType":"CPT"},{"id":5602,"precertRequired":false,"billingCode":"83704","codeType":"CPT"},{"id":5603,"precertRequired":false,"billingCode":"83718","codeType":"CPT"},{"id":5604,"precertRequired":false,"billingCode":"83719","codeType":"CPT"},{"id":5605,"precertRequired":false,"billingCode":"83721","codeType":"CPT"},{"id":5606,"precertRequired":false,"billingCode":"83727","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5608,"precertRequired":false,"billingCode":"83775","codeType":"CPT"},{"id":5609,"precertRequired":false,"billingCode":"83785","codeType":"CPT"},{"id":5610,"precertRequired":false,"billingCode":"83789","codeType":"CPT"},{"id":5611,"precertRequired":false,"billingCode":"83825","codeType":"CPT"},{"id":5612,"precertRequired":false,"billingCode":"83835","codeType":"CPT"},{"id":5613,"precertRequired":false,"billingCode":"83857","codeType":"CPT"},{"id":5614,"precertRequired":false,"billingCode":"83861","codeType":"CPT"},{"id":5615,"precertRequired":false,"billingCode":"83864","codeType":"CPT"},{"id":5616,"precertRequired":false,"billingCode":"83872","codeType":"CPT"},{"id":5617,"precertRequired":false,"billingCode":"83873","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5619,"precertRequired":false,"billingCode":"83876","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5621,"precertRequired":false,"billingCode":"83883","codeType":"CPT"},{"id":5622,"precertRequired":false,"billingCode":"83885","codeType":"CPT"},{"id":5623,"precertRequired":false,"billingCode":"83915","codeType":"CPT"},{"id":5624,"precertRequired":false,"billingCode":"83916","codeType":"CPT"},{"id":5625,"precertRequired":false,"billingCode":"83918","codeType":"CPT"},{"id":5626,"precertRequired":false,"billingCode":"83919","codeType":"CPT"},{"id":5627,"precertRequired":false,"billingCode":"83921","codeType":"CPT"},{"id":5629,"precertRequired":false,"billingCode":"83935","codeType":"CPT"},{"id":5630,"precertRequired":false,"billingCode":"83937","codeType":"CPT"},{"id":5631,"precertRequired":false,"billingCode":"83945","codeType":"CPT"},{"id":5632,"precertRequired":false,"billingCode":"83950","codeType":"CPT"},{"id":5633,"precertRequired":false,"billingCode":"83951","codeType":"CPT"},{"id":5634,"precertRequired":false,"billingCode":"83970","codeType":"CPT"},{"id":5635,"precertRequired":false,"billingCode":"83986","codeType":"CPT"},{"id":5636,"precertRequired":false,"billingCode":"83987","codeType":"CPT"},{"id":5637,"precertRequired":false,"billingCode":"83992","codeType":"CPT"},{"id":5638,"precertRequired":false,"billingCode":"83993","codeType":"CPT"},{"id":5639,"precertRequired":false,"billingCode":"84030","codeType":"CPT"},{"id":5640,"precertRequired":false,"billingCode":"84035","codeType":"CPT"},{"id":5641,"precertRequired":false,"billingCode":"84060","codeType":"CPT"},{"id":5642,"precertRequired":false,"billingCode":"84066","codeType":"CPT"},{"id":5643,"precertRequired":false,"billingCode":"84075","codeType":"CPT"},{"id":5644,"precertRequired":false,"billingCode":"84078","codeType":"CPT"},{"id":5645,"precertRequired":false,"billingCode":"84080","codeType":"CPT"},{"id":5646,"precertRequired":false,"billingCode":"84081","codeType":"CPT"},{"id":5647,"precertRequired":false,"billingCode":"84085","codeType":"CPT"},{"id":5648,"precertRequired":false,"billingCode":"84087","codeType":"CPT"},{"id":5649,"precertRequired":false,"billingCode":"84100","codeType":"CPT"},{"id":5650,"precertRequired":false,"billingCode":"84105","codeType":"CPT"},{"id":5651,"precertRequired":false,"billingCode":"84106","codeType":"CPT"},{"id":5652,"precertRequired":false,"billingCode":"84110","codeType":"CPT"},{"id":5653,"precertRequired":false,"billingCode":"84112","codeType":"CPT"},{"id":5654,"precertRequired":false,"billingCode":"84119","codeType":"CPT"},{"id":5655,"precertRequired":false,"billingCode":"84120","codeType":"CPT"},{"id":5656,"precertRequired":false,"billingCode":"84126","codeType":"CPT"},{"id":5657,"precertRequired":false,"billingCode":"84132","codeType":"CPT"},{"id":5658,"precertRequired":false,"billingCode":"84133","codeType":"CPT"},{"id":5659,"precertRequired":false,"billingCode":"84134","codeType":"CPT"},{"id":5660,"precertRequired":false,"billingCode":"84135","codeType":"CPT"},{"id":5661,"precertRequired":false,"billingCode":"84138","codeType":"CPT"},{"id":5662,"precertRequired":false,"billingCode":"84140","codeType":"CPT"},{"id":5663,"precertRequired":false,"billingCode":"84143","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5665,"precertRequired":false,"billingCode":"84145","codeType":"CPT"},{"id":5666,"precertRequired":false,"billingCode":"84146","codeType":"CPT"},{"id":5667,"precertRequired":false,"billingCode":"84150","codeType":"CPT"},{"id":5668,"precertRequired":false,"billingCode":"84152","codeType":"CPT"},{"id":5669,"precertRequired":false,"billingCode":"84153","codeType":"CPT"},{"id":5670,"precertRequired":false,"billingCode":"84154","codeType":"CPT"},{"id":5671,"precertRequired":false,"billingCode":"84155","codeType":"CPT"},{"id":5672,"precertRequired":false,"billingCode":"84156","codeType":"CPT"},{"id":5673,"precertRequired":false,"billingCode":"84157","codeType":"CPT"},{"id":5674,"precertRequired":false,"billingCode":"84160","codeType":"CPT"},{"id":5675,"precertRequired":false,"billingCode":"84163","codeType":"CPT"},{"id":5676,"precertRequired":false,"billingCode":"84165","codeType":"CPT"},{"id":5677,"precertRequired":false,"billingCode":"84166","codeType":"CPT"},{"id":5678,"precertRequired":false,"billingCode":"84181","codeType":"CPT"},{"id":5679,"precertRequired":false,"billingCode":"84182","codeType":"CPT"},{"id":5680,"precertRequired":false,"billingCode":"84202","codeType":"CPT"},{"id":5681,"precertRequired":false,"billingCode":"84203","codeType":"CPT"},{"id":5682,"precertRequired":false,"billingCode":"84206","codeType":"CPT"},{"id":5683,"precertRequired":false,"billingCode":"84207","codeType":"CPT"},{"id":5684,"precertRequired":false,"billingCode":"84210","codeType":"CPT"},{"id":5685,"precertRequired":false,"billingCode":"84220","codeType":"CPT"},{"id":5686,"precertRequired":false,"billingCode":"84228","codeType":"CPT"},{"id":5687,"precertRequired":false,"billingCode":"84233","codeType":"CPT"},{"id":5688,"precertRequired":false,"billingCode":"84234","codeType":"CPT"},{"id":5689,"precertRequired":false,"billingCode":"84235","codeType":"CPT"},{"id":5690,"precertRequired":false,"billingCode":"84238","codeType":"CPT"},{"id":5691,"precertRequired":false,"billingCode":"84244","codeType":"CPT"},{"id":5692,"precertRequired":false,"billingCode":"84252","codeType":"CPT"},{"id":5693,"precertRequired":false,"billingCode":"84255","codeType":"CPT"},{"id":5694,"precertRequired":false,"billingCode":"84260","codeType":"CPT"},{"id":5695,"precertRequired":false,"billingCode":"84270","codeType":"CPT"},{"id":5696,"precertRequired":false,"billingCode":"84275","codeType":"CPT"},{"id":5697,"precertRequired":false,"billingCode":"84285","codeType":"CPT"},{"id":5698,"precertRequired":false,"billingCode":"84295","codeType":"CPT"},{"id":5700,"precertRequired":false,"billingCode":"84302","codeType":"CPT"},{"id":5701,"precertRequired":false,"billingCode":"84305","codeType":"CPT"},{"id":5702,"precertRequired":false,"billingCode":"84307","codeType":"CPT"},{"id":5703,"precertRequired":false,"billingCode":"84311","codeType":"CPT"},{"id":5704,"precertRequired":false,"billingCode":"84315","codeType":"CPT"},{"id":5705,"precertRequired":false,"billingCode":"84375","codeType":"CPT"},{"id":5706,"precertRequired":false,"billingCode":"84376","codeType":"CPT"},{"id":5707,"precertRequired":false,"billingCode":"84377","codeType":"CPT"},{"id":5708,"precertRequired":false,"billingCode":"84378","codeType":"CPT"},{"id":5709,"precertRequired":false,"billingCode":"84379","codeType":"CPT"},{"id":5710,"precertRequired":false,"billingCode":"84392","codeType":"CPT"},{"id":5711,"precertRequired":false,"billingCode":"84402","codeType":"CPT"},{"id":5712,"precertRequired":false,"billingCode":"84403","codeType":"CPT"},{"id":5713,"precertRequired":false,"billingCode":"84410","codeType":"CPT"},{"id":5714,"precertRequired":false,"billingCode":"84425","codeType":"CPT"},{"id":5715,"precertRequired":false,"billingCode":"84430","codeType":"CPT"},{"id":5716,"precertRequired":false,"billingCode":"84431","codeType":"CPT"},{"id":5717,"precertRequired":false,"billingCode":"84432","codeType":"CPT"},{"id":5718,"precertRequired":false,"billingCode":"84436","codeType":"CPT"},{"id":5719,"precertRequired":false,"billingCode":"84437","codeType":"CPT"},{"id":5720,"precertRequired":false,"billingCode":"84439","codeType":"CPT"},{"id":5721,"precertRequired":false,"billingCode":"84442","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5723,"precertRequired":false,"billingCode":"84445","codeType":"CPT"},{"id":5724,"precertRequired":false,"billingCode":"84446","codeType":"CPT"},{"id":5725,"precertRequired":false,"billingCode":"84449","codeType":"CPT"},{"id":5726,"precertRequired":false,"billingCode":"84450","codeType":"CPT"},{"id":5727,"precertRequired":false,"billingCode":"84460","codeType":"CPT"},{"id":5728,"precertRequired":false,"billingCode":"84466","codeType":"CPT"},{"id":5729,"precertRequired":false,"billingCode":"84478","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5731,"precertRequired":false,"billingCode":"84480","codeType":"CPT"},{"id":5732,"precertRequired":false,"billingCode":"84481","codeType":"CPT"},{"id":5733,"precertRequired":false,"billingCode":"84482","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5735,"precertRequired":false,"billingCode":"84485","codeType":"CPT"},{"id":5736,"precertRequired":false,"billingCode":"84488","codeType":"CPT"},{"id":5737,"precertRequired":false,"billingCode":"84490","codeType":"CPT"},{"id":5738,"precertRequired":false,"billingCode":"84510","codeType":"CPT"},{"id":5739,"precertRequired":false,"billingCode":"84512","codeType":"CPT"},{"id":5740,"precertRequired":false,"billingCode":"84520","codeType":"CPT"},{"id":5741,"precertRequired":false,"billingCode":"84525","codeType":"CPT"},{"id":5742,"precertRequired":false,"billingCode":"84540","codeType":"CPT"},{"id":5743,"precertRequired":false,"billingCode":"84545","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5745,"precertRequired":false,"billingCode":"84560","codeType":"CPT"},{"id":5746,"precertRequired":false,"billingCode":"84577","codeType":"CPT"},{"id":5747,"precertRequired":false,"billingCode":"84578","codeType":"CPT"},{"id":5748,"precertRequired":false,"billingCode":"84580","codeType":"CPT"},{"id":5749,"precertRequired":false,"billingCode":"84583","codeType":"CPT"},{"id":5750,"precertRequired":false,"billingCode":"84585","codeType":"CPT"},{"id":5751,"precertRequired":false,"billingCode":"84586","codeType":"CPT"},{"id":5752,"precertRequired":false,"billingCode":"84588","codeType":"CPT"},{"id":5753,"precertRequired":false,"billingCode":"84590","codeType":"CPT"},{"id":5754,"precertRequired":false,"billingCode":"84591","codeType":"CPT"},{"id":5755,"precertRequired":false,"billingCode":"84597","codeType":"CPT"},{"id":5756,"precertRequired":false,"billingCode":"84600","codeType":"CPT"},{"id":5757,"precertRequired":false,"billingCode":"84620","codeType":"CPT"},{"id":5758,"precertRequired":false,"billingCode":"84630","codeType":"CPT"},{"id":5759,"precertRequired":false,"billingCode":"84681","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5763,"precertRequired":false,"billingCode":"84830","codeType":"CPT"},{"id":5764,"precertRequired":false,"billingCode":"84999","codeType":"CPT"},{"id":5765,"precertRequired":false,"billingCode":"85002","codeType":"CPT"},{"id":5766,"precertRequired":false,"billingCode":"85004","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5768,"precertRequired":false,"billingCode":"85008","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5770,"precertRequired":false,"billingCode":"85013","codeType":"CPT"},{"id":5771,"precertRequired":false,"billingCode":"85014","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5775,"precertRequired":false,"billingCode":"85032","codeType":"CPT"},{"id":5776,"precertRequired":false,"billingCode":"85041","codeType":"CPT"},{"id":5777,"precertRequired":false,"billingCode":"85044","codeType":"CPT"},{"id":5778,"precertRequired":false,"billingCode":"85045","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5780,"precertRequired":false,"billingCode":"85048","codeType":"CPT"},{"id":5781,"precertRequired":false,"billingCode":"85049","codeType":"CPT"},{"id":5782,"precertRequired":false,"billingCode":"85055","codeType":"CPT"},{"id":5783,"precertRequired":false,"billingCode":"85060","codeType":"CPT"},{"id":5784,"precertRequired":false,"billingCode":"85097","codeType":"CPT"},{"id":5785,"precertRequired":false,"billingCode":"85130","codeType":"CPT"},{"id":5786,"precertRequired":false,"billingCode":"85170","codeType":"CPT"},{"id":5787,"precertRequired":false,"billingCode":"85175","codeType":"CPT"},{"id":5788,"precertRequired":false,"billingCode":"85210","codeType":"CPT"},{"id":5789,"precertRequired":false,"billingCode":"85220","codeType":"CPT"},{"id":5790,"precertRequired":false,"billingCode":"85230","codeType":"CPT"},{"id":5791,"precertRequired":false,"billingCode":"85240","codeType":"CPT"},{"id":5792,"precertRequired":false,"billingCode":"85244","codeType":"CPT"},{"id":5793,"precertRequired":false,"billingCode":"85245","codeType":"CPT"},{"id":5794,"precertRequired":false,"billingCode":"85246","codeType":"CPT"},{"id":5795,"precertRequired":false,"billingCode":"85247","codeType":"CPT"},{"id":5796,"precertRequired":false,"billingCode":"85250","codeType":"CPT"},{"id":5797,"precertRequired":false,"billingCode":"85260","codeType":"CPT"},{"id":5798,"precertRequired":false,"billingCode":"85270","codeType":"CPT"},{"id":5799,"precertRequired":false,"billingCode":"85280","codeType":"CPT"},{"id":5800,"precertRequired":false,"billingCode":"85290","codeType":"CPT"},{"id":5801,"precertRequired":false,"billingCode":"85291","codeType":"CPT"},{"id":5802,"precertRequired":false,"billingCode":"85292","codeType":"CPT"},{"id":5803,"precertRequired":false,"billingCode":"85293","codeType":"CPT"},{"id":5804,"precertRequired":false,"billingCode":"85300","codeType":"CPT"},{"id":5805,"precertRequired":false,"billingCode":"85301","codeType":"CPT"},{"id":5806,"precertRequired":false,"billingCode":"85302","codeType":"CPT"},{"id":5807,"precertRequired":false,"billingCode":"85303","codeType":"CPT"},{"id":5808,"precertRequired":false,"billingCode":"85305","codeType":"CPT"},{"id":5809,"precertRequired":false,"billingCode":"85306","codeType":"CPT"},{"id":5810,"precertRequired":false,"billingCode":"85307","codeType":"CPT"},{"id":5811,"precertRequired":false,"billingCode":"85335","codeType":"CPT"},{"id":5812,"precertRequired":false,"billingCode":"85337","codeType":"CPT"},{"id":5813,"precertRequired":false,"billingCode":"85345","codeType":"CPT"},{"id":5814,"precertRequired":false,"billingCode":"85347","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5816,"precertRequired":false,"billingCode":"85360","codeType":"CPT"},{"id":5817,"precertRequired":false,"billingCode":"85362","codeType":"CPT"},{"id":5818,"precertRequired":false,"billingCode":"85366","codeType":"CPT"},{"id":5819,"precertRequired":false,"billingCode":"85370","codeType":"CPT"},{"id":5820,"precertRequired":false,"billingCode":"85378","codeType":"CPT"},{"id":5821,"precertRequired":false,"billingCode":"85379","codeType":"CPT"},{"id":5822,"precertRequired":false,"billingCode":"85380","codeType":"CPT"},{"id":5823,"precertRequired":false,"billingCode":"85384","codeType":"CPT"},{"id":5824,"precertRequired":false,"billingCode":"85385","codeType":"CPT"},{"id":5825,"precertRequired":false,"billingCode":"85390","codeType":"CPT"},{"id":5826,"precertRequired":false,"billingCode":"85396","codeType":"CPT"},{"id":5827,"precertRequired":false,"billingCode":"85397","codeType":"CPT"},{"id":5828,"precertRequired":false,"billingCode":"85400","codeType":"CPT"},{"id":5829,"precertRequired":false,"billingCode":"85410","codeType":"CPT"},{"id":5830,"precertRequired":false,"billingCode":"85415","codeType":"CPT"},{"id":5831,"precertRequired":false,"billingCode":"85420","codeType":"CPT"},{"id":5832,"precertRequired":false,"billingCode":"85421","codeType":"CPT"},{"id":5833,"precertRequired":false,"billingCode":"85441","codeType":"CPT"},{"id":5834,"precertRequired":false,"billingCode":"85445","codeType":"CPT"},{"id":5835,"precertRequired":false,"billingCode":"85460","codeType":"CPT"},{"id":5836,"precertRequired":false,"billingCode":"85461","codeType":"CPT"},{"id":5837,"precertRequired":false,"billingCode":"85475","codeType":"CPT"},{"id":5911,"precertRequired":false,"billingCode":"86310","codeType":"CPT"},{"id":6978,"precertRequired":false,"billingCode":"93930","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":558,"description":"Procedures to include: Colonoscopy (screening or diagnostic), EGD, Endoscopic Ultrasound. Appropriate interventions as clinically necessary (examples: banding and sclerosing, polyp removal, tumor ablation, dilatation)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":2759,"precertRequired":false,"billingCode":"43192","codeType":"CPT"},{"id":2761,"precertRequired":false,"billingCode":"43194","codeType":"CPT"},{"id":2762,"precertRequired":false,"billingCode":"43195","codeType":"CPT"},{"id":2763,"precertRequired":false,"billingCode":"43196","codeType":"CPT"},{"id":2767,"precertRequired":false,"billingCode":"43201","codeType":"CPT"},{"id":2769,"precertRequired":false,"billingCode":"43204","codeType":"CPT"},{"id":2770,"precertRequired":false,"billingCode":"43205","codeType":"CPT"},{"id":2771,"precertRequired":false,"billingCode":"43206","codeType":"CPT"},{"id":2772,"precertRequired":false,"billingCode":"43210","codeType":"CPT"},{"id":2773,"precertRequired":false,"billingCode":"43211","codeType":"CPT"},{"id":2774,"precertRequired":false,"billingCode":"43212","codeType":"CPT"},{"id":2775,"precertRequired":false,"billingCode":"43213","codeType":"CPT"},{"id":2776,"precertRequired":false,"billingCode":"43214","codeType":"CPT"},{"id":2777,"precertRequired":false,"billingCode":"43215","codeType":"CPT"},{"id":2778,"precertRequired":false,"billingCode":"43216","codeType":"CPT"},{"id":2779,"precertRequired":false,"billingCode":"43217","codeType":"CPT"},{"id":2780,"precertRequired":false,"billingCode":"43219","codeType":"CPT"},{"id":2781,"precertRequired":false,"billingCode":"43220","codeType":"CPT"},{"id":2782,"precertRequired":false,"billingCode":"43226","codeType":"CPT"},{"id":2783,"precertRequired":false,"billingCode":"43227","codeType":"CPT"},{"id":2784,"precertRequired":false,"billingCode":"43229","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2790,"precertRequired":false,"billingCode":"43237","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2806,"precertRequired":false,"billingCode":"43253","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2810,"precertRequired":false,"billingCode":"43259","codeType":"CPT"},{"id":2813,"precertRequired":false,"billingCode":"43262","codeType":"CPT"},{"id":2814,"precertRequired":false,"billingCode":"43263","codeType":"CPT"},{"id":2815,"precertRequired":false,"billingCode":"43264","codeType":"CPT"},{"id":2816,"precertRequired":false,"billingCode":"43265","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":2819,"precertRequired":false,"billingCode":"43273","codeType":"CPT"},{"id":2820,"precertRequired":false,"billingCode":"43274","codeType":"CPT"},{"id":2821,"precertRequired":false,"billingCode":"43275","codeType":"CPT"},{"id":2822,"precertRequired":false,"billingCode":"43276","codeType":"CPT"},{"id":2823,"precertRequired":false,"billingCode":"43277","codeType":"CPT"},{"id":2824,"precertRequired":false,"billingCode":"43278","codeType":"CPT"},{"id":2898,"precertRequired":false,"billingCode":"43752","codeType":"CPT"},{"id":3003,"precertRequired":false,"billingCode":"44363","codeType":"CPT"},{"id":3004,"precertRequired":false,"billingCode":"44364","codeType":"CPT"},{"id":3005,"precertRequired":false,"billingCode":"44365","codeType":"CPT"},{"id":3006,"precertRequired":false,"billingCode":"44366","codeType":"CPT"},{"id":3007,"precertRequired":false,"billingCode":"44369","codeType":"CPT"},{"id":3008,"precertRequired":false,"billingCode":"44370","codeType":"CPT"},{"id":3009,"precertRequired":false,"billingCode":"44372","codeType":"CPT"},{"id":3010,"precertRequired":false,"billingCode":"44373","codeType":"CPT"},{"id":3013,"precertRequired":false,"billingCode":"44378","codeType":"CPT"},{"id":3014,"precertRequired":false,"billingCode":"44379","codeType":"CPT"},{"id":3016,"precertRequired":false,"billingCode":"44381","codeType":"CPT"},{"id":3017,"precertRequired":false,"billingCode":"44382","codeType":"CPT"},{"id":3018,"precertRequired":false,"billingCode":"44384","codeType":"CPT"},{"id":3023,"precertRequired":false,"billingCode":"44390","codeType":"CPT"},{"id":3024,"precertRequired":false,"billingCode":"44391","codeType":"CPT"},{"id":3025,"precertRequired":false,"billingCode":"44392","codeType":"CPT"},{"id":3026,"precertRequired":false,"billingCode":"44394","codeType":"CPT"},{"id":3027,"precertRequired":false,"billingCode":"44401","codeType":"CPT"},{"id":3028,"precertRequired":false,"billingCode":"44402","codeType":"CPT"},{"id":3029,"precertRequired":false,"billingCode":"44403","codeType":"CPT"},{"id":3030,"precertRequired":false,"billingCode":"44404","codeType":"CPT"},{"id":3031,"precertRequired":false,"billingCode":"44405","codeType":"CPT"},{"id":3032,"precertRequired":false,"billingCode":"44406","codeType":"CPT"},{"id":3033,"precertRequired":false,"billingCode":"44407","codeType":"CPT"},{"id":3034,"precertRequired":false,"billingCode":"44408","codeType":"CPT"},{"id":3035,"precertRequired":false,"billingCode":"44500","codeType":"CPT"},{"id":3036,"precertRequired":false,"billingCode":"44602","codeType":"CPT"},{"id":3037,"precertRequired":false,"billingCode":"44603","codeType":"CPT"},{"id":3038,"precertRequired":false,"billingCode":"44604","codeType":"CPT"},{"id":3039,"precertRequired":false,"billingCode":"44605","codeType":"CPT"},{"id":3040,"precertRequired":false,"billingCode":"44615","codeType":"CPT"},{"id":3041,"precertRequired":false,"billingCode":"44620","codeType":"CPT"},{"id":3042,"precertRequired":false,"billingCode":"44625","codeType":"CPT"},{"id":3043,"precertRequired":false,"billingCode":"44626","codeType":"CPT"},{"id":3055,"precertRequired":false,"billingCode":"44799","codeType":"CPT"},{"id":3056,"precertRequired":false,"billingCode":"44800","codeType":"CPT"},{"id":3068,"precertRequired":false,"billingCode":"45108","codeType":"CPT"},{"id":3083,"precertRequired":false,"billingCode":"45150","codeType":"CPT"},{"id":3084,"precertRequired":false,"billingCode":"45160","codeType":"CPT"},{"id":3087,"precertRequired":false,"billingCode":"45190","codeType":"CPT"},{"id":3089,"precertRequired":false,"billingCode":"45303","codeType":"CPT"},{"id":3091,"precertRequired":false,"billingCode":"45307","codeType":"CPT"},{"id":3092,"precertRequired":false,"billingCode":"45308","codeType":"CPT"},{"id":3093,"precertRequired":false,"billingCode":"45309","codeType":"CPT"},{"id":3094,"precertRequired":false,"billingCode":"45315","codeType":"CPT"},{"id":3095,"precertRequired":false,"billingCode":"45317","codeType":"CPT"},{"id":3096,"precertRequired":false,"billingCode":"45320","codeType":"CPT"},{"id":3097,"precertRequired":false,"billingCode":"45321","codeType":"CPT"},{"id":3098,"precertRequired":false,"billingCode":"45327","codeType":"CPT"},{"id":3099,"precertRequired":false,"billingCode":"45330","codeType":"CPT"},{"id":3100,"precertRequired":false,"billingCode":"45331","codeType":"CPT"},{"id":3101,"precertRequired":false,"billingCode":"45332","codeType":"CPT"},{"id":3102,"precertRequired":false,"billingCode":"45333","codeType":"CPT"},{"id":3103,"precertRequired":false,"billingCode":"45334","codeType":"CPT"},{"id":3104,"precertRequired":false,"billingCode":"45335","codeType":"CPT"},{"id":3105,"precertRequired":false,"billingCode":"45337","codeType":"CPT"},{"id":3106,"precertRequired":false,"billingCode":"45338","codeType":"CPT"},{"id":3107,"precertRequired":false,"billingCode":"45340","codeType":"CPT"},{"id":3108,"precertRequired":false,"billingCode":"45341","codeType":"CPT"},{"id":3109,"precertRequired":false,"billingCode":"45342","codeType":"CPT"},{"id":3110,"precertRequired":false,"billingCode":"45346","codeType":"CPT"},{"id":3111,"precertRequired":false,"billingCode":"45347","codeType":"CPT"},{"id":3112,"precertRequired":false,"billingCode":"45349","codeType":"CPT"},{"id":3113,"precertRequired":false,"billingCode":"45350","codeType":"CPT"},{"id":3114,"precertRequired":true,"billingCode":"45378","codeType":"CPT"},{"id":3115,"precertRequired":false,"billingCode":"45379","codeType":"CPT"},{"id":3116,"precertRequired":true,"billingCode":"45380","codeType":"CPT"},{"id":3117,"precertRequired":false,"billingCode":"45381","codeType":"CPT"},{"id":3118,"precertRequired":false,"billingCode":"45382","codeType":"CPT"},{"id":3119,"precertRequired":false,"billingCode":"45383","codeType":"CPT"},{"id":3120,"precertRequired":true,"billingCode":"45384","codeType":"CPT"},{"id":3121,"precertRequired":true,"billingCode":"45385","codeType":"CPT"},{"id":3122,"precertRequired":false,"billingCode":"45386","codeType":"CPT"},{"id":3123,"precertRequired":false,"billingCode":"45388","codeType":"CPT"},{"id":3124,"precertRequired":false,"billingCode":"45389","codeType":"CPT"},{"id":3125,"precertRequired":false,"billingCode":"45390","codeType":"CPT"},{"id":3126,"precertRequired":false,"billingCode":"45391","codeType":"CPT"},{"id":3127,"precertRequired":false,"billingCode":"45392","codeType":"CPT"},{"id":3128,"precertRequired":false,"billingCode":"45393","codeType":"CPT"},{"id":3131,"precertRequired":false,"billingCode":"45398","codeType":"CPT"},{"id":6619,"precertRequired":false,"billingCode":"91010","codeType":"CPT"},{"id":6620,"precertRequired":false,"billingCode":"91013","codeType":"CPT"},{"id":6621,"precertRequired":false,"billingCode":"91020","codeType":"CPT"},{"id":6622,"precertRequired":false,"billingCode":"91022","codeType":"CPT"},{"id":6623,"precertRequired":false,"billingCode":"91030","codeType":"CPT"},{"id":6624,"precertRequired":false,"billingCode":"91034","codeType":"CPT"},{"id":6625,"precertRequired":false,"billingCode":"91035","codeType":"CPT"},{"id":6626,"precertRequired":false,"billingCode":"91037","codeType":"CPT"},{"id":6627,"precertRequired":false,"billingCode":"91038","codeType":"CPT"},{"id":6628,"precertRequired":false,"billingCode":"91040","codeType":"CPT"},{"id":6629,"precertRequired":false,"billingCode":"91065","codeType":"CPT"},{"id":6630,"precertRequired":false,"billingCode":"91110","codeType":"CPT"},{"id":6631,"precertRequired":false,"billingCode":"91111","codeType":"CPT"},{"id":6632,"precertRequired":false,"billingCode":"91112","codeType":"CPT"},{"id":6633,"precertRequired":false,"billingCode":"91117","codeType":"CPT"},{"id":6634,"precertRequired":false,"billingCode":"91120","codeType":"CPT"},{"id":6635,"precertRequired":false,"billingCode":"91122","codeType":"CPT"},{"id":6636,"precertRequired":false,"billingCode":"91132","codeType":"CPT"},{"id":6637,"precertRequired":false,"billingCode":"91133","codeType":"CPT"},{"id":6638,"precertRequired":false,"billingCode":"91200","codeType":"CPT"},{"id":6639,"precertRequired":false,"billingCode":"91299","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":559,"description":"Pathology services relevant to the findings","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"22-Pathology"}],"billingCodes":[{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207ZC0500X"},{"HPTC":"207ZI0100X"},{"HPTC":"207ZH0000X"},{"HPTC":"207ZD0900X"},{"HPTC":"207ZB0001X"},{"HPTC":"207ZN0500X"},{"HPTC":"207ZM0300X"},{"HPTC":"207ZP0213X"},{"HPTC":"207ZP0104X"},{"HPTC":"207ZP0101X"},{"HPTC":"207ZP0102X"},{"HPTC":"207ZF0201X"},{"HPTC":"207ZC0006X"},{"HPTC":"207ZP0105X"},{"HPTC":"207ZP0007X"}]},{"id":560,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7365,"precertRequired":false,"billingCode":"99227","codeType":"CPT"},{"id":7366,"precertRequired":false,"billingCode":"99228","codeType":"CPT"},{"id":7367,"precertRequired":false,"billingCode":"99229","codeType":"CPT"},{"id":7368,"precertRequired":false,"billingCode":"99230","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7375,"precertRequired":false,"billingCode":"99237","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7378,"precertRequired":false,"billingCode":"99240","codeType":"CPT"},{"id":7379,"precertRequired":true,"billingCode":"99241","codeType":"CPT"},{"id":7380,"precertRequired":true,"billingCode":"99242","codeType":"CPT"},{"id":7381,"precertRequired":true,"billingCode":"99243","codeType":"CPT"},{"id":7382,"precertRequired":true,"billingCode":"99244","codeType":"CPT"},{"id":7383,"precertRequired":true,"billingCode":"99245","codeType":"CPT"},{"id":7384,"precertRequired":false,"billingCode":"99246","codeType":"CPT"},{"id":7385,"precertRequired":false,"billingCode":"99247","codeType":"CPT"},{"id":7386,"precertRequired":false,"billingCode":"99248","codeType":"CPT"},{"id":7387,"precertRequired":false,"billingCode":"99249","codeType":"CPT"},{"id":7388,"precertRequired":false,"billingCode":"99250","codeType":"CPT"},{"id":7389,"precertRequired":false,"billingCode":"99251","codeType":"CPT"},{"id":7390,"precertRequired":false,"billingCode":"99252","codeType":"CPT"},{"id":7391,"precertRequired":false,"billingCode":"99253","codeType":"CPT"},{"id":7392,"precertRequired":false,"billingCode":"99254","codeType":"CPT"},{"id":7393,"precertRequired":false,"billingCode":"99255","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":561,"description":"Pre-operative medical clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7365,"precertRequired":false,"billingCode":"99227","codeType":"CPT"},{"id":7366,"precertRequired":false,"billingCode":"99228","codeType":"CPT"},{"id":7367,"precertRequired":false,"billingCode":"99229","codeType":"CPT"},{"id":7368,"precertRequired":false,"billingCode":"99230","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7375,"precertRequired":false,"billingCode":"99237","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7378,"precertRequired":false,"billingCode":"99240","codeType":"CPT"},{"id":7379,"precertRequired":true,"billingCode":"99241","codeType":"CPT"},{"id":7380,"precertRequired":true,"billingCode":"99242","codeType":"CPT"},{"id":7381,"precertRequired":true,"billingCode":"99243","codeType":"CPT"},{"id":7382,"precertRequired":true,"billingCode":"99244","codeType":"CPT"},{"id":7383,"precertRequired":true,"billingCode":"99245","codeType":"CPT"},{"id":7384,"precertRequired":false,"billingCode":"99246","codeType":"CPT"},{"id":7385,"precertRequired":false,"billingCode":"99247","codeType":"CPT"},{"id":7386,"precertRequired":false,"billingCode":"99248","codeType":"CPT"},{"id":7387,"precertRequired":false,"billingCode":"99249","codeType":"CPT"},{"id":7388,"precertRequired":false,"billingCode":"99250","codeType":"CPT"},{"id":7389,"precertRequired":false,"billingCode":"99251","codeType":"CPT"},{"id":7390,"precertRequired":false,"billingCode":"99252","codeType":"CPT"},{"id":7391,"precertRequired":false,"billingCode":"99253","codeType":"CPT"},{"id":7392,"precertRequired":false,"billingCode":"99254","codeType":"CPT"},{"id":7393,"precertRequired":false,"billingCode":"99255","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":562,"description":"One (1) follow-up visit, unless procedure included esophageal dilatation. Three (3) follow-up visits are approved for esophageal dilatation","frequency":null,"frequencyType":"","visits":4,"codeRequired":"YES","clinicalServices":[{"clinicalService":"10-Gastroenterology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RG0100X"}]},{"id":563,"description":"Follow-up images/laboratories/procedures as indicated during this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"2085R0202X"}]}]}},{"Seoc":{"id":1737,"seocKey":57,"name":"Gynecology_PRCT","seocId":"WHC_GYNECOLOGY_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for the referred condition indicated on the consult order. Conditions include well-woman exam, contraception, no periods or infrequent periods, abnormal uterine bleeding, pelvic pain, abnormal pap smear, infertility (**Separate authorization required for IUI. IVF requires special eligibility.), pelvic relaxation/prolapse, incontinence, and menopause\r\n2.  Diagnostic imaging relevant to the referred condition indicated on the consult order\r\n3.  Diagnostic studies relevant to the referred condition indicated on the consult order\r\n4.  Labs and pathology relevant to the referred condition indicated on the consult order\r\n5.  Procedures including but not limited to: Colposcopy, LEEP, cervical surgery and cryotherapy, hysteroscopy diagnostic and operative, laparoscopy diagnostic and operative, hysterectomy vaginal, abdominal, laparoscopic and robotic, vaginal surgery, tubal ligation, ovarian cystectomy, salpingectomy, salpingectomy with oophorectomy\r\n6.   Anesthesia consultation per the referred condition indicated on the consult order\r\n7.  Pre-operative medical/cardiac clearance as indicated (including H+P/labs, EKG, CXR). \r\n8.  Inpatient admission for surgical procedure if indicated.\r\n9.   Inpatient admission or observation status for complications per the referred condition indicated on the consult order\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning\r\n10. Follow-up visits for this episode of care \r\n11. Follow-up imaging relevant to the referred condition on the consult order\r\n12. Follow-up studies relevant to the referred condition on the consult order\r\n13. Pelvic Floor Physical Therapy as indicated; up to three (3) visits per week x 5 weeks (15 visits); Notify VA to request additional visits with supporting medical documentation","maxAllowableVisits":null,"disclaimer":"*Separate authorization required for IUI. IVF requires special eligibility.\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","QASP":"General Care","categoryOfCare":"GYNECOLOGY","serviceLine":"Womens Health Care","hptcs":[{"hptc":"207V00000X"},{"hptc":"363LW0102X"},{"hptc":"363LX0001X"}],"services":[{"id":5083,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult order. Conditions include well-woman exam, contraception, no periods or infrequent periods, abnormal uterine bleeding, pelvic pain, abnormal pap smear, infertility (**Separate authorization required for IUI. IVF requires special eligibility.), pelvic relaxation/prolapse, incontinence, and menopause","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7445,"precertRequired":false,"billingCode":"99385","codeType":"CPT"},{"id":7446,"precertRequired":false,"billingCode":"99386","codeType":"CPT"},{"id":7447,"precertRequired":false,"billingCode":"99387","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":7453,"precertRequired":false,"billingCode":"99396","codeType":"CPT"},{"id":7454,"precertRequired":false,"billingCode":"99397","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8217,"precertRequired":false,"billingCode":"G0445","codeType":"HCPCS"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"},{"id":13193,"precertRequired":false,"billingCode":"G0468","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":5084,"description":"Diagnostic imaging relevant to the referred condition indicated on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4734,"precertRequired":false,"billingCode":"76805","codeType":"CPT"},{"id":4736,"precertRequired":false,"billingCode":"76811","codeType":"CPT"},{"id":4741,"precertRequired":false,"billingCode":"76816","codeType":"CPT"},{"id":4744,"precertRequired":false,"billingCode":"76819","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5085,"description":"Diagnostic studies relevant to the referred condition indicated on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":3431,"precertRequired":false,"billingCode":"51784","codeType":"CPT"},{"id":4732,"precertRequired":false,"billingCode":"76801","codeType":"CPT"},{"id":4733,"precertRequired":false,"billingCode":"76802","codeType":"CPT"},{"id":4734,"precertRequired":false,"billingCode":"76805","codeType":"CPT"},{"id":4740,"precertRequired":false,"billingCode":"76815","codeType":"CPT"},{"id":4742,"precertRequired":false,"billingCode":"76817","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":6635,"precertRequired":false,"billingCode":"91122","codeType":"CPT"},{"id":13337,"precertRequired":true,"billingCode":"77021","codeType":"CPT"},{"id":13656,"precertRequired":true,"billingCode":"71260","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":5086,"description":"Labs and pathology relevant to the referred condition indicated on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5011,"precertRequired":false,"billingCode":"80055","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5016,"precertRequired":false,"billingCode":"80081","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5127,"precertRequired":false,"billingCode":"80418","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5440,"precertRequired":false,"billingCode":"82397","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5474,"precertRequired":false,"billingCode":"82627","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5485,"precertRequired":false,"billingCode":"82671","codeType":"CPT"},{"id":5486,"precertRequired":false,"billingCode":"82672","codeType":"CPT"},{"id":5487,"precertRequired":false,"billingCode":"82677","codeType":"CPT"},{"id":5488,"precertRequired":false,"billingCode":"82679","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5523,"precertRequired":false,"billingCode":"82950","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5573,"precertRequired":false,"billingCode":"83520","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5666,"precertRequired":false,"billingCode":"84146","codeType":"CPT"},{"id":5687,"precertRequired":false,"billingCode":"84233","codeType":"CPT"},{"id":5688,"precertRequired":false,"billingCode":"84234","codeType":"CPT"},{"id":5712,"precertRequired":false,"billingCode":"84403","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5763,"precertRequired":false,"billingCode":"84830","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5954,"precertRequired":false,"billingCode":"86592","codeType":"CPT"},{"id":5955,"precertRequired":false,"billingCode":"86593","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6065,"precertRequired":false,"billingCode":"86850","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6075,"precertRequired":false,"billingCode":"86901","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6156,"precertRequired":false,"billingCode":"87210","codeType":"CPT"},{"id":6168,"precertRequired":false,"billingCode":"87270","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6186,"precertRequired":false,"billingCode":"87320","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6217,"precertRequired":false,"billingCode":"87480","codeType":"CPT"},{"id":6218,"precertRequired":false,"billingCode":"87481","codeType":"CPT"},{"id":6224,"precertRequired":false,"billingCode":"87490","codeType":"CPT"},{"id":6225,"precertRequired":false,"billingCode":"87491","codeType":"CPT"},{"id":6226,"precertRequired":false,"billingCode":"87492","codeType":"CPT"},{"id":6239,"precertRequired":false,"billingCode":"87510","codeType":"CPT"},{"id":6277,"precertRequired":false,"billingCode":"87590","codeType":"CPT"},{"id":6278,"precertRequired":false,"billingCode":"87591","codeType":"CPT"},{"id":6279,"precertRequired":false,"billingCode":"87592","codeType":"CPT"},{"id":6280,"precertRequired":false,"billingCode":"87623","codeType":"CPT"},{"id":6281,"precertRequired":false,"billingCode":"87624","codeType":"CPT"},{"id":6282,"precertRequired":false,"billingCode":"87625","codeType":"CPT"},{"id":6293,"precertRequired":false,"billingCode":"87660","codeType":"CPT"},{"id":6294,"precertRequired":false,"billingCode":"87661","codeType":"CPT"},{"id":6308,"precertRequired":false,"billingCode":"87810","codeType":"CPT"},{"id":6309,"precertRequired":false,"billingCode":"87850","codeType":"CPT"},{"id":6340,"precertRequired":false,"billingCode":"88108","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6347,"precertRequired":false,"billingCode":"88141","codeType":"CPT"},{"id":6348,"precertRequired":false,"billingCode":"88142","codeType":"CPT"},{"id":6349,"precertRequired":false,"billingCode":"88143","codeType":"CPT"},{"id":6350,"precertRequired":false,"billingCode":"88147","codeType":"CPT"},{"id":6351,"precertRequired":false,"billingCode":"88148","codeType":"CPT"},{"id":6352,"precertRequired":false,"billingCode":"88150","codeType":"CPT"},{"id":6353,"precertRequired":false,"billingCode":"88152","codeType":"CPT"},{"id":6354,"precertRequired":false,"billingCode":"88153","codeType":"CPT"},{"id":6355,"precertRequired":false,"billingCode":"88155","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6357,"precertRequired":false,"billingCode":"88161","codeType":"CPT"},{"id":6358,"precertRequired":false,"billingCode":"88162","codeType":"CPT"},{"id":6359,"precertRequired":false,"billingCode":"88164","codeType":"CPT"},{"id":6360,"precertRequired":false,"billingCode":"88165","codeType":"CPT"},{"id":6361,"precertRequired":false,"billingCode":"88166","codeType":"CPT"},{"id":6362,"precertRequired":false,"billingCode":"88167","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6365,"precertRequired":false,"billingCode":"88174","codeType":"CPT"},{"id":6366,"precertRequired":false,"billingCode":"88175","codeType":"CPT"},{"id":6367,"precertRequired":false,"billingCode":"88177","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6430,"precertRequired":false,"billingCode":"88360","codeType":"CPT"},{"id":6431,"precertRequired":false,"billingCode":"88361","codeType":"CPT"},{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"},{"id":8721,"precertRequired":false,"billingCode":"P3000","codeType":"HCPCS"},{"id":8722,"precertRequired":false,"billingCode":"P3001","codeType":"HCPCS"},{"id":8769,"precertRequired":false,"billingCode":"Q0091","codeType":"HCPCS"},{"id":8770,"precertRequired":false,"billingCode":"Q0111","codeType":"HCPCS"},{"id":8771,"precertRequired":false,"billingCode":"Q0112","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5087,"description":"Procedures including but not limited to: Colposcopy, LEEP, cervical surgery and cryotherapy, hysteroscopy diagnostic and operative, laparoscopy diagnostic and operative, hysterectomy vaginal, abdominal, laparoscopic and robotic, vaginal surgery, tubal ligation, ovarian cystectomy, salpingectomy, salpingectomy with oophorectomy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":332,"precertRequired":false,"billingCode":"11976","codeType":"CPT"},{"id":333,"precertRequired":false,"billingCode":"11980","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3417,"precertRequired":false,"billingCode":"51701","codeType":"CPT"},{"id":3424,"precertRequired":false,"billingCode":"51725","codeType":"CPT"},{"id":3425,"precertRequired":false,"billingCode":"51726","codeType":"CPT"},{"id":3426,"precertRequired":false,"billingCode":"51727","codeType":"CPT"},{"id":3427,"precertRequired":false,"billingCode":"51728","codeType":"CPT"},{"id":3428,"precertRequired":false,"billingCode":"51729","codeType":"CPT"},{"id":3429,"precertRequired":false,"billingCode":"51736","codeType":"CPT"},{"id":3430,"precertRequired":false,"billingCode":"51741","codeType":"CPT"},{"id":3434,"precertRequired":false,"billingCode":"51797","codeType":"CPT"},{"id":3435,"precertRequired":false,"billingCode":"51798","codeType":"CPT"},{"id":3550,"precertRequired":false,"billingCode":"56405","codeType":"CPT"},{"id":3551,"precertRequired":false,"billingCode":"56420","codeType":"CPT"},{"id":3552,"precertRequired":false,"billingCode":"56440","codeType":"CPT"},{"id":3553,"precertRequired":false,"billingCode":"56441","codeType":"CPT"},{"id":3554,"precertRequired":false,"billingCode":"56442","codeType":"CPT"},{"id":3555,"precertRequired":false,"billingCode":"56501","codeType":"CPT"},{"id":3556,"precertRequired":false,"billingCode":"56515","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":3559,"precertRequired":false,"billingCode":"56620","codeType":"CPT"},{"id":3560,"precertRequired":false,"billingCode":"56625","codeType":"CPT"},{"id":3561,"precertRequired":false,"billingCode":"56630","codeType":"CPT"},{"id":3562,"precertRequired":false,"billingCode":"56631","codeType":"CPT"},{"id":3563,"precertRequired":false,"billingCode":"56632","codeType":"CPT"},{"id":3564,"precertRequired":false,"billingCode":"56633","codeType":"CPT"},{"id":3565,"precertRequired":false,"billingCode":"56634","codeType":"CPT"},{"id":3566,"precertRequired":false,"billingCode":"56637","codeType":"CPT"},{"id":3567,"precertRequired":false,"billingCode":"56640","codeType":"CPT"},{"id":3568,"precertRequired":false,"billingCode":"56700","codeType":"CPT"},{"id":3569,"precertRequired":false,"billingCode":"56740","codeType":"CPT"},{"id":3570,"precertRequired":false,"billingCode":"56800","codeType":"CPT"},{"id":3571,"precertRequired":false,"billingCode":"56810","codeType":"CPT"},{"id":3572,"precertRequired":false,"billingCode":"56820","codeType":"CPT"},{"id":3573,"precertRequired":false,"billingCode":"56821","codeType":"CPT"},{"id":3574,"precertRequired":false,"billingCode":"57000","codeType":"CPT"},{"id":3575,"precertRequired":false,"billingCode":"57010","codeType":"CPT"},{"id":3576,"precertRequired":false,"billingCode":"57020","codeType":"CPT"},{"id":3578,"precertRequired":false,"billingCode":"57023","codeType":"CPT"},{"id":3579,"precertRequired":false,"billingCode":"57061","codeType":"CPT"},{"id":3580,"precertRequired":false,"billingCode":"57065","codeType":"CPT"},{"id":3581,"precertRequired":false,"billingCode":"57100","codeType":"CPT"},{"id":3582,"precertRequired":false,"billingCode":"57105","codeType":"CPT"},{"id":3583,"precertRequired":false,"billingCode":"57106","codeType":"CPT"},{"id":3584,"precertRequired":false,"billingCode":"57107","codeType":"CPT"},{"id":3585,"precertRequired":false,"billingCode":"57109","codeType":"CPT"},{"id":3586,"precertRequired":false,"billingCode":"57110","codeType":"CPT"},{"id":3587,"precertRequired":false,"billingCode":"57111","codeType":"CPT"},{"id":3588,"precertRequired":false,"billingCode":"57112","codeType":"CPT"},{"id":3589,"precertRequired":false,"billingCode":"57120","codeType":"CPT"},{"id":3590,"precertRequired":false,"billingCode":"57130","codeType":"CPT"},{"id":3591,"precertRequired":false,"billingCode":"57135","codeType":"CPT"},{"id":3592,"precertRequired":false,"billingCode":"57150","codeType":"CPT"},{"id":3593,"precertRequired":false,"billingCode":"57155","codeType":"CPT"},{"id":3594,"precertRequired":false,"billingCode":"57156","codeType":"CPT"},{"id":3595,"precertRequired":false,"billingCode":"57160","codeType":"CPT"},{"id":3596,"precertRequired":false,"billingCode":"57170","codeType":"CPT"},{"id":3597,"precertRequired":false,"billingCode":"57180","codeType":"CPT"},{"id":3598,"precertRequired":false,"billingCode":"57200","codeType":"CPT"},{"id":3599,"precertRequired":false,"billingCode":"57210","codeType":"CPT"},{"id":3600,"precertRequired":false,"billingCode":"57220","codeType":"CPT"},{"id":3601,"precertRequired":false,"billingCode":"57230","codeType":"CPT"},{"id":3602,"precertRequired":false,"billingCode":"57240","codeType":"CPT"},{"id":3603,"precertRequired":false,"billingCode":"57250","codeType":"CPT"},{"id":3604,"precertRequired":false,"billingCode":"57260","codeType":"CPT"},{"id":3605,"precertRequired":false,"billingCode":"57265","codeType":"CPT"},{"id":3606,"precertRequired":false,"billingCode":"57267","codeType":"CPT"},{"id":3607,"precertRequired":false,"billingCode":"57268","codeType":"CPT"},{"id":3608,"precertRequired":false,"billingCode":"57270","codeType":"CPT"},{"id":3609,"precertRequired":false,"billingCode":"57280","codeType":"CPT"},{"id":3610,"precertRequired":false,"billingCode":"57282","codeType":"CPT"},{"id":3611,"precertRequired":false,"billingCode":"57283","codeType":"CPT"},{"id":3612,"precertRequired":false,"billingCode":"57284","codeType":"CPT"},{"id":3613,"precertRequired":false,"billingCode":"57285","codeType":"CPT"},{"id":3615,"precertRequired":false,"billingCode":"57288","codeType":"CPT"},{"id":3616,"precertRequired":false,"billingCode":"57300","codeType":"CPT"},{"id":3617,"precertRequired":false,"billingCode":"57305","codeType":"CPT"},{"id":3618,"precertRequired":false,"billingCode":"57307","codeType":"CPT"},{"id":3619,"precertRequired":false,"billingCode":"57308","codeType":"CPT"},{"id":3620,"precertRequired":false,"billingCode":"57310","codeType":"CPT"},{"id":3621,"precertRequired":false,"billingCode":"57311","codeType":"CPT"},{"id":3622,"precertRequired":false,"billingCode":"57320","codeType":"CPT"},{"id":3623,"precertRequired":false,"billingCode":"57330","codeType":"CPT"},{"id":3624,"precertRequired":false,"billingCode":"57400","codeType":"CPT"},{"id":3625,"precertRequired":false,"billingCode":"57410","codeType":"CPT"},{"id":3626,"precertRequired":false,"billingCode":"57415","codeType":"CPT"},{"id":3627,"precertRequired":false,"billingCode":"57420","codeType":"CPT"},{"id":3628,"precertRequired":false,"billingCode":"57421","codeType":"CPT"},{"id":3629,"precertRequired":false,"billingCode":"57423","codeType":"CPT"},{"id":3630,"precertRequired":false,"billingCode":"57425","codeType":"CPT"},{"id":3631,"precertRequired":false,"billingCode":"57426","codeType":"CPT"},{"id":3632,"precertRequired":false,"billingCode":"57452","codeType":"CPT"},{"id":3633,"precertRequired":false,"billingCode":"57454","codeType":"CPT"},{"id":3634,"precertRequired":false,"billingCode":"57455","codeType":"CPT"},{"id":3635,"precertRequired":false,"billingCode":"57456","codeType":"CPT"},{"id":3636,"precertRequired":false,"billingCode":"57460","codeType":"CPT"},{"id":3637,"precertRequired":false,"billingCode":"57461","codeType":"CPT"},{"id":3638,"precertRequired":false,"billingCode":"57500","codeType":"CPT"},{"id":3639,"precertRequired":false,"billingCode":"57505","codeType":"CPT"},{"id":3640,"precertRequired":false,"billingCode":"57510","codeType":"CPT"},{"id":3641,"precertRequired":false,"billingCode":"57511","codeType":"CPT"},{"id":3642,"precertRequired":false,"billingCode":"57513","codeType":"CPT"},{"id":3643,"precertRequired":false,"billingCode":"57520","codeType":"CPT"},{"id":3644,"precertRequired":false,"billingCode":"57522","codeType":"CPT"},{"id":3645,"precertRequired":false,"billingCode":"57530","codeType":"CPT"},{"id":3646,"precertRequired":false,"billingCode":"57531","codeType":"CPT"},{"id":3647,"precertRequired":false,"billingCode":"57540","codeType":"CPT"},{"id":3648,"precertRequired":false,"billingCode":"57545","codeType":"CPT"},{"id":3649,"precertRequired":false,"billingCode":"57550","codeType":"CPT"},{"id":3650,"precertRequired":false,"billingCode":"57555","codeType":"CPT"},{"id":3651,"precertRequired":false,"billingCode":"57556","codeType":"CPT"},{"id":3652,"precertRequired":false,"billingCode":"57558","codeType":"CPT"},{"id":3653,"precertRequired":false,"billingCode":"57700","codeType":"CPT"},{"id":3654,"precertRequired":false,"billingCode":"57720","codeType":"CPT"},{"id":3655,"precertRequired":false,"billingCode":"57800","codeType":"CPT"},{"id":3656,"precertRequired":false,"billingCode":"58100","codeType":"CPT"},{"id":3657,"precertRequired":false,"billingCode":"58110","codeType":"CPT"},{"id":3658,"precertRequired":false,"billingCode":"58120","codeType":"CPT"},{"id":3659,"precertRequired":false,"billingCode":"58140","codeType":"CPT"},{"id":3660,"precertRequired":false,"billingCode":"58145","codeType":"CPT"},{"id":3661,"precertRequired":false,"billingCode":"58146","codeType":"CPT"},{"id":3662,"precertRequired":false,"billingCode":"58150","codeType":"CPT"},{"id":3663,"precertRequired":false,"billingCode":"58152","codeType":"CPT"},{"id":3664,"precertRequired":false,"billingCode":"58180","codeType":"CPT"},{"id":3665,"precertRequired":false,"billingCode":"58200","codeType":"CPT"},{"id":3666,"precertRequired":false,"billingCode":"58210","codeType":"CPT"},{"id":3667,"precertRequired":false,"billingCode":"58240","codeType":"CPT"},{"id":3668,"precertRequired":false,"billingCode":"58260","codeType":"CPT"},{"id":3669,"precertRequired":false,"billingCode":"58262","codeType":"CPT"},{"id":3670,"precertRequired":false,"billingCode":"58263","codeType":"CPT"},{"id":3671,"precertRequired":false,"billingCode":"58267","codeType":"CPT"},{"id":3672,"precertRequired":false,"billingCode":"58270","codeType":"CPT"},{"id":3673,"precertRequired":false,"billingCode":"58275","codeType":"CPT"},{"id":3674,"precertRequired":false,"billingCode":"58280","codeType":"CPT"},{"id":3675,"precertRequired":false,"billingCode":"58285","codeType":"CPT"},{"id":3676,"precertRequired":false,"billingCode":"58290","codeType":"CPT"},{"id":3677,"precertRequired":false,"billingCode":"58291","codeType":"CPT"},{"id":3678,"precertRequired":false,"billingCode":"58292","codeType":"CPT"},{"id":3679,"precertRequired":false,"billingCode":"58293","codeType":"CPT"},{"id":3680,"precertRequired":false,"billingCode":"58294","codeType":"CPT"},{"id":3681,"precertRequired":false,"billingCode":"58300","codeType":"CPT"},{"id":3682,"precertRequired":false,"billingCode":"58301","codeType":"CPT"},{"id":3686,"precertRequired":false,"billingCode":"58340","codeType":"CPT"},{"id":3687,"precertRequired":false,"billingCode":"58345","codeType":"CPT"},{"id":3688,"precertRequired":false,"billingCode":"58350","codeType":"CPT"},{"id":3689,"precertRequired":false,"billingCode":"58353","codeType":"CPT"},{"id":3690,"precertRequired":false,"billingCode":"58356","codeType":"CPT"},{"id":3691,"precertRequired":false,"billingCode":"58400","codeType":"CPT"},{"id":3692,"precertRequired":false,"billingCode":"58410","codeType":"CPT"},{"id":3693,"precertRequired":false,"billingCode":"58520","codeType":"CPT"},{"id":3694,"precertRequired":false,"billingCode":"58540","codeType":"CPT"},{"id":3695,"precertRequired":false,"billingCode":"58541","codeType":"CPT"},{"id":3696,"precertRequired":false,"billingCode":"58542","codeType":"CPT"},{"id":3697,"precertRequired":false,"billingCode":"58543","codeType":"CPT"},{"id":3698,"precertRequired":false,"billingCode":"58544","codeType":"CPT"},{"id":3699,"precertRequired":false,"billingCode":"58545","codeType":"CPT"},{"id":3700,"precertRequired":false,"billingCode":"58546","codeType":"CPT"},{"id":3701,"precertRequired":false,"billingCode":"58548","codeType":"CPT"},{"id":3702,"precertRequired":false,"billingCode":"58550","codeType":"CPT"},{"id":3703,"precertRequired":false,"billingCode":"58552","codeType":"CPT"},{"id":3704,"precertRequired":false,"billingCode":"58553","codeType":"CPT"},{"id":3705,"precertRequired":false,"billingCode":"58554","codeType":"CPT"},{"id":3706,"precertRequired":false,"billingCode":"58555","codeType":"CPT"},{"id":3707,"precertRequired":false,"billingCode":"58558","codeType":"CPT"},{"id":3708,"precertRequired":false,"billingCode":"58559","codeType":"CPT"},{"id":3709,"precertRequired":false,"billingCode":"58560","codeType":"CPT"},{"id":3710,"precertRequired":false,"billingCode":"58561","codeType":"CPT"},{"id":3711,"precertRequired":false,"billingCode":"58562","codeType":"CPT"},{"id":3712,"precertRequired":false,"billingCode":"58563","codeType":"CPT"},{"id":3713,"precertRequired":false,"billingCode":"58565","codeType":"CPT"},{"id":3714,"precertRequired":false,"billingCode":"58570","codeType":"CPT"},{"id":3715,"precertRequired":false,"billingCode":"58571","codeType":"CPT"},{"id":3716,"precertRequired":false,"billingCode":"58572","codeType":"CPT"},{"id":3717,"precertRequired":false,"billingCode":"58573","codeType":"CPT"},{"id":3718,"precertRequired":false,"billingCode":"58575","codeType":"CPT"},{"id":3721,"precertRequired":false,"billingCode":"58600","codeType":"CPT"},{"id":3722,"precertRequired":false,"billingCode":"58605","codeType":"CPT"},{"id":3723,"precertRequired":false,"billingCode":"58611","codeType":"CPT"},{"id":3724,"precertRequired":false,"billingCode":"58615","codeType":"CPT"},{"id":3725,"precertRequired":false,"billingCode":"58660","codeType":"CPT"},{"id":3726,"precertRequired":false,"billingCode":"58661","codeType":"CPT"},{"id":3727,"precertRequired":false,"billingCode":"58662","codeType":"CPT"},{"id":3728,"precertRequired":true,"billingCode":"58670","codeType":"CPT"},{"id":3729,"precertRequired":false,"billingCode":"58671","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3732,"precertRequired":false,"billingCode":"58674","codeType":"CPT"},{"id":3734,"precertRequired":false,"billingCode":"58700","codeType":"CPT"},{"id":3735,"precertRequired":false,"billingCode":"58720","codeType":"CPT"},{"id":3736,"precertRequired":false,"billingCode":"58740","codeType":"CPT"},{"id":3737,"precertRequired":false,"billingCode":"58750","codeType":"CPT"},{"id":3738,"precertRequired":false,"billingCode":"58752","codeType":"CPT"},{"id":3739,"precertRequired":false,"billingCode":"58760","codeType":"CPT"},{"id":3740,"precertRequired":false,"billingCode":"58770","codeType":"CPT"},{"id":3741,"precertRequired":false,"billingCode":"58800","codeType":"CPT"},{"id":3742,"precertRequired":false,"billingCode":"58805","codeType":"CPT"},{"id":3743,"precertRequired":false,"billingCode":"58820","codeType":"CPT"},{"id":3744,"precertRequired":false,"billingCode":"58822","codeType":"CPT"},{"id":3745,"precertRequired":false,"billingCode":"58825","codeType":"CPT"},{"id":3746,"precertRequired":false,"billingCode":"58900","codeType":"CPT"},{"id":3747,"precertRequired":false,"billingCode":"58920","codeType":"CPT"},{"id":3748,"precertRequired":false,"billingCode":"58925","codeType":"CPT"},{"id":3749,"precertRequired":false,"billingCode":"58940","codeType":"CPT"},{"id":3750,"precertRequired":false,"billingCode":"58943","codeType":"CPT"},{"id":3751,"precertRequired":false,"billingCode":"58950","codeType":"CPT"},{"id":3752,"precertRequired":false,"billingCode":"58951","codeType":"CPT"},{"id":3753,"precertRequired":false,"billingCode":"58952","codeType":"CPT"},{"id":3754,"precertRequired":false,"billingCode":"58953","codeType":"CPT"},{"id":3755,"precertRequired":false,"billingCode":"58954","codeType":"CPT"},{"id":3756,"precertRequired":false,"billingCode":"58956","codeType":"CPT"},{"id":3757,"precertRequired":false,"billingCode":"58957","codeType":"CPT"},{"id":3758,"precertRequired":false,"billingCode":"58958","codeType":"CPT"},{"id":3759,"precertRequired":false,"billingCode":"58960","codeType":"CPT"},{"id":3964,"precertRequired":false,"billingCode":"64566","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8127,"precertRequired":false,"billingCode":"G0123","codeType":"HCPCS"},{"id":8128,"precertRequired":false,"billingCode":"G0124","codeType":"HCPCS"},{"id":8133,"precertRequired":false,"billingCode":"G0141","codeType":"HCPCS"},{"id":8134,"precertRequired":false,"billingCode":"G0143","codeType":"HCPCS"},{"id":8135,"precertRequired":false,"billingCode":"G0144","codeType":"HCPCS"},{"id":8136,"precertRequired":false,"billingCode":"G0145","codeType":"HCPCS"},{"id":8137,"precertRequired":false,"billingCode":"G0147","codeType":"HCPCS"},{"id":8138,"precertRequired":false,"billingCode":"G0148","codeType":"HCPCS"},{"id":8217,"precertRequired":false,"billingCode":"G0445","codeType":"HCPCS"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"},{"id":13314,"precertRequired":true,"billingCode":"49320","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":5088,"description":"Anesthesia consultation per the referred condition indicated on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":84,"precertRequired":false,"billingCode":"00800","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":97,"precertRequired":false,"billingCode":"00846","codeType":"CPT"},{"id":99,"precertRequired":false,"billingCode":"00851","codeType":"CPT"},{"id":100,"precertRequired":false,"billingCode":"00860","codeType":"CPT"},{"id":113,"precertRequired":false,"billingCode":"00906","codeType":"CPT"},{"id":131,"precertRequired":false,"billingCode":"00940","codeType":"CPT"},{"id":132,"precertRequired":false,"billingCode":"00942","codeType":"CPT"},{"id":133,"precertRequired":false,"billingCode":"00944","codeType":"CPT"},{"id":135,"precertRequired":false,"billingCode":"00950","codeType":"CPT"},{"id":136,"precertRequired":false,"billingCode":"00952","codeType":"CPT"},{"id":217,"precertRequired":false,"billingCode":"01991","codeType":"CPT"},{"id":218,"precertRequired":false,"billingCode":"01992","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":5089,"description":"Pre-operative medical/cardiac clearance as indicated (including H+P/labs, EKG, CXR).","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":6991,"precertRequired":false,"billingCode":"94010","codeType":"CPT"},{"id":6998,"precertRequired":false,"billingCode":"94060","codeType":"CPT"},{"id":6999,"precertRequired":false,"billingCode":"94070","codeType":"CPT"},{"id":7000,"precertRequired":false,"billingCode":"94150","codeType":"CPT"},{"id":7026,"precertRequired":false,"billingCode":"94726","codeType":"CPT"},{"id":7027,"precertRequired":false,"billingCode":"94727","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"},{"id":12122,"precertRequired":false,"billingCode":"G0466","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":5090,"description":"Inpatient admission for surgical procedure if indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":5091,"description":"Inpatient admission or observation status for complications per the referred condition indicated on the consult order\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":5092,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":9803,"precertRequired":false,"billingCode":"G0467","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":5093,"description":"Follow-up imaging relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4734,"precertRequired":false,"billingCode":"76805","codeType":"CPT"},{"id":4736,"precertRequired":false,"billingCode":"76811","codeType":"CPT"},{"id":4741,"precertRequired":false,"billingCode":"76816","codeType":"CPT"},{"id":4744,"precertRequired":false,"billingCode":"76819","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5094,"description":"Follow-up studies relevant to the referred condition on the consult order","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":3431,"precertRequired":false,"billingCode":"51784","codeType":"CPT"},{"id":4732,"precertRequired":false,"billingCode":"76801","codeType":"CPT"},{"id":4733,"precertRequired":false,"billingCode":"76802","codeType":"CPT"},{"id":4734,"precertRequired":false,"billingCode":"76805","codeType":"CPT"},{"id":4740,"precertRequired":false,"billingCode":"76815","codeType":"CPT"},{"id":4742,"precertRequired":false,"billingCode":"76817","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":6635,"precertRequired":false,"billingCode":"91122","codeType":"CPT"},{"id":13337,"precertRequired":true,"billingCode":"77021","codeType":"CPT"},{"id":13656,"precertRequired":true,"billingCode":"71260","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":5095,"description":"Pelvic Floor Physical Therapy as indicated; up to three (3) visits per week x 5 weeks (15 visits); Notify VA to request additional visits with supporting medical documentation","frequency":null,"frequencyType":"","visits":15,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7262,"precertRequired":false,"billingCode":"97161","codeType":"CPT"},{"id":7263,"precertRequired":false,"billingCode":"97162","codeType":"CPT"},{"id":7264,"precertRequired":false,"billingCode":"97163","codeType":"CPT"},{"id":7265,"precertRequired":false,"billingCode":"97164","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7289,"precertRequired":false,"billingCode":"97750","codeType":"CPT"},{"id":13396,"precertRequired":false,"billingCode":"90912","codeType":"CPT"},{"id":13397,"precertRequired":false,"billingCode":"90913","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":551,"seocKey":57,"name":"Gynecology_PRCT","seocId":"WHC_GYNECOLOGY_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for the referred condition indicated on the consult. Conditions include well-woman exam, contraception, no periods or infrequent periods, abnormal uterine bleeding, pelvic pain, abnormal pap smear, infertility (**Separate authorization required for IUI. IVF requires special eligibility.), pelvic relaxation/prolapse, incontinence, and menopause\r\n2.  Diagnostic imaging relevant to the referred condition indicated on the consult\r\n3.  Diagnostic studies relevant to the referred condition indicated on the consult\r\n4.  Labs and pathology relevant to the referred condition indicated on the consult\r\n5.  Procedures including but not limited to: Colposcopy, LEEP, cervical surgery and cryotherapy, hysteroscopy diagnostic and operative, laparoscopy diagnostic and operative, hysterectomy vaginal, abdominal, laparoscopic and robotic, vaginal surgery, tubal ligation, ovarian cystectomy, salpingectomy, salpingectomy with oophorectomy\r\n6.  Anesthesia consultation per the referred condition indicated on the consult\r\n7.  Pre-operative medical/cardiac clearance as indicated (including H+P/labs, EKG, CXR). \r\n8.  Inpatient admission for surgical procedure if indicated.\r\n9. Inpatient admission or observation status for complications per the referred condition indicated on the consult\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery\r\n10. Follow-up visits for this episode of care \r\n11. Follow-up imaging relevant to the referred condition on the consult\r\n12. Follow-up studies relevant to the referred condition on the consult\r\n13. Pelvic Floor Physical Therapy as indicated; up to three (3) visits per week x 5 weeks (15 visits); Notify VA to request additional visits with supporting medical documentation","maxAllowableVisits":null,"disclaimer":"*Separate authorization required for IUI. IVF requires special eligibility.\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","QASP":"General Care","categoryOfCare":"GYNECOLOGY","serviceLine":"Womens Health Care","hptcs":[{"hptc":"207V00000X"},{"hptc":"363LW0102X"},{"hptc":"363LX0001X"}],"services":[{"id":3164,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult. Conditions include well-woman exam, contraception, no periods or infrequent periods, abnormal uterine bleeding, pelvic pain, abnormal pap smear, infertility (**Separate authorization required for IUI. IVF requires special eligibility.), pelvic relaxation/prolapse, incontinence, and menopause","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7445,"precertRequired":false,"billingCode":"99385","codeType":"CPT"},{"id":7446,"precertRequired":false,"billingCode":"99386","codeType":"CPT"},{"id":7447,"precertRequired":false,"billingCode":"99387","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":7453,"precertRequired":false,"billingCode":"99396","codeType":"CPT"},{"id":7454,"precertRequired":false,"billingCode":"99397","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8217,"precertRequired":false,"billingCode":"G0445","codeType":"HCPCS"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":3165,"description":"Diagnostic imaging relevant to the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4734,"precertRequired":false,"billingCode":"76805","codeType":"CPT"},{"id":4736,"precertRequired":false,"billingCode":"76811","codeType":"CPT"},{"id":4741,"precertRequired":false,"billingCode":"76816","codeType":"CPT"},{"id":4744,"precertRequired":false,"billingCode":"76819","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3166,"description":"Diagnostic studies relevant to the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":3431,"precertRequired":false,"billingCode":"51784","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4732,"precertRequired":false,"billingCode":"76801","codeType":"CPT"},{"id":4733,"precertRequired":false,"billingCode":"76802","codeType":"CPT"},{"id":4734,"precertRequired":false,"billingCode":"76805","codeType":"CPT"},{"id":4740,"precertRequired":false,"billingCode":"76815","codeType":"CPT"},{"id":4742,"precertRequired":false,"billingCode":"76817","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4781,"precertRequired":false,"billingCode":"77021","codeType":"CPT"},{"id":6635,"precertRequired":false,"billingCode":"91122","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":3167,"description":"Labs and pathology relevant to the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5011,"precertRequired":false,"billingCode":"80055","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5016,"precertRequired":false,"billingCode":"80081","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5127,"precertRequired":false,"billingCode":"80418","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5440,"precertRequired":false,"billingCode":"82397","codeType":"CPT"},{"id":5474,"precertRequired":false,"billingCode":"82627","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5485,"precertRequired":false,"billingCode":"82671","codeType":"CPT"},{"id":5486,"precertRequired":false,"billingCode":"82672","codeType":"CPT"},{"id":5487,"precertRequired":false,"billingCode":"82677","codeType":"CPT"},{"id":5488,"precertRequired":false,"billingCode":"82679","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5523,"precertRequired":false,"billingCode":"82950","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5573,"precertRequired":false,"billingCode":"83520","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5666,"precertRequired":false,"billingCode":"84146","codeType":"CPT"},{"id":5687,"precertRequired":false,"billingCode":"84233","codeType":"CPT"},{"id":5688,"precertRequired":false,"billingCode":"84234","codeType":"CPT"},{"id":5712,"precertRequired":false,"billingCode":"84403","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5763,"precertRequired":false,"billingCode":"84830","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5954,"precertRequired":false,"billingCode":"86592","codeType":"CPT"},{"id":5955,"precertRequired":false,"billingCode":"86593","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6065,"precertRequired":false,"billingCode":"86850","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6075,"precertRequired":false,"billingCode":"86901","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6156,"precertRequired":false,"billingCode":"87210","codeType":"CPT"},{"id":6168,"precertRequired":false,"billingCode":"87270","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6186,"precertRequired":false,"billingCode":"87320","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6217,"precertRequired":false,"billingCode":"87480","codeType":"CPT"},{"id":6218,"precertRequired":false,"billingCode":"87481","codeType":"CPT"},{"id":6224,"precertRequired":false,"billingCode":"87490","codeType":"CPT"},{"id":6225,"precertRequired":false,"billingCode":"87491","codeType":"CPT"},{"id":6226,"precertRequired":false,"billingCode":"87492","codeType":"CPT"},{"id":6239,"precertRequired":false,"billingCode":"87510","codeType":"CPT"},{"id":6277,"precertRequired":false,"billingCode":"87590","codeType":"CPT"},{"id":6278,"precertRequired":false,"billingCode":"87591","codeType":"CPT"},{"id":6279,"precertRequired":false,"billingCode":"87592","codeType":"CPT"},{"id":6280,"precertRequired":false,"billingCode":"87623","codeType":"CPT"},{"id":6281,"precertRequired":false,"billingCode":"87624","codeType":"CPT"},{"id":6282,"precertRequired":false,"billingCode":"87625","codeType":"CPT"},{"id":6293,"precertRequired":false,"billingCode":"87660","codeType":"CPT"},{"id":6294,"precertRequired":false,"billingCode":"87661","codeType":"CPT"},{"id":6308,"precertRequired":false,"billingCode":"87810","codeType":"CPT"},{"id":6309,"precertRequired":false,"billingCode":"87850","codeType":"CPT"},{"id":6340,"precertRequired":false,"billingCode":"88108","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6347,"precertRequired":false,"billingCode":"88141","codeType":"CPT"},{"id":6348,"precertRequired":false,"billingCode":"88142","codeType":"CPT"},{"id":6349,"precertRequired":false,"billingCode":"88143","codeType":"CPT"},{"id":6350,"precertRequired":false,"billingCode":"88147","codeType":"CPT"},{"id":6351,"precertRequired":false,"billingCode":"88148","codeType":"CPT"},{"id":6352,"precertRequired":false,"billingCode":"88150","codeType":"CPT"},{"id":6353,"precertRequired":false,"billingCode":"88152","codeType":"CPT"},{"id":6354,"precertRequired":false,"billingCode":"88153","codeType":"CPT"},{"id":6355,"precertRequired":false,"billingCode":"88155","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6357,"precertRequired":false,"billingCode":"88161","codeType":"CPT"},{"id":6358,"precertRequired":false,"billingCode":"88162","codeType":"CPT"},{"id":6359,"precertRequired":false,"billingCode":"88164","codeType":"CPT"},{"id":6360,"precertRequired":false,"billingCode":"88165","codeType":"CPT"},{"id":6361,"precertRequired":false,"billingCode":"88166","codeType":"CPT"},{"id":6362,"precertRequired":false,"billingCode":"88167","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6365,"precertRequired":false,"billingCode":"88174","codeType":"CPT"},{"id":6366,"precertRequired":false,"billingCode":"88175","codeType":"CPT"},{"id":6367,"precertRequired":false,"billingCode":"88177","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6430,"precertRequired":false,"billingCode":"88360","codeType":"CPT"},{"id":6431,"precertRequired":false,"billingCode":"88361","codeType":"CPT"},{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"},{"id":8721,"precertRequired":false,"billingCode":"P3000","codeType":"HCPCS"},{"id":8722,"precertRequired":false,"billingCode":"P3001","codeType":"HCPCS"},{"id":8769,"precertRequired":false,"billingCode":"Q0091","codeType":"HCPCS"},{"id":8770,"precertRequired":false,"billingCode":"Q0111","codeType":"HCPCS"},{"id":8771,"precertRequired":false,"billingCode":"Q0112","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":3168,"description":"Procedures including but not limited to: Colposcopy, LEEP, cervical surgery and cryotherapy, hysteroscopy diagnostic and operative, laparoscopy diagnostic and operative, hysterectomy vaginal, abdominal, laparoscopic and robotic, vaginal surgery, tubal ligation, ovarian cystectomy, salpingectomy, salpingectomy with oophorectomy","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":332,"precertRequired":false,"billingCode":"11976","codeType":"CPT"},{"id":333,"precertRequired":false,"billingCode":"11980","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":3347,"precertRequired":false,"billingCode":"49320","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3417,"precertRequired":false,"billingCode":"51701","codeType":"CPT"},{"id":3424,"precertRequired":false,"billingCode":"51725","codeType":"CPT"},{"id":3425,"precertRequired":false,"billingCode":"51726","codeType":"CPT"},{"id":3426,"precertRequired":false,"billingCode":"51727","codeType":"CPT"},{"id":3427,"precertRequired":false,"billingCode":"51728","codeType":"CPT"},{"id":3428,"precertRequired":false,"billingCode":"51729","codeType":"CPT"},{"id":3429,"precertRequired":false,"billingCode":"51736","codeType":"CPT"},{"id":3430,"precertRequired":false,"billingCode":"51741","codeType":"CPT"},{"id":3434,"precertRequired":false,"billingCode":"51797","codeType":"CPT"},{"id":3435,"precertRequired":false,"billingCode":"51798","codeType":"CPT"},{"id":3550,"precertRequired":false,"billingCode":"56405","codeType":"CPT"},{"id":3551,"precertRequired":false,"billingCode":"56420","codeType":"CPT"},{"id":3552,"precertRequired":false,"billingCode":"56440","codeType":"CPT"},{"id":3553,"precertRequired":false,"billingCode":"56441","codeType":"CPT"},{"id":3554,"precertRequired":false,"billingCode":"56442","codeType":"CPT"},{"id":3555,"precertRequired":false,"billingCode":"56501","codeType":"CPT"},{"id":3556,"precertRequired":false,"billingCode":"56515","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":3559,"precertRequired":false,"billingCode":"56620","codeType":"CPT"},{"id":3560,"precertRequired":false,"billingCode":"56625","codeType":"CPT"},{"id":3561,"precertRequired":false,"billingCode":"56630","codeType":"CPT"},{"id":3562,"precertRequired":false,"billingCode":"56631","codeType":"CPT"},{"id":3563,"precertRequired":false,"billingCode":"56632","codeType":"CPT"},{"id":3564,"precertRequired":false,"billingCode":"56633","codeType":"CPT"},{"id":3565,"precertRequired":false,"billingCode":"56634","codeType":"CPT"},{"id":3566,"precertRequired":false,"billingCode":"56637","codeType":"CPT"},{"id":3567,"precertRequired":false,"billingCode":"56640","codeType":"CPT"},{"id":3568,"precertRequired":false,"billingCode":"56700","codeType":"CPT"},{"id":3569,"precertRequired":false,"billingCode":"56740","codeType":"CPT"},{"id":3570,"precertRequired":false,"billingCode":"56800","codeType":"CPT"},{"id":3571,"precertRequired":false,"billingCode":"56810","codeType":"CPT"},{"id":3572,"precertRequired":false,"billingCode":"56820","codeType":"CPT"},{"id":3573,"precertRequired":false,"billingCode":"56821","codeType":"CPT"},{"id":3574,"precertRequired":false,"billingCode":"57000","codeType":"CPT"},{"id":3575,"precertRequired":false,"billingCode":"57010","codeType":"CPT"},{"id":3576,"precertRequired":false,"billingCode":"57020","codeType":"CPT"},{"id":3578,"precertRequired":false,"billingCode":"57023","codeType":"CPT"},{"id":3579,"precertRequired":false,"billingCode":"57061","codeType":"CPT"},{"id":3580,"precertRequired":false,"billingCode":"57065","codeType":"CPT"},{"id":3581,"precertRequired":false,"billingCode":"57100","codeType":"CPT"},{"id":3582,"precertRequired":false,"billingCode":"57105","codeType":"CPT"},{"id":3583,"precertRequired":false,"billingCode":"57106","codeType":"CPT"},{"id":3584,"precertRequired":false,"billingCode":"57107","codeType":"CPT"},{"id":3585,"precertRequired":false,"billingCode":"57109","codeType":"CPT"},{"id":3586,"precertRequired":false,"billingCode":"57110","codeType":"CPT"},{"id":3587,"precertRequired":false,"billingCode":"57111","codeType":"CPT"},{"id":3588,"precertRequired":false,"billingCode":"57112","codeType":"CPT"},{"id":3589,"precertRequired":false,"billingCode":"57120","codeType":"CPT"},{"id":3590,"precertRequired":false,"billingCode":"57130","codeType":"CPT"},{"id":3591,"precertRequired":false,"billingCode":"57135","codeType":"CPT"},{"id":3592,"precertRequired":false,"billingCode":"57150","codeType":"CPT"},{"id":3593,"precertRequired":false,"billingCode":"57155","codeType":"CPT"},{"id":3594,"precertRequired":false,"billingCode":"57156","codeType":"CPT"},{"id":3595,"precertRequired":false,"billingCode":"57160","codeType":"CPT"},{"id":3596,"precertRequired":false,"billingCode":"57170","codeType":"CPT"},{"id":3597,"precertRequired":false,"billingCode":"57180","codeType":"CPT"},{"id":3598,"precertRequired":false,"billingCode":"57200","codeType":"CPT"},{"id":3599,"precertRequired":false,"billingCode":"57210","codeType":"CPT"},{"id":3600,"precertRequired":false,"billingCode":"57220","codeType":"CPT"},{"id":3601,"precertRequired":false,"billingCode":"57230","codeType":"CPT"},{"id":3602,"precertRequired":false,"billingCode":"57240","codeType":"CPT"},{"id":3603,"precertRequired":false,"billingCode":"57250","codeType":"CPT"},{"id":3604,"precertRequired":false,"billingCode":"57260","codeType":"CPT"},{"id":3605,"precertRequired":false,"billingCode":"57265","codeType":"CPT"},{"id":3606,"precertRequired":false,"billingCode":"57267","codeType":"CPT"},{"id":3607,"precertRequired":false,"billingCode":"57268","codeType":"CPT"},{"id":3608,"precertRequired":false,"billingCode":"57270","codeType":"CPT"},{"id":3609,"precertRequired":false,"billingCode":"57280","codeType":"CPT"},{"id":3610,"precertRequired":false,"billingCode":"57282","codeType":"CPT"},{"id":3611,"precertRequired":false,"billingCode":"57283","codeType":"CPT"},{"id":3612,"precertRequired":false,"billingCode":"57284","codeType":"CPT"},{"id":3613,"precertRequired":false,"billingCode":"57285","codeType":"CPT"},{"id":3615,"precertRequired":false,"billingCode":"57288","codeType":"CPT"},{"id":3616,"precertRequired":false,"billingCode":"57300","codeType":"CPT"},{"id":3617,"precertRequired":false,"billingCode":"57305","codeType":"CPT"},{"id":3618,"precertRequired":false,"billingCode":"57307","codeType":"CPT"},{"id":3619,"precertRequired":false,"billingCode":"57308","codeType":"CPT"},{"id":3620,"precertRequired":false,"billingCode":"57310","codeType":"CPT"},{"id":3621,"precertRequired":false,"billingCode":"57311","codeType":"CPT"},{"id":3622,"precertRequired":false,"billingCode":"57320","codeType":"CPT"},{"id":3623,"precertRequired":false,"billingCode":"57330","codeType":"CPT"},{"id":3624,"precertRequired":false,"billingCode":"57400","codeType":"CPT"},{"id":3625,"precertRequired":false,"billingCode":"57410","codeType":"CPT"},{"id":3626,"precertRequired":false,"billingCode":"57415","codeType":"CPT"},{"id":3627,"precertRequired":false,"billingCode":"57420","codeType":"CPT"},{"id":3628,"precertRequired":false,"billingCode":"57421","codeType":"CPT"},{"id":3629,"precertRequired":false,"billingCode":"57423","codeType":"CPT"},{"id":3630,"precertRequired":false,"billingCode":"57425","codeType":"CPT"},{"id":3631,"precertRequired":false,"billingCode":"57426","codeType":"CPT"},{"id":3632,"precertRequired":false,"billingCode":"57452","codeType":"CPT"},{"id":3633,"precertRequired":false,"billingCode":"57454","codeType":"CPT"},{"id":3634,"precertRequired":false,"billingCode":"57455","codeType":"CPT"},{"id":3635,"precertRequired":false,"billingCode":"57456","codeType":"CPT"},{"id":3636,"precertRequired":false,"billingCode":"57460","codeType":"CPT"},{"id":3637,"precertRequired":false,"billingCode":"57461","codeType":"CPT"},{"id":3638,"precertRequired":false,"billingCode":"57500","codeType":"CPT"},{"id":3639,"precertRequired":false,"billingCode":"57505","codeType":"CPT"},{"id":3640,"precertRequired":false,"billingCode":"57510","codeType":"CPT"},{"id":3641,"precertRequired":false,"billingCode":"57511","codeType":"CPT"},{"id":3642,"precertRequired":false,"billingCode":"57513","codeType":"CPT"},{"id":3643,"precertRequired":false,"billingCode":"57520","codeType":"CPT"},{"id":3644,"precertRequired":false,"billingCode":"57522","codeType":"CPT"},{"id":3645,"precertRequired":false,"billingCode":"57530","codeType":"CPT"},{"id":3646,"precertRequired":false,"billingCode":"57531","codeType":"CPT"},{"id":3647,"precertRequired":false,"billingCode":"57540","codeType":"CPT"},{"id":3648,"precertRequired":false,"billingCode":"57545","codeType":"CPT"},{"id":3649,"precertRequired":false,"billingCode":"57550","codeType":"CPT"},{"id":3650,"precertRequired":false,"billingCode":"57555","codeType":"CPT"},{"id":3651,"precertRequired":false,"billingCode":"57556","codeType":"CPT"},{"id":3652,"precertRequired":false,"billingCode":"57558","codeType":"CPT"},{"id":3653,"precertRequired":false,"billingCode":"57700","codeType":"CPT"},{"id":3654,"precertRequired":false,"billingCode":"57720","codeType":"CPT"},{"id":3655,"precertRequired":false,"billingCode":"57800","codeType":"CPT"},{"id":3656,"precertRequired":false,"billingCode":"58100","codeType":"CPT"},{"id":3657,"precertRequired":false,"billingCode":"58110","codeType":"CPT"},{"id":3658,"precertRequired":false,"billingCode":"58120","codeType":"CPT"},{"id":3659,"precertRequired":false,"billingCode":"58140","codeType":"CPT"},{"id":3660,"precertRequired":false,"billingCode":"58145","codeType":"CPT"},{"id":3661,"precertRequired":false,"billingCode":"58146","codeType":"CPT"},{"id":3662,"precertRequired":false,"billingCode":"58150","codeType":"CPT"},{"id":3663,"precertRequired":false,"billingCode":"58152","codeType":"CPT"},{"id":3664,"precertRequired":false,"billingCode":"58180","codeType":"CPT"},{"id":3665,"precertRequired":false,"billingCode":"58200","codeType":"CPT"},{"id":3666,"precertRequired":false,"billingCode":"58210","codeType":"CPT"},{"id":3667,"precertRequired":false,"billingCode":"58240","codeType":"CPT"},{"id":3668,"precertRequired":false,"billingCode":"58260","codeType":"CPT"},{"id":3669,"precertRequired":false,"billingCode":"58262","codeType":"CPT"},{"id":3670,"precertRequired":false,"billingCode":"58263","codeType":"CPT"},{"id":3671,"precertRequired":false,"billingCode":"58267","codeType":"CPT"},{"id":3672,"precertRequired":false,"billingCode":"58270","codeType":"CPT"},{"id":3673,"precertRequired":false,"billingCode":"58275","codeType":"CPT"},{"id":3674,"precertRequired":false,"billingCode":"58280","codeType":"CPT"},{"id":3675,"precertRequired":false,"billingCode":"58285","codeType":"CPT"},{"id":3676,"precertRequired":false,"billingCode":"58290","codeType":"CPT"},{"id":3677,"precertRequired":false,"billingCode":"58291","codeType":"CPT"},{"id":3678,"precertRequired":false,"billingCode":"58292","codeType":"CPT"},{"id":3679,"precertRequired":false,"billingCode":"58293","codeType":"CPT"},{"id":3680,"precertRequired":false,"billingCode":"58294","codeType":"CPT"},{"id":3681,"precertRequired":false,"billingCode":"58300","codeType":"CPT"},{"id":3682,"precertRequired":false,"billingCode":"58301","codeType":"CPT"},{"id":3686,"precertRequired":false,"billingCode":"58340","codeType":"CPT"},{"id":3687,"precertRequired":false,"billingCode":"58345","codeType":"CPT"},{"id":3688,"precertRequired":false,"billingCode":"58350","codeType":"CPT"},{"id":3689,"precertRequired":false,"billingCode":"58353","codeType":"CPT"},{"id":3690,"precertRequired":false,"billingCode":"58356","codeType":"CPT"},{"id":3691,"precertRequired":false,"billingCode":"58400","codeType":"CPT"},{"id":3692,"precertRequired":false,"billingCode":"58410","codeType":"CPT"},{"id":3693,"precertRequired":false,"billingCode":"58520","codeType":"CPT"},{"id":3694,"precertRequired":false,"billingCode":"58540","codeType":"CPT"},{"id":3695,"precertRequired":false,"billingCode":"58541","codeType":"CPT"},{"id":3696,"precertRequired":false,"billingCode":"58542","codeType":"CPT"},{"id":3697,"precertRequired":false,"billingCode":"58543","codeType":"CPT"},{"id":3698,"precertRequired":false,"billingCode":"58544","codeType":"CPT"},{"id":3699,"precertRequired":false,"billingCode":"58545","codeType":"CPT"},{"id":3700,"precertRequired":false,"billingCode":"58546","codeType":"CPT"},{"id":3701,"precertRequired":false,"billingCode":"58548","codeType":"CPT"},{"id":3702,"precertRequired":false,"billingCode":"58550","codeType":"CPT"},{"id":3703,"precertRequired":false,"billingCode":"58552","codeType":"CPT"},{"id":3704,"precertRequired":false,"billingCode":"58553","codeType":"CPT"},{"id":3705,"precertRequired":false,"billingCode":"58554","codeType":"CPT"},{"id":3706,"precertRequired":false,"billingCode":"58555","codeType":"CPT"},{"id":3707,"precertRequired":false,"billingCode":"58558","codeType":"CPT"},{"id":3708,"precertRequired":false,"billingCode":"58559","codeType":"CPT"},{"id":3709,"precertRequired":false,"billingCode":"58560","codeType":"CPT"},{"id":3710,"precertRequired":false,"billingCode":"58561","codeType":"CPT"},{"id":3711,"precertRequired":false,"billingCode":"58562","codeType":"CPT"},{"id":3712,"precertRequired":false,"billingCode":"58563","codeType":"CPT"},{"id":3713,"precertRequired":false,"billingCode":"58565","codeType":"CPT"},{"id":3714,"precertRequired":false,"billingCode":"58570","codeType":"CPT"},{"id":3715,"precertRequired":false,"billingCode":"58571","codeType":"CPT"},{"id":3716,"precertRequired":false,"billingCode":"58572","codeType":"CPT"},{"id":3717,"precertRequired":false,"billingCode":"58573","codeType":"CPT"},{"id":3718,"precertRequired":false,"billingCode":"58575","codeType":"CPT"},{"id":3721,"precertRequired":false,"billingCode":"58600","codeType":"CPT"},{"id":3722,"precertRequired":false,"billingCode":"58605","codeType":"CPT"},{"id":3723,"precertRequired":false,"billingCode":"58611","codeType":"CPT"},{"id":3724,"precertRequired":false,"billingCode":"58615","codeType":"CPT"},{"id":3725,"precertRequired":false,"billingCode":"58660","codeType":"CPT"},{"id":3726,"precertRequired":false,"billingCode":"58661","codeType":"CPT"},{"id":3727,"precertRequired":false,"billingCode":"58662","codeType":"CPT"},{"id":3728,"precertRequired":true,"billingCode":"58670","codeType":"CPT"},{"id":3729,"precertRequired":false,"billingCode":"58671","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3732,"precertRequired":false,"billingCode":"58674","codeType":"CPT"},{"id":3734,"precertRequired":false,"billingCode":"58700","codeType":"CPT"},{"id":3735,"precertRequired":false,"billingCode":"58720","codeType":"CPT"},{"id":3736,"precertRequired":false,"billingCode":"58740","codeType":"CPT"},{"id":3737,"precertRequired":false,"billingCode":"58750","codeType":"CPT"},{"id":3738,"precertRequired":false,"billingCode":"58752","codeType":"CPT"},{"id":3739,"precertRequired":false,"billingCode":"58760","codeType":"CPT"},{"id":3740,"precertRequired":false,"billingCode":"58770","codeType":"CPT"},{"id":3741,"precertRequired":false,"billingCode":"58800","codeType":"CPT"},{"id":3742,"precertRequired":false,"billingCode":"58805","codeType":"CPT"},{"id":3743,"precertRequired":false,"billingCode":"58820","codeType":"CPT"},{"id":3744,"precertRequired":false,"billingCode":"58822","codeType":"CPT"},{"id":3745,"precertRequired":false,"billingCode":"58825","codeType":"CPT"},{"id":3746,"precertRequired":false,"billingCode":"58900","codeType":"CPT"},{"id":3747,"precertRequired":false,"billingCode":"58920","codeType":"CPT"},{"id":3748,"precertRequired":false,"billingCode":"58925","codeType":"CPT"},{"id":3749,"precertRequired":false,"billingCode":"58940","codeType":"CPT"},{"id":3750,"precertRequired":false,"billingCode":"58943","codeType":"CPT"},{"id":3751,"precertRequired":false,"billingCode":"58950","codeType":"CPT"},{"id":3752,"precertRequired":false,"billingCode":"58951","codeType":"CPT"},{"id":3753,"precertRequired":false,"billingCode":"58952","codeType":"CPT"},{"id":3754,"precertRequired":false,"billingCode":"58953","codeType":"CPT"},{"id":3755,"precertRequired":false,"billingCode":"58954","codeType":"CPT"},{"id":3756,"precertRequired":false,"billingCode":"58956","codeType":"CPT"},{"id":3757,"precertRequired":false,"billingCode":"58957","codeType":"CPT"},{"id":3758,"precertRequired":false,"billingCode":"58958","codeType":"CPT"},{"id":3759,"precertRequired":false,"billingCode":"58960","codeType":"CPT"},{"id":3964,"precertRequired":false,"billingCode":"64566","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8127,"precertRequired":false,"billingCode":"G0123","codeType":"HCPCS"},{"id":8128,"precertRequired":false,"billingCode":"G0124","codeType":"HCPCS"},{"id":8133,"precertRequired":false,"billingCode":"G0141","codeType":"HCPCS"},{"id":8134,"precertRequired":false,"billingCode":"G0143","codeType":"HCPCS"},{"id":8135,"precertRequired":false,"billingCode":"G0144","codeType":"HCPCS"},{"id":8136,"precertRequired":false,"billingCode":"G0145","codeType":"HCPCS"},{"id":8137,"precertRequired":false,"billingCode":"G0147","codeType":"HCPCS"},{"id":8138,"precertRequired":false,"billingCode":"G0148","codeType":"HCPCS"},{"id":8217,"precertRequired":false,"billingCode":"G0445","codeType":"HCPCS"},{"id":8405,"precertRequired":true,"billingCode":"J1000","codeType":"HCPCS"},{"id":8406,"precertRequired":true,"billingCode":"J1020","codeType":"HCPCS"},{"id":8407,"precertRequired":true,"billingCode":"J1030","codeType":"HCPCS"},{"id":8408,"precertRequired":true,"billingCode":"J1040","codeType":"HCPCS"},{"id":8409,"precertRequired":false,"billingCode":"J1050","codeType":"HCPCS"},{"id":8534,"precertRequired":false,"billingCode":"J7296","codeType":"HCPCS"},{"id":8535,"precertRequired":false,"billingCode":"J7297","codeType":"HCPCS"},{"id":8536,"precertRequired":false,"billingCode":"J7298","codeType":"HCPCS"},{"id":8538,"precertRequired":false,"billingCode":"J7301","codeType":"HCPCS"},{"id":8539,"precertRequired":false,"billingCode":"J7303","codeType":"HCPCS"},{"id":8540,"precertRequired":false,"billingCode":"J7304","codeType":"HCPCS"},{"id":8541,"precertRequired":false,"billingCode":"J7306","codeType":"HCPCS"},{"id":8542,"precertRequired":false,"billingCode":"J7307","codeType":"HCPCS"},{"id":8933,"precertRequired":false,"billingCode":"S4981","codeType":"HCPCS"},{"id":8934,"precertRequired":false,"billingCode":"S4989","codeType":"HCPCS"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":3169,"description":"Anesthesia consultation per the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":84,"precertRequired":false,"billingCode":"00800","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":97,"precertRequired":false,"billingCode":"00846","codeType":"CPT"},{"id":99,"precertRequired":false,"billingCode":"00851","codeType":"CPT"},{"id":100,"precertRequired":false,"billingCode":"00860","codeType":"CPT"},{"id":113,"precertRequired":false,"billingCode":"00906","codeType":"CPT"},{"id":131,"precertRequired":false,"billingCode":"00940","codeType":"CPT"},{"id":132,"precertRequired":false,"billingCode":"00942","codeType":"CPT"},{"id":133,"precertRequired":false,"billingCode":"00944","codeType":"CPT"},{"id":135,"precertRequired":false,"billingCode":"00950","codeType":"CPT"},{"id":136,"precertRequired":false,"billingCode":"00952","codeType":"CPT"},{"id":217,"precertRequired":false,"billingCode":"01991","codeType":"CPT"},{"id":218,"precertRequired":false,"billingCode":"01992","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":3170,"description":"Pre-operative medical/cardiac clearance as indicated (including H+P/labs, EKG, CXR).","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":3171,"description":"Inpatient admission for surgical procedure if indicated.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":3172,"description":"Inpatient admission or observation status for complications per the referred condition indicated on the consult. ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":3173,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":3174,"description":"Follow-up imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3175,"description":"Follow-up studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":3431,"precertRequired":false,"billingCode":"51784","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4732,"precertRequired":false,"billingCode":"76801","codeType":"CPT"},{"id":4733,"precertRequired":false,"billingCode":"76802","codeType":"CPT"},{"id":4740,"precertRequired":false,"billingCode":"76815","codeType":"CPT"},{"id":4742,"precertRequired":false,"billingCode":"76817","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4781,"precertRequired":false,"billingCode":"77021","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":3176,"description":"Pelvic Floor Physical Therapy as indicated; up to three (3) visits per week x 5 weeks (15 visits); Notify VA to request additional visits with supporting medical documentation. Notify VA to request additional visits with supporting medical documentation.","frequency":null,"frequencyType":"week","visits":15,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6599,"precertRequired":false,"billingCode":"90911","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7262,"precertRequired":false,"billingCode":"97161","codeType":"CPT"},{"id":7263,"precertRequired":false,"billingCode":"97162","codeType":"CPT"},{"id":7264,"precertRequired":false,"billingCode":"97163","codeType":"CPT"},{"id":7265,"precertRequired":false,"billingCode":"97164","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7289,"precertRequired":false,"billingCode":"97750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":319,"seocKey":57,"name":"Gynecology_PRCT","seocId":"WHC_GYNECOLOGY_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"03-15-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for the referred condition indicated on the consult. Conditions include well-woman exam, contraception, no periods or infrequent periods, abnormal uterine bleeding, pelvic pain, abnormal pap smear, infertility (**Separate authorization required for IUI. IVF requires special eligibility.), pelvic relaxation/prolapse, incontinence, and menopause\r\n2.  Diagnostic imaging relevant to the referred condition indicated on the consult\r\n3.  Diagnostic studies relevant to the referred condition indicated on the consult\r\n4.  Labs and pathology relevant to the referred condition indicated on the consult\r\n5.  Procedures including but not limited to: Colposcopy, LEEP, cervical surgery and cryotherapy, hysteroscopy diagnostic and operative, laparoscopy diagnostic and operative, hysterectomy vaginal, abdominal, laparoscopic and robotic, vaginal surgery, tubal ligation, ovarian cystectomy, salpingectomy, salpingectomy with oophorectomy\r\n6.  Anesthesia consultation per the referred condition indicated on the consult\r\n7.  Pre-operative medical/cardiac clearance as indicated (including H+P/labs, EKG, CXR). \r\n8.  Inpatient admission for surgical procedure if indicated.\r\n9. Inpatient admission or observation status for complications per the referred condition indicated on the consult\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery\r\n10. Follow-up visits for this episode of care \r\n11. Follow-up imaging relevant to the referred condition on the consult\r\n12. Follow-up studies relevant to the referred condition on the consult\r\n13. Pelvic Floor Physical Therapy as indicated; up to three (3) visits per week x 5 weeks (15 visits); Notify VA to request additional visits with supporting medical documentation ","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n**Separate authorization required for IUI. IVF requires special eligibility.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"GYNECOLOGY","serviceLine":"Womens Health Care","hptcs":[{"hptc":"207V00000X"},{"hptc":"363LW0102X"},{"hptc":"363LX0001X"}],"services":[{"id":1566,"description":" Initial outpatient evaluation and treatment for the referred condition indicated on the consult. Conditions include well-woman exam, contraception, no periods or infrequent periods, abnormal uterine bleeding, pelvic pain, abnormal pap smear, infertility (**Separate authorization required for IUI. IVF requires special eligibility.), pelvic relaxation/prolapse, incontinence, and menopause","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7445,"precertRequired":false,"billingCode":"99385","codeType":"CPT"},{"id":7446,"precertRequired":false,"billingCode":"99386","codeType":"CPT"},{"id":7447,"precertRequired":false,"billingCode":"99387","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":7453,"precertRequired":false,"billingCode":"99396","codeType":"CPT"},{"id":7454,"precertRequired":false,"billingCode":"99397","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8217,"precertRequired":false,"billingCode":"G0445","codeType":"HCPCS"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1567,"description":"Diagnostic imaging relevant to the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4734,"precertRequired":false,"billingCode":"76805","codeType":"CPT"},{"id":4736,"precertRequired":false,"billingCode":"76811","codeType":"CPT"},{"id":4741,"precertRequired":false,"billingCode":"76816","codeType":"CPT"},{"id":4744,"precertRequired":false,"billingCode":"76819","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1568,"description":"Diagnostic studies relevant to the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":3431,"precertRequired":false,"billingCode":"51784","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4732,"precertRequired":false,"billingCode":"76801","codeType":"CPT"},{"id":4733,"precertRequired":false,"billingCode":"76802","codeType":"CPT"},{"id":4734,"precertRequired":false,"billingCode":"76805","codeType":"CPT"},{"id":4740,"precertRequired":false,"billingCode":"76815","codeType":"CPT"},{"id":4742,"precertRequired":false,"billingCode":"76817","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4781,"precertRequired":false,"billingCode":"77021","codeType":"CPT"},{"id":6635,"precertRequired":false,"billingCode":"91122","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1569,"description":"Labs and pathology relevant to the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5011,"precertRequired":false,"billingCode":"80055","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5016,"precertRequired":false,"billingCode":"80081","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5127,"precertRequired":false,"billingCode":"80418","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5418,"precertRequired":false,"billingCode":"82306","codeType":"CPT"},{"id":5440,"precertRequired":false,"billingCode":"82397","codeType":"CPT"},{"id":5474,"precertRequired":false,"billingCode":"82627","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5485,"precertRequired":false,"billingCode":"82671","codeType":"CPT"},{"id":5486,"precertRequired":false,"billingCode":"82672","codeType":"CPT"},{"id":5487,"precertRequired":false,"billingCode":"82677","codeType":"CPT"},{"id":5488,"precertRequired":false,"billingCode":"82679","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5523,"precertRequired":false,"billingCode":"82950","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5573,"precertRequired":false,"billingCode":"83520","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5666,"precertRequired":false,"billingCode":"84146","codeType":"CPT"},{"id":5687,"precertRequired":false,"billingCode":"84233","codeType":"CPT"},{"id":5688,"precertRequired":false,"billingCode":"84234","codeType":"CPT"},{"id":5712,"precertRequired":false,"billingCode":"84403","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5763,"precertRequired":false,"billingCode":"84830","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5954,"precertRequired":false,"billingCode":"86592","codeType":"CPT"},{"id":5955,"precertRequired":false,"billingCode":"86593","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6065,"precertRequired":false,"billingCode":"86850","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6075,"precertRequired":false,"billingCode":"86901","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6156,"precertRequired":false,"billingCode":"87210","codeType":"CPT"},{"id":6168,"precertRequired":false,"billingCode":"87270","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6186,"precertRequired":false,"billingCode":"87320","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6217,"precertRequired":false,"billingCode":"87480","codeType":"CPT"},{"id":6218,"precertRequired":false,"billingCode":"87481","codeType":"CPT"},{"id":6224,"precertRequired":false,"billingCode":"87490","codeType":"CPT"},{"id":6225,"precertRequired":false,"billingCode":"87491","codeType":"CPT"},{"id":6226,"precertRequired":false,"billingCode":"87492","codeType":"CPT"},{"id":6239,"precertRequired":false,"billingCode":"87510","codeType":"CPT"},{"id":6277,"precertRequired":false,"billingCode":"87590","codeType":"CPT"},{"id":6278,"precertRequired":false,"billingCode":"87591","codeType":"CPT"},{"id":6279,"precertRequired":false,"billingCode":"87592","codeType":"CPT"},{"id":6280,"precertRequired":false,"billingCode":"87623","codeType":"CPT"},{"id":6281,"precertRequired":false,"billingCode":"87624","codeType":"CPT"},{"id":6282,"precertRequired":false,"billingCode":"87625","codeType":"CPT"},{"id":6293,"precertRequired":false,"billingCode":"87660","codeType":"CPT"},{"id":6294,"precertRequired":false,"billingCode":"87661","codeType":"CPT"},{"id":6308,"precertRequired":false,"billingCode":"87810","codeType":"CPT"},{"id":6309,"precertRequired":false,"billingCode":"87850","codeType":"CPT"},{"id":6340,"precertRequired":false,"billingCode":"88108","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6347,"precertRequired":false,"billingCode":"88141","codeType":"CPT"},{"id":6348,"precertRequired":false,"billingCode":"88142","codeType":"CPT"},{"id":6349,"precertRequired":false,"billingCode":"88143","codeType":"CPT"},{"id":6350,"precertRequired":false,"billingCode":"88147","codeType":"CPT"},{"id":6351,"precertRequired":false,"billingCode":"88148","codeType":"CPT"},{"id":6352,"precertRequired":false,"billingCode":"88150","codeType":"CPT"},{"id":6353,"precertRequired":false,"billingCode":"88152","codeType":"CPT"},{"id":6354,"precertRequired":false,"billingCode":"88153","codeType":"CPT"},{"id":6355,"precertRequired":false,"billingCode":"88155","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6357,"precertRequired":false,"billingCode":"88161","codeType":"CPT"},{"id":6358,"precertRequired":false,"billingCode":"88162","codeType":"CPT"},{"id":6359,"precertRequired":false,"billingCode":"88164","codeType":"CPT"},{"id":6360,"precertRequired":false,"billingCode":"88165","codeType":"CPT"},{"id":6361,"precertRequired":false,"billingCode":"88166","codeType":"CPT"},{"id":6362,"precertRequired":false,"billingCode":"88167","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6365,"precertRequired":false,"billingCode":"88174","codeType":"CPT"},{"id":6366,"precertRequired":false,"billingCode":"88175","codeType":"CPT"},{"id":6367,"precertRequired":false,"billingCode":"88177","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6413,"precertRequired":false,"billingCode":"88321","codeType":"CPT"},{"id":6421,"precertRequired":false,"billingCode":"88341","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6430,"precertRequired":false,"billingCode":"88360","codeType":"CPT"},{"id":6431,"precertRequired":false,"billingCode":"88361","codeType":"CPT"},{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"},{"id":8721,"precertRequired":false,"billingCode":"P3000","codeType":"HCPCS"},{"id":8722,"precertRequired":false,"billingCode":"P3001","codeType":"HCPCS"},{"id":8769,"precertRequired":false,"billingCode":"Q0091","codeType":"HCPCS"},{"id":8770,"precertRequired":false,"billingCode":"Q0111","codeType":"HCPCS"},{"id":8771,"precertRequired":false,"billingCode":"Q0112","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1570,"description":"Procedures including but not limited to: Colposcopy, LEEP, cervical surgery and cryotherapy, hysteroscopy diagnostic and operative, laparoscopy diagnostic and operative, hysterectomy vaginal, abdominal, laparoscopic and robotic, vaginal surgery, tubal ligation, ovarian cystectomy, salpingectomy, salpingectomy with oophorectomy","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":332,"precertRequired":false,"billingCode":"11976","codeType":"CPT"},{"id":333,"precertRequired":false,"billingCode":"11980","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":378,"precertRequired":false,"billingCode":"13132","codeType":"CPT"},{"id":379,"precertRequired":false,"billingCode":"13133","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":3347,"precertRequired":false,"billingCode":"49320","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3417,"precertRequired":false,"billingCode":"51701","codeType":"CPT"},{"id":3424,"precertRequired":false,"billingCode":"51725","codeType":"CPT"},{"id":3425,"precertRequired":false,"billingCode":"51726","codeType":"CPT"},{"id":3426,"precertRequired":false,"billingCode":"51727","codeType":"CPT"},{"id":3427,"precertRequired":false,"billingCode":"51728","codeType":"CPT"},{"id":3428,"precertRequired":false,"billingCode":"51729","codeType":"CPT"},{"id":3429,"precertRequired":false,"billingCode":"51736","codeType":"CPT"},{"id":3430,"precertRequired":false,"billingCode":"51741","codeType":"CPT"},{"id":3434,"precertRequired":false,"billingCode":"51797","codeType":"CPT"},{"id":3435,"precertRequired":false,"billingCode":"51798","codeType":"CPT"},{"id":3550,"precertRequired":false,"billingCode":"56405","codeType":"CPT"},{"id":3551,"precertRequired":false,"billingCode":"56420","codeType":"CPT"},{"id":3552,"precertRequired":false,"billingCode":"56440","codeType":"CPT"},{"id":3553,"precertRequired":false,"billingCode":"56441","codeType":"CPT"},{"id":3554,"precertRequired":false,"billingCode":"56442","codeType":"CPT"},{"id":3555,"precertRequired":false,"billingCode":"56501","codeType":"CPT"},{"id":3556,"precertRequired":false,"billingCode":"56515","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":3559,"precertRequired":false,"billingCode":"56620","codeType":"CPT"},{"id":3560,"precertRequired":false,"billingCode":"56625","codeType":"CPT"},{"id":3561,"precertRequired":false,"billingCode":"56630","codeType":"CPT"},{"id":3562,"precertRequired":false,"billingCode":"56631","codeType":"CPT"},{"id":3563,"precertRequired":false,"billingCode":"56632","codeType":"CPT"},{"id":3564,"precertRequired":false,"billingCode":"56633","codeType":"CPT"},{"id":3565,"precertRequired":false,"billingCode":"56634","codeType":"CPT"},{"id":3566,"precertRequired":false,"billingCode":"56637","codeType":"CPT"},{"id":3567,"precertRequired":false,"billingCode":"56640","codeType":"CPT"},{"id":3568,"precertRequired":false,"billingCode":"56700","codeType":"CPT"},{"id":3569,"precertRequired":false,"billingCode":"56740","codeType":"CPT"},{"id":3570,"precertRequired":false,"billingCode":"56800","codeType":"CPT"},{"id":3571,"precertRequired":false,"billingCode":"56810","codeType":"CPT"},{"id":3572,"precertRequired":false,"billingCode":"56820","codeType":"CPT"},{"id":3573,"precertRequired":false,"billingCode":"56821","codeType":"CPT"},{"id":3574,"precertRequired":false,"billingCode":"57000","codeType":"CPT"},{"id":3575,"precertRequired":false,"billingCode":"57010","codeType":"CPT"},{"id":3576,"precertRequired":false,"billingCode":"57020","codeType":"CPT"},{"id":3578,"precertRequired":false,"billingCode":"57023","codeType":"CPT"},{"id":3579,"precertRequired":false,"billingCode":"57061","codeType":"CPT"},{"id":3580,"precertRequired":false,"billingCode":"57065","codeType":"CPT"},{"id":3581,"precertRequired":false,"billingCode":"57100","codeType":"CPT"},{"id":3582,"precertRequired":false,"billingCode":"57105","codeType":"CPT"},{"id":3583,"precertRequired":false,"billingCode":"57106","codeType":"CPT"},{"id":3584,"precertRequired":false,"billingCode":"57107","codeType":"CPT"},{"id":3585,"precertRequired":false,"billingCode":"57109","codeType":"CPT"},{"id":3586,"precertRequired":false,"billingCode":"57110","codeType":"CPT"},{"id":3587,"precertRequired":false,"billingCode":"57111","codeType":"CPT"},{"id":3588,"precertRequired":false,"billingCode":"57112","codeType":"CPT"},{"id":3589,"precertRequired":false,"billingCode":"57120","codeType":"CPT"},{"id":3590,"precertRequired":false,"billingCode":"57130","codeType":"CPT"},{"id":3591,"precertRequired":false,"billingCode":"57135","codeType":"CPT"},{"id":3592,"precertRequired":false,"billingCode":"57150","codeType":"CPT"},{"id":3593,"precertRequired":false,"billingCode":"57155","codeType":"CPT"},{"id":3594,"precertRequired":false,"billingCode":"57156","codeType":"CPT"},{"id":3595,"precertRequired":false,"billingCode":"57160","codeType":"CPT"},{"id":3596,"precertRequired":false,"billingCode":"57170","codeType":"CPT"},{"id":3597,"precertRequired":false,"billingCode":"57180","codeType":"CPT"},{"id":3598,"precertRequired":false,"billingCode":"57200","codeType":"CPT"},{"id":3599,"precertRequired":false,"billingCode":"57210","codeType":"CPT"},{"id":3600,"precertRequired":false,"billingCode":"57220","codeType":"CPT"},{"id":3601,"precertRequired":false,"billingCode":"57230","codeType":"CPT"},{"id":3602,"precertRequired":false,"billingCode":"57240","codeType":"CPT"},{"id":3603,"precertRequired":false,"billingCode":"57250","codeType":"CPT"},{"id":3604,"precertRequired":false,"billingCode":"57260","codeType":"CPT"},{"id":3605,"precertRequired":false,"billingCode":"57265","codeType":"CPT"},{"id":3606,"precertRequired":false,"billingCode":"57267","codeType":"CPT"},{"id":3607,"precertRequired":false,"billingCode":"57268","codeType":"CPT"},{"id":3608,"precertRequired":false,"billingCode":"57270","codeType":"CPT"},{"id":3609,"precertRequired":false,"billingCode":"57280","codeType":"CPT"},{"id":3610,"precertRequired":false,"billingCode":"57282","codeType":"CPT"},{"id":3611,"precertRequired":false,"billingCode":"57283","codeType":"CPT"},{"id":3612,"precertRequired":false,"billingCode":"57284","codeType":"CPT"},{"id":3613,"precertRequired":false,"billingCode":"57285","codeType":"CPT"},{"id":3615,"precertRequired":false,"billingCode":"57288","codeType":"CPT"},{"id":3616,"precertRequired":false,"billingCode":"57300","codeType":"CPT"},{"id":3617,"precertRequired":false,"billingCode":"57305","codeType":"CPT"},{"id":3618,"precertRequired":false,"billingCode":"57307","codeType":"CPT"},{"id":3619,"precertRequired":false,"billingCode":"57308","codeType":"CPT"},{"id":3620,"precertRequired":false,"billingCode":"57310","codeType":"CPT"},{"id":3621,"precertRequired":false,"billingCode":"57311","codeType":"CPT"},{"id":3622,"precertRequired":false,"billingCode":"57320","codeType":"CPT"},{"id":3623,"precertRequired":false,"billingCode":"57330","codeType":"CPT"},{"id":3624,"precertRequired":false,"billingCode":"57400","codeType":"CPT"},{"id":3625,"precertRequired":false,"billingCode":"57410","codeType":"CPT"},{"id":3626,"precertRequired":false,"billingCode":"57415","codeType":"CPT"},{"id":3627,"precertRequired":false,"billingCode":"57420","codeType":"CPT"},{"id":3628,"precertRequired":false,"billingCode":"57421","codeType":"CPT"},{"id":3629,"precertRequired":false,"billingCode":"57423","codeType":"CPT"},{"id":3630,"precertRequired":false,"billingCode":"57425","codeType":"CPT"},{"id":3631,"precertRequired":false,"billingCode":"57426","codeType":"CPT"},{"id":3632,"precertRequired":false,"billingCode":"57452","codeType":"CPT"},{"id":3633,"precertRequired":false,"billingCode":"57454","codeType":"CPT"},{"id":3634,"precertRequired":false,"billingCode":"57455","codeType":"CPT"},{"id":3635,"precertRequired":false,"billingCode":"57456","codeType":"CPT"},{"id":3636,"precertRequired":false,"billingCode":"57460","codeType":"CPT"},{"id":3637,"precertRequired":false,"billingCode":"57461","codeType":"CPT"},{"id":3638,"precertRequired":false,"billingCode":"57500","codeType":"CPT"},{"id":3639,"precertRequired":false,"billingCode":"57505","codeType":"CPT"},{"id":3640,"precertRequired":false,"billingCode":"57510","codeType":"CPT"},{"id":3641,"precertRequired":false,"billingCode":"57511","codeType":"CPT"},{"id":3642,"precertRequired":false,"billingCode":"57513","codeType":"CPT"},{"id":3643,"precertRequired":false,"billingCode":"57520","codeType":"CPT"},{"id":3644,"precertRequired":false,"billingCode":"57522","codeType":"CPT"},{"id":3645,"precertRequired":false,"billingCode":"57530","codeType":"CPT"},{"id":3646,"precertRequired":false,"billingCode":"57531","codeType":"CPT"},{"id":3647,"precertRequired":false,"billingCode":"57540","codeType":"CPT"},{"id":3648,"precertRequired":false,"billingCode":"57545","codeType":"CPT"},{"id":3649,"precertRequired":false,"billingCode":"57550","codeType":"CPT"},{"id":3650,"precertRequired":false,"billingCode":"57555","codeType":"CPT"},{"id":3651,"precertRequired":false,"billingCode":"57556","codeType":"CPT"},{"id":3652,"precertRequired":false,"billingCode":"57558","codeType":"CPT"},{"id":3653,"precertRequired":false,"billingCode":"57700","codeType":"CPT"},{"id":3654,"precertRequired":false,"billingCode":"57720","codeType":"CPT"},{"id":3655,"precertRequired":false,"billingCode":"57800","codeType":"CPT"},{"id":3656,"precertRequired":false,"billingCode":"58100","codeType":"CPT"},{"id":3657,"precertRequired":false,"billingCode":"58110","codeType":"CPT"},{"id":3658,"precertRequired":false,"billingCode":"58120","codeType":"CPT"},{"id":3659,"precertRequired":false,"billingCode":"58140","codeType":"CPT"},{"id":3660,"precertRequired":false,"billingCode":"58145","codeType":"CPT"},{"id":3661,"precertRequired":false,"billingCode":"58146","codeType":"CPT"},{"id":3662,"precertRequired":false,"billingCode":"58150","codeType":"CPT"},{"id":3663,"precertRequired":false,"billingCode":"58152","codeType":"CPT"},{"id":3664,"precertRequired":false,"billingCode":"58180","codeType":"CPT"},{"id":3665,"precertRequired":false,"billingCode":"58200","codeType":"CPT"},{"id":3666,"precertRequired":false,"billingCode":"58210","codeType":"CPT"},{"id":3667,"precertRequired":false,"billingCode":"58240","codeType":"CPT"},{"id":3668,"precertRequired":false,"billingCode":"58260","codeType":"CPT"},{"id":3669,"precertRequired":false,"billingCode":"58262","codeType":"CPT"},{"id":3670,"precertRequired":false,"billingCode":"58263","codeType":"CPT"},{"id":3671,"precertRequired":false,"billingCode":"58267","codeType":"CPT"},{"id":3672,"precertRequired":false,"billingCode":"58270","codeType":"CPT"},{"id":3673,"precertRequired":false,"billingCode":"58275","codeType":"CPT"},{"id":3674,"precertRequired":false,"billingCode":"58280","codeType":"CPT"},{"id":3675,"precertRequired":false,"billingCode":"58285","codeType":"CPT"},{"id":3676,"precertRequired":false,"billingCode":"58290","codeType":"CPT"},{"id":3677,"precertRequired":false,"billingCode":"58291","codeType":"CPT"},{"id":3678,"precertRequired":false,"billingCode":"58292","codeType":"CPT"},{"id":3679,"precertRequired":false,"billingCode":"58293","codeType":"CPT"},{"id":3680,"precertRequired":false,"billingCode":"58294","codeType":"CPT"},{"id":3681,"precertRequired":false,"billingCode":"58300","codeType":"CPT"},{"id":3682,"precertRequired":false,"billingCode":"58301","codeType":"CPT"},{"id":3686,"precertRequired":false,"billingCode":"58340","codeType":"CPT"},{"id":3687,"precertRequired":false,"billingCode":"58345","codeType":"CPT"},{"id":3688,"precertRequired":false,"billingCode":"58350","codeType":"CPT"},{"id":3689,"precertRequired":false,"billingCode":"58353","codeType":"CPT"},{"id":3690,"precertRequired":false,"billingCode":"58356","codeType":"CPT"},{"id":3691,"precertRequired":false,"billingCode":"58400","codeType":"CPT"},{"id":3692,"precertRequired":false,"billingCode":"58410","codeType":"CPT"},{"id":3693,"precertRequired":false,"billingCode":"58520","codeType":"CPT"},{"id":3694,"precertRequired":false,"billingCode":"58540","codeType":"CPT"},{"id":3695,"precertRequired":false,"billingCode":"58541","codeType":"CPT"},{"id":3696,"precertRequired":false,"billingCode":"58542","codeType":"CPT"},{"id":3697,"precertRequired":false,"billingCode":"58543","codeType":"CPT"},{"id":3698,"precertRequired":false,"billingCode":"58544","codeType":"CPT"},{"id":3699,"precertRequired":false,"billingCode":"58545","codeType":"CPT"},{"id":3700,"precertRequired":false,"billingCode":"58546","codeType":"CPT"},{"id":3701,"precertRequired":false,"billingCode":"58548","codeType":"CPT"},{"id":3702,"precertRequired":false,"billingCode":"58550","codeType":"CPT"},{"id":3703,"precertRequired":false,"billingCode":"58552","codeType":"CPT"},{"id":3704,"precertRequired":false,"billingCode":"58553","codeType":"CPT"},{"id":3705,"precertRequired":false,"billingCode":"58554","codeType":"CPT"},{"id":3706,"precertRequired":false,"billingCode":"58555","codeType":"CPT"},{"id":3707,"precertRequired":false,"billingCode":"58558","codeType":"CPT"},{"id":3708,"precertRequired":false,"billingCode":"58559","codeType":"CPT"},{"id":3709,"precertRequired":false,"billingCode":"58560","codeType":"CPT"},{"id":3710,"precertRequired":false,"billingCode":"58561","codeType":"CPT"},{"id":3711,"precertRequired":false,"billingCode":"58562","codeType":"CPT"},{"id":3712,"precertRequired":false,"billingCode":"58563","codeType":"CPT"},{"id":3713,"precertRequired":false,"billingCode":"58565","codeType":"CPT"},{"id":3714,"precertRequired":false,"billingCode":"58570","codeType":"CPT"},{"id":3715,"precertRequired":false,"billingCode":"58571","codeType":"CPT"},{"id":3716,"precertRequired":false,"billingCode":"58572","codeType":"CPT"},{"id":3717,"precertRequired":false,"billingCode":"58573","codeType":"CPT"},{"id":3718,"precertRequired":false,"billingCode":"58575","codeType":"CPT"},{"id":3721,"precertRequired":false,"billingCode":"58600","codeType":"CPT"},{"id":3722,"precertRequired":false,"billingCode":"58605","codeType":"CPT"},{"id":3723,"precertRequired":false,"billingCode":"58611","codeType":"CPT"},{"id":3724,"precertRequired":false,"billingCode":"58615","codeType":"CPT"},{"id":3725,"precertRequired":false,"billingCode":"58660","codeType":"CPT"},{"id":3726,"precertRequired":false,"billingCode":"58661","codeType":"CPT"},{"id":3727,"precertRequired":false,"billingCode":"58662","codeType":"CPT"},{"id":3728,"precertRequired":true,"billingCode":"58670","codeType":"CPT"},{"id":3729,"precertRequired":false,"billingCode":"58671","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3732,"precertRequired":false,"billingCode":"58674","codeType":"CPT"},{"id":3734,"precertRequired":false,"billingCode":"58700","codeType":"CPT"},{"id":3735,"precertRequired":false,"billingCode":"58720","codeType":"CPT"},{"id":3736,"precertRequired":false,"billingCode":"58740","codeType":"CPT"},{"id":3737,"precertRequired":false,"billingCode":"58750","codeType":"CPT"},{"id":3738,"precertRequired":false,"billingCode":"58752","codeType":"CPT"},{"id":3739,"precertRequired":false,"billingCode":"58760","codeType":"CPT"},{"id":3740,"precertRequired":false,"billingCode":"58770","codeType":"CPT"},{"id":3741,"precertRequired":false,"billingCode":"58800","codeType":"CPT"},{"id":3742,"precertRequired":false,"billingCode":"58805","codeType":"CPT"},{"id":3743,"precertRequired":false,"billingCode":"58820","codeType":"CPT"},{"id":3744,"precertRequired":false,"billingCode":"58822","codeType":"CPT"},{"id":3745,"precertRequired":false,"billingCode":"58825","codeType":"CPT"},{"id":3746,"precertRequired":false,"billingCode":"58900","codeType":"CPT"},{"id":3747,"precertRequired":false,"billingCode":"58920","codeType":"CPT"},{"id":3748,"precertRequired":false,"billingCode":"58925","codeType":"CPT"},{"id":3749,"precertRequired":false,"billingCode":"58940","codeType":"CPT"},{"id":3750,"precertRequired":false,"billingCode":"58943","codeType":"CPT"},{"id":3751,"precertRequired":false,"billingCode":"58950","codeType":"CPT"},{"id":3752,"precertRequired":false,"billingCode":"58951","codeType":"CPT"},{"id":3753,"precertRequired":false,"billingCode":"58952","codeType":"CPT"},{"id":3754,"precertRequired":false,"billingCode":"58953","codeType":"CPT"},{"id":3755,"precertRequired":false,"billingCode":"58954","codeType":"CPT"},{"id":3756,"precertRequired":false,"billingCode":"58956","codeType":"CPT"},{"id":3757,"precertRequired":false,"billingCode":"58957","codeType":"CPT"},{"id":3758,"precertRequired":false,"billingCode":"58958","codeType":"CPT"},{"id":3759,"precertRequired":false,"billingCode":"58960","codeType":"CPT"},{"id":3964,"precertRequired":false,"billingCode":"64566","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8127,"precertRequired":false,"billingCode":"G0123","codeType":"HCPCS"},{"id":8128,"precertRequired":false,"billingCode":"G0124","codeType":"HCPCS"},{"id":8133,"precertRequired":false,"billingCode":"G0141","codeType":"HCPCS"},{"id":8134,"precertRequired":false,"billingCode":"G0143","codeType":"HCPCS"},{"id":8135,"precertRequired":false,"billingCode":"G0144","codeType":"HCPCS"},{"id":8136,"precertRequired":false,"billingCode":"G0145","codeType":"HCPCS"},{"id":8137,"precertRequired":false,"billingCode":"G0147","codeType":"HCPCS"},{"id":8138,"precertRequired":false,"billingCode":"G0148","codeType":"HCPCS"},{"id":8217,"precertRequired":false,"billingCode":"G0445","codeType":"HCPCS"},{"id":8405,"precertRequired":true,"billingCode":"J1000","codeType":"HCPCS"},{"id":8406,"precertRequired":true,"billingCode":"J1020","codeType":"HCPCS"},{"id":8407,"precertRequired":true,"billingCode":"J1030","codeType":"HCPCS"},{"id":8408,"precertRequired":true,"billingCode":"J1040","codeType":"HCPCS"},{"id":8409,"precertRequired":false,"billingCode":"J1050","codeType":"HCPCS"},{"id":8534,"precertRequired":false,"billingCode":"J7296","codeType":"HCPCS"},{"id":8535,"precertRequired":false,"billingCode":"J7297","codeType":"HCPCS"},{"id":8536,"precertRequired":false,"billingCode":"J7298","codeType":"HCPCS"},{"id":8538,"precertRequired":false,"billingCode":"J7301","codeType":"HCPCS"},{"id":8539,"precertRequired":false,"billingCode":"J7303","codeType":"HCPCS"},{"id":8540,"precertRequired":false,"billingCode":"J7304","codeType":"HCPCS"},{"id":8541,"precertRequired":false,"billingCode":"J7306","codeType":"HCPCS"},{"id":8542,"precertRequired":false,"billingCode":"J7307","codeType":"HCPCS"},{"id":8933,"precertRequired":false,"billingCode":"S4981","codeType":"HCPCS"},{"id":8934,"precertRequired":false,"billingCode":"S4989","codeType":"HCPCS"},{"id":9162,"precertRequired":true,"billingCode":"11102","codeType":"CPT"},{"id":9163,"precertRequired":true,"billingCode":"11103","codeType":"CPT"},{"id":9164,"precertRequired":true,"billingCode":"11104","codeType":"CPT"},{"id":9165,"precertRequired":true,"billingCode":"11105","codeType":"CPT"},{"id":9166,"precertRequired":true,"billingCode":"11106","codeType":"CPT"},{"id":9167,"precertRequired":true,"billingCode":"11107","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1571,"description":"Anesthesia consultation per the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":84,"precertRequired":false,"billingCode":"00800","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":97,"precertRequired":false,"billingCode":"00846","codeType":"CPT"},{"id":99,"precertRequired":false,"billingCode":"00851","codeType":"CPT"},{"id":100,"precertRequired":false,"billingCode":"00860","codeType":"CPT"},{"id":113,"precertRequired":false,"billingCode":"00906","codeType":"CPT"},{"id":131,"precertRequired":false,"billingCode":"00940","codeType":"CPT"},{"id":132,"precertRequired":false,"billingCode":"00942","codeType":"CPT"},{"id":133,"precertRequired":false,"billingCode":"00944","codeType":"CPT"},{"id":135,"precertRequired":false,"billingCode":"00950","codeType":"CPT"},{"id":136,"precertRequired":false,"billingCode":"00952","codeType":"CPT"},{"id":217,"precertRequired":false,"billingCode":"01991","codeType":"CPT"},{"id":218,"precertRequired":false,"billingCode":"01992","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1572,"description":"Pre-operative medical/cardiac clearance as indicated (including H+P/labs, EKG, CXR). ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1573,"description":"Inpatient admission for surgical procedure if indicated.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1574,"description":" Inpatient admission or observation status for complications per the referred condition indicated on the consult. ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1575,"description":"Follow-up visits for this episode of care ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1576,"description":"Follow-up imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4791,"precertRequired":false,"billingCode":"77067","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1577,"description":"Follow-up studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":3431,"precertRequired":false,"billingCode":"51784","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4732,"precertRequired":false,"billingCode":"76801","codeType":"CPT"},{"id":4733,"precertRequired":false,"billingCode":"76802","codeType":"CPT"},{"id":4740,"precertRequired":false,"billingCode":"76815","codeType":"CPT"},{"id":4742,"precertRequired":false,"billingCode":"76817","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4781,"precertRequired":false,"billingCode":"77021","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1578,"description":"Pelvic Floor Physical Therapy as indicated; up to three (3) visits per week x 5 weeks (15 visits); Notify VA to request additional visits with supporting medical documentation. Notify VA to request additional visits with supporting medical documentation.  ","frequency":null,"frequencyType":"week","visits":15,"codeRequired":"YES","clinicalServices":[{"clinicalService":"65-Physical therapist"}],"billingCodes":[{"id":6599,"precertRequired":false,"billingCode":"90911","codeType":"CPT"},{"id":7246,"precertRequired":false,"billingCode":"97032","codeType":"CPT"},{"id":7252,"precertRequired":false,"billingCode":"97110","codeType":"CPT"},{"id":7253,"precertRequired":false,"billingCode":"97112","codeType":"CPT"},{"id":7262,"precertRequired":false,"billingCode":"97161","codeType":"CPT"},{"id":7263,"precertRequired":false,"billingCode":"97162","codeType":"CPT"},{"id":7264,"precertRequired":false,"billingCode":"97163","codeType":"CPT"},{"id":7265,"precertRequired":false,"billingCode":"97164","codeType":"CPT"},{"id":7274,"precertRequired":false,"billingCode":"97530","codeType":"CPT"},{"id":7289,"precertRequired":false,"billingCode":"97750","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2251E1200X"},{"HPTC":"2251E1300X"},{"HPTC":"2251H1300X"},{"HPTC":"2251P0200X"},{"HPTC":"2251H1200X"},{"HPTC":"2251S0007X"},{"HPTC":"2251X0800X"},{"HPTC":"225100000X"},{"HPTC":"2251C2600X"},{"HPTC":"2251N0400X"},{"HPTC":"2251G0304X"}]}]}},{"Seoc":{"id":276,"seocKey":57,"name":"Gynecology_PRCT","seocId":"WHC_GYNECOLOGY_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"01-03-2019","endDate":"03-15-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult. Conditions include contraception, no periods or infrequent periods, abnormal uterine bleeding, pelvic pain, abnormal pap smear, infertility, pelvic relaxation/prolapse, incontinence, and menopause\r\n2. Diagnostic imaging relevant to the referred condition indicated on the consult\r\n3. Diagnostic studies relevant to the referred condition indicated on the consult\r\n4. Labs and pathology relevant to the referred condition indicated on the consult\r\n5. Procedures to include: Colposcopy, LEEP, cervical surgery and cryotherapy, hysteroscopy diagnostic and operative, uterine ablation, uterine artery embolization*, laparoscopy diagnostic and operative, hysterectomy vaginal, abdominal, laparoscopic and robotic, vaginal surgery, tubal ligation, ovarian cystectomy, salpingectomy, salpingectomy with oophorectomy\r\n6. Anesthesia consultation per the referred condition indicated on the consult\r\n7. Pre-operative medical/cardiac clearance as indicated (including H+P/labs, EKG, CXR). May be completed at VA if primary care provider is assigned and available\r\n8. Inpatient admission for surgical procedure if indicated\r\n9. Inpatient admission or observation status for complications per the referred condition indicated on the consult\r\n** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n10. Follow-up visits for this episode of care\r\n11. Follow-up imaging relevant to the referred condition on the consult\r\n12. Follow-up studies relevant to the referred condition on the consult","maxAllowableVisits":null,"disclaimer":"*Gynecologist may co-manage after the procedure as an inpatient\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n** Visits for ancillary services are not included in the frequency total.  The number of visits authorized for ancillary services are noted within its service line description above.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"GYNECOLOGY","serviceLine":"Womens Health Care","hptcs":[{"hptc":"207V00000X"},{"hptc":"363LW0102X"},{"hptc":"363LX0001X"}],"services":[{"id":1139,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult. Conditions include contraception, no periods or infrequent periods, abnormal uterine bleeding, pelvic pain, abnormal pap smear, infertility, pelvic relaxation/prolapse, incontinence, and menopause","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"},{"id":7445,"precertRequired":false,"billingCode":"99385","codeType":"CPT"},{"id":7446,"precertRequired":false,"billingCode":"99386","codeType":"CPT"},{"id":7447,"precertRequired":false,"billingCode":"99387","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":7453,"precertRequired":false,"billingCode":"99396","codeType":"CPT"},{"id":7454,"precertRequired":false,"billingCode":"99397","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":7662,"precertRequired":false,"billingCode":"4159F","codeType":"CPT"},{"id":7663,"precertRequired":false,"billingCode":"4340F","codeType":"CPT"},{"id":7687,"precertRequired":false,"billingCode":"A4261","codeType":"HCPCS"},{"id":7688,"precertRequired":false,"billingCode":"A4264","codeType":"HCPCS"},{"id":7690,"precertRequired":false,"billingCode":"A4267","codeType":"HCPCS"},{"id":7691,"precertRequired":false,"billingCode":"A4268","codeType":"HCPCS"},{"id":7692,"precertRequired":false,"billingCode":"A4269","codeType":"HCPCS"},{"id":8405,"precertRequired":true,"billingCode":"J1000","codeType":"HCPCS"},{"id":8406,"precertRequired":true,"billingCode":"J1020","codeType":"HCPCS"},{"id":8407,"precertRequired":true,"billingCode":"J1030","codeType":"HCPCS"},{"id":8408,"precertRequired":true,"billingCode":"J1040","codeType":"HCPCS"},{"id":8409,"precertRequired":false,"billingCode":"J1050","codeType":"HCPCS"},{"id":8534,"precertRequired":false,"billingCode":"J7296","codeType":"HCPCS"},{"id":8535,"precertRequired":false,"billingCode":"J7297","codeType":"HCPCS"},{"id":8536,"precertRequired":false,"billingCode":"J7298","codeType":"HCPCS"},{"id":8537,"precertRequired":false,"billingCode":"J7300","codeType":"HCPCS"},{"id":8538,"precertRequired":false,"billingCode":"J7301","codeType":"HCPCS"},{"id":8539,"precertRequired":false,"billingCode":"J7303","codeType":"HCPCS"},{"id":8540,"precertRequired":false,"billingCode":"J7304","codeType":"HCPCS"},{"id":8541,"precertRequired":false,"billingCode":"J7306","codeType":"HCPCS"},{"id":8542,"precertRequired":false,"billingCode":"J7307","codeType":"HCPCS"},{"id":8892,"precertRequired":false,"billingCode":"S0610","codeType":"HCPCS"},{"id":8893,"precertRequired":false,"billingCode":"S0612","codeType":"HCPCS"},{"id":8894,"precertRequired":false,"billingCode":"S0613","codeType":"HCPCS"},{"id":8933,"precertRequired":false,"billingCode":"S4981","codeType":"HCPCS"},{"id":8934,"precertRequired":false,"billingCode":"S4989","codeType":"HCPCS"},{"id":8935,"precertRequired":false,"billingCode":"S4993","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1140,"description":"Diagnostic imaging relevant to the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4710,"precertRequired":false,"billingCode":"76499","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4774,"precertRequired":false,"billingCode":"76999","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4781,"precertRequired":false,"billingCode":"77021","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1141,"description":"Diagnostic studies relevant to the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8127,"precertRequired":false,"billingCode":"G0123","codeType":"HCPCS"},{"id":8128,"precertRequired":false,"billingCode":"G0124","codeType":"HCPCS"},{"id":8133,"precertRequired":false,"billingCode":"G0141","codeType":"HCPCS"},{"id":8134,"precertRequired":false,"billingCode":"G0143","codeType":"HCPCS"},{"id":8135,"precertRequired":false,"billingCode":"G0144","codeType":"HCPCS"},{"id":8136,"precertRequired":false,"billingCode":"G0145","codeType":"HCPCS"},{"id":8137,"precertRequired":false,"billingCode":"G0147","codeType":"HCPCS"},{"id":8138,"precertRequired":false,"billingCode":"G0148","codeType":"HCPCS"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":8217,"precertRequired":false,"billingCode":"G0445","codeType":"HCPCS"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1142,"description":"Labs and pathology relevant to the referred condition indicated on the consult ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5011,"precertRequired":false,"billingCode":"80055","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5016,"precertRequired":false,"billingCode":"80081","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5127,"precertRequired":false,"billingCode":"80418","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5485,"precertRequired":false,"billingCode":"82671","codeType":"CPT"},{"id":5486,"precertRequired":false,"billingCode":"82672","codeType":"CPT"},{"id":5487,"precertRequired":false,"billingCode":"82677","codeType":"CPT"},{"id":5488,"precertRequired":false,"billingCode":"82679","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5687,"precertRequired":false,"billingCode":"84233","codeType":"CPT"},{"id":5688,"precertRequired":false,"billingCode":"84234","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5763,"precertRequired":false,"billingCode":"84830","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5954,"precertRequired":false,"billingCode":"86592","codeType":"CPT"},{"id":5955,"precertRequired":false,"billingCode":"86593","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6065,"precertRequired":false,"billingCode":"86850","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6075,"precertRequired":false,"billingCode":"86901","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6156,"precertRequired":false,"billingCode":"87210","codeType":"CPT"},{"id":6168,"precertRequired":false,"billingCode":"87270","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6186,"precertRequired":false,"billingCode":"87320","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6224,"precertRequired":false,"billingCode":"87490","codeType":"CPT"},{"id":6225,"precertRequired":false,"billingCode":"87491","codeType":"CPT"},{"id":6226,"precertRequired":false,"billingCode":"87492","codeType":"CPT"},{"id":6277,"precertRequired":false,"billingCode":"87590","codeType":"CPT"},{"id":6278,"precertRequired":false,"billingCode":"87591","codeType":"CPT"},{"id":6279,"precertRequired":false,"billingCode":"87592","codeType":"CPT"},{"id":6280,"precertRequired":false,"billingCode":"87623","codeType":"CPT"},{"id":6281,"precertRequired":false,"billingCode":"87624","codeType":"CPT"},{"id":6282,"precertRequired":false,"billingCode":"87625","codeType":"CPT"},{"id":6308,"precertRequired":false,"billingCode":"87810","codeType":"CPT"},{"id":6309,"precertRequired":false,"billingCode":"87850","codeType":"CPT"},{"id":6347,"precertRequired":false,"billingCode":"88141","codeType":"CPT"},{"id":6348,"precertRequired":false,"billingCode":"88142","codeType":"CPT"},{"id":6349,"precertRequired":false,"billingCode":"88143","codeType":"CPT"},{"id":6350,"precertRequired":false,"billingCode":"88147","codeType":"CPT"},{"id":6351,"precertRequired":false,"billingCode":"88148","codeType":"CPT"},{"id":6352,"precertRequired":false,"billingCode":"88150","codeType":"CPT"},{"id":6353,"precertRequired":false,"billingCode":"88152","codeType":"CPT"},{"id":6354,"precertRequired":false,"billingCode":"88153","codeType":"CPT"},{"id":6355,"precertRequired":false,"billingCode":"88155","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6357,"precertRequired":false,"billingCode":"88161","codeType":"CPT"},{"id":6358,"precertRequired":false,"billingCode":"88162","codeType":"CPT"},{"id":6359,"precertRequired":false,"billingCode":"88164","codeType":"CPT"},{"id":6360,"precertRequired":false,"billingCode":"88165","codeType":"CPT"},{"id":6361,"precertRequired":false,"billingCode":"88166","codeType":"CPT"},{"id":6362,"precertRequired":false,"billingCode":"88167","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6365,"precertRequired":false,"billingCode":"88174","codeType":"CPT"},{"id":6366,"precertRequired":false,"billingCode":"88175","codeType":"CPT"},{"id":6367,"precertRequired":false,"billingCode":"88177","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7434,"precertRequired":false,"billingCode":"99372","codeType":"CPT"},{"id":8721,"precertRequired":false,"billingCode":"P3000","codeType":"HCPCS"},{"id":8722,"precertRequired":false,"billingCode":"P3001","codeType":"HCPCS"},{"id":8769,"precertRequired":false,"billingCode":"Q0091","codeType":"HCPCS"},{"id":8770,"precertRequired":false,"billingCode":"Q0111","codeType":"HCPCS"},{"id":8771,"precertRequired":false,"billingCode":"Q0112","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1143,"description":"Procedures to include: Colposcopy, LEEP, cervical surgery and cryotherapy, hysteroscopy diagnostic and operative, uterine ablation, uterine artery embolization*, laparoscopy diagnostic and operative, hysterectomy vaginal, abdominal, laparoscopic and robotic, vaginal surgery, tubal ligation, ovarian cystectomy, salpingectomy, salpingectomy with oophorectomy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":255,"precertRequired":false,"billingCode":"11100","codeType":"CPT"},{"id":256,"precertRequired":false,"billingCode":"11101","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":332,"precertRequired":false,"billingCode":"11976","codeType":"CPT"},{"id":333,"precertRequired":false,"billingCode":"11980","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":2662,"precertRequired":false,"billingCode":"37241","codeType":"CPT"},{"id":2663,"precertRequired":false,"billingCode":"37242","codeType":"CPT"},{"id":2664,"precertRequired":false,"billingCode":"37243","codeType":"CPT"},{"id":2665,"precertRequired":false,"billingCode":"37244","codeType":"CPT"},{"id":3347,"precertRequired":false,"billingCode":"49320","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3491,"precertRequired":false,"billingCode":"53060","codeType":"CPT"},{"id":3550,"precertRequired":false,"billingCode":"56405","codeType":"CPT"},{"id":3551,"precertRequired":false,"billingCode":"56420","codeType":"CPT"},{"id":3552,"precertRequired":false,"billingCode":"56440","codeType":"CPT"},{"id":3553,"precertRequired":false,"billingCode":"56441","codeType":"CPT"},{"id":3554,"precertRequired":false,"billingCode":"56442","codeType":"CPT"},{"id":3555,"precertRequired":false,"billingCode":"56501","codeType":"CPT"},{"id":3556,"precertRequired":false,"billingCode":"56515","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":3559,"precertRequired":false,"billingCode":"56620","codeType":"CPT"},{"id":3560,"precertRequired":false,"billingCode":"56625","codeType":"CPT"},{"id":3561,"precertRequired":false,"billingCode":"56630","codeType":"CPT"},{"id":3562,"precertRequired":false,"billingCode":"56631","codeType":"CPT"},{"id":3563,"precertRequired":false,"billingCode":"56632","codeType":"CPT"},{"id":3564,"precertRequired":false,"billingCode":"56633","codeType":"CPT"},{"id":3565,"precertRequired":false,"billingCode":"56634","codeType":"CPT"},{"id":3566,"precertRequired":false,"billingCode":"56637","codeType":"CPT"},{"id":3567,"precertRequired":false,"billingCode":"56640","codeType":"CPT"},{"id":3568,"precertRequired":false,"billingCode":"56700","codeType":"CPT"},{"id":3569,"precertRequired":false,"billingCode":"56740","codeType":"CPT"},{"id":3570,"precertRequired":false,"billingCode":"56800","codeType":"CPT"},{"id":3571,"precertRequired":false,"billingCode":"56810","codeType":"CPT"},{"id":3572,"precertRequired":false,"billingCode":"56820","codeType":"CPT"},{"id":3573,"precertRequired":false,"billingCode":"56821","codeType":"CPT"},{"id":3574,"precertRequired":false,"billingCode":"57000","codeType":"CPT"},{"id":3575,"precertRequired":false,"billingCode":"57010","codeType":"CPT"},{"id":3576,"precertRequired":false,"billingCode":"57020","codeType":"CPT"},{"id":3578,"precertRequired":false,"billingCode":"57023","codeType":"CPT"},{"id":3579,"precertRequired":false,"billingCode":"57061","codeType":"CPT"},{"id":3580,"precertRequired":false,"billingCode":"57065","codeType":"CPT"},{"id":3581,"precertRequired":false,"billingCode":"57100","codeType":"CPT"},{"id":3582,"precertRequired":false,"billingCode":"57105","codeType":"CPT"},{"id":3583,"precertRequired":false,"billingCode":"57106","codeType":"CPT"},{"id":3584,"precertRequired":false,"billingCode":"57107","codeType":"CPT"},{"id":3585,"precertRequired":false,"billingCode":"57109","codeType":"CPT"},{"id":3586,"precertRequired":false,"billingCode":"57110","codeType":"CPT"},{"id":3587,"precertRequired":false,"billingCode":"57111","codeType":"CPT"},{"id":3588,"precertRequired":false,"billingCode":"57112","codeType":"CPT"},{"id":3589,"precertRequired":false,"billingCode":"57120","codeType":"CPT"},{"id":3590,"precertRequired":false,"billingCode":"57130","codeType":"CPT"},{"id":3591,"precertRequired":false,"billingCode":"57135","codeType":"CPT"},{"id":3592,"precertRequired":false,"billingCode":"57150","codeType":"CPT"},{"id":3593,"precertRequired":false,"billingCode":"57155","codeType":"CPT"},{"id":3594,"precertRequired":false,"billingCode":"57156","codeType":"CPT"},{"id":3595,"precertRequired":false,"billingCode":"57160","codeType":"CPT"},{"id":3596,"precertRequired":false,"billingCode":"57170","codeType":"CPT"},{"id":3597,"precertRequired":false,"billingCode":"57180","codeType":"CPT"},{"id":3598,"precertRequired":false,"billingCode":"57200","codeType":"CPT"},{"id":3599,"precertRequired":false,"billingCode":"57210","codeType":"CPT"},{"id":3609,"precertRequired":false,"billingCode":"57280","codeType":"CPT"},{"id":3610,"precertRequired":false,"billingCode":"57282","codeType":"CPT"},{"id":3611,"precertRequired":false,"billingCode":"57283","codeType":"CPT"},{"id":3612,"precertRequired":false,"billingCode":"57284","codeType":"CPT"},{"id":3613,"precertRequired":false,"billingCode":"57285","codeType":"CPT"},{"id":3616,"precertRequired":false,"billingCode":"57300","codeType":"CPT"},{"id":3617,"precertRequired":false,"billingCode":"57305","codeType":"CPT"},{"id":3618,"precertRequired":false,"billingCode":"57307","codeType":"CPT"},{"id":3619,"precertRequired":false,"billingCode":"57308","codeType":"CPT"},{"id":3620,"precertRequired":false,"billingCode":"57310","codeType":"CPT"},{"id":3621,"precertRequired":false,"billingCode":"57311","codeType":"CPT"},{"id":3622,"precertRequired":false,"billingCode":"57320","codeType":"CPT"},{"id":3623,"precertRequired":false,"billingCode":"57330","codeType":"CPT"},{"id":3624,"precertRequired":false,"billingCode":"57400","codeType":"CPT"},{"id":3625,"precertRequired":false,"billingCode":"57410","codeType":"CPT"},{"id":3626,"precertRequired":false,"billingCode":"57415","codeType":"CPT"},{"id":3627,"precertRequired":false,"billingCode":"57420","codeType":"CPT"},{"id":3628,"precertRequired":false,"billingCode":"57421","codeType":"CPT"},{"id":3629,"precertRequired":false,"billingCode":"57423","codeType":"CPT"},{"id":3630,"precertRequired":false,"billingCode":"57425","codeType":"CPT"},{"id":3631,"precertRequired":false,"billingCode":"57426","codeType":"CPT"},{"id":3632,"precertRequired":false,"billingCode":"57452","codeType":"CPT"},{"id":3633,"precertRequired":false,"billingCode":"57454","codeType":"CPT"},{"id":3634,"precertRequired":false,"billingCode":"57455","codeType":"CPT"},{"id":3635,"precertRequired":false,"billingCode":"57456","codeType":"CPT"},{"id":3636,"precertRequired":false,"billingCode":"57460","codeType":"CPT"},{"id":3637,"precertRequired":false,"billingCode":"57461","codeType":"CPT"},{"id":3638,"precertRequired":false,"billingCode":"57500","codeType":"CPT"},{"id":3639,"precertRequired":false,"billingCode":"57505","codeType":"CPT"},{"id":3640,"precertRequired":false,"billingCode":"57510","codeType":"CPT"},{"id":3641,"precertRequired":false,"billingCode":"57511","codeType":"CPT"},{"id":3642,"precertRequired":false,"billingCode":"57513","codeType":"CPT"},{"id":3643,"precertRequired":false,"billingCode":"57520","codeType":"CPT"},{"id":3644,"precertRequired":false,"billingCode":"57522","codeType":"CPT"},{"id":3645,"precertRequired":false,"billingCode":"57530","codeType":"CPT"},{"id":3646,"precertRequired":false,"billingCode":"57531","codeType":"CPT"},{"id":3647,"precertRequired":false,"billingCode":"57540","codeType":"CPT"},{"id":3648,"precertRequired":false,"billingCode":"57545","codeType":"CPT"},{"id":3649,"precertRequired":false,"billingCode":"57550","codeType":"CPT"},{"id":3650,"precertRequired":false,"billingCode":"57555","codeType":"CPT"},{"id":3651,"precertRequired":false,"billingCode":"57556","codeType":"CPT"},{"id":3652,"precertRequired":false,"billingCode":"57558","codeType":"CPT"},{"id":3653,"precertRequired":false,"billingCode":"57700","codeType":"CPT"},{"id":3654,"precertRequired":false,"billingCode":"57720","codeType":"CPT"},{"id":3655,"precertRequired":false,"billingCode":"57800","codeType":"CPT"},{"id":3656,"precertRequired":false,"billingCode":"58100","codeType":"CPT"},{"id":3657,"precertRequired":false,"billingCode":"58110","codeType":"CPT"},{"id":3658,"precertRequired":false,"billingCode":"58120","codeType":"CPT"},{"id":3659,"precertRequired":false,"billingCode":"58140","codeType":"CPT"},{"id":3660,"precertRequired":false,"billingCode":"58145","codeType":"CPT"},{"id":3661,"precertRequired":false,"billingCode":"58146","codeType":"CPT"},{"id":3662,"precertRequired":false,"billingCode":"58150","codeType":"CPT"},{"id":3663,"precertRequired":false,"billingCode":"58152","codeType":"CPT"},{"id":3664,"precertRequired":false,"billingCode":"58180","codeType":"CPT"},{"id":3665,"precertRequired":false,"billingCode":"58200","codeType":"CPT"},{"id":3666,"precertRequired":false,"billingCode":"58210","codeType":"CPT"},{"id":3667,"precertRequired":false,"billingCode":"58240","codeType":"CPT"},{"id":3668,"precertRequired":false,"billingCode":"58260","codeType":"CPT"},{"id":3669,"precertRequired":false,"billingCode":"58262","codeType":"CPT"},{"id":3670,"precertRequired":false,"billingCode":"58263","codeType":"CPT"},{"id":3671,"precertRequired":false,"billingCode":"58267","codeType":"CPT"},{"id":3672,"precertRequired":false,"billingCode":"58270","codeType":"CPT"},{"id":3673,"precertRequired":false,"billingCode":"58275","codeType":"CPT"},{"id":3674,"precertRequired":false,"billingCode":"58280","codeType":"CPT"},{"id":3675,"precertRequired":false,"billingCode":"58285","codeType":"CPT"},{"id":3676,"precertRequired":false,"billingCode":"58290","codeType":"CPT"},{"id":3677,"precertRequired":false,"billingCode":"58291","codeType":"CPT"},{"id":3678,"precertRequired":false,"billingCode":"58292","codeType":"CPT"},{"id":3679,"precertRequired":false,"billingCode":"58293","codeType":"CPT"},{"id":3680,"precertRequired":false,"billingCode":"58294","codeType":"CPT"},{"id":3681,"precertRequired":false,"billingCode":"58300","codeType":"CPT"},{"id":3682,"precertRequired":false,"billingCode":"58301","codeType":"CPT"},{"id":3686,"precertRequired":false,"billingCode":"58340","codeType":"CPT"},{"id":3687,"precertRequired":false,"billingCode":"58345","codeType":"CPT"},{"id":3688,"precertRequired":false,"billingCode":"58350","codeType":"CPT"},{"id":3689,"precertRequired":false,"billingCode":"58353","codeType":"CPT"},{"id":3690,"precertRequired":false,"billingCode":"58356","codeType":"CPT"},{"id":3691,"precertRequired":false,"billingCode":"58400","codeType":"CPT"},{"id":3692,"precertRequired":false,"billingCode":"58410","codeType":"CPT"},{"id":3693,"precertRequired":false,"billingCode":"58520","codeType":"CPT"},{"id":3694,"precertRequired":false,"billingCode":"58540","codeType":"CPT"},{"id":3695,"precertRequired":false,"billingCode":"58541","codeType":"CPT"},{"id":3696,"precertRequired":false,"billingCode":"58542","codeType":"CPT"},{"id":3697,"precertRequired":false,"billingCode":"58543","codeType":"CPT"},{"id":3698,"precertRequired":false,"billingCode":"58544","codeType":"CPT"},{"id":3699,"precertRequired":false,"billingCode":"58545","codeType":"CPT"},{"id":3700,"precertRequired":false,"billingCode":"58546","codeType":"CPT"},{"id":3701,"precertRequired":false,"billingCode":"58548","codeType":"CPT"},{"id":3702,"precertRequired":false,"billingCode":"58550","codeType":"CPT"},{"id":3703,"precertRequired":false,"billingCode":"58552","codeType":"CPT"},{"id":3704,"precertRequired":false,"billingCode":"58553","codeType":"CPT"},{"id":3705,"precertRequired":false,"billingCode":"58554","codeType":"CPT"},{"id":3706,"precertRequired":false,"billingCode":"58555","codeType":"CPT"},{"id":3707,"precertRequired":false,"billingCode":"58558","codeType":"CPT"},{"id":3708,"precertRequired":false,"billingCode":"58559","codeType":"CPT"},{"id":3709,"precertRequired":false,"billingCode":"58560","codeType":"CPT"},{"id":3710,"precertRequired":false,"billingCode":"58561","codeType":"CPT"},{"id":3711,"precertRequired":false,"billingCode":"58562","codeType":"CPT"},{"id":3712,"precertRequired":false,"billingCode":"58563","codeType":"CPT"},{"id":3713,"precertRequired":false,"billingCode":"58565","codeType":"CPT"},{"id":3714,"precertRequired":false,"billingCode":"58570","codeType":"CPT"},{"id":3715,"precertRequired":false,"billingCode":"58571","codeType":"CPT"},{"id":3716,"precertRequired":false,"billingCode":"58572","codeType":"CPT"},{"id":3717,"precertRequired":false,"billingCode":"58573","codeType":"CPT"},{"id":3718,"precertRequired":false,"billingCode":"58575","codeType":"CPT"},{"id":3719,"precertRequired":false,"billingCode":"58578","codeType":"CPT"},{"id":3720,"precertRequired":false,"billingCode":"58579","codeType":"CPT"},{"id":3721,"precertRequired":false,"billingCode":"58600","codeType":"CPT"},{"id":3722,"precertRequired":false,"billingCode":"58605","codeType":"CPT"},{"id":3723,"precertRequired":false,"billingCode":"58611","codeType":"CPT"},{"id":3724,"precertRequired":false,"billingCode":"58615","codeType":"CPT"},{"id":3725,"precertRequired":false,"billingCode":"58660","codeType":"CPT"},{"id":3726,"precertRequired":false,"billingCode":"58661","codeType":"CPT"},{"id":3727,"precertRequired":false,"billingCode":"58662","codeType":"CPT"},{"id":3728,"precertRequired":true,"billingCode":"58670","codeType":"CPT"},{"id":3729,"precertRequired":false,"billingCode":"58671","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3732,"precertRequired":false,"billingCode":"58674","codeType":"CPT"},{"id":3733,"precertRequired":false,"billingCode":"58679","codeType":"CPT"},{"id":3734,"precertRequired":false,"billingCode":"58700","codeType":"CPT"},{"id":3735,"precertRequired":false,"billingCode":"58720","codeType":"CPT"},{"id":3736,"precertRequired":false,"billingCode":"58740","codeType":"CPT"},{"id":3737,"precertRequired":false,"billingCode":"58750","codeType":"CPT"},{"id":3738,"precertRequired":false,"billingCode":"58752","codeType":"CPT"},{"id":3739,"precertRequired":false,"billingCode":"58760","codeType":"CPT"},{"id":3740,"precertRequired":false,"billingCode":"58770","codeType":"CPT"},{"id":3741,"precertRequired":false,"billingCode":"58800","codeType":"CPT"},{"id":3742,"precertRequired":false,"billingCode":"58805","codeType":"CPT"},{"id":3743,"precertRequired":false,"billingCode":"58820","codeType":"CPT"},{"id":3744,"precertRequired":false,"billingCode":"58822","codeType":"CPT"},{"id":3745,"precertRequired":false,"billingCode":"58825","codeType":"CPT"},{"id":3746,"precertRequired":false,"billingCode":"58900","codeType":"CPT"},{"id":3747,"precertRequired":false,"billingCode":"58920","codeType":"CPT"},{"id":3748,"precertRequired":false,"billingCode":"58925","codeType":"CPT"},{"id":3749,"precertRequired":false,"billingCode":"58940","codeType":"CPT"},{"id":3750,"precertRequired":false,"billingCode":"58943","codeType":"CPT"},{"id":3751,"precertRequired":false,"billingCode":"58950","codeType":"CPT"},{"id":3752,"precertRequired":false,"billingCode":"58951","codeType":"CPT"},{"id":3753,"precertRequired":false,"billingCode":"58952","codeType":"CPT"},{"id":3754,"precertRequired":false,"billingCode":"58953","codeType":"CPT"},{"id":3755,"precertRequired":false,"billingCode":"58954","codeType":"CPT"},{"id":3756,"precertRequired":false,"billingCode":"58956","codeType":"CPT"},{"id":3757,"precertRequired":false,"billingCode":"58957","codeType":"CPT"},{"id":3758,"precertRequired":false,"billingCode":"58958","codeType":"CPT"},{"id":3759,"precertRequired":false,"billingCode":"58960","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1144,"description":"Anesthesia consultation per the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":84,"precertRequired":false,"billingCode":"00800","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":97,"precertRequired":false,"billingCode":"00846","codeType":"CPT"},{"id":99,"precertRequired":false,"billingCode":"00851","codeType":"CPT"},{"id":100,"precertRequired":false,"billingCode":"00860","codeType":"CPT"},{"id":113,"precertRequired":false,"billingCode":"00906","codeType":"CPT"},{"id":131,"precertRequired":false,"billingCode":"00940","codeType":"CPT"},{"id":132,"precertRequired":false,"billingCode":"00942","codeType":"CPT"},{"id":133,"precertRequired":false,"billingCode":"00944","codeType":"CPT"},{"id":135,"precertRequired":false,"billingCode":"00950","codeType":"CPT"},{"id":136,"precertRequired":false,"billingCode":"00952","codeType":"CPT"},{"id":217,"precertRequired":false,"billingCode":"01991","codeType":"CPT"},{"id":218,"precertRequired":false,"billingCode":"01992","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":220,"precertRequired":false,"billingCode":"01999","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1145,"description":"Pre-operative medical/cardiac clearance as indicated (including H+P/labs, EKG, CXR). May be completed at VA if primary care provider is assigned and available.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1146,"description":"Inpatient admission for surgical procedure if indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1147,"description":"Inpatient admission or observation status for complications per the referred condition indicated on the consult ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1148,"description":"Follow-up visits for this episode of care ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":7453,"precertRequired":false,"billingCode":"99396","codeType":"CPT"},{"id":7454,"precertRequired":false,"billingCode":"99397","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":8892,"precertRequired":false,"billingCode":"S0610","codeType":"HCPCS"},{"id":8893,"precertRequired":false,"billingCode":"S0612","codeType":"HCPCS"},{"id":8894,"precertRequired":false,"billingCode":"S0613","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":1149,"description":"Follow-up imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4710,"precertRequired":false,"billingCode":"76499","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4774,"precertRequired":false,"billingCode":"76999","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4781,"precertRequired":false,"billingCode":"77021","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1150,"description":"Follow-up studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8127,"precertRequired":false,"billingCode":"G0123","codeType":"HCPCS"},{"id":8128,"precertRequired":false,"billingCode":"G0124","codeType":"HCPCS"},{"id":8133,"precertRequired":false,"billingCode":"G0141","codeType":"HCPCS"},{"id":8134,"precertRequired":false,"billingCode":"G0143","codeType":"HCPCS"},{"id":8135,"precertRequired":false,"billingCode":"G0144","codeType":"HCPCS"},{"id":8136,"precertRequired":false,"billingCode":"G0145","codeType":"HCPCS"},{"id":8137,"precertRequired":false,"billingCode":"G0147","codeType":"HCPCS"},{"id":8138,"precertRequired":false,"billingCode":"G0148","codeType":"HCPCS"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":8217,"precertRequired":false,"billingCode":"G0445","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]}]}},{"Seoc":{"id":109,"seocKey":57,"name":"Gynecology_PRCT","seocId":"WHC_GYNECOLOGY_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"09-21-2018","endDate":"01-03-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult. Conditions include contraception, no periods or infrequent periods, abnormal uterine bleeding, pelvic pain, abnormal pap smear, infertility, pelvic relaxation/prolapse, incontinence, and menopause\r\n2. Diagnostic imaging relevant to the referred condition indicated on the consult\r\n3. Diagnostic studies relevant to the referred condition indicated on the consult\r\n4. Labs and pathology relevant to the referred condition indicated on the consult\r\n5. Procedures to include: Colposcopy, LEEP, cervical surgery and cryotherapy, hysteroscopy diagnostic and operative, uterine ablation, uterine artery embolization*, laparoscopy diagnostic and operative, hysterectomy vaginal, abdominal, laparoscopic and robotic, vaginal surgery, tubal ligation, ovarian cystectomy, salpingectomy, salpingectomy with oophorectomy\r\n6. Anesthesia consultation per the referred condition indicated on the consult\r\n7. Pre-operative medical/cardiac clearance as indicated (including H+P/labs, EKG, CXR). May be completed at VA if primary care provider is assigned and available\r\n8. Inpatient admission for surgical procedure if indicated\r\n9. Inpatient admission or observation status for complications per the referred condition indicated on the consult\r\n** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery\r\n10. Follow-up visits for this episode of care\r\n11. Follow-up imaging relevant to the referred condition on the consult\r\n12. Follow-up studies relevant to the referred condition on the consult","maxAllowableVisits":999,"disclaimer":"*Gynecologist may co-manage after the procedure as an inpatient\r\n*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n** Visits for ancillary services are not included in the frequency total.  The number of visits authorized for ancillary services are noted within its service line description above.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"GYNECOLOGY","serviceLine":"Womens Health Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":187,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult. Conditions include contraception, no periods or infrequent periods, abnormal uterine bleeding, pelvic pain, abnormal pap smear, infertility, pelvic relaxation/prolapse, incontinence, and menopause","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":7324,"precertRequired":false,"billingCode":"99071","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"},{"id":7445,"precertRequired":false,"billingCode":"99385","codeType":"CPT"},{"id":7446,"precertRequired":false,"billingCode":"99386","codeType":"CPT"},{"id":7447,"precertRequired":false,"billingCode":"99387","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":7453,"precertRequired":false,"billingCode":"99396","codeType":"CPT"},{"id":7454,"precertRequired":false,"billingCode":"99397","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":7662,"precertRequired":false,"billingCode":"4159F","codeType":"CPT"},{"id":7663,"precertRequired":false,"billingCode":"4340F","codeType":"CPT"},{"id":7687,"precertRequired":false,"billingCode":"A4261","codeType":"HCPCS"},{"id":7688,"precertRequired":false,"billingCode":"A4264","codeType":"HCPCS"},{"id":7690,"precertRequired":false,"billingCode":"A4267","codeType":"HCPCS"},{"id":7691,"precertRequired":false,"billingCode":"A4268","codeType":"HCPCS"},{"id":7692,"precertRequired":false,"billingCode":"A4269","codeType":"HCPCS"},{"id":8405,"precertRequired":true,"billingCode":"J1000","codeType":"HCPCS"},{"id":8406,"precertRequired":true,"billingCode":"J1020","codeType":"HCPCS"},{"id":8407,"precertRequired":true,"billingCode":"J1030","codeType":"HCPCS"},{"id":8408,"precertRequired":true,"billingCode":"J1040","codeType":"HCPCS"},{"id":8409,"precertRequired":false,"billingCode":"J1050","codeType":"HCPCS"},{"id":8534,"precertRequired":false,"billingCode":"J7296","codeType":"HCPCS"},{"id":8535,"precertRequired":false,"billingCode":"J7297","codeType":"HCPCS"},{"id":8536,"precertRequired":false,"billingCode":"J7298","codeType":"HCPCS"},{"id":8537,"precertRequired":false,"billingCode":"J7300","codeType":"HCPCS"},{"id":8538,"precertRequired":false,"billingCode":"J7301","codeType":"HCPCS"},{"id":8539,"precertRequired":false,"billingCode":"J7303","codeType":"HCPCS"},{"id":8540,"precertRequired":false,"billingCode":"J7304","codeType":"HCPCS"},{"id":8541,"precertRequired":false,"billingCode":"J7306","codeType":"HCPCS"},{"id":8542,"precertRequired":false,"billingCode":"J7307","codeType":"HCPCS"},{"id":8892,"precertRequired":false,"billingCode":"S0610","codeType":"HCPCS"},{"id":8893,"precertRequired":false,"billingCode":"S0612","codeType":"HCPCS"},{"id":8894,"precertRequired":false,"billingCode":"S0613","codeType":"HCPCS"},{"id":8933,"precertRequired":false,"billingCode":"S4981","codeType":"HCPCS"},{"id":8934,"precertRequired":false,"billingCode":"S4989","codeType":"HCPCS"},{"id":8935,"precertRequired":false,"billingCode":"S4993","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":188,"description":"Diagnostic imaging relevant to the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4710,"precertRequired":false,"billingCode":"76499","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4774,"precertRequired":false,"billingCode":"76999","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4781,"precertRequired":false,"billingCode":"77021","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":189,"description":"Diagnostic studies relevant to the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8127,"precertRequired":false,"billingCode":"G0123","codeType":"HCPCS"},{"id":8128,"precertRequired":false,"billingCode":"G0124","codeType":"HCPCS"},{"id":8133,"precertRequired":false,"billingCode":"G0141","codeType":"HCPCS"},{"id":8134,"precertRequired":false,"billingCode":"G0143","codeType":"HCPCS"},{"id":8135,"precertRequired":false,"billingCode":"G0144","codeType":"HCPCS"},{"id":8136,"precertRequired":false,"billingCode":"G0145","codeType":"HCPCS"},{"id":8137,"precertRequired":false,"billingCode":"G0147","codeType":"HCPCS"},{"id":8138,"precertRequired":false,"billingCode":"G0148","codeType":"HCPCS"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":8217,"precertRequired":false,"billingCode":"G0445","codeType":"HCPCS"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":190,"description":"Labs and pathology relevant to the referred condition indicated on the consult ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5011,"precertRequired":false,"billingCode":"80055","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5016,"precertRequired":false,"billingCode":"80081","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5127,"precertRequired":false,"billingCode":"80418","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5485,"precertRequired":false,"billingCode":"82671","codeType":"CPT"},{"id":5486,"precertRequired":false,"billingCode":"82672","codeType":"CPT"},{"id":5487,"precertRequired":false,"billingCode":"82677","codeType":"CPT"},{"id":5488,"precertRequired":false,"billingCode":"82679","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5687,"precertRequired":false,"billingCode":"84233","codeType":"CPT"},{"id":5688,"precertRequired":false,"billingCode":"84234","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5763,"precertRequired":false,"billingCode":"84830","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5954,"precertRequired":false,"billingCode":"86592","codeType":"CPT"},{"id":5955,"precertRequired":false,"billingCode":"86593","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6065,"precertRequired":false,"billingCode":"86850","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6075,"precertRequired":false,"billingCode":"86901","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6156,"precertRequired":false,"billingCode":"87210","codeType":"CPT"},{"id":6168,"precertRequired":false,"billingCode":"87270","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6186,"precertRequired":false,"billingCode":"87320","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6224,"precertRequired":false,"billingCode":"87490","codeType":"CPT"},{"id":6225,"precertRequired":false,"billingCode":"87491","codeType":"CPT"},{"id":6226,"precertRequired":false,"billingCode":"87492","codeType":"CPT"},{"id":6277,"precertRequired":false,"billingCode":"87590","codeType":"CPT"},{"id":6278,"precertRequired":false,"billingCode":"87591","codeType":"CPT"},{"id":6279,"precertRequired":false,"billingCode":"87592","codeType":"CPT"},{"id":6280,"precertRequired":false,"billingCode":"87623","codeType":"CPT"},{"id":6281,"precertRequired":false,"billingCode":"87624","codeType":"CPT"},{"id":6282,"precertRequired":false,"billingCode":"87625","codeType":"CPT"},{"id":6308,"precertRequired":false,"billingCode":"87810","codeType":"CPT"},{"id":6309,"precertRequired":false,"billingCode":"87850","codeType":"CPT"},{"id":6347,"precertRequired":false,"billingCode":"88141","codeType":"CPT"},{"id":6348,"precertRequired":false,"billingCode":"88142","codeType":"CPT"},{"id":6349,"precertRequired":false,"billingCode":"88143","codeType":"CPT"},{"id":6350,"precertRequired":false,"billingCode":"88147","codeType":"CPT"},{"id":6351,"precertRequired":false,"billingCode":"88148","codeType":"CPT"},{"id":6352,"precertRequired":false,"billingCode":"88150","codeType":"CPT"},{"id":6353,"precertRequired":false,"billingCode":"88152","codeType":"CPT"},{"id":6354,"precertRequired":false,"billingCode":"88153","codeType":"CPT"},{"id":6355,"precertRequired":false,"billingCode":"88155","codeType":"CPT"},{"id":6356,"precertRequired":false,"billingCode":"88160","codeType":"CPT"},{"id":6357,"precertRequired":false,"billingCode":"88161","codeType":"CPT"},{"id":6358,"precertRequired":false,"billingCode":"88162","codeType":"CPT"},{"id":6359,"precertRequired":false,"billingCode":"88164","codeType":"CPT"},{"id":6360,"precertRequired":false,"billingCode":"88165","codeType":"CPT"},{"id":6361,"precertRequired":false,"billingCode":"88166","codeType":"CPT"},{"id":6362,"precertRequired":false,"billingCode":"88167","codeType":"CPT"},{"id":6363,"precertRequired":false,"billingCode":"88172","codeType":"CPT"},{"id":6364,"precertRequired":false,"billingCode":"88173","codeType":"CPT"},{"id":6365,"precertRequired":false,"billingCode":"88174","codeType":"CPT"},{"id":6366,"precertRequired":false,"billingCode":"88175","codeType":"CPT"},{"id":6367,"precertRequired":false,"billingCode":"88177","codeType":"CPT"},{"id":7319,"precertRequired":false,"billingCode":"99000","codeType":"CPT"},{"id":7434,"precertRequired":false,"billingCode":"99372","codeType":"CPT"},{"id":8721,"precertRequired":false,"billingCode":"P3000","codeType":"HCPCS"},{"id":8722,"precertRequired":false,"billingCode":"P3001","codeType":"HCPCS"},{"id":8769,"precertRequired":false,"billingCode":"Q0091","codeType":"HCPCS"},{"id":8770,"precertRequired":false,"billingCode":"Q0111","codeType":"HCPCS"},{"id":8771,"precertRequired":false,"billingCode":"Q0112","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":191,"description":"Procedures to include: Colposcopy, LEEP, cervical surgery and cryotherapy, hysteroscopy diagnostic and operative, uterine ablation, uterine artery embolization*, laparoscopy diagnostic and operative, hysterectomy vaginal, abdominal, laparoscopic and robotic, vaginal surgery, tubal ligation, ovarian cystectomy, salpingectomy, salpingectomy with oophorectomy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":227,"precertRequired":false,"billingCode":"10060","codeType":"CPT"},{"id":228,"precertRequired":false,"billingCode":"10061","codeType":"CPT"},{"id":233,"precertRequired":false,"billingCode":"10140","codeType":"CPT"},{"id":236,"precertRequired":false,"billingCode":"10180","codeType":"CPT"},{"id":239,"precertRequired":false,"billingCode":"11004","codeType":"CPT"},{"id":240,"precertRequired":false,"billingCode":"11005","codeType":"CPT"},{"id":241,"precertRequired":false,"billingCode":"11006","codeType":"CPT"},{"id":242,"precertRequired":false,"billingCode":"11008","codeType":"CPT"},{"id":255,"precertRequired":false,"billingCode":"11100","codeType":"CPT"},{"id":256,"precertRequired":false,"billingCode":"11101","codeType":"CPT"},{"id":277,"precertRequired":false,"billingCode":"11420","codeType":"CPT"},{"id":278,"precertRequired":false,"billingCode":"11421","codeType":"CPT"},{"id":279,"precertRequired":false,"billingCode":"11422","codeType":"CPT"},{"id":280,"precertRequired":false,"billingCode":"11423","codeType":"CPT"},{"id":281,"precertRequired":false,"billingCode":"11424","codeType":"CPT"},{"id":282,"precertRequired":false,"billingCode":"11426","codeType":"CPT"},{"id":301,"precertRequired":false,"billingCode":"11620","codeType":"CPT"},{"id":302,"precertRequired":false,"billingCode":"11621","codeType":"CPT"},{"id":303,"precertRequired":false,"billingCode":"11622","codeType":"CPT"},{"id":304,"precertRequired":false,"billingCode":"11623","codeType":"CPT"},{"id":305,"precertRequired":false,"billingCode":"11624","codeType":"CPT"},{"id":306,"precertRequired":false,"billingCode":"11626","codeType":"CPT"},{"id":332,"precertRequired":false,"billingCode":"11976","codeType":"CPT"},{"id":333,"precertRequired":false,"billingCode":"11980","codeType":"CPT"},{"id":334,"precertRequired":false,"billingCode":"11981","codeType":"CPT"},{"id":335,"precertRequired":false,"billingCode":"11982","codeType":"CPT"},{"id":336,"precertRequired":false,"billingCode":"11983","codeType":"CPT"},{"id":337,"precertRequired":false,"billingCode":"12001","codeType":"CPT"},{"id":338,"precertRequired":false,"billingCode":"12002","codeType":"CPT"},{"id":339,"precertRequired":false,"billingCode":"12004","codeType":"CPT"},{"id":340,"precertRequired":false,"billingCode":"12005","codeType":"CPT"},{"id":341,"precertRequired":false,"billingCode":"12006","codeType":"CPT"},{"id":342,"precertRequired":false,"billingCode":"12007","codeType":"CPT"},{"id":358,"precertRequired":false,"billingCode":"12041","codeType":"CPT"},{"id":359,"precertRequired":false,"billingCode":"12042","codeType":"CPT"},{"id":360,"precertRequired":false,"billingCode":"12044","codeType":"CPT"},{"id":361,"precertRequired":false,"billingCode":"12045","codeType":"CPT"},{"id":362,"precertRequired":false,"billingCode":"12046","codeType":"CPT"},{"id":363,"precertRequired":false,"billingCode":"12047","codeType":"CPT"},{"id":377,"precertRequired":false,"billingCode":"13131","codeType":"CPT"},{"id":381,"precertRequired":false,"billingCode":"13152","codeType":"CPT"},{"id":382,"precertRequired":false,"billingCode":"13153","codeType":"CPT"},{"id":479,"precertRequired":false,"billingCode":"17250","codeType":"CPT"},{"id":486,"precertRequired":false,"billingCode":"17270","codeType":"CPT"},{"id":487,"precertRequired":false,"billingCode":"17271","codeType":"CPT"},{"id":488,"precertRequired":false,"billingCode":"17272","codeType":"CPT"},{"id":489,"precertRequired":false,"billingCode":"17273","codeType":"CPT"},{"id":490,"precertRequired":false,"billingCode":"17274","codeType":"CPT"},{"id":491,"precertRequired":false,"billingCode":"17276","codeType":"CPT"},{"id":2662,"precertRequired":false,"billingCode":"37241","codeType":"CPT"},{"id":2663,"precertRequired":false,"billingCode":"37242","codeType":"CPT"},{"id":2664,"precertRequired":false,"billingCode":"37243","codeType":"CPT"},{"id":2665,"precertRequired":false,"billingCode":"37244","codeType":"CPT"},{"id":3347,"precertRequired":false,"billingCode":"49320","codeType":"CPT"},{"id":3348,"precertRequired":false,"billingCode":"49321","codeType":"CPT"},{"id":3349,"precertRequired":false,"billingCode":"49322","codeType":"CPT"},{"id":3354,"precertRequired":false,"billingCode":"49327","codeType":"CPT"},{"id":3491,"precertRequired":false,"billingCode":"53060","codeType":"CPT"},{"id":3550,"precertRequired":false,"billingCode":"56405","codeType":"CPT"},{"id":3551,"precertRequired":false,"billingCode":"56420","codeType":"CPT"},{"id":3552,"precertRequired":false,"billingCode":"56440","codeType":"CPT"},{"id":3553,"precertRequired":false,"billingCode":"56441","codeType":"CPT"},{"id":3554,"precertRequired":false,"billingCode":"56442","codeType":"CPT"},{"id":3555,"precertRequired":false,"billingCode":"56501","codeType":"CPT"},{"id":3556,"precertRequired":false,"billingCode":"56515","codeType":"CPT"},{"id":3557,"precertRequired":false,"billingCode":"56605","codeType":"CPT"},{"id":3558,"precertRequired":false,"billingCode":"56606","codeType":"CPT"},{"id":3559,"precertRequired":false,"billingCode":"56620","codeType":"CPT"},{"id":3560,"precertRequired":false,"billingCode":"56625","codeType":"CPT"},{"id":3561,"precertRequired":false,"billingCode":"56630","codeType":"CPT"},{"id":3562,"precertRequired":false,"billingCode":"56631","codeType":"CPT"},{"id":3563,"precertRequired":false,"billingCode":"56632","codeType":"CPT"},{"id":3564,"precertRequired":false,"billingCode":"56633","codeType":"CPT"},{"id":3565,"precertRequired":false,"billingCode":"56634","codeType":"CPT"},{"id":3566,"precertRequired":false,"billingCode":"56637","codeType":"CPT"},{"id":3567,"precertRequired":false,"billingCode":"56640","codeType":"CPT"},{"id":3568,"precertRequired":false,"billingCode":"56700","codeType":"CPT"},{"id":3569,"precertRequired":false,"billingCode":"56740","codeType":"CPT"},{"id":3570,"precertRequired":false,"billingCode":"56800","codeType":"CPT"},{"id":3571,"precertRequired":false,"billingCode":"56810","codeType":"CPT"},{"id":3572,"precertRequired":false,"billingCode":"56820","codeType":"CPT"},{"id":3573,"precertRequired":false,"billingCode":"56821","codeType":"CPT"},{"id":3574,"precertRequired":false,"billingCode":"57000","codeType":"CPT"},{"id":3575,"precertRequired":false,"billingCode":"57010","codeType":"CPT"},{"id":3576,"precertRequired":false,"billingCode":"57020","codeType":"CPT"},{"id":3578,"precertRequired":false,"billingCode":"57023","codeType":"CPT"},{"id":3579,"precertRequired":false,"billingCode":"57061","codeType":"CPT"},{"id":3580,"precertRequired":false,"billingCode":"57065","codeType":"CPT"},{"id":3581,"precertRequired":false,"billingCode":"57100","codeType":"CPT"},{"id":3582,"precertRequired":false,"billingCode":"57105","codeType":"CPT"},{"id":3583,"precertRequired":false,"billingCode":"57106","codeType":"CPT"},{"id":3584,"precertRequired":false,"billingCode":"57107","codeType":"CPT"},{"id":3585,"precertRequired":false,"billingCode":"57109","codeType":"CPT"},{"id":3586,"precertRequired":false,"billingCode":"57110","codeType":"CPT"},{"id":3587,"precertRequired":false,"billingCode":"57111","codeType":"CPT"},{"id":3588,"precertRequired":false,"billingCode":"57112","codeType":"CPT"},{"id":3589,"precertRequired":false,"billingCode":"57120","codeType":"CPT"},{"id":3590,"precertRequired":false,"billingCode":"57130","codeType":"CPT"},{"id":3591,"precertRequired":false,"billingCode":"57135","codeType":"CPT"},{"id":3592,"precertRequired":false,"billingCode":"57150","codeType":"CPT"},{"id":3593,"precertRequired":false,"billingCode":"57155","codeType":"CPT"},{"id":3594,"precertRequired":false,"billingCode":"57156","codeType":"CPT"},{"id":3595,"precertRequired":false,"billingCode":"57160","codeType":"CPT"},{"id":3596,"precertRequired":false,"billingCode":"57170","codeType":"CPT"},{"id":3597,"precertRequired":false,"billingCode":"57180","codeType":"CPT"},{"id":3598,"precertRequired":false,"billingCode":"57200","codeType":"CPT"},{"id":3599,"precertRequired":false,"billingCode":"57210","codeType":"CPT"},{"id":3609,"precertRequired":false,"billingCode":"57280","codeType":"CPT"},{"id":3610,"precertRequired":false,"billingCode":"57282","codeType":"CPT"},{"id":3611,"precertRequired":false,"billingCode":"57283","codeType":"CPT"},{"id":3612,"precertRequired":false,"billingCode":"57284","codeType":"CPT"},{"id":3613,"precertRequired":false,"billingCode":"57285","codeType":"CPT"},{"id":3616,"precertRequired":false,"billingCode":"57300","codeType":"CPT"},{"id":3617,"precertRequired":false,"billingCode":"57305","codeType":"CPT"},{"id":3618,"precertRequired":false,"billingCode":"57307","codeType":"CPT"},{"id":3619,"precertRequired":false,"billingCode":"57308","codeType":"CPT"},{"id":3620,"precertRequired":false,"billingCode":"57310","codeType":"CPT"},{"id":3621,"precertRequired":false,"billingCode":"57311","codeType":"CPT"},{"id":3622,"precertRequired":false,"billingCode":"57320","codeType":"CPT"},{"id":3623,"precertRequired":false,"billingCode":"57330","codeType":"CPT"},{"id":3624,"precertRequired":false,"billingCode":"57400","codeType":"CPT"},{"id":3625,"precertRequired":false,"billingCode":"57410","codeType":"CPT"},{"id":3626,"precertRequired":false,"billingCode":"57415","codeType":"CPT"},{"id":3627,"precertRequired":false,"billingCode":"57420","codeType":"CPT"},{"id":3628,"precertRequired":false,"billingCode":"57421","codeType":"CPT"},{"id":3629,"precertRequired":false,"billingCode":"57423","codeType":"CPT"},{"id":3630,"precertRequired":false,"billingCode":"57425","codeType":"CPT"},{"id":3631,"precertRequired":false,"billingCode":"57426","codeType":"CPT"},{"id":3632,"precertRequired":false,"billingCode":"57452","codeType":"CPT"},{"id":3633,"precertRequired":false,"billingCode":"57454","codeType":"CPT"},{"id":3634,"precertRequired":false,"billingCode":"57455","codeType":"CPT"},{"id":3635,"precertRequired":false,"billingCode":"57456","codeType":"CPT"},{"id":3636,"precertRequired":false,"billingCode":"57460","codeType":"CPT"},{"id":3637,"precertRequired":false,"billingCode":"57461","codeType":"CPT"},{"id":3638,"precertRequired":false,"billingCode":"57500","codeType":"CPT"},{"id":3639,"precertRequired":false,"billingCode":"57505","codeType":"CPT"},{"id":3640,"precertRequired":false,"billingCode":"57510","codeType":"CPT"},{"id":3641,"precertRequired":false,"billingCode":"57511","codeType":"CPT"},{"id":3642,"precertRequired":false,"billingCode":"57513","codeType":"CPT"},{"id":3643,"precertRequired":false,"billingCode":"57520","codeType":"CPT"},{"id":3644,"precertRequired":false,"billingCode":"57522","codeType":"CPT"},{"id":3645,"precertRequired":false,"billingCode":"57530","codeType":"CPT"},{"id":3646,"precertRequired":false,"billingCode":"57531","codeType":"CPT"},{"id":3647,"precertRequired":false,"billingCode":"57540","codeType":"CPT"},{"id":3648,"precertRequired":false,"billingCode":"57545","codeType":"CPT"},{"id":3649,"precertRequired":false,"billingCode":"57550","codeType":"CPT"},{"id":3650,"precertRequired":false,"billingCode":"57555","codeType":"CPT"},{"id":3651,"precertRequired":false,"billingCode":"57556","codeType":"CPT"},{"id":3652,"precertRequired":false,"billingCode":"57558","codeType":"CPT"},{"id":3653,"precertRequired":false,"billingCode":"57700","codeType":"CPT"},{"id":3654,"precertRequired":false,"billingCode":"57720","codeType":"CPT"},{"id":3655,"precertRequired":false,"billingCode":"57800","codeType":"CPT"},{"id":3656,"precertRequired":false,"billingCode":"58100","codeType":"CPT"},{"id":3657,"precertRequired":false,"billingCode":"58110","codeType":"CPT"},{"id":3658,"precertRequired":false,"billingCode":"58120","codeType":"CPT"},{"id":3659,"precertRequired":false,"billingCode":"58140","codeType":"CPT"},{"id":3660,"precertRequired":false,"billingCode":"58145","codeType":"CPT"},{"id":3661,"precertRequired":false,"billingCode":"58146","codeType":"CPT"},{"id":3662,"precertRequired":false,"billingCode":"58150","codeType":"CPT"},{"id":3663,"precertRequired":false,"billingCode":"58152","codeType":"CPT"},{"id":3664,"precertRequired":false,"billingCode":"58180","codeType":"CPT"},{"id":3665,"precertRequired":false,"billingCode":"58200","codeType":"CPT"},{"id":3666,"precertRequired":false,"billingCode":"58210","codeType":"CPT"},{"id":3667,"precertRequired":false,"billingCode":"58240","codeType":"CPT"},{"id":3668,"precertRequired":false,"billingCode":"58260","codeType":"CPT"},{"id":3669,"precertRequired":false,"billingCode":"58262","codeType":"CPT"},{"id":3670,"precertRequired":false,"billingCode":"58263","codeType":"CPT"},{"id":3671,"precertRequired":false,"billingCode":"58267","codeType":"CPT"},{"id":3672,"precertRequired":false,"billingCode":"58270","codeType":"CPT"},{"id":3673,"precertRequired":false,"billingCode":"58275","codeType":"CPT"},{"id":3674,"precertRequired":false,"billingCode":"58280","codeType":"CPT"},{"id":3675,"precertRequired":false,"billingCode":"58285","codeType":"CPT"},{"id":3676,"precertRequired":false,"billingCode":"58290","codeType":"CPT"},{"id":3677,"precertRequired":false,"billingCode":"58291","codeType":"CPT"},{"id":3678,"precertRequired":false,"billingCode":"58292","codeType":"CPT"},{"id":3679,"precertRequired":false,"billingCode":"58293","codeType":"CPT"},{"id":3680,"precertRequired":false,"billingCode":"58294","codeType":"CPT"},{"id":3681,"precertRequired":false,"billingCode":"58300","codeType":"CPT"},{"id":3682,"precertRequired":false,"billingCode":"58301","codeType":"CPT"},{"id":3686,"precertRequired":false,"billingCode":"58340","codeType":"CPT"},{"id":3687,"precertRequired":false,"billingCode":"58345","codeType":"CPT"},{"id":3688,"precertRequired":false,"billingCode":"58350","codeType":"CPT"},{"id":3689,"precertRequired":false,"billingCode":"58353","codeType":"CPT"},{"id":3690,"precertRequired":false,"billingCode":"58356","codeType":"CPT"},{"id":3691,"precertRequired":false,"billingCode":"58400","codeType":"CPT"},{"id":3692,"precertRequired":false,"billingCode":"58410","codeType":"CPT"},{"id":3693,"precertRequired":false,"billingCode":"58520","codeType":"CPT"},{"id":3694,"precertRequired":false,"billingCode":"58540","codeType":"CPT"},{"id":3695,"precertRequired":false,"billingCode":"58541","codeType":"CPT"},{"id":3696,"precertRequired":false,"billingCode":"58542","codeType":"CPT"},{"id":3697,"precertRequired":false,"billingCode":"58543","codeType":"CPT"},{"id":3698,"precertRequired":false,"billingCode":"58544","codeType":"CPT"},{"id":3699,"precertRequired":false,"billingCode":"58545","codeType":"CPT"},{"id":3700,"precertRequired":false,"billingCode":"58546","codeType":"CPT"},{"id":3701,"precertRequired":false,"billingCode":"58548","codeType":"CPT"},{"id":3702,"precertRequired":false,"billingCode":"58550","codeType":"CPT"},{"id":3703,"precertRequired":false,"billingCode":"58552","codeType":"CPT"},{"id":3704,"precertRequired":false,"billingCode":"58553","codeType":"CPT"},{"id":3705,"precertRequired":false,"billingCode":"58554","codeType":"CPT"},{"id":3706,"precertRequired":false,"billingCode":"58555","codeType":"CPT"},{"id":3707,"precertRequired":false,"billingCode":"58558","codeType":"CPT"},{"id":3708,"precertRequired":false,"billingCode":"58559","codeType":"CPT"},{"id":3709,"precertRequired":false,"billingCode":"58560","codeType":"CPT"},{"id":3710,"precertRequired":false,"billingCode":"58561","codeType":"CPT"},{"id":3711,"precertRequired":false,"billingCode":"58562","codeType":"CPT"},{"id":3712,"precertRequired":false,"billingCode":"58563","codeType":"CPT"},{"id":3713,"precertRequired":false,"billingCode":"58565","codeType":"CPT"},{"id":3714,"precertRequired":false,"billingCode":"58570","codeType":"CPT"},{"id":3715,"precertRequired":false,"billingCode":"58571","codeType":"CPT"},{"id":3716,"precertRequired":false,"billingCode":"58572","codeType":"CPT"},{"id":3717,"precertRequired":false,"billingCode":"58573","codeType":"CPT"},{"id":3718,"precertRequired":false,"billingCode":"58575","codeType":"CPT"},{"id":3719,"precertRequired":false,"billingCode":"58578","codeType":"CPT"},{"id":3720,"precertRequired":false,"billingCode":"58579","codeType":"CPT"},{"id":3721,"precertRequired":false,"billingCode":"58600","codeType":"CPT"},{"id":3722,"precertRequired":false,"billingCode":"58605","codeType":"CPT"},{"id":3723,"precertRequired":false,"billingCode":"58611","codeType":"CPT"},{"id":3724,"precertRequired":false,"billingCode":"58615","codeType":"CPT"},{"id":3725,"precertRequired":false,"billingCode":"58660","codeType":"CPT"},{"id":3726,"precertRequired":false,"billingCode":"58661","codeType":"CPT"},{"id":3727,"precertRequired":false,"billingCode":"58662","codeType":"CPT"},{"id":3728,"precertRequired":true,"billingCode":"58670","codeType":"CPT"},{"id":3729,"precertRequired":false,"billingCode":"58671","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3732,"precertRequired":false,"billingCode":"58674","codeType":"CPT"},{"id":3733,"precertRequired":false,"billingCode":"58679","codeType":"CPT"},{"id":3734,"precertRequired":false,"billingCode":"58700","codeType":"CPT"},{"id":3735,"precertRequired":false,"billingCode":"58720","codeType":"CPT"},{"id":3736,"precertRequired":false,"billingCode":"58740","codeType":"CPT"},{"id":3737,"precertRequired":false,"billingCode":"58750","codeType":"CPT"},{"id":3738,"precertRequired":false,"billingCode":"58752","codeType":"CPT"},{"id":3739,"precertRequired":false,"billingCode":"58760","codeType":"CPT"},{"id":3740,"precertRequired":false,"billingCode":"58770","codeType":"CPT"},{"id":3741,"precertRequired":false,"billingCode":"58800","codeType":"CPT"},{"id":3742,"precertRequired":false,"billingCode":"58805","codeType":"CPT"},{"id":3743,"precertRequired":false,"billingCode":"58820","codeType":"CPT"},{"id":3744,"precertRequired":false,"billingCode":"58822","codeType":"CPT"},{"id":3745,"precertRequired":false,"billingCode":"58825","codeType":"CPT"},{"id":3746,"precertRequired":false,"billingCode":"58900","codeType":"CPT"},{"id":3747,"precertRequired":false,"billingCode":"58920","codeType":"CPT"},{"id":3748,"precertRequired":false,"billingCode":"58925","codeType":"CPT"},{"id":3749,"precertRequired":false,"billingCode":"58940","codeType":"CPT"},{"id":3750,"precertRequired":false,"billingCode":"58943","codeType":"CPT"},{"id":3751,"precertRequired":false,"billingCode":"58950","codeType":"CPT"},{"id":3752,"precertRequired":false,"billingCode":"58951","codeType":"CPT"},{"id":3753,"precertRequired":false,"billingCode":"58952","codeType":"CPT"},{"id":3754,"precertRequired":false,"billingCode":"58953","codeType":"CPT"},{"id":3755,"precertRequired":false,"billingCode":"58954","codeType":"CPT"},{"id":3756,"precertRequired":false,"billingCode":"58956","codeType":"CPT"},{"id":3757,"precertRequired":false,"billingCode":"58957","codeType":"CPT"},{"id":3758,"precertRequired":false,"billingCode":"58958","codeType":"CPT"},{"id":3759,"precertRequired":false,"billingCode":"58960","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":192,"description":"Anesthesia consultation per the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":84,"precertRequired":false,"billingCode":"00800","codeType":"CPT"},{"id":89,"precertRequired":false,"billingCode":"00820","codeType":"CPT"},{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":97,"precertRequired":false,"billingCode":"00846","codeType":"CPT"},{"id":99,"precertRequired":false,"billingCode":"00851","codeType":"CPT"},{"id":100,"precertRequired":false,"billingCode":"00860","codeType":"CPT"},{"id":113,"precertRequired":false,"billingCode":"00906","codeType":"CPT"},{"id":131,"precertRequired":false,"billingCode":"00940","codeType":"CPT"},{"id":132,"precertRequired":false,"billingCode":"00942","codeType":"CPT"},{"id":133,"precertRequired":false,"billingCode":"00944","codeType":"CPT"},{"id":135,"precertRequired":false,"billingCode":"00950","codeType":"CPT"},{"id":136,"precertRequired":false,"billingCode":"00952","codeType":"CPT"},{"id":217,"precertRequired":false,"billingCode":"01991","codeType":"CPT"},{"id":218,"precertRequired":false,"billingCode":"01992","codeType":"CPT"},{"id":219,"precertRequired":false,"billingCode":"01996","codeType":"CPT"},{"id":220,"precertRequired":false,"billingCode":"01999","codeType":"CPT"},{"id":7329,"precertRequired":false,"billingCode":"99100","codeType":"CPT"},{"id":7330,"precertRequired":false,"billingCode":"99116","codeType":"CPT"},{"id":7331,"precertRequired":false,"billingCode":"99135","codeType":"CPT"},{"id":7332,"precertRequired":false,"billingCode":"99140","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":193,"description":"Pre-operative medical/cardiac clearance as indicated (including H+P/labs, EKG, CXR). May be completed at VA if primary care provider is assigned and available.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":194,"description":"Inpatient admission for surgical procedure if indicated.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":195,"description":"Inpatient admission or observation status for complications per the referred condition indicated on the consult ** VA notification within 72 hours to local Community Care office who initiated the referral is required for complications related to the initial surgery","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":196,"description":"Follow-up visits for this episode of care ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"},{"id":7452,"precertRequired":false,"billingCode":"99395","codeType":"CPT"},{"id":7453,"precertRequired":false,"billingCode":"99396","codeType":"CPT"},{"id":7454,"precertRequired":false,"billingCode":"99397","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":8892,"precertRequired":false,"billingCode":"S0610","codeType":"HCPCS"},{"id":8893,"precertRequired":false,"billingCode":"S0612","codeType":"HCPCS"},{"id":8894,"precertRequired":false,"billingCode":"S0613","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":197,"description":"Follow-up imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4486,"precertRequired":false,"billingCode":"72191","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4575,"precertRequired":false,"billingCode":"74174","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4703,"precertRequired":false,"billingCode":"76376","codeType":"CPT"},{"id":4704,"precertRequired":false,"billingCode":"76377","codeType":"CPT"},{"id":4707,"precertRequired":false,"billingCode":"76496","codeType":"CPT"},{"id":4708,"precertRequired":false,"billingCode":"76497","codeType":"CPT"},{"id":4709,"precertRequired":false,"billingCode":"76498","codeType":"CPT"},{"id":4710,"precertRequired":false,"billingCode":"76499","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4769,"precertRequired":true,"billingCode":"76948","codeType":"CPT"},{"id":4773,"precertRequired":false,"billingCode":"76998","codeType":"CPT"},{"id":4774,"precertRequired":false,"billingCode":"76999","codeType":"CPT"},{"id":4776,"precertRequired":true,"billingCode":"77002","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4781,"precertRequired":false,"billingCode":"77021","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":198,"description":"Follow-up studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8127,"precertRequired":false,"billingCode":"G0123","codeType":"HCPCS"},{"id":8128,"precertRequired":false,"billingCode":"G0124","codeType":"HCPCS"},{"id":8133,"precertRequired":false,"billingCode":"G0141","codeType":"HCPCS"},{"id":8134,"precertRequired":false,"billingCode":"G0143","codeType":"HCPCS"},{"id":8135,"precertRequired":false,"billingCode":"G0144","codeType":"HCPCS"},{"id":8136,"precertRequired":false,"billingCode":"G0145","codeType":"HCPCS"},{"id":8137,"precertRequired":false,"billingCode":"G0147","codeType":"HCPCS"},{"id":8138,"precertRequired":false,"billingCode":"G0148","codeType":"HCPCS"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":8217,"precertRequired":false,"billingCode":"G0445","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]}]}},{"Seoc":{"id":1756,"seocKey":58,"name":"Hematology_PRCT","seocId":"MSC_HEMATOLOGY_1.0.6_PRCT","versionNumber":"1.0.6","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"06-08-2020","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for the referred condition indicated on the consult order\r\n2.  Diagnostic imaging relevant to the referred condition on the consult order\r\n3.  Labs and pathology relevant to the referred condition on the consult order\r\n4.  Procedures related to the referred condition on the consult including but no limited to:  bone marrow aspiration, lumbar puncture, etc. \r\n5.  Inpatient or observation admission for treatment, if indicated\r\n6.  Inpatient admission or observation status for complications related to treatment\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n7.  Infusion therapy or phlebotomy as clinically indicated by hematologist (in clinic)","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"HEMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RH0000X"}],"services":[{"id":5264,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":5265,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4369,"precertRequired":false,"billingCode":"70100","codeType":"CPT"},{"id":4370,"precertRequired":false,"billingCode":"70110","codeType":"CPT"},{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4374,"precertRequired":false,"billingCode":"70140","codeType":"CPT"},{"id":4376,"precertRequired":false,"billingCode":"70150","codeType":"CPT"},{"id":4377,"precertRequired":false,"billingCode":"70160","codeType":"CPT"},{"id":4378,"precertRequired":false,"billingCode":"70170","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4383,"precertRequired":false,"billingCode":"70240","codeType":"CPT"},{"id":4384,"precertRequired":false,"billingCode":"70250","codeType":"CPT"},{"id":4385,"precertRequired":false,"billingCode":"70260","codeType":"CPT"},{"id":4386,"precertRequired":false,"billingCode":"70300","codeType":"CPT"},{"id":4387,"precertRequired":false,"billingCode":"70310","codeType":"CPT"},{"id":4388,"precertRequired":false,"billingCode":"70320","codeType":"CPT"},{"id":4389,"precertRequired":false,"billingCode":"70328","codeType":"CPT"},{"id":4390,"precertRequired":false,"billingCode":"70330","codeType":"CPT"},{"id":4391,"precertRequired":false,"billingCode":"70332","codeType":"CPT"},{"id":4392,"precertRequired":false,"billingCode":"70336","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4396,"precertRequired":false,"billingCode":"70380","codeType":"CPT"},{"id":4397,"precertRequired":false,"billingCode":"70390","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4494,"precertRequired":false,"billingCode":"72200","codeType":"CPT"},{"id":4495,"precertRequired":false,"billingCode":"72202","codeType":"CPT"},{"id":4496,"precertRequired":false,"billingCode":"72220","codeType":"CPT"},{"id":4497,"precertRequired":false,"billingCode":"72240","codeType":"CPT"},{"id":4498,"precertRequired":true,"billingCode":"72255","codeType":"CPT"},{"id":4499,"precertRequired":false,"billingCode":"72265","codeType":"CPT"},{"id":4500,"precertRequired":true,"billingCode":"72270","codeType":"CPT"},{"id":4504,"precertRequired":false,"billingCode":"73000","codeType":"CPT"},{"id":4505,"precertRequired":false,"billingCode":"73010","codeType":"CPT"},{"id":4506,"precertRequired":false,"billingCode":"73020","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4508,"precertRequired":false,"billingCode":"73040","codeType":"CPT"},{"id":4509,"precertRequired":false,"billingCode":"73050","codeType":"CPT"},{"id":4510,"precertRequired":false,"billingCode":"73060","codeType":"CPT"},{"id":4511,"precertRequired":false,"billingCode":"73070","codeType":"CPT"},{"id":4512,"precertRequired":false,"billingCode":"73080","codeType":"CPT"},{"id":4513,"precertRequired":false,"billingCode":"73085","codeType":"CPT"},{"id":4514,"precertRequired":false,"billingCode":"73090","codeType":"CPT"},{"id":4515,"precertRequired":false,"billingCode":"73092","codeType":"CPT"},{"id":4516,"precertRequired":false,"billingCode":"73100","codeType":"CPT"},{"id":4517,"precertRequired":false,"billingCode":"73110","codeType":"CPT"},{"id":4518,"precertRequired":false,"billingCode":"73115","codeType":"CPT"},{"id":4519,"precertRequired":false,"billingCode":"73120","codeType":"CPT"},{"id":4520,"precertRequired":false,"billingCode":"73130","codeType":"CPT"},{"id":4521,"precertRequired":false,"billingCode":"73140","codeType":"CPT"},{"id":4526,"precertRequired":true,"billingCode":"73218","codeType":"CPT"},{"id":4527,"precertRequired":true,"billingCode":"73219","codeType":"CPT"},{"id":4528,"precertRequired":true,"billingCode":"73220","codeType":"CPT"},{"id":4529,"precertRequired":true,"billingCode":"73221","codeType":"CPT"},{"id":4530,"precertRequired":true,"billingCode":"73222","codeType":"CPT"},{"id":4531,"precertRequired":true,"billingCode":"73223","codeType":"CPT"},{"id":4532,"precertRequired":false,"billingCode":"73225","codeType":"CPT"},{"id":4533,"precertRequired":false,"billingCode":"73501","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4535,"precertRequired":false,"billingCode":"73503","codeType":"CPT"},{"id":4536,"precertRequired":false,"billingCode":"73521","codeType":"CPT"},{"id":4537,"precertRequired":false,"billingCode":"73522","codeType":"CPT"},{"id":4538,"precertRequired":false,"billingCode":"73523","codeType":"CPT"},{"id":4539,"precertRequired":false,"billingCode":"73525","codeType":"CPT"},{"id":4540,"precertRequired":false,"billingCode":"73551","codeType":"CPT"},{"id":4541,"precertRequired":false,"billingCode":"73552","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"},{"id":4543,"precertRequired":false,"billingCode":"73562","codeType":"CPT"},{"id":4544,"precertRequired":false,"billingCode":"73564","codeType":"CPT"},{"id":4545,"precertRequired":false,"billingCode":"73565","codeType":"CPT"},{"id":4546,"precertRequired":false,"billingCode":"73580","codeType":"CPT"},{"id":4547,"precertRequired":false,"billingCode":"73590","codeType":"CPT"},{"id":4548,"precertRequired":false,"billingCode":"73592","codeType":"CPT"},{"id":4549,"precertRequired":false,"billingCode":"73600","codeType":"CPT"},{"id":4550,"precertRequired":false,"billingCode":"73610","codeType":"CPT"},{"id":4551,"precertRequired":false,"billingCode":"73615","codeType":"CPT"},{"id":4552,"precertRequired":false,"billingCode":"73620","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4554,"precertRequired":false,"billingCode":"73650","codeType":"CPT"},{"id":4555,"precertRequired":false,"billingCode":"73660","codeType":"CPT"},{"id":4560,"precertRequired":true,"billingCode":"73718","codeType":"CPT"},{"id":4561,"precertRequired":true,"billingCode":"73719","codeType":"CPT"},{"id":4562,"precertRequired":true,"billingCode":"73720","codeType":"CPT"},{"id":4563,"precertRequired":true,"billingCode":"73721","codeType":"CPT"},{"id":4564,"precertRequired":true,"billingCode":"73722","codeType":"CPT"},{"id":4565,"precertRequired":true,"billingCode":"73723","codeType":"CPT"},{"id":4566,"precertRequired":true,"billingCode":"73725","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4614,"precertRequired":false,"billingCode":"74400","codeType":"CPT"},{"id":4615,"precertRequired":false,"billingCode":"74410","codeType":"CPT"},{"id":4616,"precertRequired":false,"billingCode":"74415","codeType":"CPT"},{"id":4617,"precertRequired":false,"billingCode":"74420","codeType":"CPT"},{"id":4618,"precertRequired":false,"billingCode":"74425","codeType":"CPT"},{"id":4619,"precertRequired":false,"billingCode":"74430","codeType":"CPT"},{"id":4620,"precertRequired":false,"billingCode":"74440","codeType":"CPT"},{"id":4622,"precertRequired":false,"billingCode":"74450","codeType":"CPT"},{"id":4623,"precertRequired":false,"billingCode":"74455","codeType":"CPT"},{"id":4624,"precertRequired":false,"billingCode":"74470","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4722,"precertRequired":false,"billingCode":"76641","codeType":"CPT"},{"id":4723,"precertRequired":false,"billingCode":"76642","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4755,"precertRequired":false,"billingCode":"76870","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4757,"precertRequired":false,"billingCode":"76873","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4759,"precertRequired":false,"billingCode":"76882","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4782,"precertRequired":false,"billingCode":"77053","codeType":"CPT"},{"id":4783,"precertRequired":false,"billingCode":"77054","codeType":"CPT"},{"id":4786,"precertRequired":false,"billingCode":"77061","codeType":"CPT"},{"id":4787,"precertRequired":false,"billingCode":"77062","codeType":"CPT"},{"id":4788,"precertRequired":false,"billingCode":"77063","codeType":"CPT"},{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4894,"precertRequired":false,"billingCode":"78140","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4906,"precertRequired":false,"billingCode":"78230","codeType":"CPT"},{"id":4907,"precertRequired":false,"billingCode":"78231","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4925,"precertRequired":false,"billingCode":"78315","codeType":"CPT"},{"id":4959,"precertRequired":false,"billingCode":"78600","codeType":"CPT"},{"id":4960,"precertRequired":false,"billingCode":"78601","codeType":"CPT"},{"id":4961,"precertRequired":false,"billingCode":"78605","codeType":"CPT"},{"id":4962,"precertRequired":false,"billingCode":"78606","codeType":"CPT"},{"id":4970,"precertRequired":false,"billingCode":"78700","codeType":"CPT"},{"id":4971,"precertRequired":false,"billingCode":"78701","codeType":"CPT"},{"id":4979,"precertRequired":false,"billingCode":"78761","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4985,"precertRequired":false,"billingCode":"78804","codeType":"CPT"},{"id":9769,"precertRequired":true,"billingCode":"77046","codeType":"CPT"},{"id":9770,"precertRequired":true,"billingCode":"77047","codeType":"CPT"},{"id":9771,"precertRequired":true,"billingCode":"77048","codeType":"CPT"},{"id":9772,"precertRequired":true,"billingCode":"77049","codeType":"CPT"},{"id":13326,"precertRequired":true,"billingCode":"70545","codeType":"CPT"},{"id":13327,"precertRequired":true,"billingCode":"70546","codeType":"CPT"},{"id":13328,"precertRequired":true,"billingCode":"70547","codeType":"CPT"},{"id":13329,"precertRequired":true,"billingCode":"70548","codeType":"CPT"},{"id":13330,"precertRequired":true,"billingCode":"70554","codeType":"CPT"},{"id":13331,"precertRequired":true,"billingCode":"70555","codeType":"CPT"},{"id":13332,"precertRequired":true,"billingCode":"70557","codeType":"CPT"},{"id":13333,"precertRequired":true,"billingCode":"70558","codeType":"CPT"},{"id":13334,"precertRequired":true,"billingCode":"70559","codeType":"CPT"},{"id":13443,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":13444,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":13445,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":13450,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":13451,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":13452,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":13453,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":13454,"precertRequired":false,"billingCode":"74260","codeType":"CPT"},{"id":13455,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":13456,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":13457,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":13458,"precertRequired":false,"billingCode":"78607","codeType":"CPT"},{"id":13459,"precertRequired":false,"billingCode":"78710","codeType":"CPT"},{"id":13656,"precertRequired":true,"billingCode":"71260","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":5266,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5429,"precertRequired":false,"billingCode":"82374","codeType":"CPT"},{"id":5430,"precertRequired":false,"billingCode":"82375","codeType":"CPT"},{"id":5431,"precertRequired":false,"billingCode":"82376","codeType":"CPT"},{"id":5453,"precertRequired":false,"billingCode":"82525","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5480,"precertRequired":false,"billingCode":"82657","codeType":"CPT"},{"id":5481,"precertRequired":false,"billingCode":"82658","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5585,"precertRequired":false,"billingCode":"83625","codeType":"CPT"},{"id":5590,"precertRequired":false,"billingCode":"83655","codeType":"CPT"},{"id":5654,"precertRequired":false,"billingCode":"84119","codeType":"CPT"},{"id":5656,"precertRequired":false,"billingCode":"84126","codeType":"CPT"},{"id":5758,"precertRequired":false,"billingCode":"84630","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5765,"precertRequired":false,"billingCode":"85002","codeType":"CPT"},{"id":5766,"precertRequired":false,"billingCode":"85004","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5768,"precertRequired":false,"billingCode":"85008","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5770,"precertRequired":false,"billingCode":"85013","codeType":"CPT"},{"id":5771,"precertRequired":false,"billingCode":"85014","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5775,"precertRequired":false,"billingCode":"85032","codeType":"CPT"},{"id":5776,"precertRequired":false,"billingCode":"85041","codeType":"CPT"},{"id":5777,"precertRequired":false,"billingCode":"85044","codeType":"CPT"},{"id":5778,"precertRequired":false,"billingCode":"85045","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5780,"precertRequired":false,"billingCode":"85048","codeType":"CPT"},{"id":5781,"precertRequired":false,"billingCode":"85049","codeType":"CPT"},{"id":5782,"precertRequired":false,"billingCode":"85055","codeType":"CPT"},{"id":5783,"precertRequired":false,"billingCode":"85060","codeType":"CPT"},{"id":5784,"precertRequired":false,"billingCode":"85097","codeType":"CPT"},{"id":5785,"precertRequired":false,"billingCode":"85130","codeType":"CPT"},{"id":5788,"precertRequired":false,"billingCode":"85210","codeType":"CPT"},{"id":5789,"precertRequired":false,"billingCode":"85220","codeType":"CPT"},{"id":5790,"precertRequired":false,"billingCode":"85230","codeType":"CPT"},{"id":5791,"precertRequired":false,"billingCode":"85240","codeType":"CPT"},{"id":5792,"precertRequired":false,"billingCode":"85244","codeType":"CPT"},{"id":5793,"precertRequired":false,"billingCode":"85245","codeType":"CPT"},{"id":5794,"precertRequired":false,"billingCode":"85246","codeType":"CPT"},{"id":5796,"precertRequired":false,"billingCode":"85250","codeType":"CPT"},{"id":5797,"precertRequired":false,"billingCode":"85260","codeType":"CPT"},{"id":5798,"precertRequired":false,"billingCode":"85270","codeType":"CPT"},{"id":5799,"precertRequired":false,"billingCode":"85280","codeType":"CPT"},{"id":5800,"precertRequired":false,"billingCode":"85290","codeType":"CPT"},{"id":5806,"precertRequired":false,"billingCode":"85302","codeType":"CPT"},{"id":5807,"precertRequired":false,"billingCode":"85303","codeType":"CPT"},{"id":5808,"precertRequired":false,"billingCode":"85305","codeType":"CPT"},{"id":5809,"precertRequired":false,"billingCode":"85306","codeType":"CPT"},{"id":5810,"precertRequired":false,"billingCode":"85307","codeType":"CPT"},{"id":5813,"precertRequired":false,"billingCode":"85345","codeType":"CPT"},{"id":5814,"precertRequired":false,"billingCode":"85347","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5826,"precertRequired":false,"billingCode":"85396","codeType":"CPT"},{"id":5827,"precertRequired":false,"billingCode":"85397","codeType":"CPT"},{"id":5835,"precertRequired":false,"billingCode":"85460","codeType":"CPT"},{"id":5836,"precertRequired":false,"billingCode":"85461","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5860,"precertRequired":false,"billingCode":"85705","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5862,"precertRequired":false,"billingCode":"85732","codeType":"CPT"},{"id":5863,"precertRequired":false,"billingCode":"85810","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5922,"precertRequired":false,"billingCode":"86335","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8450,"precertRequired":false,"billingCode":"J1756","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":5267,"description":"Procedures related to the referred condition on the consult including but no limited to:  bone marrow aspiration, lumbar puncture, etc.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":68,"precertRequired":false,"billingCode":"00635","codeType":"CPT"},{"id":137,"precertRequired":false,"billingCode":"01112","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2547,"precertRequired":false,"billingCode":"36455","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2567,"precertRequired":false,"billingCode":"36565","codeType":"CPT"},{"id":2568,"precertRequired":false,"billingCode":"36566","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2572,"precertRequired":false,"billingCode":"36571","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2583,"precertRequired":false,"billingCode":"36590","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2585,"precertRequired":false,"billingCode":"36592","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":2590,"precertRequired":false,"billingCode":"36598","codeType":"CPT"},{"id":2595,"precertRequired":false,"billingCode":"36640","codeType":"CPT"},{"id":2679,"precertRequired":false,"billingCode":"38220","codeType":"CPT"},{"id":2680,"precertRequired":false,"billingCode":"38221","codeType":"CPT"},{"id":2681,"precertRequired":false,"billingCode":"38222","codeType":"CPT"},{"id":2689,"precertRequired":false,"billingCode":"38505","codeType":"CPT"},{"id":2692,"precertRequired":false,"billingCode":"38525","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":3881,"precertRequired":false,"billingCode":"62272","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":6960,"precertRequired":true,"billingCode":"93792","codeType":"CPT"},{"id":6961,"precertRequired":false,"billingCode":"93793","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7891,"precertRequired":false,"billingCode":"A9552","codeType":"HCPCS"},{"id":7911,"precertRequired":false,"billingCode":"A9575","codeType":"HCPCS"},{"id":7913,"precertRequired":false,"billingCode":"A9577","codeType":"HCPCS"},{"id":7921,"precertRequired":false,"billingCode":"A9585","codeType":"HCPCS"},{"id":7929,"precertRequired":false,"billingCode":"A9606","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8387,"precertRequired":false,"billingCode":"J0641","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8397,"precertRequired":true,"billingCode":"J0881","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8478,"precertRequired":false,"billingCode":"J2505","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8497,"precertRequired":false,"billingCode":"J2930","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":9817,"precertRequired":false,"billingCode":"J1447","codeType":"HCPCS"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"},{"id":11583,"precertRequired":false,"billingCode":"36522","codeType":"CPT"},{"id":11586,"precertRequired":false,"billingCode":"38792","codeType":"CPT"},{"id":11587,"precertRequired":false,"billingCode":"J1300","codeType":"HCPCS"},{"id":11588,"precertRequired":false,"billingCode":"J2796","codeType":"HCPCS"},{"id":11589,"precertRequired":false,"billingCode":"J2820","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":5268,"description":"Inpatient or observation admission for treatment, if indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":5269,"description":"Inpatient admission or observation status for complications related to treatment\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":5270,"description":"Infusion therapy or phlebotomy as clinically indicated by hematologist (in clinic)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":137,"precertRequired":false,"billingCode":"01112","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2583,"precertRequired":false,"billingCode":"36590","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2585,"precertRequired":false,"billingCode":"36592","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":2590,"precertRequired":false,"billingCode":"36598","codeType":"CPT"},{"id":2595,"precertRequired":false,"billingCode":"36640","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":6960,"precertRequired":true,"billingCode":"93792","codeType":"CPT"},{"id":6961,"precertRequired":false,"billingCode":"93793","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7891,"precertRequired":false,"billingCode":"A9552","codeType":"HCPCS"},{"id":7911,"precertRequired":false,"billingCode":"A9575","codeType":"HCPCS"},{"id":7913,"precertRequired":false,"billingCode":"A9577","codeType":"HCPCS"},{"id":7921,"precertRequired":false,"billingCode":"A9585","codeType":"HCPCS"},{"id":7929,"precertRequired":false,"billingCode":"A9606","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8387,"precertRequired":false,"billingCode":"J0641","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8397,"precertRequired":true,"billingCode":"J0881","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8478,"precertRequired":false,"billingCode":"J2505","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8497,"precertRequired":false,"billingCode":"J2930","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8723,"precertRequired":false,"billingCode":"P9010","codeType":"HCPCS"},{"id":8724,"precertRequired":false,"billingCode":"P9011","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8728,"precertRequired":false,"billingCode":"P9019","codeType":"HCPCS"},{"id":8729,"precertRequired":false,"billingCode":"P9020","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8740,"precertRequired":false,"billingCode":"P9038","codeType":"HCPCS"},{"id":8741,"precertRequired":false,"billingCode":"P9039","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8751,"precertRequired":false,"billingCode":"P9051","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8754,"precertRequired":false,"billingCode":"P9054","codeType":"HCPCS"},{"id":8756,"precertRequired":false,"billingCode":"P9056","codeType":"HCPCS"},{"id":8757,"precertRequired":false,"billingCode":"P9057","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8759,"precertRequired":false,"billingCode":"P9059","codeType":"HCPCS"},{"id":8761,"precertRequired":false,"billingCode":"P9070","codeType":"HCPCS"},{"id":8762,"precertRequired":false,"billingCode":"P9071","codeType":"HCPCS"},{"id":8763,"precertRequired":false,"billingCode":"P9073","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":9817,"precertRequired":false,"billingCode":"J1447","codeType":"HCPCS"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"},{"id":11583,"precertRequired":false,"billingCode":"36522","codeType":"CPT"},{"id":11587,"precertRequired":false,"billingCode":"J1300","codeType":"HCPCS"},{"id":11588,"precertRequired":false,"billingCode":"J2796","codeType":"HCPCS"},{"id":11589,"precertRequired":false,"billingCode":"J2820","codeType":"HCPCS"},{"id":11590,"precertRequired":false,"billingCode":"P9100","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]}]}},{"Seoc":{"id":524,"seocKey":58,"name":"Hematology_PRCT","seocId":"MSC_HEMATOLOGY_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":"06-08-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.  Diagnostic imaging relevant to the referred condition on the consult  \r\n3.  Labs and pathology relevant to the referred condition on the consult\r\n4.  Procedures related to the referred condition on the consult including but no limited to:  bone marrow aspiration, lumbar puncture, etc. \r\n5.  Inpatient or observation admission for treatment, if indicated\r\n6.  Inpatient admission or observation status for complications related to treatment\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the treatment\r\n7.  Infusion therapy or phlebotomy as clinically indicated by hematologist (in clinic)","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"HEMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RH0000X"}],"services":[{"id":3041,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":3042,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4369,"precertRequired":false,"billingCode":"70100","codeType":"CPT"},{"id":4370,"precertRequired":false,"billingCode":"70110","codeType":"CPT"},{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4374,"precertRequired":false,"billingCode":"70140","codeType":"CPT"},{"id":4376,"precertRequired":false,"billingCode":"70150","codeType":"CPT"},{"id":4377,"precertRequired":false,"billingCode":"70160","codeType":"CPT"},{"id":4378,"precertRequired":false,"billingCode":"70170","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4383,"precertRequired":false,"billingCode":"70240","codeType":"CPT"},{"id":4384,"precertRequired":false,"billingCode":"70250","codeType":"CPT"},{"id":4385,"precertRequired":false,"billingCode":"70260","codeType":"CPT"},{"id":4386,"precertRequired":false,"billingCode":"70300","codeType":"CPT"},{"id":4387,"precertRequired":false,"billingCode":"70310","codeType":"CPT"},{"id":4388,"precertRequired":false,"billingCode":"70320","codeType":"CPT"},{"id":4389,"precertRequired":false,"billingCode":"70328","codeType":"CPT"},{"id":4390,"precertRequired":false,"billingCode":"70330","codeType":"CPT"},{"id":4391,"precertRequired":false,"billingCode":"70332","codeType":"CPT"},{"id":4392,"precertRequired":false,"billingCode":"70336","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4396,"precertRequired":false,"billingCode":"70380","codeType":"CPT"},{"id":4397,"precertRequired":false,"billingCode":"70390","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4416,"precertRequired":false,"billingCode":"70545","codeType":"CPT"},{"id":4417,"precertRequired":false,"billingCode":"70546","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4424,"precertRequired":false,"billingCode":"70554","codeType":"CPT"},{"id":4425,"precertRequired":false,"billingCode":"70555","codeType":"CPT"},{"id":4426,"precertRequired":false,"billingCode":"70557","codeType":"CPT"},{"id":4427,"precertRequired":false,"billingCode":"70558","codeType":"CPT"},{"id":4428,"precertRequired":false,"billingCode":"70559","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4494,"precertRequired":false,"billingCode":"72200","codeType":"CPT"},{"id":4495,"precertRequired":false,"billingCode":"72202","codeType":"CPT"},{"id":4496,"precertRequired":false,"billingCode":"72220","codeType":"CPT"},{"id":4497,"precertRequired":false,"billingCode":"72240","codeType":"CPT"},{"id":4498,"precertRequired":true,"billingCode":"72255","codeType":"CPT"},{"id":4499,"precertRequired":false,"billingCode":"72265","codeType":"CPT"},{"id":4500,"precertRequired":true,"billingCode":"72270","codeType":"CPT"},{"id":4504,"precertRequired":false,"billingCode":"73000","codeType":"CPT"},{"id":4505,"precertRequired":false,"billingCode":"73010","codeType":"CPT"},{"id":4506,"precertRequired":false,"billingCode":"73020","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4508,"precertRequired":false,"billingCode":"73040","codeType":"CPT"},{"id":4509,"precertRequired":false,"billingCode":"73050","codeType":"CPT"},{"id":4510,"precertRequired":false,"billingCode":"73060","codeType":"CPT"},{"id":4511,"precertRequired":false,"billingCode":"73070","codeType":"CPT"},{"id":4512,"precertRequired":false,"billingCode":"73080","codeType":"CPT"},{"id":4513,"precertRequired":false,"billingCode":"73085","codeType":"CPT"},{"id":4514,"precertRequired":false,"billingCode":"73090","codeType":"CPT"},{"id":4515,"precertRequired":false,"billingCode":"73092","codeType":"CPT"},{"id":4516,"precertRequired":false,"billingCode":"73100","codeType":"CPT"},{"id":4517,"precertRequired":false,"billingCode":"73110","codeType":"CPT"},{"id":4518,"precertRequired":false,"billingCode":"73115","codeType":"CPT"},{"id":4519,"precertRequired":false,"billingCode":"73120","codeType":"CPT"},{"id":4520,"precertRequired":false,"billingCode":"73130","codeType":"CPT"},{"id":4521,"precertRequired":false,"billingCode":"73140","codeType":"CPT"},{"id":4526,"precertRequired":true,"billingCode":"73218","codeType":"CPT"},{"id":4527,"precertRequired":true,"billingCode":"73219","codeType":"CPT"},{"id":4528,"precertRequired":true,"billingCode":"73220","codeType":"CPT"},{"id":4529,"precertRequired":true,"billingCode":"73221","codeType":"CPT"},{"id":4530,"precertRequired":true,"billingCode":"73222","codeType":"CPT"},{"id":4531,"precertRequired":true,"billingCode":"73223","codeType":"CPT"},{"id":4532,"precertRequired":false,"billingCode":"73225","codeType":"CPT"},{"id":4533,"precertRequired":false,"billingCode":"73501","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4535,"precertRequired":false,"billingCode":"73503","codeType":"CPT"},{"id":4536,"precertRequired":false,"billingCode":"73521","codeType":"CPT"},{"id":4537,"precertRequired":false,"billingCode":"73522","codeType":"CPT"},{"id":4538,"precertRequired":false,"billingCode":"73523","codeType":"CPT"},{"id":4539,"precertRequired":false,"billingCode":"73525","codeType":"CPT"},{"id":4540,"precertRequired":false,"billingCode":"73551","codeType":"CPT"},{"id":4541,"precertRequired":false,"billingCode":"73552","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"},{"id":4543,"precertRequired":false,"billingCode":"73562","codeType":"CPT"},{"id":4544,"precertRequired":false,"billingCode":"73564","codeType":"CPT"},{"id":4545,"precertRequired":false,"billingCode":"73565","codeType":"CPT"},{"id":4546,"precertRequired":false,"billingCode":"73580","codeType":"CPT"},{"id":4547,"precertRequired":false,"billingCode":"73590","codeType":"CPT"},{"id":4548,"precertRequired":false,"billingCode":"73592","codeType":"CPT"},{"id":4549,"precertRequired":false,"billingCode":"73600","codeType":"CPT"},{"id":4550,"precertRequired":false,"billingCode":"73610","codeType":"CPT"},{"id":4551,"precertRequired":false,"billingCode":"73615","codeType":"CPT"},{"id":4552,"precertRequired":false,"billingCode":"73620","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4554,"precertRequired":false,"billingCode":"73650","codeType":"CPT"},{"id":4555,"precertRequired":false,"billingCode":"73660","codeType":"CPT"},{"id":4560,"precertRequired":true,"billingCode":"73718","codeType":"CPT"},{"id":4561,"precertRequired":true,"billingCode":"73719","codeType":"CPT"},{"id":4562,"precertRequired":true,"billingCode":"73720","codeType":"CPT"},{"id":4563,"precertRequired":true,"billingCode":"73721","codeType":"CPT"},{"id":4564,"precertRequired":true,"billingCode":"73722","codeType":"CPT"},{"id":4565,"precertRequired":true,"billingCode":"73723","codeType":"CPT"},{"id":4566,"precertRequired":true,"billingCode":"73725","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4597,"precertRequired":false,"billingCode":"74260","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4614,"precertRequired":false,"billingCode":"74400","codeType":"CPT"},{"id":4615,"precertRequired":false,"billingCode":"74410","codeType":"CPT"},{"id":4616,"precertRequired":false,"billingCode":"74415","codeType":"CPT"},{"id":4617,"precertRequired":false,"billingCode":"74420","codeType":"CPT"},{"id":4618,"precertRequired":false,"billingCode":"74425","codeType":"CPT"},{"id":4619,"precertRequired":false,"billingCode":"74430","codeType":"CPT"},{"id":4620,"precertRequired":false,"billingCode":"74440","codeType":"CPT"},{"id":4622,"precertRequired":false,"billingCode":"74450","codeType":"CPT"},{"id":4623,"precertRequired":false,"billingCode":"74455","codeType":"CPT"},{"id":4624,"precertRequired":false,"billingCode":"74470","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4722,"precertRequired":false,"billingCode":"76641","codeType":"CPT"},{"id":4723,"precertRequired":false,"billingCode":"76642","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4755,"precertRequired":false,"billingCode":"76870","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4757,"precertRequired":false,"billingCode":"76873","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4759,"precertRequired":false,"billingCode":"76882","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4782,"precertRequired":false,"billingCode":"77053","codeType":"CPT"},{"id":4783,"precertRequired":false,"billingCode":"77054","codeType":"CPT"},{"id":4786,"precertRequired":false,"billingCode":"77061","codeType":"CPT"},{"id":4787,"precertRequired":false,"billingCode":"77062","codeType":"CPT"},{"id":4788,"precertRequired":false,"billingCode":"77063","codeType":"CPT"},{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4894,"precertRequired":false,"billingCode":"78140","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4906,"precertRequired":false,"billingCode":"78230","codeType":"CPT"},{"id":4907,"precertRequired":false,"billingCode":"78231","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4925,"precertRequired":false,"billingCode":"78315","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4959,"precertRequired":false,"billingCode":"78600","codeType":"CPT"},{"id":4960,"precertRequired":false,"billingCode":"78601","codeType":"CPT"},{"id":4961,"precertRequired":false,"billingCode":"78605","codeType":"CPT"},{"id":4962,"precertRequired":false,"billingCode":"78606","codeType":"CPT"},{"id":4963,"precertRequired":false,"billingCode":"78607","codeType":"CPT"},{"id":4970,"precertRequired":false,"billingCode":"78700","codeType":"CPT"},{"id":4971,"precertRequired":false,"billingCode":"78701","codeType":"CPT"},{"id":4975,"precertRequired":false,"billingCode":"78710","codeType":"CPT"},{"id":4979,"precertRequired":false,"billingCode":"78761","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4985,"precertRequired":false,"billingCode":"78804","codeType":"CPT"},{"id":9769,"precertRequired":true,"billingCode":"77046","codeType":"CPT"},{"id":9770,"precertRequired":true,"billingCode":"77047","codeType":"CPT"},{"id":9771,"precertRequired":true,"billingCode":"77048","codeType":"CPT"},{"id":9772,"precertRequired":true,"billingCode":"77049","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3043,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5429,"precertRequired":false,"billingCode":"82374","codeType":"CPT"},{"id":5430,"precertRequired":false,"billingCode":"82375","codeType":"CPT"},{"id":5431,"precertRequired":false,"billingCode":"82376","codeType":"CPT"},{"id":5453,"precertRequired":false,"billingCode":"82525","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5480,"precertRequired":false,"billingCode":"82657","codeType":"CPT"},{"id":5481,"precertRequired":false,"billingCode":"82658","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5585,"precertRequired":false,"billingCode":"83625","codeType":"CPT"},{"id":5590,"precertRequired":false,"billingCode":"83655","codeType":"CPT"},{"id":5654,"precertRequired":false,"billingCode":"84119","codeType":"CPT"},{"id":5656,"precertRequired":false,"billingCode":"84126","codeType":"CPT"},{"id":5758,"precertRequired":false,"billingCode":"84630","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5765,"precertRequired":false,"billingCode":"85002","codeType":"CPT"},{"id":5766,"precertRequired":false,"billingCode":"85004","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5768,"precertRequired":false,"billingCode":"85008","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5770,"precertRequired":false,"billingCode":"85013","codeType":"CPT"},{"id":5771,"precertRequired":false,"billingCode":"85014","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5775,"precertRequired":false,"billingCode":"85032","codeType":"CPT"},{"id":5776,"precertRequired":false,"billingCode":"85041","codeType":"CPT"},{"id":5777,"precertRequired":false,"billingCode":"85044","codeType":"CPT"},{"id":5778,"precertRequired":false,"billingCode":"85045","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5780,"precertRequired":false,"billingCode":"85048","codeType":"CPT"},{"id":5781,"precertRequired":false,"billingCode":"85049","codeType":"CPT"},{"id":5782,"precertRequired":false,"billingCode":"85055","codeType":"CPT"},{"id":5783,"precertRequired":false,"billingCode":"85060","codeType":"CPT"},{"id":5784,"precertRequired":false,"billingCode":"85097","codeType":"CPT"},{"id":5785,"precertRequired":false,"billingCode":"85130","codeType":"CPT"},{"id":5788,"precertRequired":false,"billingCode":"85210","codeType":"CPT"},{"id":5789,"precertRequired":false,"billingCode":"85220","codeType":"CPT"},{"id":5790,"precertRequired":false,"billingCode":"85230","codeType":"CPT"},{"id":5791,"precertRequired":false,"billingCode":"85240","codeType":"CPT"},{"id":5792,"precertRequired":false,"billingCode":"85244","codeType":"CPT"},{"id":5793,"precertRequired":false,"billingCode":"85245","codeType":"CPT"},{"id":5794,"precertRequired":false,"billingCode":"85246","codeType":"CPT"},{"id":5796,"precertRequired":false,"billingCode":"85250","codeType":"CPT"},{"id":5797,"precertRequired":false,"billingCode":"85260","codeType":"CPT"},{"id":5798,"precertRequired":false,"billingCode":"85270","codeType":"CPT"},{"id":5799,"precertRequired":false,"billingCode":"85280","codeType":"CPT"},{"id":5800,"precertRequired":false,"billingCode":"85290","codeType":"CPT"},{"id":5806,"precertRequired":false,"billingCode":"85302","codeType":"CPT"},{"id":5807,"precertRequired":false,"billingCode":"85303","codeType":"CPT"},{"id":5808,"precertRequired":false,"billingCode":"85305","codeType":"CPT"},{"id":5809,"precertRequired":false,"billingCode":"85306","codeType":"CPT"},{"id":5810,"precertRequired":false,"billingCode":"85307","codeType":"CPT"},{"id":5813,"precertRequired":false,"billingCode":"85345","codeType":"CPT"},{"id":5814,"precertRequired":false,"billingCode":"85347","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5826,"precertRequired":false,"billingCode":"85396","codeType":"CPT"},{"id":5827,"precertRequired":false,"billingCode":"85397","codeType":"CPT"},{"id":5835,"precertRequired":false,"billingCode":"85460","codeType":"CPT"},{"id":5836,"precertRequired":false,"billingCode":"85461","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5860,"precertRequired":false,"billingCode":"85705","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5862,"precertRequired":false,"billingCode":"85732","codeType":"CPT"},{"id":5863,"precertRequired":false,"billingCode":"85810","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5922,"precertRequired":false,"billingCode":"86335","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8450,"precertRequired":false,"billingCode":"J1756","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":3044,"description":"Procedures related to the referred condition on the consult including but no limited to:  bone marrow aspiration, lumbar puncture, etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":68,"precertRequired":false,"billingCode":"00635","codeType":"CPT"},{"id":137,"precertRequired":false,"billingCode":"01112","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2547,"precertRequired":false,"billingCode":"36455","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2567,"precertRequired":false,"billingCode":"36565","codeType":"CPT"},{"id":2568,"precertRequired":false,"billingCode":"36566","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2572,"precertRequired":false,"billingCode":"36571","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2583,"precertRequired":false,"billingCode":"36590","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2585,"precertRequired":false,"billingCode":"36592","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":2590,"precertRequired":false,"billingCode":"36598","codeType":"CPT"},{"id":2595,"precertRequired":false,"billingCode":"36640","codeType":"CPT"},{"id":2679,"precertRequired":false,"billingCode":"38220","codeType":"CPT"},{"id":2680,"precertRequired":false,"billingCode":"38221","codeType":"CPT"},{"id":2681,"precertRequired":false,"billingCode":"38222","codeType":"CPT"},{"id":2689,"precertRequired":false,"billingCode":"38505","codeType":"CPT"},{"id":2692,"precertRequired":false,"billingCode":"38525","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":3881,"precertRequired":false,"billingCode":"62272","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":6960,"precertRequired":true,"billingCode":"93792","codeType":"CPT"},{"id":6961,"precertRequired":false,"billingCode":"93793","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7891,"precertRequired":false,"billingCode":"A9552","codeType":"HCPCS"},{"id":7911,"precertRequired":false,"billingCode":"A9575","codeType":"HCPCS"},{"id":7913,"precertRequired":false,"billingCode":"A9577","codeType":"HCPCS"},{"id":7921,"precertRequired":false,"billingCode":"A9585","codeType":"HCPCS"},{"id":7929,"precertRequired":false,"billingCode":"A9606","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8387,"precertRequired":false,"billingCode":"J0641","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8397,"precertRequired":true,"billingCode":"J0881","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8478,"precertRequired":false,"billingCode":"J2505","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8497,"precertRequired":false,"billingCode":"J2930","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":9817,"precertRequired":false,"billingCode":"J1447","codeType":"HCPCS"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"},{"id":11583,"precertRequired":false,"billingCode":"36522","codeType":"CPT"},{"id":11584,"precertRequired":false,"billingCode":"38242","codeType":"CPT"},{"id":11585,"precertRequired":false,"billingCode":"38243","codeType":"CPT"},{"id":11586,"precertRequired":false,"billingCode":"38792","codeType":"CPT"},{"id":11587,"precertRequired":false,"billingCode":"J1300","codeType":"HCPCS"},{"id":11588,"precertRequired":false,"billingCode":"J2796","codeType":"HCPCS"},{"id":11589,"precertRequired":false,"billingCode":"J2820","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":3045,"description":"Inpatient or observation admission for treatment, if indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":3046,"description":"Inpatient admission or observation status for complications related to treatment\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the treatment","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":3047,"description":"Infusion therapy or phlebotomy as clinically indicated by hematologist (in clinic)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":137,"precertRequired":false,"billingCode":"01112","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2583,"precertRequired":false,"billingCode":"36590","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2585,"precertRequired":false,"billingCode":"36592","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":2590,"precertRequired":false,"billingCode":"36598","codeType":"CPT"},{"id":2595,"precertRequired":false,"billingCode":"36640","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":6960,"precertRequired":true,"billingCode":"93792","codeType":"CPT"},{"id":6961,"precertRequired":false,"billingCode":"93793","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7891,"precertRequired":false,"billingCode":"A9552","codeType":"HCPCS"},{"id":7911,"precertRequired":false,"billingCode":"A9575","codeType":"HCPCS"},{"id":7913,"precertRequired":false,"billingCode":"A9577","codeType":"HCPCS"},{"id":7921,"precertRequired":false,"billingCode":"A9585","codeType":"HCPCS"},{"id":7929,"precertRequired":false,"billingCode":"A9606","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8387,"precertRequired":false,"billingCode":"J0641","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8397,"precertRequired":true,"billingCode":"J0881","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8478,"precertRequired":false,"billingCode":"J2505","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8497,"precertRequired":false,"billingCode":"J2930","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8723,"precertRequired":false,"billingCode":"P9010","codeType":"HCPCS"},{"id":8724,"precertRequired":false,"billingCode":"P9011","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8728,"precertRequired":false,"billingCode":"P9019","codeType":"HCPCS"},{"id":8729,"precertRequired":false,"billingCode":"P9020","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8740,"precertRequired":false,"billingCode":"P9038","codeType":"HCPCS"},{"id":8741,"precertRequired":false,"billingCode":"P9039","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8751,"precertRequired":false,"billingCode":"P9051","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8754,"precertRequired":false,"billingCode":"P9054","codeType":"HCPCS"},{"id":8756,"precertRequired":false,"billingCode":"P9056","codeType":"HCPCS"},{"id":8757,"precertRequired":false,"billingCode":"P9057","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8759,"precertRequired":false,"billingCode":"P9059","codeType":"HCPCS"},{"id":8761,"precertRequired":false,"billingCode":"P9070","codeType":"HCPCS"},{"id":8762,"precertRequired":false,"billingCode":"P9071","codeType":"HCPCS"},{"id":8763,"precertRequired":false,"billingCode":"P9073","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":9817,"precertRequired":false,"billingCode":"J1447","codeType":"HCPCS"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"},{"id":11583,"precertRequired":false,"billingCode":"36522","codeType":"CPT"},{"id":11587,"precertRequired":false,"billingCode":"J1300","codeType":"HCPCS"},{"id":11588,"precertRequired":false,"billingCode":"J2796","codeType":"HCPCS"},{"id":11589,"precertRequired":false,"billingCode":"J2820","codeType":"HCPCS"},{"id":11590,"precertRequired":false,"billingCode":"P9100","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]}]}},{"Seoc":{"id":433,"seocKey":58,"name":"Hematology_PRCT","seocId":"MSC_HEMATOLOGY_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"05-21-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.  Diagnostic imaging relevant to the referred condition on the consult  \r\n3.  Labs and pathology relevant to the referred condition on the consult\r\n4.  Procedures related to the referred condition on the consult including but no limited to:  bone marrow aspiration, lumbar puncture, etc. \r\n5.  Inpatient or observation admission for treatment, if indicated\r\n6.  Inpatient admission or observation status for complications related to treatment\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the treatment\r\n7.  Infusion therapy or phlebotomy as clinically indicated by hematologist (in clinic)","maxAllowableVisits":null,"disclaimer":"* Clinical trials and non-FDA approved treatments ARE NOT approved under this referral. If a clinical trial is indicated it will require VA review and approval via a RFS (Request for Services) to ensure the trial is being conducted under an Investigational New Drug (IND) application or the drug, biologicals or medical devices are prescribed under a compassionate use exemption, or the trial does not include any unapproved drugs, biologicals or medical devices. \r\n* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"HEMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RH0000X"}],"services":[{"id":2327,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2328,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4369,"precertRequired":false,"billingCode":"70100","codeType":"CPT"},{"id":4370,"precertRequired":false,"billingCode":"70110","codeType":"CPT"},{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4374,"precertRequired":false,"billingCode":"70140","codeType":"CPT"},{"id":4376,"precertRequired":false,"billingCode":"70150","codeType":"CPT"},{"id":4377,"precertRequired":false,"billingCode":"70160","codeType":"CPT"},{"id":4378,"precertRequired":false,"billingCode":"70170","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4383,"precertRequired":false,"billingCode":"70240","codeType":"CPT"},{"id":4384,"precertRequired":false,"billingCode":"70250","codeType":"CPT"},{"id":4385,"precertRequired":false,"billingCode":"70260","codeType":"CPT"},{"id":4386,"precertRequired":false,"billingCode":"70300","codeType":"CPT"},{"id":4387,"precertRequired":false,"billingCode":"70310","codeType":"CPT"},{"id":4388,"precertRequired":false,"billingCode":"70320","codeType":"CPT"},{"id":4389,"precertRequired":false,"billingCode":"70328","codeType":"CPT"},{"id":4390,"precertRequired":false,"billingCode":"70330","codeType":"CPT"},{"id":4391,"precertRequired":false,"billingCode":"70332","codeType":"CPT"},{"id":4392,"precertRequired":false,"billingCode":"70336","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4396,"precertRequired":false,"billingCode":"70380","codeType":"CPT"},{"id":4397,"precertRequired":false,"billingCode":"70390","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4416,"precertRequired":false,"billingCode":"70545","codeType":"CPT"},{"id":4417,"precertRequired":false,"billingCode":"70546","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4424,"precertRequired":false,"billingCode":"70554","codeType":"CPT"},{"id":4425,"precertRequired":false,"billingCode":"70555","codeType":"CPT"},{"id":4426,"precertRequired":false,"billingCode":"70557","codeType":"CPT"},{"id":4427,"precertRequired":false,"billingCode":"70558","codeType":"CPT"},{"id":4428,"precertRequired":false,"billingCode":"70559","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4494,"precertRequired":false,"billingCode":"72200","codeType":"CPT"},{"id":4495,"precertRequired":false,"billingCode":"72202","codeType":"CPT"},{"id":4496,"precertRequired":false,"billingCode":"72220","codeType":"CPT"},{"id":4497,"precertRequired":false,"billingCode":"72240","codeType":"CPT"},{"id":4498,"precertRequired":true,"billingCode":"72255","codeType":"CPT"},{"id":4499,"precertRequired":false,"billingCode":"72265","codeType":"CPT"},{"id":4500,"precertRequired":true,"billingCode":"72270","codeType":"CPT"},{"id":4504,"precertRequired":false,"billingCode":"73000","codeType":"CPT"},{"id":4505,"precertRequired":false,"billingCode":"73010","codeType":"CPT"},{"id":4506,"precertRequired":false,"billingCode":"73020","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4508,"precertRequired":false,"billingCode":"73040","codeType":"CPT"},{"id":4509,"precertRequired":false,"billingCode":"73050","codeType":"CPT"},{"id":4510,"precertRequired":false,"billingCode":"73060","codeType":"CPT"},{"id":4511,"precertRequired":false,"billingCode":"73070","codeType":"CPT"},{"id":4512,"precertRequired":false,"billingCode":"73080","codeType":"CPT"},{"id":4513,"precertRequired":false,"billingCode":"73085","codeType":"CPT"},{"id":4514,"precertRequired":false,"billingCode":"73090","codeType":"CPT"},{"id":4515,"precertRequired":false,"billingCode":"73092","codeType":"CPT"},{"id":4516,"precertRequired":false,"billingCode":"73100","codeType":"CPT"},{"id":4517,"precertRequired":false,"billingCode":"73110","codeType":"CPT"},{"id":4518,"precertRequired":false,"billingCode":"73115","codeType":"CPT"},{"id":4519,"precertRequired":false,"billingCode":"73120","codeType":"CPT"},{"id":4520,"precertRequired":false,"billingCode":"73130","codeType":"CPT"},{"id":4521,"precertRequired":false,"billingCode":"73140","codeType":"CPT"},{"id":4526,"precertRequired":true,"billingCode":"73218","codeType":"CPT"},{"id":4527,"precertRequired":true,"billingCode":"73219","codeType":"CPT"},{"id":4528,"precertRequired":true,"billingCode":"73220","codeType":"CPT"},{"id":4529,"precertRequired":true,"billingCode":"73221","codeType":"CPT"},{"id":4530,"precertRequired":true,"billingCode":"73222","codeType":"CPT"},{"id":4531,"precertRequired":true,"billingCode":"73223","codeType":"CPT"},{"id":4532,"precertRequired":false,"billingCode":"73225","codeType":"CPT"},{"id":4533,"precertRequired":false,"billingCode":"73501","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4535,"precertRequired":false,"billingCode":"73503","codeType":"CPT"},{"id":4536,"precertRequired":false,"billingCode":"73521","codeType":"CPT"},{"id":4537,"precertRequired":false,"billingCode":"73522","codeType":"CPT"},{"id":4538,"precertRequired":false,"billingCode":"73523","codeType":"CPT"},{"id":4539,"precertRequired":false,"billingCode":"73525","codeType":"CPT"},{"id":4540,"precertRequired":false,"billingCode":"73551","codeType":"CPT"},{"id":4541,"precertRequired":false,"billingCode":"73552","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"},{"id":4543,"precertRequired":false,"billingCode":"73562","codeType":"CPT"},{"id":4544,"precertRequired":false,"billingCode":"73564","codeType":"CPT"},{"id":4545,"precertRequired":false,"billingCode":"73565","codeType":"CPT"},{"id":4546,"precertRequired":false,"billingCode":"73580","codeType":"CPT"},{"id":4547,"precertRequired":false,"billingCode":"73590","codeType":"CPT"},{"id":4548,"precertRequired":false,"billingCode":"73592","codeType":"CPT"},{"id":4549,"precertRequired":false,"billingCode":"73600","codeType":"CPT"},{"id":4550,"precertRequired":false,"billingCode":"73610","codeType":"CPT"},{"id":4551,"precertRequired":false,"billingCode":"73615","codeType":"CPT"},{"id":4552,"precertRequired":false,"billingCode":"73620","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4554,"precertRequired":false,"billingCode":"73650","codeType":"CPT"},{"id":4555,"precertRequired":false,"billingCode":"73660","codeType":"CPT"},{"id":4560,"precertRequired":true,"billingCode":"73718","codeType":"CPT"},{"id":4561,"precertRequired":true,"billingCode":"73719","codeType":"CPT"},{"id":4562,"precertRequired":true,"billingCode":"73720","codeType":"CPT"},{"id":4563,"precertRequired":true,"billingCode":"73721","codeType":"CPT"},{"id":4564,"precertRequired":true,"billingCode":"73722","codeType":"CPT"},{"id":4565,"precertRequired":true,"billingCode":"73723","codeType":"CPT"},{"id":4566,"precertRequired":true,"billingCode":"73725","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4597,"precertRequired":false,"billingCode":"74260","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4614,"precertRequired":false,"billingCode":"74400","codeType":"CPT"},{"id":4615,"precertRequired":false,"billingCode":"74410","codeType":"CPT"},{"id":4616,"precertRequired":false,"billingCode":"74415","codeType":"CPT"},{"id":4617,"precertRequired":false,"billingCode":"74420","codeType":"CPT"},{"id":4618,"precertRequired":false,"billingCode":"74425","codeType":"CPT"},{"id":4619,"precertRequired":false,"billingCode":"74430","codeType":"CPT"},{"id":4620,"precertRequired":false,"billingCode":"74440","codeType":"CPT"},{"id":4622,"precertRequired":false,"billingCode":"74450","codeType":"CPT"},{"id":4623,"precertRequired":false,"billingCode":"74455","codeType":"CPT"},{"id":4624,"precertRequired":false,"billingCode":"74470","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4722,"precertRequired":false,"billingCode":"76641","codeType":"CPT"},{"id":4723,"precertRequired":false,"billingCode":"76642","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4755,"precertRequired":false,"billingCode":"76870","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4757,"precertRequired":false,"billingCode":"76873","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4759,"precertRequired":false,"billingCode":"76882","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4782,"precertRequired":false,"billingCode":"77053","codeType":"CPT"},{"id":4783,"precertRequired":false,"billingCode":"77054","codeType":"CPT"},{"id":4786,"precertRequired":false,"billingCode":"77061","codeType":"CPT"},{"id":4787,"precertRequired":false,"billingCode":"77062","codeType":"CPT"},{"id":4788,"precertRequired":false,"billingCode":"77063","codeType":"CPT"},{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4894,"precertRequired":false,"billingCode":"78140","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4906,"precertRequired":false,"billingCode":"78230","codeType":"CPT"},{"id":4907,"precertRequired":false,"billingCode":"78231","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4925,"precertRequired":false,"billingCode":"78315","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4959,"precertRequired":false,"billingCode":"78600","codeType":"CPT"},{"id":4960,"precertRequired":false,"billingCode":"78601","codeType":"CPT"},{"id":4961,"precertRequired":false,"billingCode":"78605","codeType":"CPT"},{"id":4962,"precertRequired":false,"billingCode":"78606","codeType":"CPT"},{"id":4963,"precertRequired":false,"billingCode":"78607","codeType":"CPT"},{"id":4970,"precertRequired":false,"billingCode":"78700","codeType":"CPT"},{"id":4971,"precertRequired":false,"billingCode":"78701","codeType":"CPT"},{"id":4975,"precertRequired":false,"billingCode":"78710","codeType":"CPT"},{"id":4979,"precertRequired":false,"billingCode":"78761","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4985,"precertRequired":false,"billingCode":"78804","codeType":"CPT"},{"id":9769,"precertRequired":true,"billingCode":"77046","codeType":"CPT"},{"id":9770,"precertRequired":true,"billingCode":"77047","codeType":"CPT"},{"id":9771,"precertRequired":true,"billingCode":"77048","codeType":"CPT"},{"id":9772,"precertRequired":true,"billingCode":"77049","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2329,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5429,"precertRequired":false,"billingCode":"82374","codeType":"CPT"},{"id":5430,"precertRequired":false,"billingCode":"82375","codeType":"CPT"},{"id":5431,"precertRequired":false,"billingCode":"82376","codeType":"CPT"},{"id":5453,"precertRequired":false,"billingCode":"82525","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5480,"precertRequired":false,"billingCode":"82657","codeType":"CPT"},{"id":5481,"precertRequired":false,"billingCode":"82658","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5585,"precertRequired":false,"billingCode":"83625","codeType":"CPT"},{"id":5590,"precertRequired":false,"billingCode":"83655","codeType":"CPT"},{"id":5654,"precertRequired":false,"billingCode":"84119","codeType":"CPT"},{"id":5656,"precertRequired":false,"billingCode":"84126","codeType":"CPT"},{"id":5758,"precertRequired":false,"billingCode":"84630","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5765,"precertRequired":false,"billingCode":"85002","codeType":"CPT"},{"id":5766,"precertRequired":false,"billingCode":"85004","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5768,"precertRequired":false,"billingCode":"85008","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5770,"precertRequired":false,"billingCode":"85013","codeType":"CPT"},{"id":5771,"precertRequired":false,"billingCode":"85014","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5775,"precertRequired":false,"billingCode":"85032","codeType":"CPT"},{"id":5776,"precertRequired":false,"billingCode":"85041","codeType":"CPT"},{"id":5777,"precertRequired":false,"billingCode":"85044","codeType":"CPT"},{"id":5778,"precertRequired":false,"billingCode":"85045","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5780,"precertRequired":false,"billingCode":"85048","codeType":"CPT"},{"id":5781,"precertRequired":false,"billingCode":"85049","codeType":"CPT"},{"id":5782,"precertRequired":false,"billingCode":"85055","codeType":"CPT"},{"id":5783,"precertRequired":false,"billingCode":"85060","codeType":"CPT"},{"id":5784,"precertRequired":false,"billingCode":"85097","codeType":"CPT"},{"id":5785,"precertRequired":false,"billingCode":"85130","codeType":"CPT"},{"id":5788,"precertRequired":false,"billingCode":"85210","codeType":"CPT"},{"id":5789,"precertRequired":false,"billingCode":"85220","codeType":"CPT"},{"id":5790,"precertRequired":false,"billingCode":"85230","codeType":"CPT"},{"id":5791,"precertRequired":false,"billingCode":"85240","codeType":"CPT"},{"id":5792,"precertRequired":false,"billingCode":"85244","codeType":"CPT"},{"id":5793,"precertRequired":false,"billingCode":"85245","codeType":"CPT"},{"id":5794,"precertRequired":false,"billingCode":"85246","codeType":"CPT"},{"id":5796,"precertRequired":false,"billingCode":"85250","codeType":"CPT"},{"id":5797,"precertRequired":false,"billingCode":"85260","codeType":"CPT"},{"id":5798,"precertRequired":false,"billingCode":"85270","codeType":"CPT"},{"id":5799,"precertRequired":false,"billingCode":"85280","codeType":"CPT"},{"id":5800,"precertRequired":false,"billingCode":"85290","codeType":"CPT"},{"id":5806,"precertRequired":false,"billingCode":"85302","codeType":"CPT"},{"id":5807,"precertRequired":false,"billingCode":"85303","codeType":"CPT"},{"id":5808,"precertRequired":false,"billingCode":"85305","codeType":"CPT"},{"id":5809,"precertRequired":false,"billingCode":"85306","codeType":"CPT"},{"id":5810,"precertRequired":false,"billingCode":"85307","codeType":"CPT"},{"id":5813,"precertRequired":false,"billingCode":"85345","codeType":"CPT"},{"id":5814,"precertRequired":false,"billingCode":"85347","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5826,"precertRequired":false,"billingCode":"85396","codeType":"CPT"},{"id":5827,"precertRequired":false,"billingCode":"85397","codeType":"CPT"},{"id":5835,"precertRequired":false,"billingCode":"85460","codeType":"CPT"},{"id":5836,"precertRequired":false,"billingCode":"85461","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5860,"precertRequired":false,"billingCode":"85705","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5862,"precertRequired":false,"billingCode":"85732","codeType":"CPT"},{"id":5863,"precertRequired":false,"billingCode":"85810","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5922,"precertRequired":false,"billingCode":"86335","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8450,"precertRequired":false,"billingCode":"J1756","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":11581,"precertRequired":false,"billingCode":"85028","codeType":"CPT"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":2330,"description":"Procedures related to the referred condition on the consult including but no limited to:  bone marrow aspiration, lumbar puncture, etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":68,"precertRequired":false,"billingCode":"00635","codeType":"CPT"},{"id":137,"precertRequired":false,"billingCode":"01112","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2547,"precertRequired":false,"billingCode":"36455","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2567,"precertRequired":false,"billingCode":"36565","codeType":"CPT"},{"id":2568,"precertRequired":false,"billingCode":"36566","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2572,"precertRequired":false,"billingCode":"36571","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2583,"precertRequired":false,"billingCode":"36590","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2585,"precertRequired":false,"billingCode":"36592","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":2590,"precertRequired":false,"billingCode":"36598","codeType":"CPT"},{"id":2595,"precertRequired":false,"billingCode":"36640","codeType":"CPT"},{"id":2679,"precertRequired":false,"billingCode":"38220","codeType":"CPT"},{"id":2680,"precertRequired":false,"billingCode":"38221","codeType":"CPT"},{"id":2681,"precertRequired":false,"billingCode":"38222","codeType":"CPT"},{"id":2689,"precertRequired":false,"billingCode":"38505","codeType":"CPT"},{"id":2692,"precertRequired":false,"billingCode":"38525","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":3881,"precertRequired":false,"billingCode":"62272","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":6960,"precertRequired":true,"billingCode":"93792","codeType":"CPT"},{"id":6961,"precertRequired":false,"billingCode":"93793","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7891,"precertRequired":false,"billingCode":"A9552","codeType":"HCPCS"},{"id":7911,"precertRequired":false,"billingCode":"A9575","codeType":"HCPCS"},{"id":7913,"precertRequired":false,"billingCode":"A9577","codeType":"HCPCS"},{"id":7921,"precertRequired":false,"billingCode":"A9585","codeType":"HCPCS"},{"id":7929,"precertRequired":false,"billingCode":"A9606","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8387,"precertRequired":false,"billingCode":"J0641","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8397,"precertRequired":true,"billingCode":"J0881","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8478,"precertRequired":false,"billingCode":"J2505","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8497,"precertRequired":false,"billingCode":"J2930","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":9817,"precertRequired":false,"billingCode":"J1447","codeType":"HCPCS"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"},{"id":11583,"precertRequired":false,"billingCode":"36522","codeType":"CPT"},{"id":11584,"precertRequired":false,"billingCode":"38242","codeType":"CPT"},{"id":11585,"precertRequired":false,"billingCode":"38243","codeType":"CPT"},{"id":11586,"precertRequired":false,"billingCode":"38792","codeType":"CPT"},{"id":11587,"precertRequired":false,"billingCode":"J1300","codeType":"HCPCS"},{"id":11588,"precertRequired":false,"billingCode":"J2796","codeType":"HCPCS"},{"id":11589,"precertRequired":false,"billingCode":"J2820","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2331,"description":"Inpatient or observation admission for treatment, if indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2332,"description":"Inpatient admission or observation status for complications related to treatment\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the treatment","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2333,"description":"Infusion therapy or phlebotomy as clinically indicated by hematologist (in clinic)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":137,"precertRequired":false,"billingCode":"01112","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2583,"precertRequired":false,"billingCode":"36590","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2585,"precertRequired":false,"billingCode":"36592","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":2590,"precertRequired":false,"billingCode":"36598","codeType":"CPT"},{"id":2595,"precertRequired":false,"billingCode":"36640","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":6960,"precertRequired":true,"billingCode":"93792","codeType":"CPT"},{"id":6961,"precertRequired":false,"billingCode":"93793","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7891,"precertRequired":false,"billingCode":"A9552","codeType":"HCPCS"},{"id":7911,"precertRequired":false,"billingCode":"A9575","codeType":"HCPCS"},{"id":7913,"precertRequired":false,"billingCode":"A9577","codeType":"HCPCS"},{"id":7921,"precertRequired":false,"billingCode":"A9585","codeType":"HCPCS"},{"id":7929,"precertRequired":false,"billingCode":"A9606","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8387,"precertRequired":false,"billingCode":"J0641","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8397,"precertRequired":true,"billingCode":"J0881","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8478,"precertRequired":false,"billingCode":"J2505","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8497,"precertRequired":false,"billingCode":"J2930","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8723,"precertRequired":false,"billingCode":"P9010","codeType":"HCPCS"},{"id":8724,"precertRequired":false,"billingCode":"P9011","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8728,"precertRequired":false,"billingCode":"P9019","codeType":"HCPCS"},{"id":8729,"precertRequired":false,"billingCode":"P9020","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8740,"precertRequired":false,"billingCode":"P9038","codeType":"HCPCS"},{"id":8741,"precertRequired":false,"billingCode":"P9039","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8751,"precertRequired":false,"billingCode":"P9051","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8754,"precertRequired":false,"billingCode":"P9054","codeType":"HCPCS"},{"id":8756,"precertRequired":false,"billingCode":"P9056","codeType":"HCPCS"},{"id":8757,"precertRequired":false,"billingCode":"P9057","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8759,"precertRequired":false,"billingCode":"P9059","codeType":"HCPCS"},{"id":8761,"precertRequired":false,"billingCode":"P9070","codeType":"HCPCS"},{"id":8762,"precertRequired":false,"billingCode":"P9071","codeType":"HCPCS"},{"id":8763,"precertRequired":false,"billingCode":"P9073","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":9817,"precertRequired":false,"billingCode":"J1447","codeType":"HCPCS"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"},{"id":11583,"precertRequired":false,"billingCode":"36522","codeType":"CPT"},{"id":11587,"precertRequired":false,"billingCode":"J1300","codeType":"HCPCS"},{"id":11588,"precertRequired":false,"billingCode":"J2796","codeType":"HCPCS"},{"id":11589,"precertRequired":false,"billingCode":"J2820","codeType":"HCPCS"},{"id":11590,"precertRequired":false,"billingCode":"P9100","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]}]}},{"Seoc":{"id":419,"seocKey":58,"name":"Benign Hematology_PRCT","seocId":"MSC_BENIGN HEMATOLOGY_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"05-17-2019","endDate":"05-21-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.  Diagnostic imaging relevant to the referred condition on the consult  \r\n3.  Labs and pathology relevant to the referred condition on the consult\r\n4.  Procedures related to the referred condition on the consult including but no limited to:  bone marrow aspiration, lumbar puncture, etc. \r\n5.  Inpatient or observation admission for treatment, if indicated\r\n6.  Inpatient admission or observation status for complications related to treatment\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the treatment\r\n7.  Infusion therapy or phlebotomy as clinically indicated by hematologist (in clinic)","maxAllowableVisits":null,"disclaimer":"* Clinical trials and non-FDA approved treatments ARE NOT approved under this referral. If a clinical trial is indicated it will require VA review and approval via a RFS (Request for Services) to ensure the trial is being conducted under an Investigational New Drug (IND) application or the drug, biologicals or medical devices are prescribed under a compassionate use exemption, or the trial does not include any unapproved drugs, biologicals or medical devices. \r\n* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"HEMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RH0000X"}],"services":[{"id":2201,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2202,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4366,"precertRequired":false,"billingCode":"70010","codeType":"CPT"},{"id":4369,"precertRequired":false,"billingCode":"70100","codeType":"CPT"},{"id":4370,"precertRequired":false,"billingCode":"70110","codeType":"CPT"},{"id":4371,"precertRequired":false,"billingCode":"70120","codeType":"CPT"},{"id":4372,"precertRequired":false,"billingCode":"70130","codeType":"CPT"},{"id":4373,"precertRequired":false,"billingCode":"70134","codeType":"CPT"},{"id":4374,"precertRequired":false,"billingCode":"70140","codeType":"CPT"},{"id":4376,"precertRequired":false,"billingCode":"70150","codeType":"CPT"},{"id":4377,"precertRequired":false,"billingCode":"70160","codeType":"CPT"},{"id":4378,"precertRequired":false,"billingCode":"70170","codeType":"CPT"},{"id":4379,"precertRequired":false,"billingCode":"70190","codeType":"CPT"},{"id":4380,"precertRequired":false,"billingCode":"70200","codeType":"CPT"},{"id":4381,"precertRequired":false,"billingCode":"70210","codeType":"CPT"},{"id":4382,"precertRequired":false,"billingCode":"70220","codeType":"CPT"},{"id":4383,"precertRequired":false,"billingCode":"70240","codeType":"CPT"},{"id":4384,"precertRequired":false,"billingCode":"70250","codeType":"CPT"},{"id":4385,"precertRequired":false,"billingCode":"70260","codeType":"CPT"},{"id":4386,"precertRequired":false,"billingCode":"70300","codeType":"CPT"},{"id":4387,"precertRequired":false,"billingCode":"70310","codeType":"CPT"},{"id":4388,"precertRequired":false,"billingCode":"70320","codeType":"CPT"},{"id":4389,"precertRequired":false,"billingCode":"70328","codeType":"CPT"},{"id":4390,"precertRequired":false,"billingCode":"70330","codeType":"CPT"},{"id":4391,"precertRequired":false,"billingCode":"70332","codeType":"CPT"},{"id":4392,"precertRequired":false,"billingCode":"70336","codeType":"CPT"},{"id":4393,"precertRequired":false,"billingCode":"70360","codeType":"CPT"},{"id":4394,"precertRequired":false,"billingCode":"70370","codeType":"CPT"},{"id":4396,"precertRequired":false,"billingCode":"70380","codeType":"CPT"},{"id":4397,"precertRequired":false,"billingCode":"70390","codeType":"CPT"},{"id":4412,"precertRequired":false,"billingCode":"70540","codeType":"CPT"},{"id":4413,"precertRequired":true,"billingCode":"70542","codeType":"CPT"},{"id":4414,"precertRequired":true,"billingCode":"70543","codeType":"CPT"},{"id":4415,"precertRequired":true,"billingCode":"70544","codeType":"CPT"},{"id":4416,"precertRequired":false,"billingCode":"70545","codeType":"CPT"},{"id":4417,"precertRequired":false,"billingCode":"70546","codeType":"CPT"},{"id":4418,"precertRequired":false,"billingCode":"70547","codeType":"CPT"},{"id":4419,"precertRequired":false,"billingCode":"70548","codeType":"CPT"},{"id":4420,"precertRequired":true,"billingCode":"70549","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4424,"precertRequired":false,"billingCode":"70554","codeType":"CPT"},{"id":4425,"precertRequired":false,"billingCode":"70555","codeType":"CPT"},{"id":4426,"precertRequired":false,"billingCode":"70557","codeType":"CPT"},{"id":4427,"precertRequired":false,"billingCode":"70558","codeType":"CPT"},{"id":4428,"precertRequired":false,"billingCode":"70559","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4435,"precertRequired":false,"billingCode":"71100","codeType":"CPT"},{"id":4436,"precertRequired":false,"billingCode":"71101","codeType":"CPT"},{"id":4437,"precertRequired":false,"billingCode":"71110","codeType":"CPT"},{"id":4438,"precertRequired":false,"billingCode":"71111","codeType":"CPT"},{"id":4439,"precertRequired":false,"billingCode":"71120","codeType":"CPT"},{"id":4440,"precertRequired":false,"billingCode":"71130","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4444,"precertRequired":false,"billingCode":"71275","codeType":"CPT"},{"id":4445,"precertRequired":true,"billingCode":"71550","codeType":"CPT"},{"id":4446,"precertRequired":true,"billingCode":"71551","codeType":"CPT"},{"id":4447,"precertRequired":true,"billingCode":"71552","codeType":"CPT"},{"id":4448,"precertRequired":true,"billingCode":"71555","codeType":"CPT"},{"id":4449,"precertRequired":false,"billingCode":"72020","codeType":"CPT"},{"id":4450,"precertRequired":false,"billingCode":"72040","codeType":"CPT"},{"id":4451,"precertRequired":false,"billingCode":"72050","codeType":"CPT"},{"id":4452,"precertRequired":false,"billingCode":"72052","codeType":"CPT"},{"id":4453,"precertRequired":false,"billingCode":"72070","codeType":"CPT"},{"id":4454,"precertRequired":false,"billingCode":"72072","codeType":"CPT"},{"id":4455,"precertRequired":false,"billingCode":"72074","codeType":"CPT"},{"id":4456,"precertRequired":false,"billingCode":"72080","codeType":"CPT"},{"id":4457,"precertRequired":false,"billingCode":"72081","codeType":"CPT"},{"id":4458,"precertRequired":false,"billingCode":"72082","codeType":"CPT"},{"id":4459,"precertRequired":false,"billingCode":"72083","codeType":"CPT"},{"id":4460,"precertRequired":false,"billingCode":"72084","codeType":"CPT"},{"id":4461,"precertRequired":false,"billingCode":"72100","codeType":"CPT"},{"id":4462,"precertRequired":false,"billingCode":"72110","codeType":"CPT"},{"id":4463,"precertRequired":false,"billingCode":"72114","codeType":"CPT"},{"id":4464,"precertRequired":false,"billingCode":"72120","codeType":"CPT"},{"id":4474,"precertRequired":true,"billingCode":"72141","codeType":"CPT"},{"id":4475,"precertRequired":true,"billingCode":"72142","codeType":"CPT"},{"id":4476,"precertRequired":true,"billingCode":"72146","codeType":"CPT"},{"id":4477,"precertRequired":true,"billingCode":"72147","codeType":"CPT"},{"id":4478,"precertRequired":true,"billingCode":"72148","codeType":"CPT"},{"id":4479,"precertRequired":true,"billingCode":"72149","codeType":"CPT"},{"id":4480,"precertRequired":false,"billingCode":"72156","codeType":"CPT"},{"id":4481,"precertRequired":true,"billingCode":"72157","codeType":"CPT"},{"id":4482,"precertRequired":true,"billingCode":"72158","codeType":"CPT"},{"id":4483,"precertRequired":false,"billingCode":"72159","codeType":"CPT"},{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4493,"precertRequired":false,"billingCode":"72198","codeType":"CPT"},{"id":4494,"precertRequired":false,"billingCode":"72200","codeType":"CPT"},{"id":4495,"precertRequired":false,"billingCode":"72202","codeType":"CPT"},{"id":4496,"precertRequired":false,"billingCode":"72220","codeType":"CPT"},{"id":4497,"precertRequired":false,"billingCode":"72240","codeType":"CPT"},{"id":4498,"precertRequired":true,"billingCode":"72255","codeType":"CPT"},{"id":4499,"precertRequired":false,"billingCode":"72265","codeType":"CPT"},{"id":4500,"precertRequired":true,"billingCode":"72270","codeType":"CPT"},{"id":4504,"precertRequired":false,"billingCode":"73000","codeType":"CPT"},{"id":4505,"precertRequired":false,"billingCode":"73010","codeType":"CPT"},{"id":4506,"precertRequired":false,"billingCode":"73020","codeType":"CPT"},{"id":4507,"precertRequired":false,"billingCode":"73030","codeType":"CPT"},{"id":4508,"precertRequired":false,"billingCode":"73040","codeType":"CPT"},{"id":4509,"precertRequired":false,"billingCode":"73050","codeType":"CPT"},{"id":4510,"precertRequired":false,"billingCode":"73060","codeType":"CPT"},{"id":4511,"precertRequired":false,"billingCode":"73070","codeType":"CPT"},{"id":4512,"precertRequired":false,"billingCode":"73080","codeType":"CPT"},{"id":4513,"precertRequired":false,"billingCode":"73085","codeType":"CPT"},{"id":4514,"precertRequired":false,"billingCode":"73090","codeType":"CPT"},{"id":4515,"precertRequired":false,"billingCode":"73092","codeType":"CPT"},{"id":4516,"precertRequired":false,"billingCode":"73100","codeType":"CPT"},{"id":4517,"precertRequired":false,"billingCode":"73110","codeType":"CPT"},{"id":4518,"precertRequired":false,"billingCode":"73115","codeType":"CPT"},{"id":4519,"precertRequired":false,"billingCode":"73120","codeType":"CPT"},{"id":4520,"precertRequired":false,"billingCode":"73130","codeType":"CPT"},{"id":4521,"precertRequired":false,"billingCode":"73140","codeType":"CPT"},{"id":4526,"precertRequired":true,"billingCode":"73218","codeType":"CPT"},{"id":4527,"precertRequired":true,"billingCode":"73219","codeType":"CPT"},{"id":4528,"precertRequired":true,"billingCode":"73220","codeType":"CPT"},{"id":4529,"precertRequired":true,"billingCode":"73221","codeType":"CPT"},{"id":4530,"precertRequired":true,"billingCode":"73222","codeType":"CPT"},{"id":4531,"precertRequired":true,"billingCode":"73223","codeType":"CPT"},{"id":4532,"precertRequired":false,"billingCode":"73225","codeType":"CPT"},{"id":4533,"precertRequired":false,"billingCode":"73501","codeType":"CPT"},{"id":4534,"precertRequired":false,"billingCode":"73502","codeType":"CPT"},{"id":4535,"precertRequired":false,"billingCode":"73503","codeType":"CPT"},{"id":4536,"precertRequired":false,"billingCode":"73521","codeType":"CPT"},{"id":4537,"precertRequired":false,"billingCode":"73522","codeType":"CPT"},{"id":4538,"precertRequired":false,"billingCode":"73523","codeType":"CPT"},{"id":4539,"precertRequired":false,"billingCode":"73525","codeType":"CPT"},{"id":4540,"precertRequired":false,"billingCode":"73551","codeType":"CPT"},{"id":4541,"precertRequired":false,"billingCode":"73552","codeType":"CPT"},{"id":4542,"precertRequired":false,"billingCode":"73560","codeType":"CPT"},{"id":4543,"precertRequired":false,"billingCode":"73562","codeType":"CPT"},{"id":4544,"precertRequired":false,"billingCode":"73564","codeType":"CPT"},{"id":4545,"precertRequired":false,"billingCode":"73565","codeType":"CPT"},{"id":4546,"precertRequired":false,"billingCode":"73580","codeType":"CPT"},{"id":4547,"precertRequired":false,"billingCode":"73590","codeType":"CPT"},{"id":4548,"precertRequired":false,"billingCode":"73592","codeType":"CPT"},{"id":4549,"precertRequired":false,"billingCode":"73600","codeType":"CPT"},{"id":4550,"precertRequired":false,"billingCode":"73610","codeType":"CPT"},{"id":4551,"precertRequired":false,"billingCode":"73615","codeType":"CPT"},{"id":4552,"precertRequired":false,"billingCode":"73620","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4554,"precertRequired":false,"billingCode":"73650","codeType":"CPT"},{"id":4555,"precertRequired":false,"billingCode":"73660","codeType":"CPT"},{"id":4560,"precertRequired":true,"billingCode":"73718","codeType":"CPT"},{"id":4561,"precertRequired":true,"billingCode":"73719","codeType":"CPT"},{"id":4562,"precertRequired":true,"billingCode":"73720","codeType":"CPT"},{"id":4563,"precertRequired":true,"billingCode":"73721","codeType":"CPT"},{"id":4564,"precertRequired":true,"billingCode":"73722","codeType":"CPT"},{"id":4565,"precertRequired":true,"billingCode":"73723","codeType":"CPT"},{"id":4566,"precertRequired":true,"billingCode":"73725","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4571,"precertRequired":false,"billingCode":"74022","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4583,"precertRequired":false,"billingCode":"74185","codeType":"CPT"},{"id":4585,"precertRequired":false,"billingCode":"74210","codeType":"CPT"},{"id":4586,"precertRequired":false,"billingCode":"74220","codeType":"CPT"},{"id":4589,"precertRequired":false,"billingCode":"74240","codeType":"CPT"},{"id":4590,"precertRequired":false,"billingCode":"74241","codeType":"CPT"},{"id":4591,"precertRequired":false,"billingCode":"74245","codeType":"CPT"},{"id":4592,"precertRequired":false,"billingCode":"74246","codeType":"CPT"},{"id":4593,"precertRequired":false,"billingCode":"74247","codeType":"CPT"},{"id":4594,"precertRequired":false,"billingCode":"74249","codeType":"CPT"},{"id":4595,"precertRequired":false,"billingCode":"74250","codeType":"CPT"},{"id":4596,"precertRequired":false,"billingCode":"74251","codeType":"CPT"},{"id":4597,"precertRequired":false,"billingCode":"74260","codeType":"CPT"},{"id":4601,"precertRequired":false,"billingCode":"74270","codeType":"CPT"},{"id":4602,"precertRequired":false,"billingCode":"74280","codeType":"CPT"},{"id":4603,"precertRequired":false,"billingCode":"74283","codeType":"CPT"},{"id":4604,"precertRequired":false,"billingCode":"74290","codeType":"CPT"},{"id":4614,"precertRequired":false,"billingCode":"74400","codeType":"CPT"},{"id":4615,"precertRequired":false,"billingCode":"74410","codeType":"CPT"},{"id":4616,"precertRequired":false,"billingCode":"74415","codeType":"CPT"},{"id":4617,"precertRequired":false,"billingCode":"74420","codeType":"CPT"},{"id":4618,"precertRequired":false,"billingCode":"74425","codeType":"CPT"},{"id":4619,"precertRequired":false,"billingCode":"74430","codeType":"CPT"},{"id":4620,"precertRequired":false,"billingCode":"74440","codeType":"CPT"},{"id":4622,"precertRequired":false,"billingCode":"74450","codeType":"CPT"},{"id":4623,"precertRequired":false,"billingCode":"74455","codeType":"CPT"},{"id":4624,"precertRequired":false,"billingCode":"74470","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4657,"precertRequired":false,"billingCode":"75801","codeType":"CPT"},{"id":4658,"precertRequired":false,"billingCode":"75803","codeType":"CPT"},{"id":4659,"precertRequired":false,"billingCode":"75805","codeType":"CPT"},{"id":4660,"precertRequired":false,"billingCode":"75807","codeType":"CPT"},{"id":4662,"precertRequired":false,"billingCode":"75810","codeType":"CPT"},{"id":4711,"precertRequired":false,"billingCode":"76506","codeType":"CPT"},{"id":4712,"precertRequired":false,"billingCode":"76510","codeType":"CPT"},{"id":4713,"precertRequired":false,"billingCode":"76511","codeType":"CPT"},{"id":4714,"precertRequired":false,"billingCode":"76512","codeType":"CPT"},{"id":4715,"precertRequired":false,"billingCode":"76513","codeType":"CPT"},{"id":4720,"precertRequired":false,"billingCode":"76536","codeType":"CPT"},{"id":4721,"precertRequired":true,"billingCode":"76604","codeType":"CPT"},{"id":4722,"precertRequired":false,"billingCode":"76641","codeType":"CPT"},{"id":4723,"precertRequired":false,"billingCode":"76642","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4728,"precertRequired":false,"billingCode":"76770","codeType":"CPT"},{"id":4729,"precertRequired":false,"billingCode":"76775","codeType":"CPT"},{"id":4731,"precertRequired":false,"billingCode":"76800","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4755,"precertRequired":false,"billingCode":"76870","codeType":"CPT"},{"id":4756,"precertRequired":false,"billingCode":"76872","codeType":"CPT"},{"id":4757,"precertRequired":false,"billingCode":"76873","codeType":"CPT"},{"id":4758,"precertRequired":false,"billingCode":"76881","codeType":"CPT"},{"id":4759,"precertRequired":false,"billingCode":"76882","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4778,"precertRequired":false,"billingCode":"77012","codeType":"CPT"},{"id":4780,"precertRequired":true,"billingCode":"77014","codeType":"CPT"},{"id":4782,"precertRequired":false,"billingCode":"77053","codeType":"CPT"},{"id":4783,"precertRequired":false,"billingCode":"77054","codeType":"CPT"},{"id":4786,"precertRequired":false,"billingCode":"77061","codeType":"CPT"},{"id":4787,"precertRequired":false,"billingCode":"77062","codeType":"CPT"},{"id":4788,"precertRequired":false,"billingCode":"77063","codeType":"CPT"},{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4795,"precertRequired":false,"billingCode":"77074","codeType":"CPT"},{"id":4796,"precertRequired":false,"billingCode":"77075","codeType":"CPT"},{"id":4872,"precertRequired":false,"billingCode":"78012","codeType":"CPT"},{"id":4873,"precertRequired":false,"billingCode":"78013","codeType":"CPT"},{"id":4874,"precertRequired":false,"billingCode":"78014","codeType":"CPT"},{"id":4875,"precertRequired":false,"billingCode":"78015","codeType":"CPT"},{"id":4876,"precertRequired":false,"billingCode":"78016","codeType":"CPT"},{"id":4877,"precertRequired":false,"billingCode":"78018","codeType":"CPT"},{"id":4878,"precertRequired":false,"billingCode":"78020","codeType":"CPT"},{"id":4879,"precertRequired":false,"billingCode":"78070","codeType":"CPT"},{"id":4880,"precertRequired":false,"billingCode":"78071","codeType":"CPT"},{"id":4881,"precertRequired":false,"billingCode":"78072","codeType":"CPT"},{"id":4882,"precertRequired":false,"billingCode":"78075","codeType":"CPT"},{"id":4884,"precertRequired":false,"billingCode":"78102","codeType":"CPT"},{"id":4885,"precertRequired":false,"billingCode":"78103","codeType":"CPT"},{"id":4886,"precertRequired":false,"billingCode":"78104","codeType":"CPT"},{"id":4887,"precertRequired":false,"billingCode":"78110","codeType":"CPT"},{"id":4888,"precertRequired":false,"billingCode":"78111","codeType":"CPT"},{"id":4889,"precertRequired":false,"billingCode":"78120","codeType":"CPT"},{"id":4890,"precertRequired":false,"billingCode":"78121","codeType":"CPT"},{"id":4891,"precertRequired":false,"billingCode":"78122","codeType":"CPT"},{"id":4892,"precertRequired":false,"billingCode":"78130","codeType":"CPT"},{"id":4893,"precertRequired":false,"billingCode":"78135","codeType":"CPT"},{"id":4894,"precertRequired":false,"billingCode":"78140","codeType":"CPT"},{"id":4895,"precertRequired":false,"billingCode":"78185","codeType":"CPT"},{"id":4896,"precertRequired":false,"billingCode":"78191","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4904,"precertRequired":false,"billingCode":"78226","codeType":"CPT"},{"id":4905,"precertRequired":false,"billingCode":"78227","codeType":"CPT"},{"id":4906,"precertRequired":false,"billingCode":"78230","codeType":"CPT"},{"id":4907,"precertRequired":false,"billingCode":"78231","codeType":"CPT"},{"id":4920,"precertRequired":false,"billingCode":"78290","codeType":"CPT"},{"id":4922,"precertRequired":false,"billingCode":"78300","codeType":"CPT"},{"id":4923,"precertRequired":false,"billingCode":"78305","codeType":"CPT"},{"id":4924,"precertRequired":false,"billingCode":"78306","codeType":"CPT"},{"id":4925,"precertRequired":false,"billingCode":"78315","codeType":"CPT"},{"id":4926,"precertRequired":false,"billingCode":"78320","codeType":"CPT"},{"id":4959,"precertRequired":false,"billingCode":"78600","codeType":"CPT"},{"id":4960,"precertRequired":false,"billingCode":"78601","codeType":"CPT"},{"id":4961,"precertRequired":false,"billingCode":"78605","codeType":"CPT"},{"id":4962,"precertRequired":false,"billingCode":"78606","codeType":"CPT"},{"id":4963,"precertRequired":false,"billingCode":"78607","codeType":"CPT"},{"id":4970,"precertRequired":false,"billingCode":"78700","codeType":"CPT"},{"id":4971,"precertRequired":false,"billingCode":"78701","codeType":"CPT"},{"id":4975,"precertRequired":false,"billingCode":"78710","codeType":"CPT"},{"id":4979,"precertRequired":false,"billingCode":"78761","codeType":"CPT"},{"id":4981,"precertRequired":false,"billingCode":"78800","codeType":"CPT"},{"id":4982,"precertRequired":false,"billingCode":"78801","codeType":"CPT"},{"id":4983,"precertRequired":false,"billingCode":"78802","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":4985,"precertRequired":false,"billingCode":"78804","codeType":"CPT"},{"id":9769,"precertRequired":true,"billingCode":"77046","codeType":"CPT"},{"id":9770,"precertRequired":true,"billingCode":"77047","codeType":"CPT"},{"id":9771,"precertRequired":true,"billingCode":"77048","codeType":"CPT"},{"id":9772,"precertRequired":true,"billingCode":"77049","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":2207,"description":"Labs and pathology relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5429,"precertRequired":false,"billingCode":"82374","codeType":"CPT"},{"id":5430,"precertRequired":false,"billingCode":"82375","codeType":"CPT"},{"id":5431,"precertRequired":false,"billingCode":"82376","codeType":"CPT"},{"id":5453,"precertRequired":false,"billingCode":"82525","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5480,"precertRequired":false,"billingCode":"82657","codeType":"CPT"},{"id":5481,"precertRequired":false,"billingCode":"82658","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5585,"precertRequired":false,"billingCode":"83625","codeType":"CPT"},{"id":5590,"precertRequired":false,"billingCode":"83655","codeType":"CPT"},{"id":5654,"precertRequired":false,"billingCode":"84119","codeType":"CPT"},{"id":5656,"precertRequired":false,"billingCode":"84126","codeType":"CPT"},{"id":5758,"precertRequired":false,"billingCode":"84630","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5765,"precertRequired":false,"billingCode":"85002","codeType":"CPT"},{"id":5766,"precertRequired":false,"billingCode":"85004","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5768,"precertRequired":false,"billingCode":"85008","codeType":"CPT"},{"id":5769,"precertRequired":false,"billingCode":"85009","codeType":"CPT"},{"id":5770,"precertRequired":false,"billingCode":"85013","codeType":"CPT"},{"id":5771,"precertRequired":false,"billingCode":"85014","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5775,"precertRequired":false,"billingCode":"85032","codeType":"CPT"},{"id":5776,"precertRequired":false,"billingCode":"85041","codeType":"CPT"},{"id":5777,"precertRequired":false,"billingCode":"85044","codeType":"CPT"},{"id":5778,"precertRequired":false,"billingCode":"85045","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5780,"precertRequired":false,"billingCode":"85048","codeType":"CPT"},{"id":5781,"precertRequired":false,"billingCode":"85049","codeType":"CPT"},{"id":5782,"precertRequired":false,"billingCode":"85055","codeType":"CPT"},{"id":5783,"precertRequired":false,"billingCode":"85060","codeType":"CPT"},{"id":5784,"precertRequired":false,"billingCode":"85097","codeType":"CPT"},{"id":5785,"precertRequired":false,"billingCode":"85130","codeType":"CPT"},{"id":5788,"precertRequired":false,"billingCode":"85210","codeType":"CPT"},{"id":5789,"precertRequired":false,"billingCode":"85220","codeType":"CPT"},{"id":5790,"precertRequired":false,"billingCode":"85230","codeType":"CPT"},{"id":5791,"precertRequired":false,"billingCode":"85240","codeType":"CPT"},{"id":5792,"precertRequired":false,"billingCode":"85244","codeType":"CPT"},{"id":5793,"precertRequired":false,"billingCode":"85245","codeType":"CPT"},{"id":5794,"precertRequired":false,"billingCode":"85246","codeType":"CPT"},{"id":5796,"precertRequired":false,"billingCode":"85250","codeType":"CPT"},{"id":5797,"precertRequired":false,"billingCode":"85260","codeType":"CPT"},{"id":5798,"precertRequired":false,"billingCode":"85270","codeType":"CPT"},{"id":5799,"precertRequired":false,"billingCode":"85280","codeType":"CPT"},{"id":5800,"precertRequired":false,"billingCode":"85290","codeType":"CPT"},{"id":5806,"precertRequired":false,"billingCode":"85302","codeType":"CPT"},{"id":5807,"precertRequired":false,"billingCode":"85303","codeType":"CPT"},{"id":5808,"precertRequired":false,"billingCode":"85305","codeType":"CPT"},{"id":5809,"precertRequired":false,"billingCode":"85306","codeType":"CPT"},{"id":5810,"precertRequired":false,"billingCode":"85307","codeType":"CPT"},{"id":5813,"precertRequired":false,"billingCode":"85345","codeType":"CPT"},{"id":5814,"precertRequired":false,"billingCode":"85347","codeType":"CPT"},{"id":5815,"precertRequired":false,"billingCode":"85348","codeType":"CPT"},{"id":5826,"precertRequired":false,"billingCode":"85396","codeType":"CPT"},{"id":5827,"precertRequired":false,"billingCode":"85397","codeType":"CPT"},{"id":5835,"precertRequired":false,"billingCode":"85460","codeType":"CPT"},{"id":5836,"precertRequired":false,"billingCode":"85461","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5860,"precertRequired":false,"billingCode":"85705","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5862,"precertRequired":false,"billingCode":"85732","codeType":"CPT"},{"id":5863,"precertRequired":false,"billingCode":"85810","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5922,"precertRequired":false,"billingCode":"86335","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8450,"precertRequired":false,"billingCode":"J1756","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":11581,"precertRequired":false,"billingCode":"85028","codeType":"CPT"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":2208,"description":"Procedures related to the referred condition on the consult including but no limited to:  bone marrow aspiration, lumbar puncture, etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":68,"precertRequired":false,"billingCode":"00635","codeType":"CPT"},{"id":137,"precertRequired":false,"billingCode":"01112","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2547,"precertRequired":false,"billingCode":"36455","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2567,"precertRequired":false,"billingCode":"36565","codeType":"CPT"},{"id":2568,"precertRequired":false,"billingCode":"36566","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2572,"precertRequired":false,"billingCode":"36571","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2583,"precertRequired":false,"billingCode":"36590","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2585,"precertRequired":false,"billingCode":"36592","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":2590,"precertRequired":false,"billingCode":"36598","codeType":"CPT"},{"id":2595,"precertRequired":false,"billingCode":"36640","codeType":"CPT"},{"id":2679,"precertRequired":false,"billingCode":"38220","codeType":"CPT"},{"id":2680,"precertRequired":false,"billingCode":"38221","codeType":"CPT"},{"id":2681,"precertRequired":false,"billingCode":"38222","codeType":"CPT"},{"id":2689,"precertRequired":false,"billingCode":"38505","codeType":"CPT"},{"id":2692,"precertRequired":false,"billingCode":"38525","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":3881,"precertRequired":false,"billingCode":"62272","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":6960,"precertRequired":true,"billingCode":"93792","codeType":"CPT"},{"id":6961,"precertRequired":false,"billingCode":"93793","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7891,"precertRequired":false,"billingCode":"A9552","codeType":"HCPCS"},{"id":7911,"precertRequired":false,"billingCode":"A9575","codeType":"HCPCS"},{"id":7913,"precertRequired":false,"billingCode":"A9577","codeType":"HCPCS"},{"id":7921,"precertRequired":false,"billingCode":"A9585","codeType":"HCPCS"},{"id":7929,"precertRequired":false,"billingCode":"A9606","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8387,"precertRequired":false,"billingCode":"J0641","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8397,"precertRequired":true,"billingCode":"J0881","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8478,"precertRequired":false,"billingCode":"J2505","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8497,"precertRequired":false,"billingCode":"J2930","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":9817,"precertRequired":false,"billingCode":"J1447","codeType":"HCPCS"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"},{"id":11583,"precertRequired":false,"billingCode":"36522","codeType":"CPT"},{"id":11584,"precertRequired":false,"billingCode":"38242","codeType":"CPT"},{"id":11585,"precertRequired":false,"billingCode":"38243","codeType":"CPT"},{"id":11586,"precertRequired":false,"billingCode":"38792","codeType":"CPT"},{"id":11587,"precertRequired":false,"billingCode":"J1300","codeType":"HCPCS"},{"id":11588,"precertRequired":false,"billingCode":"J2796","codeType":"HCPCS"},{"id":11589,"precertRequired":false,"billingCode":"J2820","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2209,"description":"Inpatient or observation admission for treatment, if indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2210,"description":"Inpatient admission or observation status for complications related to treatment\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the treatment","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":2211,"description":"Infusion therapy or phlebotomy as clinically indicated by hematologist (in clinic)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":52,"precertRequired":false,"billingCode":"00532","codeType":"CPT"},{"id":137,"precertRequired":false,"billingCode":"01112","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":2509,"precertRequired":false,"billingCode":"36000","codeType":"CPT"},{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":2557,"precertRequired":false,"billingCode":"36514","codeType":"CPT"},{"id":2563,"precertRequired":false,"billingCode":"36558","codeType":"CPT"},{"id":2565,"precertRequired":false,"billingCode":"36561","codeType":"CPT"},{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2583,"precertRequired":false,"billingCode":"36590","codeType":"CPT"},{"id":2584,"precertRequired":false,"billingCode":"36591","codeType":"CPT"},{"id":2585,"precertRequired":false,"billingCode":"36592","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":2590,"precertRequired":false,"billingCode":"36598","codeType":"CPT"},{"id":2595,"precertRequired":false,"billingCode":"36640","codeType":"CPT"},{"id":4764,"precertRequired":false,"billingCode":"76937","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4897,"precertRequired":false,"billingCode":"78195","codeType":"CPT"},{"id":6960,"precertRequired":true,"billingCode":"93792","codeType":"CPT"},{"id":6961,"precertRequired":false,"billingCode":"93793","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7891,"precertRequired":false,"billingCode":"A9552","codeType":"HCPCS"},{"id":7911,"precertRequired":false,"billingCode":"A9575","codeType":"HCPCS"},{"id":7913,"precertRequired":false,"billingCode":"A9577","codeType":"HCPCS"},{"id":7921,"precertRequired":false,"billingCode":"A9585","codeType":"HCPCS"},{"id":7929,"precertRequired":false,"billingCode":"A9606","codeType":"HCPCS"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8387,"precertRequired":false,"billingCode":"J0641","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8397,"precertRequired":true,"billingCode":"J0881","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8449,"precertRequired":false,"billingCode":"J1750","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8478,"precertRequired":false,"billingCode":"J2505","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8497,"precertRequired":false,"billingCode":"J2930","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8723,"precertRequired":false,"billingCode":"P9010","codeType":"HCPCS"},{"id":8724,"precertRequired":false,"billingCode":"P9011","codeType":"HCPCS"},{"id":8726,"precertRequired":false,"billingCode":"P9016","codeType":"HCPCS"},{"id":8728,"precertRequired":false,"billingCode":"P9019","codeType":"HCPCS"},{"id":8729,"precertRequired":false,"billingCode":"P9020","codeType":"HCPCS"},{"id":8730,"precertRequired":false,"billingCode":"P9021","codeType":"HCPCS"},{"id":8736,"precertRequired":false,"billingCode":"P9034","codeType":"HCPCS"},{"id":8737,"precertRequired":false,"billingCode":"P9035","codeType":"HCPCS"},{"id":8739,"precertRequired":false,"billingCode":"P9037","codeType":"HCPCS"},{"id":8740,"precertRequired":false,"billingCode":"P9038","codeType":"HCPCS"},{"id":8741,"precertRequired":false,"billingCode":"P9039","codeType":"HCPCS"},{"id":8742,"precertRequired":false,"billingCode":"P9040","codeType":"HCPCS"},{"id":8751,"precertRequired":false,"billingCode":"P9051","codeType":"HCPCS"},{"id":8753,"precertRequired":false,"billingCode":"P9053","codeType":"HCPCS"},{"id":8754,"precertRequired":false,"billingCode":"P9054","codeType":"HCPCS"},{"id":8756,"precertRequired":false,"billingCode":"P9056","codeType":"HCPCS"},{"id":8757,"precertRequired":false,"billingCode":"P9057","codeType":"HCPCS"},{"id":8758,"precertRequired":false,"billingCode":"P9058","codeType":"HCPCS"},{"id":8759,"precertRequired":false,"billingCode":"P9059","codeType":"HCPCS"},{"id":8761,"precertRequired":false,"billingCode":"P9070","codeType":"HCPCS"},{"id":8762,"precertRequired":false,"billingCode":"P9071","codeType":"HCPCS"},{"id":8763,"precertRequired":false,"billingCode":"P9073","codeType":"HCPCS"},{"id":8772,"precertRequired":false,"billingCode":"Q0138","codeType":"HCPCS"},{"id":9817,"precertRequired":false,"billingCode":"J1447","codeType":"HCPCS"},{"id":11582,"precertRequired":false,"billingCode":"J1439","codeType":"HCPCS"},{"id":11583,"precertRequired":false,"billingCode":"36522","codeType":"CPT"},{"id":11587,"precertRequired":false,"billingCode":"J1300","codeType":"HCPCS"},{"id":11588,"precertRequired":false,"billingCode":"J2796","codeType":"HCPCS"},{"id":11589,"precertRequired":false,"billingCode":"J2820","codeType":"HCPCS"},{"id":11590,"precertRequired":false,"billingCode":"P9100","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]}]}},{"Seoc":{"id":275,"seocKey":58,"name":"Hematology_PRCT","seocId":"MSC_HEMATOLOGY_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"05-17-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic images as clinically required\r\n3. Diagnostic studies, labs and pathology services relevant to the referred condition\r\n4. Infusion therapy as clinically indicated by hematologist\r\n5. Follow-up images/studies/laboratories as indicated\r\n6. Follow-up visits for this episode of care","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**Clinical trials and non-FDA approved treatments ARE NOT approved under this referral. If a clinical trial is indicated it will require VA review and approval via a SAR (Secondary Authorization Request) to ensure the trial is being conducted under an Investigational Drug (IND) application or the drug, biologicals or medical devices are prescribed under a compassionate use exemption, or the trial does not include any unapproved drugs, biologicals or medical devices.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"HEMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RH0000X"}],"services":[{"id":1133,"description":" Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":6538,"precertRequired":false,"billingCode":"90658","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":1134,"description":"Diagnostic images as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1135,"description":"Diagnostic studies, labs and pathology services relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2114,"precertRequired":true,"billingCode":"32554","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2679,"precertRequired":false,"billingCode":"38220","codeType":"CPT"},{"id":2680,"precertRequired":false,"billingCode":"38221","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1136,"description":"Infusion therapy as clinically indicated by hematologist ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":3423,"precertRequired":false,"billingCode":"51720","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7202,"precertRequired":false,"billingCode":"96401","codeType":"CPT"},{"id":7203,"precertRequired":false,"billingCode":"96402","codeType":"CPT"},{"id":7204,"precertRequired":false,"billingCode":"96405","codeType":"CPT"},{"id":7206,"precertRequired":false,"billingCode":"96409","codeType":"CPT"},{"id":7207,"precertRequired":false,"billingCode":"96411","codeType":"CPT"},{"id":7208,"precertRequired":false,"billingCode":"96413","codeType":"CPT"},{"id":7209,"precertRequired":false,"billingCode":"96415","codeType":"CPT"},{"id":7210,"precertRequired":false,"billingCode":"96416","codeType":"CPT"},{"id":7211,"precertRequired":false,"billingCode":"96417","codeType":"CPT"},{"id":7212,"precertRequired":false,"billingCode":"96420","codeType":"CPT"},{"id":7213,"precertRequired":false,"billingCode":"96422","codeType":"CPT"},{"id":7214,"precertRequired":false,"billingCode":"96423","codeType":"CPT"},{"id":7215,"precertRequired":false,"billingCode":"96425","codeType":"CPT"},{"id":7216,"precertRequired":false,"billingCode":"96440","codeType":"CPT"},{"id":7217,"precertRequired":false,"billingCode":"96446","codeType":"CPT"},{"id":7218,"precertRequired":false,"billingCode":"96450","codeType":"CPT"},{"id":7222,"precertRequired":false,"billingCode":"96542","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7429,"precertRequired":false,"billingCode":"99363","codeType":"CPT"},{"id":7430,"precertRequired":false,"billingCode":"99364","codeType":"CPT"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8497,"precertRequired":false,"billingCode":"J2930","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8524,"precertRequired":false,"billingCode":"J7042","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8577,"precertRequired":false,"billingCode":"J9000","codeType":"HCPCS"},{"id":8586,"precertRequired":false,"billingCode":"J9031","codeType":"HCPCS"},{"id":8592,"precertRequired":false,"billingCode":"J9040","codeType":"HCPCS"},{"id":8596,"precertRequired":false,"billingCode":"J9045","codeType":"HCPCS"},{"id":8600,"precertRequired":false,"billingCode":"J9060","codeType":"HCPCS"},{"id":8602,"precertRequired":false,"billingCode":"J9070","codeType":"HCPCS"},{"id":8604,"precertRequired":false,"billingCode":"J9100","codeType":"HCPCS"},{"id":8613,"precertRequired":false,"billingCode":"J9171","codeType":"HCPCS"},{"id":8617,"precertRequired":false,"billingCode":"J9181","codeType":"HCPCS"},{"id":8618,"precertRequired":false,"billingCode":"J9185","codeType":"HCPCS"},{"id":8619,"precertRequired":false,"billingCode":"J9190","codeType":"HCPCS"},{"id":8621,"precertRequired":false,"billingCode":"J9201","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8625,"precertRequired":false,"billingCode":"J9206","codeType":"HCPCS"},{"id":8627,"precertRequired":false,"billingCode":"J9208","codeType":"HCPCS"},{"id":8628,"precertRequired":false,"billingCode":"J9209","codeType":"HCPCS"},{"id":8631,"precertRequired":false,"billingCode":"J9213","codeType":"HCPCS"},{"id":8632,"precertRequired":false,"billingCode":"J9214","codeType":"HCPCS"},{"id":8635,"precertRequired":false,"billingCode":"J9217","codeType":"HCPCS"},{"id":8636,"precertRequired":false,"billingCode":"J9218","codeType":"HCPCS"},{"id":8643,"precertRequired":false,"billingCode":"J9250","codeType":"HCPCS"},{"id":8644,"precertRequired":false,"billingCode":"J9260","codeType":"HCPCS"},{"id":8650,"precertRequired":false,"billingCode":"J9267","codeType":"HCPCS"},{"id":8656,"precertRequired":false,"billingCode":"J9293","codeType":"HCPCS"},{"id":8666,"precertRequired":false,"billingCode":"J9310","codeType":"HCPCS"},{"id":8673,"precertRequired":false,"billingCode":"J9351","codeType":"HCPCS"},{"id":8678,"precertRequired":false,"billingCode":"J9360","codeType":"HCPCS"},{"id":8679,"precertRequired":false,"billingCode":"J9370","codeType":"HCPCS"},{"id":8681,"precertRequired":false,"billingCode":"J9390","codeType":"HCPCS"},{"id":8791,"precertRequired":false,"billingCode":"Q2050","codeType":"HCPCS"},{"id":8823,"precertRequired":false,"billingCode":"Q4081","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":1137,"description":"Follow-up images/studies/laboratories as indicated ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2114,"precertRequired":true,"billingCode":"32554","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2679,"precertRequired":false,"billingCode":"38220","codeType":"CPT"},{"id":2680,"precertRequired":false,"billingCode":"38221","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1138,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]}]}},{"Seoc":{"id":35,"seocKey":58,"name":"Hematology_PRCT","seocId":"MSC_HEMATOLOGY_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"01-02-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic images as clinically required\r\n3. Diagnostic studies, labs and pathology services relevant to the referred condition\r\n4. Infusion therapy as clinically indicated by hematologist\r\n5. Follow-up images/studies/laboratories as indicated\r\n6. Follow-up visits for this episode of care","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**Clinical trials and non-FDA approved treatments ARE NOT approved under this referral. If a clinical trial is indicated it will require VA review and approval via a SAR (Secondary Authorization Request) to ensure the trial is being conducted under an Investigational Drug (IND) application or the drug, biologicals or medical devices are prescribed under a compassionate use exemption, or the trial does not include any unapproved drugs, biologicals or medical devices.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"HEMATOLOGY","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":199,"description":" Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":6538,"precertRequired":false,"billingCode":"90658","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":200,"description":"Diagnostic images as clinically required","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":201,"description":"Diagnostic studies, labs and pathology services relevant to the referred condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2114,"precertRequired":true,"billingCode":"32554","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2679,"precertRequired":false,"billingCode":"38220","codeType":"CPT"},{"id":2680,"precertRequired":false,"billingCode":"38221","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":202,"description":"Infusion therapy as clinically indicated by hematologist ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":2546,"precertRequired":false,"billingCode":"36430","codeType":"CPT"},{"id":3423,"precertRequired":false,"billingCode":"51720","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7202,"precertRequired":false,"billingCode":"96401","codeType":"CPT"},{"id":7203,"precertRequired":false,"billingCode":"96402","codeType":"CPT"},{"id":7204,"precertRequired":false,"billingCode":"96405","codeType":"CPT"},{"id":7206,"precertRequired":false,"billingCode":"96409","codeType":"CPT"},{"id":7207,"precertRequired":false,"billingCode":"96411","codeType":"CPT"},{"id":7208,"precertRequired":false,"billingCode":"96413","codeType":"CPT"},{"id":7209,"precertRequired":false,"billingCode":"96415","codeType":"CPT"},{"id":7210,"precertRequired":false,"billingCode":"96416","codeType":"CPT"},{"id":7211,"precertRequired":false,"billingCode":"96417","codeType":"CPT"},{"id":7212,"precertRequired":false,"billingCode":"96420","codeType":"CPT"},{"id":7213,"precertRequired":false,"billingCode":"96422","codeType":"CPT"},{"id":7214,"precertRequired":false,"billingCode":"96423","codeType":"CPT"},{"id":7215,"precertRequired":false,"billingCode":"96425","codeType":"CPT"},{"id":7216,"precertRequired":false,"billingCode":"96440","codeType":"CPT"},{"id":7217,"precertRequired":false,"billingCode":"96446","codeType":"CPT"},{"id":7218,"precertRequired":false,"billingCode":"96450","codeType":"CPT"},{"id":7222,"precertRequired":false,"billingCode":"96542","codeType":"CPT"},{"id":7344,"precertRequired":false,"billingCode":"99195","codeType":"CPT"},{"id":7429,"precertRequired":false,"billingCode":"99363","codeType":"CPT"},{"id":7430,"precertRequired":false,"billingCode":"99364","codeType":"CPT"},{"id":8386,"precertRequired":false,"billingCode":"J0640","codeType":"HCPCS"},{"id":8394,"precertRequired":false,"billingCode":"J0780","codeType":"HCPCS"},{"id":8399,"precertRequired":false,"billingCode":"J0885","codeType":"HCPCS"},{"id":8412,"precertRequired":false,"billingCode":"J1100","codeType":"HCPCS"},{"id":8416,"precertRequired":false,"billingCode":"J1200","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8433,"precertRequired":false,"billingCode":"J1568","codeType":"HCPCS"},{"id":8454,"precertRequired":false,"billingCode":"J1940","codeType":"HCPCS"},{"id":8460,"precertRequired":false,"billingCode":"J2060","codeType":"HCPCS"},{"id":8462,"precertRequired":false,"billingCode":"J2175","codeType":"HCPCS"},{"id":8464,"precertRequired":false,"billingCode":"J2270","codeType":"HCPCS"},{"id":8474,"precertRequired":false,"billingCode":"J2430","codeType":"HCPCS"},{"id":8479,"precertRequired":false,"billingCode":"J2550","codeType":"HCPCS"},{"id":8491,"precertRequired":false,"billingCode":"J2792","codeType":"HCPCS"},{"id":8496,"precertRequired":false,"billingCode":"J2920","codeType":"HCPCS"},{"id":8497,"precertRequired":false,"billingCode":"J2930","codeType":"HCPCS"},{"id":8515,"precertRequired":false,"billingCode":"J3420","codeType":"HCPCS"},{"id":8517,"precertRequired":false,"billingCode":"J3480","codeType":"HCPCS"},{"id":8518,"precertRequired":false,"billingCode":"J3489","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8524,"precertRequired":false,"billingCode":"J7042","codeType":"HCPCS"},{"id":8526,"precertRequired":false,"billingCode":"J7060","codeType":"HCPCS"},{"id":8528,"precertRequired":false,"billingCode":"J7100","codeType":"HCPCS"},{"id":8529,"precertRequired":false,"billingCode":"J7110","codeType":"HCPCS"},{"id":8577,"precertRequired":false,"billingCode":"J9000","codeType":"HCPCS"},{"id":8586,"precertRequired":false,"billingCode":"J9031","codeType":"HCPCS"},{"id":8592,"precertRequired":false,"billingCode":"J9040","codeType":"HCPCS"},{"id":8596,"precertRequired":false,"billingCode":"J9045","codeType":"HCPCS"},{"id":8600,"precertRequired":false,"billingCode":"J9060","codeType":"HCPCS"},{"id":8602,"precertRequired":false,"billingCode":"J9070","codeType":"HCPCS"},{"id":8604,"precertRequired":false,"billingCode":"J9100","codeType":"HCPCS"},{"id":8613,"precertRequired":false,"billingCode":"J9171","codeType":"HCPCS"},{"id":8617,"precertRequired":false,"billingCode":"J9181","codeType":"HCPCS"},{"id":8618,"precertRequired":false,"billingCode":"J9185","codeType":"HCPCS"},{"id":8619,"precertRequired":false,"billingCode":"J9190","codeType":"HCPCS"},{"id":8621,"precertRequired":false,"billingCode":"J9201","codeType":"HCPCS"},{"id":8622,"precertRequired":false,"billingCode":"J9202","codeType":"HCPCS"},{"id":8625,"precertRequired":false,"billingCode":"J9206","codeType":"HCPCS"},{"id":8627,"precertRequired":false,"billingCode":"J9208","codeType":"HCPCS"},{"id":8628,"precertRequired":false,"billingCode":"J9209","codeType":"HCPCS"},{"id":8631,"precertRequired":false,"billingCode":"J9213","codeType":"HCPCS"},{"id":8632,"precertRequired":false,"billingCode":"J9214","codeType":"HCPCS"},{"id":8635,"precertRequired":false,"billingCode":"J9217","codeType":"HCPCS"},{"id":8636,"precertRequired":false,"billingCode":"J9218","codeType":"HCPCS"},{"id":8643,"precertRequired":false,"billingCode":"J9250","codeType":"HCPCS"},{"id":8644,"precertRequired":false,"billingCode":"J9260","codeType":"HCPCS"},{"id":8650,"precertRequired":false,"billingCode":"J9267","codeType":"HCPCS"},{"id":8656,"precertRequired":false,"billingCode":"J9293","codeType":"HCPCS"},{"id":8666,"precertRequired":false,"billingCode":"J9310","codeType":"HCPCS"},{"id":8673,"precertRequired":false,"billingCode":"J9351","codeType":"HCPCS"},{"id":8678,"precertRequired":false,"billingCode":"J9360","codeType":"HCPCS"},{"id":8679,"precertRequired":false,"billingCode":"J9370","codeType":"HCPCS"},{"id":8681,"precertRequired":false,"billingCode":"J9390","codeType":"HCPCS"},{"id":8791,"precertRequired":false,"billingCode":"Q2050","codeType":"HCPCS"},{"id":8823,"precertRequired":false,"billingCode":"Q4081","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]},{"id":203,"description":"Follow-up images/studies/laboratories as indicated ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":551,"precertRequired":false,"billingCode":"20220","codeType":"CPT"},{"id":1995,"precertRequired":true,"billingCode":"31505","codeType":"CPT"},{"id":1996,"precertRequired":false,"billingCode":"31510","codeType":"CPT"},{"id":2009,"precertRequired":true,"billingCode":"31575","codeType":"CPT"},{"id":2114,"precertRequired":true,"billingCode":"32554","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2679,"precertRequired":false,"billingCode":"38220","codeType":"CPT"},{"id":2680,"precertRequired":false,"billingCode":"38221","codeType":"CPT"},{"id":3088,"precertRequired":true,"billingCode":"45300","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":204,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"82-Hematology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RH0000X"}]}]}},{"Seoc":{"id":1884,"seocKey":59,"name":"Home Based Dialysis_PRCT","seocId":"DIA_HOME BASED DIALYSIS_1.1.5_PRCT","versionNumber":"1.1.5","description":"This authorization covers services associated with all medical care listed below as clinically indicated for the treatment of a Veteran with ESRD by home dialysis.  ** Referrals approved through the National Dialysis Contract may not extend past the end of the VA fiscal year of September 30th. Referrals through CCN 365 duration may cross the fiscal year.","effectiveDate":"07-23-2020","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. All home dialysis services necessary for the treatment of a Veteran with ESRD by dialysis\r\n2. All necessary dialysis nursing services required for the training of a veteran and his/her designated support person for home or self care dialysis \r\n* Home dialysis training sessions (must follow CMS guidelines for allowed training sessions per modality (hemodialysis or peritoneal dialysis)\r\n* Home Dialysis Associated facility must be and remain CMS certified and meet CMS Conditions for Coverage.","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"DIALYSIS","serviceLine":"Dialysis","hptcs":[{"hptc":"261QE0700X"}],"services":[{"id":6038,"description":"All home dialysis services necessary for the treatment of a Veteran with ESRD by dialysis","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":6618,"precertRequired":true,"billingCode":"90999","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":6039,"description":"All necessary dialysis nursing services required for the training of a veteran and his/her designated support person for home or self care dialysis \r\n* Home dialysis training sessions (must follow CMS guidelines for allowed training sessions per modality (hemodialysis or peritoneal dialysis)\r\n* Home Dialysis Associated facility must be and remain CMS certified and meet CMS Conditions for Coverage.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":6603,"precertRequired":false,"billingCode":"90945","codeType":"CPT"},{"id":6604,"precertRequired":true,"billingCode":"90947","codeType":"CPT"},{"id":6608,"precertRequired":true,"billingCode":"90960","codeType":"CPT"},{"id":6609,"precertRequired":true,"billingCode":"90961","codeType":"CPT"},{"id":6610,"precertRequired":true,"billingCode":"90962","codeType":"CPT"},{"id":6612,"precertRequired":true,"billingCode":"90965","codeType":"CPT"},{"id":6613,"precertRequired":true,"billingCode":"90966","codeType":"CPT"},{"id":6615,"precertRequired":true,"billingCode":"90970","codeType":"CPT"},{"id":6616,"precertRequired":false,"billingCode":"90989","codeType":"CPT"},{"id":6617,"precertRequired":true,"billingCode":"90993","codeType":"CPT"},{"id":7411,"precertRequired":false,"billingCode":"99339","codeType":"CPT"},{"id":7412,"precertRequired":false,"billingCode":"99340","codeType":"CPT"},{"id":7413,"precertRequired":false,"billingCode":"99341","codeType":"CPT"},{"id":7414,"precertRequired":false,"billingCode":"99342","codeType":"CPT"},{"id":7415,"precertRequired":false,"billingCode":"99343","codeType":"CPT"},{"id":7416,"precertRequired":false,"billingCode":"99344","codeType":"CPT"},{"id":7417,"precertRequired":false,"billingCode":"99345","codeType":"CPT"},{"id":7418,"precertRequired":false,"billingCode":"99347","codeType":"CPT"},{"id":7419,"precertRequired":false,"billingCode":"99348","codeType":"CPT"},{"id":7420,"precertRequired":false,"billingCode":"99349","codeType":"CPT"},{"id":7421,"precertRequired":false,"billingCode":"99350","codeType":"CPT"},{"id":7509,"precertRequired":true,"billingCode":"99512","codeType":"CPT"},{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]}]}},{"Seoc":{"id":604,"seocKey":59,"name":"Home Based Dialysis_PRCT","seocId":"DIA_HOME BASED DIALYSIS_1.1.4_PRCT","versionNumber":"1.1.4","description":"This authorization covers services associated with all medical care listed below as clinically indicated for the treatment of a Veteran with ESRD by home dialysis.  ** This referral may not extend past the end of the VA fiscal year of September 30th.","effectiveDate":"07-28-2019","endDate":"07-23-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. All home dialysis services necessary for the treatment of a Veteran with ESRD by dialysis\r\n2.  Labs relevant to the referred condition on the consult\r\n3. Respite in-center maintenance dialysis as clinically indicated \r\n4. All necessary dialysis nursing services required for the training of a veteran and his/her designated support person for home or self care dialysis \r\n* Home dialysis training sessions (must follow CMS guidelines for allowed trainiing sessions per modality (hemodialysis or peritoneal dialysis)\r\n Note:   VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for hospitalization related to dialysis complications","maxAllowableVisits":null,"disclaimer":"* Home Dialysis Associated facility must be and remain CMS certified and meet CMS Conditions for Coverage.\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","QASP":"General Care","categoryOfCare":"DIALYSIS","serviceLine":"Dialysis","hptcs":[{"hptc":"261QE0700X"}],"services":[{"id":3356,"description":"All home dialysis services necessary for the treatment of a Veteran with ESRD by dialysis","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":6603,"precertRequired":false,"billingCode":"90945","codeType":"CPT"},{"id":6604,"precertRequired":true,"billingCode":"90947","codeType":"CPT"},{"id":6608,"precertRequired":true,"billingCode":"90960","codeType":"CPT"},{"id":6609,"precertRequired":true,"billingCode":"90961","codeType":"CPT"},{"id":6610,"precertRequired":true,"billingCode":"90962","codeType":"CPT"},{"id":6613,"precertRequired":true,"billingCode":"90966","codeType":"CPT"},{"id":6615,"precertRequired":true,"billingCode":"90970","codeType":"CPT"},{"id":6618,"precertRequired":true,"billingCode":"90999","codeType":"CPT"},{"id":7413,"precertRequired":false,"billingCode":"99341","codeType":"CPT"},{"id":7414,"precertRequired":false,"billingCode":"99342","codeType":"CPT"},{"id":7415,"precertRequired":false,"billingCode":"99343","codeType":"CPT"},{"id":7416,"precertRequired":false,"billingCode":"99344","codeType":"CPT"},{"id":7417,"precertRequired":false,"billingCode":"99345","codeType":"CPT"},{"id":7418,"precertRequired":false,"billingCode":"99347","codeType":"CPT"},{"id":7419,"precertRequired":false,"billingCode":"99348","codeType":"CPT"},{"id":7420,"precertRequired":false,"billingCode":"99349","codeType":"CPT"},{"id":7421,"precertRequired":false,"billingCode":"99350","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":3357,"description":"Labs relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5657,"precertRequired":false,"billingCode":"84132","codeType":"CPT"},{"id":5671,"precertRequired":false,"billingCode":"84155","codeType":"CPT"},{"id":5728,"precertRequired":false,"billingCode":"84466","codeType":"CPT"},{"id":5729,"precertRequired":false,"billingCode":"84478","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5740,"precertRequired":false,"billingCode":"84520","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5771,"precertRequired":false,"billingCode":"85014","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5778,"precertRequired":false,"billingCode":"85045","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6246,"precertRequired":false,"billingCode":"87522","codeType":"CPT"},{"id":8241,"precertRequired":false,"billingCode":"G0499","codeType":"HCPCS"},{"id":11848,"precertRequired":false,"billingCode":"G0306","codeType":"HCPCS"},{"id":11849,"precertRequired":false,"billingCode":"G0307","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":3358,"description":"Respite in-center maintenance dialysis as clinically indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":6609,"precertRequired":true,"billingCode":"90961","codeType":"CPT"},{"id":6610,"precertRequired":true,"billingCode":"90962","codeType":"CPT"},{"id":6615,"precertRequired":true,"billingCode":"90970","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":3359,"description":"All necessary dialysis nursing services required for the training of a veteran and his/her designated support person for home or self care dialysis \r\n* Home dialysis training sessions (must follow CMS guidelines for allowed trainiing sessions per modality (hemodialysis or peritoneal dialysis)\r\note:   VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for hospitalization related to dialysis complications","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":6616,"precertRequired":false,"billingCode":"90989","codeType":"CPT"},{"id":6617,"precertRequired":true,"billingCode":"90993","codeType":"CPT"},{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]}]}},{"Seoc":{"id":440,"seocKey":59,"name":"Home Based Dialysis_PRCT","seocId":"DIA_HOME BASED DIALYSIS_1.1.3_PRCT","versionNumber":"1.1.3","description":"This authorization covers services associated with all medical care listed below as clinically indicated for the treatment of a Veteran with ESRD by home dialysis.  ** This referral may not extend past the end of the VA fiscal year of September 30th.","effectiveDate":"05-21-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. All home dialysis services necessary for the treatment of a Veteran with ESRD by dialysis\r\n2.  Labs relevant to the referred condition on the consult\r\n3. Respite in-center maintenance dialysis as clinically indicated \r\n4. All necessary dialysis nursing services required for the training of a veteran and his/her designated support person for home or self care dialysis \r\n* Home dialysis training sessions (must follow CMS guidelines for allowed trainiing sessions per modality (hemodialysis or peritoneal dialysis)\r\n Note:   VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for hospitalization related to dialysis complications","maxAllowableVisits":null,"disclaimer":"* Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n* DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n* Home Dialysis Associated facility must be and remain CMS certified and meet CMS Conditions for Coverage.\r\n* All routine non- bundled medications  will be provided by the VA as prescribed by the contract community nephrologist in accordance with the VA national medication formulary and non-formulary request process.\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only.","QASP":"General Care","categoryOfCare":"DIALYSIS","serviceLine":"Dialysis","hptcs":[{"hptc":"261QE0700X"}],"services":[{"id":2384,"description":"All home dialysis services necessary for the treatment of a Veteran with ESRD by dialysis","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":6603,"precertRequired":false,"billingCode":"90945","codeType":"CPT"},{"id":6604,"precertRequired":true,"billingCode":"90947","codeType":"CPT"},{"id":6608,"precertRequired":true,"billingCode":"90960","codeType":"CPT"},{"id":6609,"precertRequired":true,"billingCode":"90961","codeType":"CPT"},{"id":6610,"precertRequired":true,"billingCode":"90962","codeType":"CPT"},{"id":6613,"precertRequired":true,"billingCode":"90966","codeType":"CPT"},{"id":6615,"precertRequired":true,"billingCode":"90970","codeType":"CPT"},{"id":6618,"precertRequired":true,"billingCode":"90999","codeType":"CPT"},{"id":7413,"precertRequired":false,"billingCode":"99341","codeType":"CPT"},{"id":7414,"precertRequired":false,"billingCode":"99342","codeType":"CPT"},{"id":7415,"precertRequired":false,"billingCode":"99343","codeType":"CPT"},{"id":7416,"precertRequired":false,"billingCode":"99344","codeType":"CPT"},{"id":7417,"precertRequired":false,"billingCode":"99345","codeType":"CPT"},{"id":7418,"precertRequired":false,"billingCode":"99347","codeType":"CPT"},{"id":7419,"precertRequired":false,"billingCode":"99348","codeType":"CPT"},{"id":7420,"precertRequired":false,"billingCode":"99349","codeType":"CPT"},{"id":7421,"precertRequired":false,"billingCode":"99350","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":2390,"description":"Labs relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5657,"precertRequired":false,"billingCode":"84132","codeType":"CPT"},{"id":5671,"precertRequired":false,"billingCode":"84155","codeType":"CPT"},{"id":5728,"precertRequired":false,"billingCode":"84466","codeType":"CPT"},{"id":5729,"precertRequired":false,"billingCode":"84478","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5740,"precertRequired":false,"billingCode":"84520","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5771,"precertRequired":false,"billingCode":"85014","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5778,"precertRequired":false,"billingCode":"85045","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6246,"precertRequired":false,"billingCode":"87522","codeType":"CPT"},{"id":8241,"precertRequired":false,"billingCode":"G0499","codeType":"HCPCS"},{"id":11848,"precertRequired":false,"billingCode":"G0306","codeType":"HCPCS"},{"id":11849,"precertRequired":false,"billingCode":"G0307","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":2391,"description":"Respite in-center maintenance dialysis as clinically indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":6609,"precertRequired":true,"billingCode":"90961","codeType":"CPT"},{"id":6610,"precertRequired":true,"billingCode":"90962","codeType":"CPT"},{"id":6615,"precertRequired":true,"billingCode":"90970","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":2392,"description":"All necessary dialysis nursing services required for the training of a veteran and his/her designated support person for home or self care dialysis \r\n* Home dialysis training sessions (must follow CMS guidelines for allowed trainiing sessions per modality (hemodialysis or peritoneal dialysis)\r\note:   VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for hospitalization related to dialysis complications","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":6616,"precertRequired":false,"billingCode":"90989","codeType":"CPT"},{"id":6617,"precertRequired":true,"billingCode":"90993","codeType":"CPT"},{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]}]}},{"Seoc":{"id":177,"seocKey":59,"name":"Home Based Dialysis_PRCT","seocId":"DIA_HOME BASED DIALYSIS_1.1.2_PRCT","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below as clinically indicated for the treatment of a Veterand with ESRD by either home hemodialysis or home peritoneal dialysis ","effectiveDate":"01-02-2019","endDate":"05-21-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. All home dialysis services necessary for the treatment of a Veteran with ESRD by either peritoneal or hemo-dialysis\r\n2. All necessary  hemo- or peritoneal dialysis equipmen\r\n3. All required  hemo- or peritoneal dialysis supplies\r\n4. All bundled dialysis labs and medications\r\n5. Dialysis nursing services required for support of home based dialysis outpatient care\r\n6. Respite incenter maintenance dialysis as clinically indicated","maxAllowableVisits":null,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** Home Dialysis Associated facility must be and remain CMS certified and meet CMS Conditions for Coverage.\r\n** All routine non- bundled medications  will be provided by the VA as prescribed by the contract community nephrologist in accordance with the VA national medication formulary and non-formulary request process.\r\nUrgent/emergent prescriptions can be provided for a 14 day supply only","QASP":"General Care","categoryOfCare":"DIALYSIS","serviceLine":"Dialysis","hptcs":[{"hptc":"261QE0700X"}],"services":[{"id":654,"description":"All home dialysis services necessary for the treatment of a Veteran with ESRD by either peritoneal or hemo-dialysis","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":655,"description":"All necessary  hemo- or peritoneal dialysis equipment","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7789,"precertRequired":true,"billingCode":"A4690","codeType":"HCPCS"},{"id":7804,"precertRequired":false,"billingCode":"A4730","codeType":"HCPCS"},{"id":7807,"precertRequired":false,"billingCode":"A4740","codeType":"HCPCS"},{"id":8095,"precertRequired":true,"billingCode":"E1520","codeType":"HCPCS"},{"id":8096,"precertRequired":true,"billingCode":"E1590","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":656,"description":"All required  hemo- or peritoneal dialysis supplies","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7671,"precertRequired":false,"billingCode":"A4216","codeType":"HCPCS"},{"id":7790,"precertRequired":false,"billingCode":"A4706","codeType":"HCPCS"},{"id":7791,"precertRequired":true,"billingCode":"A4707","codeType":"HCPCS"},{"id":7792,"precertRequired":false,"billingCode":"A4708","codeType":"HCPCS"},{"id":7794,"precertRequired":false,"billingCode":"A4714","codeType":"HCPCS"},{"id":7799,"precertRequired":false,"billingCode":"A4723","codeType":"HCPCS"},{"id":7808,"precertRequired":false,"billingCode":"A4750","codeType":"HCPCS"},{"id":7809,"precertRequired":false,"billingCode":"A4755","codeType":"HCPCS"},{"id":7934,"precertRequired":true,"billingCode":"B4164","codeType":"HCPCS"},{"id":7935,"precertRequired":true,"billingCode":"B4189","codeType":"HCPCS"},{"id":7936,"precertRequired":true,"billingCode":"B5000","codeType":"HCPCS"},{"id":7937,"precertRequired":true,"billingCode":"B9006","codeType":"HCPCS"},{"id":7939,"precertRequired":true,"billingCode":"C1750","codeType":"HCPCS"},{"id":7940,"precertRequired":true,"billingCode":"C1752","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":657,"description":"All bundled dialysis labs and medications","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5451,"precertRequired":false,"billingCode":"82507","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":658,"description":"Dialysis nursing services required for support of home based dialysis outpatient care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":6612,"precertRequired":true,"billingCode":"90965","codeType":"CPT"},{"id":6613,"precertRequired":true,"billingCode":"90966","codeType":"CPT"},{"id":6616,"precertRequired":false,"billingCode":"90989","codeType":"CPT"},{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"},{"id":9024,"precertRequired":false,"billingCode":"S9445","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":659,"description":"Respite incenter maintenance dialysis as clinically indicated ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]}]}},{"Seoc":{"id":70,"seocKey":59,"name":"Home Based Dialysis_PRCT","seocId":"MSC_HOME BASED DIALYSIS_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below as clinically indicated for the treatment of a Veterand with ESRD by either home hemodialysis or home peritoneal dialysis ","effectiveDate":"05-31-2018","endDate":"01-02-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. All home dialysis services necessary for the treatment of a Veteran with ESRD by either peritoneal or hemo-dialysis\r\n2. All necessary  hemo- or peritoneal dialysis equipmen\r\n3. All required  hemo- or peritoneal dialysis supplies\r\n4. All bundled dialysis labs and medications\r\n5. Dialysis nursing services required for support of home based dialysis outpatient care\r\n6. Respite incenter maintenance dialysis as clinically indicated","maxAllowableVisits":999,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** Home Dialysis Associated facility must be and remain CMS certified and meet CMS Conditions for Coverage.\r\n** All routine non- bundled medications  will be provided by the VA as prescribed by the contract community nephrologist in accordance with the VA national medication formulary and non-formulary request process.\r\nUrgent/emergent prescriptions can be provided for a 14 day supply only","QASP":"General Care","categoryOfCare":"DIALYSIS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":205,"description":"All home dialysis services necessary for the treatment of a Veteran with ESRD by either peritoneal or hemo-dialysis","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":2561,"precertRequired":false,"billingCode":"36556","codeType":"CPT"},{"id":3366,"precertRequired":false,"billingCode":"49421","codeType":"CPT"},{"id":3367,"precertRequired":false,"billingCode":"49422","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":206,"description":"All necessary  hemo- or peritoneal dialysis equipment","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7789,"precertRequired":true,"billingCode":"A4690","codeType":"HCPCS"},{"id":7804,"precertRequired":false,"billingCode":"A4730","codeType":"HCPCS"},{"id":7807,"precertRequired":false,"billingCode":"A4740","codeType":"HCPCS"},{"id":8095,"precertRequired":true,"billingCode":"E1520","codeType":"HCPCS"},{"id":8096,"precertRequired":true,"billingCode":"E1590","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":207,"description":"All required  hemo- or peritoneal dialysis supplies","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":7671,"precertRequired":false,"billingCode":"A4216","codeType":"HCPCS"},{"id":7790,"precertRequired":false,"billingCode":"A4706","codeType":"HCPCS"},{"id":7791,"precertRequired":true,"billingCode":"A4707","codeType":"HCPCS"},{"id":7792,"precertRequired":false,"billingCode":"A4708","codeType":"HCPCS"},{"id":7794,"precertRequired":false,"billingCode":"A4714","codeType":"HCPCS"},{"id":7799,"precertRequired":false,"billingCode":"A4723","codeType":"HCPCS"},{"id":7808,"precertRequired":false,"billingCode":"A4750","codeType":"HCPCS"},{"id":7809,"precertRequired":false,"billingCode":"A4755","codeType":"HCPCS"},{"id":7934,"precertRequired":true,"billingCode":"B4164","codeType":"HCPCS"},{"id":7935,"precertRequired":true,"billingCode":"B4189","codeType":"HCPCS"},{"id":7936,"precertRequired":true,"billingCode":"B5000","codeType":"HCPCS"},{"id":7937,"precertRequired":true,"billingCode":"B9006","codeType":"HCPCS"},{"id":7939,"precertRequired":true,"billingCode":"C1750","codeType":"HCPCS"},{"id":7940,"precertRequired":true,"billingCode":"C1752","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":208,"description":"All bundled dialysis labs and medications","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5068,"precertRequired":false,"billingCode":"80329","codeType":"CPT"},{"id":5069,"precertRequired":false,"billingCode":"80330","codeType":"CPT"},{"id":5070,"precertRequired":false,"billingCode":"80331","codeType":"CPT"},{"id":5451,"precertRequired":false,"billingCode":"82507","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":209,"description":"Dialysis nursing services required for support of home based dialysis outpatient care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[{"id":6612,"precertRequired":true,"billingCode":"90965","codeType":"CPT"},{"id":6613,"precertRequired":true,"billingCode":"90966","codeType":"CPT"},{"id":6616,"precertRequired":false,"billingCode":"90989","codeType":"CPT"},{"id":8207,"precertRequired":true,"billingCode":"G0420","codeType":"HCPCS"},{"id":9024,"precertRequired":false,"billingCode":"S9445","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]},{"id":210,"description":"Respite incenter maintenance dialysis as clinically indicated ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"B4-End-Stage Renal Disease Facility"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"291U00000X"},{"HPTC":"261QR0401X"},{"HPTC":"261QR0400X"},{"HPTC":"291900000X"},{"HPTC":"261QE0700X"},{"HPTC":"261QR1300X"},{"HPTC":"251G00000X"},{"HPTC":"261QF0400X"},{"HPTC":"261QM0801X"},{"HPTC":"282J00000X"},{"HPTC":"335U00000X"}]}]}},{"Seoc":{"id":1885,"seocKey":60,"name":"Hospice Home_PRCT","seocId":"NIC_HOSPICE HOME_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with the specialty(s) identified for this episode of care, including all medical care listed below relevant to the referred care specified on the consult order.","effectiveDate":"07-23-2020","endDate":null,"duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial evaluation for formulation of a hospice treatment plan\r\nHome hospice services in Home as necessary per the consult order and offered in a comprehensive bundled service package: \r\na) Routine Home Care (delivered in the Veteran's place of residence); \r\nb) Continuous Care (more than 8 hours per day of predominantly nursing care delivered in the Veteran's place of residence);  \r\n \r\nNote: Duration and frequency  of visits determined by level of hospice care as necessary per the consult","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"NIC HOSPICE/PALLIATIVE CARE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251G00000X"}],"services":[{"id":6042,"description":"Initial evaluation for formulation of a hospice treatment plan\r\nHome hospice services in Home as necessary per the consult order and offered in a comprehensive bundled service package: \r\na) Routine Home Care (delivered in the Veteran's place of residence); \r\nb) Continuous Care (more than 8 hours per day of predominantly nursing care delivered in the Veteran's place of residence);  \r\n \r\nNote: Duration and frequency  of visits determined by level of hospice care as necessary per the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"17-Hospice and palliative care"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7437,"precertRequired":false,"billingCode":"99377","codeType":"CPT"},{"id":7438,"precertRequired":false,"billingCode":"99378","codeType":"CPT"},{"id":8139,"precertRequired":false,"billingCode":"G0151","codeType":"HCPCS"},{"id":8140,"precertRequired":false,"billingCode":"G0152","codeType":"HCPCS"},{"id":8141,"precertRequired":false,"billingCode":"G0153","codeType":"HCPCS"},{"id":8142,"precertRequired":true,"billingCode":"G0155","codeType":"HCPCS"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8180,"precertRequired":false,"billingCode":"G0299","codeType":"HCPCS"},{"id":8181,"precertRequired":false,"billingCode":"G0300","codeType":"HCPCS"},{"id":8323,"precertRequired":false,"billingCode":"G9474","codeType":"HCPCS"},{"id":8324,"precertRequired":false,"billingCode":"G9477","codeType":"HCPCS"},{"id":8325,"precertRequired":false,"billingCode":"G9479","codeType":"HCPCS"},{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"},{"id":8848,"precertRequired":false,"billingCode":"Q5002","codeType":"HCPCS"},{"id":8849,"precertRequired":true,"billingCode":"Q5004","codeType":"HCPCS"},{"id":11915,"precertRequired":true,"billingCode":"Q5009","codeType":"HCPCS"},{"id":11916,"precertRequired":true,"billingCode":"Q5003","codeType":"HCPCS"},{"id":12274,"precertRequired":false,"billingCode":"G0337","codeType":"HCPCS"},{"id":13661,"precertRequired":false,"billingCode":"G9473","codeType":"HCPCS"},{"id":13662,"precertRequired":false,"billingCode":"G9475","codeType":"HCPCS"},{"id":13663,"precertRequired":false,"billingCode":"G9476","codeType":"HCPCS"},{"id":13664,"precertRequired":false,"billingCode":"G9478","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207PH0002X"},{"HPTC":"2084H0002X"},{"HPTC":"207RH0002X"},{"HPTC":"207VH0002X"},{"HPTC":"207QH0002X"},{"HPTC":"2086H0002X"},{"HPTC":"207LH0002X"}]}]}},{"Seoc":{"id":606,"seocKey":60,"name":"Hospice Home_PRCT","seocId":"NIC_HOSPICE HOME_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all home hospice care listed below.","effectiveDate":"07-28-2019","endDate":"07-23-2020","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial evaluation for formulation of a hospice treatment plan\r\n      Home hospice services in Home as necessary per the consult and offered in a comprehensive bundled service package: \r\na) Routine Home Care (delivered in the Veteran's place of residence); \r\nb) Continuous Care (more than 8 hours per day of predominantly nursing care delivered in the Veteran's place of residence);  \r\n \r\n Note: Duration and frequency  of visits determined by level of hospice care as necessary per the consult","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"NIC HOSPICE/PALLIATIVE CARE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251G00000X"}],"services":[{"id":3362,"description":"1.  Initial evaluation for formulation of a hospice treatment plan\r\n      Home hospice services in Home as necessary per the consult and offered in a comprehensive bundled service package: \r\na) Routine Home Care (delivered in the Veteran's place of residence); \r\nb) Continuous Care (more than 8 hours per day of predominantly nursing care delivered in the Veteran's place of residence);  \r\n \r\nNote: Duration and frequency  of visits determined by level of hospice care as necessary per the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"17-Hospice and palliative care"}],"billingCodes":[{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"},{"id":8848,"precertRequired":false,"billingCode":"Q5002","codeType":"HCPCS"},{"id":8849,"precertRequired":true,"billingCode":"Q5004","codeType":"HCPCS"},{"id":8854,"precertRequired":true,"billingCode":"Q5010","codeType":"HCPCS"},{"id":11915,"precertRequired":true,"billingCode":"Q5009","codeType":"HCPCS"},{"id":11916,"precertRequired":true,"billingCode":"Q5003","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207PH0002X"},{"HPTC":"2084H0002X"},{"HPTC":"207RH0002X"},{"HPTC":"207VH0002X"},{"HPTC":"207QH0002X"},{"HPTC":"2086H0002X"},{"HPTC":"207LH0002X"}]}]}},{"Seoc":{"id":446,"seocKey":60,"name":"Hospice Home_PRCT","seocId":"NIC_HOSPICE HOME_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all home hospice care listed below.","effectiveDate":"05-24-2019","endDate":"07-28-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial evaluation for formulation of a hospice treatment plan\r\n      Home hospice services in Home as necessary per the consult and offered in a comprehensive bundled service package: \r\na) Routine Home Care (delivered in the Veteran's place of residence); \r\nb) Continuous Care (more than 8 hours per day of predominantly nursing care delivered in the Veteran's place of residence);  \r\n \r\n Note: Duration and frequency  of visits determined by level of hospice care as necessary per the consult","maxAllowableVisits":null,"disclaimer":"**If an inpatient admission occurs please notify the VA facility authorizing the hospice services.\r\n**Additional consultations needed relevant to the referred patient condition require VA review and approval.  For hospice care, any changes in the level of hospice care require a new authorization and prior VA approval.\r\n**All DME is provided as part of the hospice per diem.\r\n**The hospice provider is responsible for providing all medications related to the terminal illness. \r\n**Service Intensity Add (SIA) on is managed by VA claims grouper and additional authorization is not needed.","QASP":"General Care","categoryOfCare":"NIC HOSPICE/PALLIATIVE CARE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251G00000X"}],"services":[{"id":2432,"description":"1.  Initial evaluation for formulation of a hospice treatment plan\r\n      Home hospice services in Home as necessary per the consult and offered in a comprehensive bundled service package: \r\na) Routine Home Care (delivered in the Veteran's place of residence); \r\nb) Continuous Care (more than 8 hours per day of predominantly nursing care delivered in the Veteran's place of residence);  \r\n \r\nNote: Duration and frequency  of visits determined by level of hospice care as necessary per the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"17-Hospice and palliative care"}],"billingCodes":[{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"},{"id":8848,"precertRequired":false,"billingCode":"Q5002","codeType":"HCPCS"},{"id":8849,"precertRequired":true,"billingCode":"Q5004","codeType":"HCPCS"},{"id":8854,"precertRequired":true,"billingCode":"Q5010","codeType":"HCPCS"},{"id":11915,"precertRequired":true,"billingCode":"Q5009","codeType":"HCPCS"},{"id":11916,"precertRequired":true,"billingCode":"Q5003","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207PH0002X"},{"HPTC":"2084H0002X"},{"HPTC":"207RH0002X"},{"HPTC":"207VH0002X"},{"HPTC":"207QH0002X"},{"HPTC":"2086H0002X"},{"HPTC":"207LH0002X"}]}]}},{"Seoc":{"id":274,"seocKey":60,"name":"Home Hospice_PRCT","seocId":"NIC_HOME HOSPICE_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"01-02-2019","endDate":"05-24-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial evaluation for formulation of a hospice treatment plan\r\n2. Home hospice services in one of four categories as necessary per the consult and offered in a comprehensive bundled service package: 1) Routine Home Care (delivered in the Veteran's place of residence); 2) Continuous Care (more than 8 hours per day of predominantly nursing care delivered in the Veteran's place of residence); 3) Inpatient Respite Care (care provided to a hospice patient in order that the usual caregiver can rest); 4) General Inpatient Care (care requiring and delivered in an inpatient setting)\r\n3. Duration and frequency determined by level of hospice care as necessary per the consult","maxAllowableVisits":null,"disclaimer":"**If an inpatient admission occurs please notify the VA facility authorizing the hospice services.\r\n**Additional consultations needed relevant to the referred patient condition require VA review and approval.  For hospice care, any changes in the level of hospice care require a new authorization and prior VA approval.\r\n**All DME is provided as part of the hospice per diem.\r\n**The hospice provider is responsible for providing all medications related to the terminal illness.\r\n**Service Intensity Add (SIA) on is managed by VA claims grouper and additional authorization is not needed.","QASP":"General Care","categoryOfCare":"NIC HOSPICE/PALLIATIVE CARE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251G00000X"},{"hptc":"315D00000X"}],"services":[{"id":1130,"description":"Initial evaluation for formulation of a hospice treatment plan","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7401,"precertRequired":true,"billingCode":"99304","codeType":"CPT"},{"id":7402,"precertRequired":true,"billingCode":"99305","codeType":"CPT"},{"id":7403,"precertRequired":true,"billingCode":"99306","codeType":"CPT"},{"id":7404,"precertRequired":false,"billingCode":"99307","codeType":"CPT"},{"id":7405,"precertRequired":false,"billingCode":"99308","codeType":"CPT"},{"id":7406,"precertRequired":false,"billingCode":"99309","codeType":"CPT"},{"id":7407,"precertRequired":false,"billingCode":"99310","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7435,"precertRequired":false,"billingCode":"99374","codeType":"CPT"},{"id":7436,"precertRequired":false,"billingCode":"99375","codeType":"CPT"},{"id":7437,"precertRequired":false,"billingCode":"99377","codeType":"CPT"},{"id":7439,"precertRequired":false,"billingCode":"99379","codeType":"CPT"},{"id":7440,"precertRequired":false,"billingCode":"99380","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":1131,"description":"Home hospice services in one of four categories as necessary per the consult and offered in a comprehensive bundled service package (see Procedural Overview no.2 for additional information)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7328,"precertRequired":false,"billingCode":"99091","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7401,"precertRequired":true,"billingCode":"99304","codeType":"CPT"},{"id":7402,"precertRequired":true,"billingCode":"99305","codeType":"CPT"},{"id":7403,"precertRequired":true,"billingCode":"99306","codeType":"CPT"},{"id":7404,"precertRequired":false,"billingCode":"99307","codeType":"CPT"},{"id":7405,"precertRequired":false,"billingCode":"99308","codeType":"CPT"},{"id":7406,"precertRequired":false,"billingCode":"99309","codeType":"CPT"},{"id":7407,"precertRequired":false,"billingCode":"99310","codeType":"CPT"},{"id":7408,"precertRequired":false,"billingCode":"99315","codeType":"CPT"},{"id":7409,"precertRequired":false,"billingCode":"99316","codeType":"CPT"},{"id":7411,"precertRequired":false,"billingCode":"99339","codeType":"CPT"},{"id":7412,"precertRequired":false,"billingCode":"99340","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7435,"precertRequired":false,"billingCode":"99374","codeType":"CPT"},{"id":7436,"precertRequired":false,"billingCode":"99375","codeType":"CPT"},{"id":7437,"precertRequired":false,"billingCode":"99377","codeType":"CPT"},{"id":7439,"precertRequired":false,"billingCode":"99379","codeType":"CPT"},{"id":7440,"precertRequired":false,"billingCode":"99380","codeType":"CPT"},{"id":7495,"precertRequired":false,"billingCode":"99497","codeType":"CPT"},{"id":7496,"precertRequired":false,"billingCode":"99498","codeType":"CPT"},{"id":8323,"precertRequired":false,"billingCode":"G9474","codeType":"HCPCS"},{"id":8324,"precertRequired":false,"billingCode":"G9477","codeType":"HCPCS"},{"id":8325,"precertRequired":false,"billingCode":"G9479","codeType":"HCPCS"},{"id":8848,"precertRequired":false,"billingCode":"Q5002","codeType":"HCPCS"},{"id":8849,"precertRequired":true,"billingCode":"Q5004","codeType":"HCPCS"},{"id":8850,"precertRequired":true,"billingCode":"Q5005","codeType":"HCPCS"},{"id":8851,"precertRequired":true,"billingCode":"Q5006","codeType":"HCPCS"},{"id":8853,"precertRequired":true,"billingCode":"Q5008","codeType":"HCPCS"},{"id":8854,"precertRequired":true,"billingCode":"Q5010","codeType":"HCPCS"},{"id":8888,"precertRequired":false,"billingCode":"S0255","codeType":"HCPCS"},{"id":8889,"precertRequired":false,"billingCode":"S0257","codeType":"HCPCS"},{"id":8984,"precertRequired":true,"billingCode":"S9126","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":1132,"description":"Duration and frequency determined by level of hospice care as necessary per the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":71,"seocKey":60,"name":"Home Hospice_PRCT","seocId":"NIC_HOME HOSPICE_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"05-31-2018","endDate":"01-02-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial evaluation for formulation of a hospice treatment plan\r\n2. Home hospice services in one of four categories as necessary per the consult and offered in a comprehensive bundled service package: 1) Routine Home Care (delivered in the Veteran's place of residence); 2) Continuous Care (more than 8 hours per day of predominantly nursing care delivered in the Veteran's place of residence); 3) Inpatient Respite Care (care provided to a hospice patient in order that the usual caregiver can rest); 4) General Inpatient Care (care requiring and delivered in an inpatient setting)\r\n3. Duration and frequency determined by level of hospice care as necessary per the consult","maxAllowableVisits":999,"disclaimer":"**If an inpatient admission occurs please notify the VA facility authorizing the hospice services.\r\n**Additional consultations needed relevant to the referred patient condition require VA review and approval.  For hospice care, any changes in the level of hospice care require a new authorization and prior VA approval.\r\n**All DME is provided as part of the hospice per diem.\r\n**The hospice provider is responsible for providing all medications related to the terminal illness.\r\n**Service Intensity Add (SIA) on is managed by VA claims grouper and additional authorization is not needed.","QASP":"General Care","categoryOfCare":"NIC HOSPICE/PALLIATIVE CARE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":379,"description":"Initial evaluation for formulation of a hospice treatment plan","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7401,"precertRequired":true,"billingCode":"99304","codeType":"CPT"},{"id":7402,"precertRequired":true,"billingCode":"99305","codeType":"CPT"},{"id":7403,"precertRequired":true,"billingCode":"99306","codeType":"CPT"},{"id":7404,"precertRequired":false,"billingCode":"99307","codeType":"CPT"},{"id":7405,"precertRequired":false,"billingCode":"99308","codeType":"CPT"},{"id":7406,"precertRequired":false,"billingCode":"99309","codeType":"CPT"},{"id":7407,"precertRequired":false,"billingCode":"99310","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7435,"precertRequired":false,"billingCode":"99374","codeType":"CPT"},{"id":7436,"precertRequired":false,"billingCode":"99375","codeType":"CPT"},{"id":7437,"precertRequired":false,"billingCode":"99377","codeType":"CPT"},{"id":7439,"precertRequired":false,"billingCode":"99379","codeType":"CPT"},{"id":7440,"precertRequired":false,"billingCode":"99380","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":380,"description":"Home hospice services in one of four categories as necessary per the consult and offered in a comprehensive bundled service package (see Procedural Overview no.2 for additional information)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7327,"precertRequired":false,"billingCode":"99090","codeType":"CPT"},{"id":7328,"precertRequired":false,"billingCode":"99091","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7401,"precertRequired":true,"billingCode":"99304","codeType":"CPT"},{"id":7402,"precertRequired":true,"billingCode":"99305","codeType":"CPT"},{"id":7403,"precertRequired":true,"billingCode":"99306","codeType":"CPT"},{"id":7404,"precertRequired":false,"billingCode":"99307","codeType":"CPT"},{"id":7405,"precertRequired":false,"billingCode":"99308","codeType":"CPT"},{"id":7406,"precertRequired":false,"billingCode":"99309","codeType":"CPT"},{"id":7407,"precertRequired":false,"billingCode":"99310","codeType":"CPT"},{"id":7408,"precertRequired":false,"billingCode":"99315","codeType":"CPT"},{"id":7409,"precertRequired":false,"billingCode":"99316","codeType":"CPT"},{"id":7411,"precertRequired":false,"billingCode":"99339","codeType":"CPT"},{"id":7412,"precertRequired":false,"billingCode":"99340","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"},{"id":7431,"precertRequired":false,"billingCode":"99366","codeType":"CPT"},{"id":7432,"precertRequired":false,"billingCode":"99367","codeType":"CPT"},{"id":7433,"precertRequired":false,"billingCode":"99368","codeType":"CPT"},{"id":7435,"precertRequired":false,"billingCode":"99374","codeType":"CPT"},{"id":7436,"precertRequired":false,"billingCode":"99375","codeType":"CPT"},{"id":7437,"precertRequired":false,"billingCode":"99377","codeType":"CPT"},{"id":7439,"precertRequired":false,"billingCode":"99379","codeType":"CPT"},{"id":7440,"precertRequired":false,"billingCode":"99380","codeType":"CPT"},{"id":7495,"precertRequired":false,"billingCode":"99497","codeType":"CPT"},{"id":7496,"precertRequired":false,"billingCode":"99498","codeType":"CPT"},{"id":8323,"precertRequired":false,"billingCode":"G9474","codeType":"HCPCS"},{"id":8324,"precertRequired":false,"billingCode":"G9477","codeType":"HCPCS"},{"id":8325,"precertRequired":false,"billingCode":"G9479","codeType":"HCPCS"},{"id":8848,"precertRequired":false,"billingCode":"Q5002","codeType":"HCPCS"},{"id":8849,"precertRequired":true,"billingCode":"Q5004","codeType":"HCPCS"},{"id":8850,"precertRequired":true,"billingCode":"Q5005","codeType":"HCPCS"},{"id":8851,"precertRequired":true,"billingCode":"Q5006","codeType":"HCPCS"},{"id":8853,"precertRequired":true,"billingCode":"Q5008","codeType":"HCPCS"},{"id":8854,"precertRequired":true,"billingCode":"Q5010","codeType":"HCPCS"},{"id":8888,"precertRequired":false,"billingCode":"S0255","codeType":"HCPCS"},{"id":8889,"precertRequired":false,"billingCode":"S0257","codeType":"HCPCS"},{"id":8984,"precertRequired":true,"billingCode":"S9126","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":381,"description":"Duration and frequency determined by level of hospice care as necessary per the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":273,"seocKey":61,"name":"Home Respite_PRCT","seocId":"NIC_HOME RESPITE_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"01-03-2019","endDate":"05-10-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Respite Services provided in the home of the Veteran as indicated on the consult\r\n2. Duration and frequency as indicated on the consult in day long increments for up to 30 days in a calendar year","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"General Care","categoryOfCare":"NIC RESPITE CARE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251E00000X"},{"hptc":"251G00000X"}],"services":[{"id":1128,"description":"Respite Services provided in the home of the Veteran as indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7411,"precertRequired":false,"billingCode":"99339","codeType":"CPT"},{"id":7412,"precertRequired":false,"billingCode":"99340","codeType":"CPT"},{"id":7437,"precertRequired":false,"billingCode":"99377","codeType":"CPT"},{"id":7438,"precertRequired":false,"billingCode":"99378","codeType":"CPT"},{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":1129,"description":"Duration and frequency as indicated on the consult in day long increments for up to 30 days in a calendar year.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":72,"seocKey":61,"name":"Home Respite_PRCT","seocId":"NIC_HOME RESPITE_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"05-31-2018","endDate":"01-03-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Respite Services provided in the home of the Veteran as indicated on the consult\r\n2. Duration and frequency as indicated on the consult in day long increments for up to 30 days in a calendar year","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.","QASP":"General Care","categoryOfCare":"NIC RESPITE CARE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":373,"description":"Respite Services provided in the home of the Veteran as indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7411,"precertRequired":false,"billingCode":"99339","codeType":"CPT"},{"id":7412,"precertRequired":false,"billingCode":"99340","codeType":"CPT"},{"id":7437,"precertRequired":false,"billingCode":"99377","codeType":"CPT"},{"id":7438,"precertRequired":false,"billingCode":"99378","codeType":"CPT"},{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":374,"description":"Duration and frequency as indicated on the consult in day long increments for up to 30 days in a calendar year.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":272,"seocKey":62,"name":"Homemaker - Home Health Aide 12 month_PRCT","seocId":"NIC_HOMEMAKER - HOME HEALTH AIDE 12 MONTH_1.1.2_PRCT","versionNumber":"1.1.2","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"01-03-2019","endDate":"05-10-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Homemaker/home health aide services to assist with activities of daily living per the Case Mix tool and indicated on the consult\r\n2. Duration and frequency determined by plan of care established by H/HHA agency and Veteran","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the referred patient condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.","QASP":"General Care","categoryOfCare":"NIC HOMEMAKER/HOME HEALTH AIDE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251E00000X"}],"services":[{"id":1126,"description":"Homemaker/home health aide services to assist with activities of daily living per the Case Mix tool and indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7502,"precertRequired":true,"billingCode":"99504","codeType":"CPT"},{"id":7504,"precertRequired":false,"billingCode":"99506","codeType":"CPT"},{"id":7507,"precertRequired":false,"billingCode":"99510","codeType":"CPT"},{"id":7509,"precertRequired":true,"billingCode":"99512","codeType":"CPT"},{"id":7511,"precertRequired":false,"billingCode":"99601","codeType":"CPT"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"},{"id":8952,"precertRequired":false,"billingCode":"S5130","codeType":"HCPCS"},{"id":8953,"precertRequired":false,"billingCode":"S5131","codeType":"HCPCS"},{"id":8981,"precertRequired":false,"billingCode":"S9122","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":1127,"description":" Duration and frequency determined by plan of care established by H/HHA agency and Veteran.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":73,"seocKey":62,"name":"Homemaker - Home Health Aide 12 month_PRCT","seocId":"NIC_HOMEMAKER - HOME HEALTH AIDE 12 MONTH_1.1.1_PRCT","versionNumber":"1.1.1","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"05-31-2018","endDate":"01-03-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Homemaker/home health aide services to assist with activities of daily living per the Case Mix tool and indicated on the consult\r\n2. Duration and frequency determined by plan of care established by H/HHA agency and Veteran","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the referred patient condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.","QASP":"General Care","categoryOfCare":"NIC HOMEMAKER/HOME HEALTH AIDE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":375,"description":"Homemaker/home health aide services to assist with activities of daily living per the Case Mix tool and indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7502,"precertRequired":true,"billingCode":"99504","codeType":"CPT"},{"id":7504,"precertRequired":false,"billingCode":"99506","codeType":"CPT"},{"id":7507,"precertRequired":false,"billingCode":"99510","codeType":"CPT"},{"id":7509,"precertRequired":true,"billingCode":"99512","codeType":"CPT"},{"id":7511,"precertRequired":false,"billingCode":"99601","codeType":"CPT"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"},{"id":8952,"precertRequired":false,"billingCode":"S5130","codeType":"HCPCS"},{"id":8953,"precertRequired":false,"billingCode":"S5131","codeType":"HCPCS"},{"id":8981,"precertRequired":false,"billingCode":"S9122","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":376,"description":" Duration and frequency determined by plan of care established by H/HHA agency and Veteran.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":271,"seocKey":63,"name":"Homemaker - Home Health Aide 6 month_PRCT","seocId":"NIC_HOMEMAKER - HOME HEALTH AIDE 6 MONTH_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"01-03-2019","endDate":"05-10-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Homemaker/home health aide services to assist with activities of daily living per the Case Mix tool and indicated on the consult\r\n2. Duration and frequency determined by plan of care established by H/HHA agency and Veteran","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the referred patient condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.","QASP":"General Care","categoryOfCare":"NIC HOMEMAKER/HOME HEALTH AIDE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"251E00000X"}],"services":[{"id":1124,"description":"Homemaker/home health aide services to assist with activities of daily living per the Case Mix tool and indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7502,"precertRequired":true,"billingCode":"99504","codeType":"CPT"},{"id":7504,"precertRequired":false,"billingCode":"99506","codeType":"CPT"},{"id":7507,"precertRequired":false,"billingCode":"99510","codeType":"CPT"},{"id":7509,"precertRequired":true,"billingCode":"99512","codeType":"CPT"},{"id":7511,"precertRequired":false,"billingCode":"99601","codeType":"CPT"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"},{"id":8952,"precertRequired":false,"billingCode":"S5130","codeType":"HCPCS"},{"id":8953,"precertRequired":false,"billingCode":"S5131","codeType":"HCPCS"},{"id":8981,"precertRequired":false,"billingCode":"S9122","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":1125,"description":" Duration and frequency determined by plan of care established by H/HHA agency and Veteran.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":74,"seocKey":63,"name":"Homemaker - Home Health Aide 6 month_PRCT","seocId":"NIC_HOMEMAKER - HOME HEALTH AIDE 6 MONTH_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below.","effectiveDate":"05-31-2018","endDate":"01-03-2019","duration":180,"REV":false,"PRCT":true,"proceduralOverview":"1. Homemaker/home health aide services to assist with activities of daily living per the Case Mix tool and indicated on the consult\r\n2. Duration and frequency determined by plan of care established by H/HHA agency and Veteran","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the referred patient condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.","QASP":"General Care","categoryOfCare":"NIC HOMEMAKER/HOME HEALTH AIDE","serviceLine":"Non-Institutional Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":377,"description":"Homemaker/home health aide services to assist with activities of daily living per the Case Mix tool and indicated on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[{"id":7502,"precertRequired":true,"billingCode":"99504","codeType":"CPT"},{"id":7504,"precertRequired":false,"billingCode":"99506","codeType":"CPT"},{"id":7507,"precertRequired":false,"billingCode":"99510","codeType":"CPT"},{"id":7509,"precertRequired":true,"billingCode":"99512","codeType":"CPT"},{"id":7511,"precertRequired":false,"billingCode":"99601","codeType":"CPT"},{"id":8143,"precertRequired":false,"billingCode":"G0156","codeType":"HCPCS"},{"id":8847,"precertRequired":false,"billingCode":"Q5001","codeType":"HCPCS"},{"id":8952,"precertRequired":false,"billingCode":"S5130","codeType":"HCPCS"},{"id":8953,"precertRequired":false,"billingCode":"S5131","codeType":"HCPCS"},{"id":8981,"precertRequired":false,"billingCode":"S9122","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"251E00000X"}]},{"id":378,"description":" Duration and frequency determined by plan of care established by H/HHA agency and Veteran.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"A4-Home health agency"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"251E00000X"}]}]}},{"Seoc":{"id":607,"seocKey":64,"name":"Hormonal Therapy - Feminizing Transgender_PRCT","seocId":"MSC_HORMONAL THERAPY - FEMINIZING TRANSGENDER_1.9.3_PRCT","versionNumber":"1.9.3","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"07-28-2019","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional \r\n2. Initial outpatient visit to evaluate, review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate demasculinizing therapy if risk factors controlled and no contraindications for therapy\r\n3. Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.  Electrolyte panel one week after initiation or adjustment of spironolactone dose.  EKG at baseline for GnRH agonist and periodically as clinically appropriate thereafter\r\n4. Follow up visits to assess effect one to three months after demasculinization therapy; determine readiness to initiate feminizing therapy\r\n5. Initiate feminizing hormone therapy\r\n6. Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable\r\n7. Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RE0101X"}],"services":[{"id":3363,"description":"Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":3364,"description":"Initial outpatient visit to evaluate, review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate demasculinizing therapy if risk factors controlled and no contraindications for therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":3365,"description":"Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.  Electrolyte panel one week after initiation or adjustment of spironolactone dose.  EKG at baseline for GnRH agonist and periodically as clinically appropriate thereafter.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5132,"precertRequired":false,"billingCode":"80428","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":3366,"description":"Follow up visits to assess effect one to three months after demasculinization therapy; determine readiness to initiate feminizing therapy.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7325,"precertRequired":false,"billingCode":"99078","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":3367,"description":"Initiate feminizing hormone therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":8405,"precertRequired":true,"billingCode":"J1000","codeType":"HCPCS"},{"id":8410,"precertRequired":true,"billingCode":"J1071","codeType":"HCPCS"},{"id":8425,"precertRequired":true,"billingCode":"J1380","codeType":"HCPCS"},{"id":8426,"precertRequired":true,"billingCode":"J1410","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":3368,"description":"Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4927,"precertRequired":false,"billingCode":"78350","codeType":"CPT"},{"id":4928,"precertRequired":false,"billingCode":"78351","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":3369,"description":"Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]}]}},{"Seoc":{"id":270,"seocKey":64,"name":"Hormonal Therapy - Feminizing Transgender_PRCT","seocId":"MSC_HORMONAL THERAPY - FEMINIZING TRANSGENDER_1.9.2_PRCT","versionNumber":"1.9.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional \r\n2. Initial outpatient visit to evaluate, review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate demasculinizing therapy if risk factors controlled and no contraindications for therapy\r\n3. Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.  Electrolyte panel one week after initiation or adjustment of spironolactone dose.  EKG at baseline for GnRH agonist and periodically as clinically appropriate thereafter\r\n4. Follow up visits to assess effect one to three months after demasculinization therapy; determine readiness to initiate feminizing therapy\r\n5. Initiate feminizing hormone therapy\r\n6. Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable\r\n7. Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","maxAllowableVisits":null,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RE0101X"}],"services":[{"id":1117,"description":"Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":1118,"description":"Initial outpatient visit to evaluate, review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate demasculinizing therapy if risk factors controlled and no contraindications for therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":1119,"description":"Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.  Electrolyte panel one week after initiation or adjustment of spironolactone dose.  EKG at baseline for GnRH agonist and periodically as clinically appropriate thereafter. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5132,"precertRequired":false,"billingCode":"80428","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1120,"description":"Follow up visits to assess effect one to three months after demasculinization therapy; determine readiness to initiate feminizing therapy.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7325,"precertRequired":false,"billingCode":"99078","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":1121,"description":"Initiate feminizing hormone therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":8405,"precertRequired":true,"billingCode":"J1000","codeType":"HCPCS"},{"id":8410,"precertRequired":true,"billingCode":"J1071","codeType":"HCPCS"},{"id":8425,"precertRequired":true,"billingCode":"J1380","codeType":"HCPCS"},{"id":8426,"precertRequired":true,"billingCode":"J1410","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":1122,"description":"Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4927,"precertRequired":false,"billingCode":"78350","codeType":"CPT"},{"id":4928,"precertRequired":false,"billingCode":"78351","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1123,"description":"Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]}]}},{"Seoc":{"id":75,"seocKey":64,"name":"Hormonal Therapy - Feminizing Transgender_PRCT","seocId":"MSC_HORMONAL THERAPY - FEMINIZING TRANSGENDER_1.9.1_PRCT","versionNumber":"1.9.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"05-31-2018","endDate":"01-02-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional \r\n2. Initial outpatient visit to evaluate, review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate demasculinizing therapy if risk factors controlled and no contraindications for therapy\r\n3. Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.  Electrolyte panel one week after initiation or adjustment of spironolactone dose.  EKG at baseline for GnRH agonist and periodically as clinically appropriate thereafter\r\n4. Follow up visits to assess effect one to three months after demasculinization therapy; determine readiness to initiate feminizing therapy\r\n5. Initiate feminizing hormone therapy\r\n6. Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable\r\n7. Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","maxAllowableVisits":999,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":211,"description":"Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":212,"description":"Initial outpatient visit to evaluate, review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate demasculinizing therapy if risk factors controlled and no contraindications for therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":213,"description":"Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.  Electrolyte panel one week after initiation or adjustment of spironolactone dose.  EKG at baseline for GnRH agonist and periodically as clinically appropriate thereafter. ","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5132,"precertRequired":false,"billingCode":"80428","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":214,"description":"Follow up visits to assess effect one to three months after demasculinization therapy; determine readiness to initiate feminizing therapy.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7325,"precertRequired":false,"billingCode":"99078","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":215,"description":"Initiate feminizing hormone therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":8405,"precertRequired":true,"billingCode":"J1000","codeType":"HCPCS"},{"id":8410,"precertRequired":true,"billingCode":"J1071","codeType":"HCPCS"},{"id":8425,"precertRequired":true,"billingCode":"J1380","codeType":"HCPCS"},{"id":8426,"precertRequired":true,"billingCode":"J1410","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":216,"description":"Diagnostic laboratory/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4927,"precertRequired":false,"billingCode":"78350","codeType":"CPT"},{"id":4928,"precertRequired":false,"billingCode":"78351","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":217,"description":"Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]}]}},{"Seoc":{"id":608,"seocKey":65,"name":"Hormonal Therapy - Masculinizing Transgender_PRCT","seocId":"MSC_HORMONAL THERAPY - MASCULINIZING TRANSGENDER_1.10.3_PRCT","versionNumber":"1.10.3","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"07-28-2019","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional\r\n2. Initial outpatient visit to review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate masculinizing therapy if risk factors controlled and no contraindications for therapy\r\n3. Diagnostic laboratories/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable\r\n4. Follow up visits to assess effect every 1 to 3 months upon initiation or change of regimen then every 6 to 12 months once stable\r\n5. Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","maxAllowableVisits":null,"disclaimer":"*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","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RE0101X"}],"services":[{"id":3370,"description":"Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":3371,"description":"Initial outpatient visit to review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate masculinizing therapy if risk factors controlled and no contraindications for therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":3372,"description":"Diagnostic laboratories/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5009,"precertRequired":false,"billingCode":"80051","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5132,"precertRequired":false,"billingCode":"80428","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":3373,"description":"Follow up visits to assess effect every 1 to 3 months upon initiation or change of regimen then every 6 to 12 months once stable.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7325,"precertRequired":false,"billingCode":"99078","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":8410,"precertRequired":true,"billingCode":"J1071","codeType":"HCPCS"},{"id":8499,"precertRequired":true,"billingCode":"J3121","codeType":"HCPCS"},{"id":8500,"precertRequired":true,"billingCode":"J3145","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":3374,"description":"Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4927,"precertRequired":false,"billingCode":"78350","codeType":"CPT"},{"id":4928,"precertRequired":false,"billingCode":"78351","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]}]}},{"Seoc":{"id":269,"seocKey":65,"name":"Hormonal Therapy - Masculinizing Transgender_PRCT","seocId":"MSC_HORMONAL THERAPY - MASCULINIZING TRANSGENDER_1.10.2_PRCT","versionNumber":"1.10.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional\r\n2. Initial outpatient visit to review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate masculinizing therapy if risk factors controlled and no contraindications for therapy\r\n3. Diagnostic laboratories/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable\r\n4. Follow up visits to assess effect every 1 to 3 months upon initiation or change of regimen then every 6 to 12 months once stable\r\n5. Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","maxAllowableVisits":null,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RE0101X"}],"services":[{"id":1112,"description":"Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":1113,"description":"Initial outpatient visit to review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate masculinizing therapy if risk factors controlled and no contraindications for therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":1114,"description":"Diagnostic laboratories/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5132,"precertRequired":false,"billingCode":"80428","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1115,"description":"Follow up visits to assess effect every 1 to 3 months upon initiation or change of regimen then every 6 to 12 months once stable.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7325,"precertRequired":false,"billingCode":"99078","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":8410,"precertRequired":true,"billingCode":"J1071","codeType":"HCPCS"},{"id":8499,"precertRequired":true,"billingCode":"J3121","codeType":"HCPCS"},{"id":8500,"precertRequired":true,"billingCode":"J3145","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":1116,"description":"Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4927,"precertRequired":false,"billingCode":"78350","codeType":"CPT"},{"id":4928,"precertRequired":false,"billingCode":"78351","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]}]}},{"Seoc":{"id":76,"seocKey":65,"name":"Hormonal Therapy - Masculinizing Transgender_PRCT","seocId":"MSC_HORMONAL THERAPY - MASCULINIZING TRANSGENDER_1.10.1_PRCT","versionNumber":"1.10.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"05-31-2018","endDate":"01-02-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1. Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional\r\n2. Initial outpatient visit to review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate masculinizing therapy if risk factors controlled and no contraindications for therapy\r\n3. Diagnostic laboratories/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable\r\n4. Follow up visits to assess effect every 1 to 3 months upon initiation or change of regimen then every 6 to 12 months once stable\r\n5. Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","maxAllowableVisits":999,"disclaimer":"** Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n** DME, prosthetics and orthotics will be reviewed by the VA for provision.\r\n** All routine medications will be provided by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":218,"description":"Verification of a diagnosis of Gender Dysphoria and readiness evaluation by a mental health professional","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":6570,"precertRequired":true,"billingCode":"90791","codeType":"CPT"},{"id":6571,"precertRequired":false,"billingCode":"90792","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":219,"description":"Initial outpatient visit to review medical risks, gain informed consent, discuss treatment goals, physical exam, and determine treatment plan for gender transition; initiate masculinizing therapy if risk factors controlled and no contraindications for therapy","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":220,"description":"Diagnostic laboratories/studies to monitor therapeutic dose every 1 to 3 months upon initiation or adjustment of regimen then every 6 to 12 months once stable.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5013,"precertRequired":false,"billingCode":"80069","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5132,"precertRequired":false,"billingCode":"80428","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":221,"description":"Follow up visits to assess effect every 1 to 3 months upon initiation or change of regimen then every 6 to 12 months once stable.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7312,"precertRequired":false,"billingCode":"98960","codeType":"CPT"},{"id":7313,"precertRequired":false,"billingCode":"98961","codeType":"CPT"},{"id":7314,"precertRequired":false,"billingCode":"98962","codeType":"CPT"},{"id":7325,"precertRequired":false,"billingCode":"99078","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":8410,"precertRequired":true,"billingCode":"J1071","codeType":"HCPCS"},{"id":8499,"precertRequired":true,"billingCode":"J3121","codeType":"HCPCS"},{"id":8500,"precertRequired":true,"billingCode":"J3145","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]},{"id":222,"description":"Health Maintenance and screening as clinically appropriate (cancer screening and bone mineral density if at risk)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"46-Endocrinology"}],"billingCodes":[{"id":4789,"precertRequired":false,"billingCode":"77065","codeType":"CPT"},{"id":4790,"precertRequired":false,"billingCode":"77066","codeType":"CPT"},{"id":4927,"precertRequired":false,"billingCode":"78350","codeType":"CPT"},{"id":4928,"precertRequired":false,"billingCode":"78351","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"273R00000X"},{"HPTC":"207RE0101X"}]}]}},{"Seoc":{"id":1671,"seocKey":66,"name":"Infectious Disease_PRCT","seocId":"MSC_INFECTIOUS DISEASE_1.0.6_PRCT","versionNumber":"1.0.6","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"01-24-2020","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.    Diagnostic imaging relevant to the referred patient condition on the consult \r\n3.    Diagnostic studies/procedures relevant to the referred condition on the consult including but not limited to: fibroscan, liver biopsy, MR Elastography.  EGD is included for medically necessary esophageal/gastric variceal surveillance and for acute issues related to portal hypertension. This does not include routine upper gastrointestinal endoscopy or colonoscopy for non-hepatic related conditions. \r\n4.   Labs and pathology services relevant to the referred patient condition on the consult\r\n5.   Follow-up visits for this episode of care\r\n6.   Age-appropriate immunizations and HIV-specific immunizations\r\n7.   Screening services, including but are not limited to:  Sexually transmitted infections [STIs], cervical cancer, bone density, hepatitis, etc.\r\n8.   Medication management to include education, prescribing and monitoring of FDA approved medications.   All routine medications will be provided by the VA as prescribed by the community Infectious Disease consultant in accordance with VA national medication formulary and non-formulary request process.\r\n9.   Assessment of ongoing sexual and drug-use behaviors, and counseling or other interventions to reduce transmission behaviors\r\n10. Follow-up imaging as relevant to the patient condition on the consult\r\n11. Follow-up studies as relevant to the patient condition on the consult\r\n12. Interventional procedures to treat decompensated cirrhosis, including but not limited to: paracentesis, TIPS shunts, and tunneled drainage catheter \r\n13. Anesthesia consultation related to the procedure \r\n14. Pre-procedure medical clearance as indicated (including H+P/labs, EKG, CXR) \r\n15. Inpatient or observation admission for procedure\r\n16. Inpatient or observation admission for procedure complications \r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n17. Infusion therapy in clinic or hydration as clinically indicated for the referred condition on the consult.","maxAllowableVisits":null,"disclaimer":"* HCC surveillance should be done in accordance with American Association for the Study of Liver Disease [AASLD] guidance. Surveillance modalities can include ultrasound, CT, or MRI, with or without AFP. \r\n* Treating providers should follow the CDC guidelines in reference to HIV and HIV PrEP\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","QASP":"General Care","categoryOfCare":"INFECTIOUS DISEASE","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0200X"}],"services":[{"id":4699,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4700,"description":"Diagnostic imaging relevant to the referred patient condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":4984,"precertRequired":false,"billingCode":"78803","codeType":"CPT"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"},{"id":13335,"precertRequired":true,"billingCode":"76000","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":4701,"description":"Diagnostic studies/procedures relevant to the referred condition on the consult including but not limited to: fibroscan, liver biopsy, MR Elastography.  EGD is included for medically necessary esophageal/gastric variceal surveillance and for acute issues related to portal hypertension. This does not include routine upper gastrointestinal endoscopy or colonoscopy for non-hepatic related conditions.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":249,"precertRequired":false,"billingCode":"11045","codeType":"CPT"},{"id":250,"precertRequired":false,"billingCode":"11046","codeType":"CPT"},{"id":2772,"precertRequired":false,"billingCode":"43210","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2790,"precertRequired":false,"billingCode":"43237","codeType":"CPT"},{"id":2791,"precertRequired":false,"billingCode":"43238","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2793,"precertRequired":false,"billingCode":"43240","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2795,"precertRequired":false,"billingCode":"43242","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":2818,"precertRequired":false,"billingCode":"43270","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3228,"precertRequired":false,"billingCode":"47100","codeType":"CPT"},{"id":3229,"precertRequired":false,"billingCode":"47120","codeType":"CPT"},{"id":3230,"precertRequired":false,"billingCode":"47122","codeType":"CPT"},{"id":3231,"precertRequired":false,"billingCode":"47125","codeType":"CPT"},{"id":3232,"precertRequired":false,"billingCode":"47130","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":4706,"precertRequired":false,"billingCode":"76390","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":6638,"precertRequired":false,"billingCode":"91200","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":7282,"precertRequired":false,"billingCode":"97598","codeType":"CPT"},{"id":9766,"precertRequired":false,"billingCode":"76391","codeType":"CPT"},{"id":12225,"precertRequired":false,"billingCode":"76981","codeType":"CPT"},{"id":12226,"precertRequired":false,"billingCode":"76982","codeType":"CPT"},{"id":12227,"precertRequired":false,"billingCode":"76983","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4702,"description":"Labs and pathology services relevant to the referred patient condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5016,"precertRequired":false,"billingCode":"80081","codeType":"CPT"},{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5217,"precertRequired":true,"billingCode":"81256","codeType":"CPT"},{"id":5379,"precertRequired":false,"billingCode":"82088","codeType":"CPT"},{"id":5380,"precertRequired":false,"billingCode":"82103","codeType":"CPT"},{"id":5381,"precertRequired":false,"billingCode":"82104","codeType":"CPT"},{"id":5382,"precertRequired":false,"billingCode":"82105","codeType":"CPT"},{"id":5393,"precertRequired":false,"billingCode":"82140","codeType":"CPT"},{"id":5395,"precertRequired":false,"billingCode":"82150","codeType":"CPT"},{"id":5401,"precertRequired":false,"billingCode":"82172","codeType":"CPT"},{"id":5405,"precertRequired":false,"billingCode":"82232","codeType":"CPT"},{"id":5408,"precertRequired":false,"billingCode":"82247","codeType":"CPT"},{"id":5439,"precertRequired":false,"billingCode":"82390","codeType":"CPT"},{"id":5446,"precertRequired":false,"billingCode":"82465","codeType":"CPT"},{"id":5453,"precertRequired":false,"billingCode":"82525","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5467,"precertRequired":false,"billingCode":"82595","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5507,"precertRequired":false,"billingCode":"82784","codeType":"CPT"},{"id":5508,"precertRequired":false,"billingCode":"82785","codeType":"CPT"},{"id":5509,"precertRequired":false,"billingCode":"82787","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5528,"precertRequired":false,"billingCode":"82962","codeType":"CPT"},{"id":5531,"precertRequired":false,"billingCode":"82977","codeType":"CPT"},{"id":5540,"precertRequired":false,"billingCode":"83010","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5570,"precertRequired":false,"billingCode":"83516","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5578,"precertRequired":false,"billingCode":"83550","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5597,"precertRequired":false,"billingCode":"83690","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5623,"precertRequired":false,"billingCode":"83915","codeType":"CPT"},{"id":5643,"precertRequired":false,"billingCode":"84075","codeType":"CPT"},{"id":5645,"precertRequired":false,"billingCode":"84080","codeType":"CPT"},{"id":5671,"precertRequired":false,"billingCode":"84155","codeType":"CPT"},{"id":5674,"precertRequired":false,"billingCode":"84160","codeType":"CPT"},{"id":5676,"precertRequired":false,"billingCode":"84165","codeType":"CPT"},{"id":5720,"precertRequired":false,"billingCode":"84439","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5726,"precertRequired":false,"billingCode":"84450","codeType":"CPT"},{"id":5727,"precertRequired":false,"billingCode":"84460","codeType":"CPT"},{"id":5729,"precertRequired":false,"billingCode":"84478","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5735,"precertRequired":false,"billingCode":"84485","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5862,"precertRequired":false,"billingCode":"85732","codeType":"CPT"},{"id":5873,"precertRequired":false,"billingCode":"86038","codeType":"CPT"},{"id":5874,"precertRequired":false,"billingCode":"86039","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5900,"precertRequired":false,"billingCode":"86255","codeType":"CPT"},{"id":5901,"precertRequired":false,"billingCode":"86256","codeType":"CPT"},{"id":5913,"precertRequired":false,"billingCode":"86317","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5931,"precertRequired":false,"billingCode":"86355","codeType":"CPT"},{"id":5933,"precertRequired":false,"billingCode":"86357","codeType":"CPT"},{"id":5934,"precertRequired":false,"billingCode":"86359","codeType":"CPT"},{"id":5935,"precertRequired":false,"billingCode":"86360","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5954,"precertRequired":false,"billingCode":"86592","codeType":"CPT"},{"id":5955,"precertRequired":false,"billingCode":"86593","codeType":"CPT"},{"id":5956,"precertRequired":false,"billingCode":"86602","codeType":"CPT"},{"id":5957,"precertRequired":false,"billingCode":"86603","codeType":"CPT"},{"id":5958,"precertRequired":false,"billingCode":"86606","codeType":"CPT"},{"id":5959,"precertRequired":false,"billingCode":"86609","codeType":"CPT"},{"id":5960,"precertRequired":false,"billingCode":"86611","codeType":"CPT"},{"id":5961,"precertRequired":false,"billingCode":"86612","codeType":"CPT"},{"id":5962,"precertRequired":false,"billingCode":"86615","codeType":"CPT"},{"id":5963,"precertRequired":false,"billingCode":"86617","codeType":"CPT"},{"id":5964,"precertRequired":false,"billingCode":"86618","codeType":"CPT"},{"id":5965,"precertRequired":false,"billingCode":"86619","codeType":"CPT"},{"id":5966,"precertRequired":false,"billingCode":"86622","codeType":"CPT"},{"id":5967,"precertRequired":false,"billingCode":"86625","codeType":"CPT"},{"id":5968,"precertRequired":false,"billingCode":"86628","codeType":"CPT"},{"id":5969,"precertRequired":false,"billingCode":"86631","codeType":"CPT"},{"id":5970,"precertRequired":false,"billingCode":"86632","codeType":"CPT"},{"id":5971,"precertRequired":false,"billingCode":"86635","codeType":"CPT"},{"id":5972,"precertRequired":false,"billingCode":"86638","codeType":"CPT"},{"id":5973,"precertRequired":false,"billingCode":"86641","codeType":"CPT"},{"id":5974,"precertRequired":false,"billingCode":"86644","codeType":"CPT"},{"id":5975,"precertRequired":false,"billingCode":"86645","codeType":"CPT"},{"id":5976,"precertRequired":false,"billingCode":"86648","codeType":"CPT"},{"id":5977,"precertRequired":false,"billingCode":"86651","codeType":"CPT"},{"id":5978,"precertRequired":false,"billingCode":"86652","codeType":"CPT"},{"id":5979,"precertRequired":false,"billingCode":"86653","codeType":"CPT"},{"id":5980,"precertRequired":false,"billingCode":"86654","codeType":"CPT"},{"id":5981,"precertRequired":false,"billingCode":"86658","codeType":"CPT"},{"id":5982,"precertRequired":false,"billingCode":"86663","codeType":"CPT"},{"id":5983,"precertRequired":false,"billingCode":"86664","codeType":"CPT"},{"id":5984,"precertRequired":false,"billingCode":"86665","codeType":"CPT"},{"id":5985,"precertRequired":false,"billingCode":"86666","codeType":"CPT"},{"id":5986,"precertRequired":false,"billingCode":"86668","codeType":"CPT"},{"id":5987,"precertRequired":false,"billingCode":"86671","codeType":"CPT"},{"id":5988,"precertRequired":false,"billingCode":"86674","codeType":"CPT"},{"id":5989,"precertRequired":false,"billingCode":"86677","codeType":"CPT"},{"id":5990,"precertRequired":false,"billingCode":"86682","codeType":"CPT"},{"id":5991,"precertRequired":false,"billingCode":"86684","codeType":"CPT"},{"id":5992,"precertRequired":false,"billingCode":"86687","codeType":"CPT"},{"id":5993,"precertRequired":false,"billingCode":"86688","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":5995,"precertRequired":false,"billingCode":"86692","codeType":"CPT"},{"id":5996,"precertRequired":false,"billingCode":"86694","codeType":"CPT"},{"id":5997,"precertRequired":false,"billingCode":"86695","codeType":"CPT"},{"id":5998,"precertRequired":false,"billingCode":"86696","codeType":"CPT"},{"id":5999,"precertRequired":false,"billingCode":"86698","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6003,"precertRequired":false,"billingCode":"86704","codeType":"CPT"},{"id":6004,"precertRequired":false,"billingCode":"86705","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6006,"precertRequired":false,"billingCode":"86707","codeType":"CPT"},{"id":6007,"precertRequired":false,"billingCode":"86708","codeType":"CPT"},{"id":6008,"precertRequired":false,"billingCode":"86709","codeType":"CPT"},{"id":6009,"precertRequired":false,"billingCode":"86710","codeType":"CPT"},{"id":6010,"precertRequired":false,"billingCode":"86711","codeType":"CPT"},{"id":6011,"precertRequired":false,"billingCode":"86713","codeType":"CPT"},{"id":6012,"precertRequired":false,"billingCode":"86717","codeType":"CPT"},{"id":6013,"precertRequired":false,"billingCode":"86720","codeType":"CPT"},{"id":6014,"precertRequired":false,"billingCode":"86723","codeType":"CPT"},{"id":6015,"precertRequired":false,"billingCode":"86727","codeType":"CPT"},{"id":6016,"precertRequired":false,"billingCode":"86732","codeType":"CPT"},{"id":6017,"precertRequired":false,"billingCode":"86735","codeType":"CPT"},{"id":6018,"precertRequired":false,"billingCode":"86738","codeType":"CPT"},{"id":6019,"precertRequired":false,"billingCode":"86741","codeType":"CPT"},{"id":6020,"precertRequired":false,"billingCode":"86744","codeType":"CPT"},{"id":6021,"precertRequired":false,"billingCode":"86747","codeType":"CPT"},{"id":6022,"precertRequired":false,"billingCode":"86750","codeType":"CPT"},{"id":6023,"precertRequired":false,"billingCode":"86753","codeType":"CPT"},{"id":6024,"precertRequired":false,"billingCode":"86756","codeType":"CPT"},{"id":6025,"precertRequired":false,"billingCode":"86757","codeType":"CPT"},{"id":6026,"precertRequired":false,"billingCode":"86759","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6028,"precertRequired":false,"billingCode":"86765","codeType":"CPT"},{"id":6029,"precertRequired":false,"billingCode":"86768","codeType":"CPT"},{"id":6030,"precertRequired":false,"billingCode":"86771","codeType":"CPT"},{"id":6031,"precertRequired":false,"billingCode":"86774","codeType":"CPT"},{"id":6032,"precertRequired":false,"billingCode":"86777","codeType":"CPT"},{"id":6033,"precertRequired":false,"billingCode":"86778","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6037,"precertRequired":false,"billingCode":"86788","codeType":"CPT"},{"id":6038,"precertRequired":false,"billingCode":"86789","codeType":"CPT"},{"id":6039,"precertRequired":false,"billingCode":"86790","codeType":"CPT"},{"id":6040,"precertRequired":false,"billingCode":"86793","codeType":"CPT"},{"id":6041,"precertRequired":false,"billingCode":"86794","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6044,"precertRequired":false,"billingCode":"86804","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6105,"precertRequired":false,"billingCode":"87003","codeType":"CPT"},{"id":6106,"precertRequired":false,"billingCode":"87015","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"},{"id":6108,"precertRequired":false,"billingCode":"87045","codeType":"CPT"},{"id":6109,"precertRequired":false,"billingCode":"87046","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6112,"precertRequired":false,"billingCode":"87073","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6114,"precertRequired":false,"billingCode":"87076","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6120,"precertRequired":false,"billingCode":"87101","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6122,"precertRequired":false,"billingCode":"87103","codeType":"CPT"},{"id":6123,"precertRequired":false,"billingCode":"87106","codeType":"CPT"},{"id":6124,"precertRequired":false,"billingCode":"87107","codeType":"CPT"},{"id":6125,"precertRequired":false,"billingCode":"87109","codeType":"CPT"},{"id":6126,"precertRequired":false,"billingCode":"87110","codeType":"CPT"},{"id":6127,"precertRequired":false,"billingCode":"87116","codeType":"CPT"},{"id":6128,"precertRequired":false,"billingCode":"87118","codeType":"CPT"},{"id":6129,"precertRequired":false,"billingCode":"87140","codeType":"CPT"},{"id":6130,"precertRequired":false,"billingCode":"87143","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6132,"precertRequired":false,"billingCode":"87149","codeType":"CPT"},{"id":6133,"precertRequired":false,"billingCode":"87150","codeType":"CPT"},{"id":6134,"precertRequired":false,"billingCode":"87152","codeType":"CPT"},{"id":6135,"precertRequired":false,"billingCode":"87153","codeType":"CPT"},{"id":6136,"precertRequired":false,"billingCode":"87158","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6139,"precertRequired":false,"billingCode":"87168","codeType":"CPT"},{"id":6140,"precertRequired":false,"billingCode":"87169","codeType":"CPT"},{"id":6141,"precertRequired":false,"billingCode":"87172","codeType":"CPT"},{"id":6142,"precertRequired":false,"billingCode":"87176","codeType":"CPT"},{"id":6143,"precertRequired":false,"billingCode":"87177","codeType":"CPT"},{"id":6144,"precertRequired":false,"billingCode":"87181","codeType":"CPT"},{"id":6145,"precertRequired":false,"billingCode":"87184","codeType":"CPT"},{"id":6146,"precertRequired":false,"billingCode":"87185","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6148,"precertRequired":false,"billingCode":"87187","codeType":"CPT"},{"id":6149,"precertRequired":false,"billingCode":"87188","codeType":"CPT"},{"id":6150,"precertRequired":false,"billingCode":"87190","codeType":"CPT"},{"id":6151,"precertRequired":false,"billingCode":"87197","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6153,"precertRequired":false,"billingCode":"87206","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6155,"precertRequired":false,"billingCode":"87209","codeType":"CPT"},{"id":6156,"precertRequired":false,"billingCode":"87210","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6158,"precertRequired":false,"billingCode":"87230","codeType":"CPT"},{"id":6159,"precertRequired":false,"billingCode":"87250","codeType":"CPT"},{"id":6160,"precertRequired":false,"billingCode":"87252","codeType":"CPT"},{"id":6161,"precertRequired":false,"billingCode":"87253","codeType":"CPT"},{"id":6162,"precertRequired":false,"billingCode":"87254","codeType":"CPT"},{"id":6163,"precertRequired":false,"billingCode":"87255","codeType":"CPT"},{"id":6164,"precertRequired":false,"billingCode":"87260","codeType":"CPT"},{"id":6165,"precertRequired":false,"billingCode":"87265","codeType":"CPT"},{"id":6166,"precertRequired":false,"billingCode":"87267","codeType":"CPT"},{"id":6167,"precertRequired":false,"billingCode":"87269","codeType":"CPT"},{"id":6168,"precertRequired":false,"billingCode":"87270","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6173,"precertRequired":false,"billingCode":"87275","codeType":"CPT"},{"id":6174,"precertRequired":false,"billingCode":"87276","codeType":"CPT"},{"id":6175,"precertRequired":false,"billingCode":"87278","codeType":"CPT"},{"id":6176,"precertRequired":false,"billingCode":"87279","codeType":"CPT"},{"id":6177,"precertRequired":false,"billingCode":"87280","codeType":"CPT"},{"id":6178,"precertRequired":false,"billingCode":"87281","codeType":"CPT"},{"id":6179,"precertRequired":false,"billingCode":"87283","codeType":"CPT"},{"id":6180,"precertRequired":false,"billingCode":"87285","codeType":"CPT"},{"id":6181,"precertRequired":false,"billingCode":"87290","codeType":"CPT"},{"id":6183,"precertRequired":false,"billingCode":"87300","codeType":"CPT"},{"id":6184,"precertRequired":false,"billingCode":"87301","codeType":"CPT"},{"id":6185,"precertRequired":false,"billingCode":"87305","codeType":"CPT"},{"id":6186,"precertRequired":false,"billingCode":"87320","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6191,"precertRequired":false,"billingCode":"87332","codeType":"CPT"},{"id":6192,"precertRequired":false,"billingCode":"87335","codeType":"CPT"},{"id":6193,"precertRequired":false,"billingCode":"87336","codeType":"CPT"},{"id":6194,"precertRequired":false,"billingCode":"87337","codeType":"CPT"},{"id":6195,"precertRequired":false,"billingCode":"87338","codeType":"CPT"},{"id":6196,"precertRequired":false,"billingCode":"87339","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6198,"precertRequired":false,"billingCode":"87341","codeType":"CPT"},{"id":6199,"precertRequired":false,"billingCode":"87350","codeType":"CPT"},{"id":6200,"precertRequired":false,"billingCode":"87380","codeType":"CPT"},{"id":6201,"precertRequired":false,"billingCode":"87385","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6203,"precertRequired":false,"billingCode":"87390","codeType":"CPT"},{"id":6204,"precertRequired":false,"billingCode":"87391","codeType":"CPT"},{"id":6205,"precertRequired":false,"billingCode":"87400","codeType":"CPT"},{"id":6206,"precertRequired":false,"billingCode":"87420","codeType":"CPT"},{"id":6207,"precertRequired":false,"billingCode":"87425","codeType":"CPT"},{"id":6208,"precertRequired":false,"billingCode":"87427","codeType":"CPT"},{"id":6209,"precertRequired":false,"billingCode":"87430","codeType":"CPT"},{"id":6210,"precertRequired":false,"billingCode":"87449","codeType":"CPT"},{"id":6211,"precertRequired":false,"billingCode":"87450","codeType":"CPT"},{"id":6212,"precertRequired":false,"billingCode":"87451","codeType":"CPT"},{"id":6213,"precertRequired":false,"billingCode":"87471","codeType":"CPT"},{"id":6214,"precertRequired":false,"billingCode":"87472","codeType":"CPT"},{"id":6215,"precertRequired":false,"billingCode":"87475","codeType":"CPT"},{"id":6216,"precertRequired":false,"billingCode":"87476","codeType":"CPT"},{"id":6217,"precertRequired":false,"billingCode":"87480","codeType":"CPT"},{"id":6218,"precertRequired":false,"billingCode":"87481","codeType":"CPT"},{"id":6219,"precertRequired":false,"billingCode":"87482","codeType":"CPT"},{"id":6220,"precertRequired":false,"billingCode":"87483","codeType":"CPT"},{"id":6221,"precertRequired":false,"billingCode":"87485","codeType":"CPT"},{"id":6222,"precertRequired":false,"billingCode":"87486","codeType":"CPT"},{"id":6223,"precertRequired":false,"billingCode":"87487","codeType":"CPT"},{"id":6224,"precertRequired":false,"billingCode":"87490","codeType":"CPT"},{"id":6225,"precertRequired":false,"billingCode":"87491","codeType":"CPT"},{"id":6226,"precertRequired":false,"billingCode":"87492","codeType":"CPT"},{"id":6227,"precertRequired":false,"billingCode":"87493","codeType":"CPT"},{"id":6228,"precertRequired":false,"billingCode":"87495","codeType":"CPT"},{"id":6229,"precertRequired":false,"billingCode":"87496","codeType":"CPT"},{"id":6230,"precertRequired":false,"billingCode":"87497","codeType":"CPT"},{"id":6231,"precertRequired":false,"billingCode":"87498","codeType":"CPT"},{"id":6232,"precertRequired":false,"billingCode":"87500","codeType":"CPT"},{"id":6233,"precertRequired":false,"billingCode":"87501","codeType":"CPT"},{"id":6234,"precertRequired":false,"billingCode":"87502","codeType":"CPT"},{"id":6235,"precertRequired":false,"billingCode":"87503","codeType":"CPT"},{"id":6236,"precertRequired":false,"billingCode":"87505","codeType":"CPT"},{"id":6237,"precertRequired":false,"billingCode":"87506","codeType":"CPT"},{"id":6238,"precertRequired":false,"billingCode":"87507","codeType":"CPT"},{"id":6239,"precertRequired":false,"billingCode":"87510","codeType":"CPT"},{"id":6240,"precertRequired":false,"billingCode":"87511","codeType":"CPT"},{"id":6241,"precertRequired":false,"billingCode":"87512","codeType":"CPT"},{"id":6242,"precertRequired":false,"billingCode":"87516","codeType":"CPT"},{"id":6243,"precertRequired":false,"billingCode":"87517","codeType":"CPT"},{"id":6244,"precertRequired":false,"billingCode":"87520","codeType":"CPT"},{"id":6245,"precertRequired":false,"billingCode":"87521","codeType":"CPT"},{"id":6246,"precertRequired":false,"billingCode":"87522","codeType":"CPT"},{"id":6247,"precertRequired":false,"billingCode":"87525","codeType":"CPT"},{"id":6248,"precertRequired":false,"billingCode":"87526","codeType":"CPT"},{"id":6249,"precertRequired":false,"billingCode":"87527","codeType":"CPT"},{"id":6250,"precertRequired":false,"billingCode":"87528","codeType":"CPT"},{"id":6251,"precertRequired":false,"billingCode":"87529","codeType":"CPT"},{"id":6252,"precertRequired":false,"billingCode":"87530","codeType":"CPT"},{"id":6253,"precertRequired":false,"billingCode":"87531","codeType":"CPT"},{"id":6254,"precertRequired":false,"billingCode":"87532","codeType":"CPT"},{"id":6255,"precertRequired":false,"billingCode":"87533","codeType":"CPT"},{"id":6256,"precertRequired":false,"billingCode":"87534","codeType":"CPT"},{"id":6257,"precertRequired":false,"billingCode":"87535","codeType":"CPT"},{"id":6258,"precertRequired":false,"billingCode":"87536","codeType":"CPT"},{"id":6259,"precertRequired":false,"billingCode":"87537","codeType":"CPT"},{"id":6260,"precertRequired":false,"billingCode":"87538","codeType":"CPT"},{"id":6261,"precertRequired":false,"billingCode":"87539","codeType":"CPT"},{"id":6262,"precertRequired":false,"billingCode":"87540","codeType":"CPT"},{"id":6263,"precertRequired":false,"billingCode":"87541","codeType":"CPT"},{"id":6264,"precertRequired":false,"billingCode":"87542","codeType":"CPT"},{"id":6265,"precertRequired":false,"billingCode":"87550","codeType":"CPT"},{"id":6266,"precertRequired":false,"billingCode":"87551","codeType":"CPT"},{"id":6267,"precertRequired":false,"billingCode":"87552","codeType":"CPT"},{"id":6268,"precertRequired":false,"billingCode":"87555","codeType":"CPT"},{"id":6269,"precertRequired":false,"billingCode":"87556","codeType":"CPT"},{"id":6270,"precertRequired":false,"billingCode":"87557","codeType":"CPT"},{"id":6271,"precertRequired":false,"billingCode":"87560","codeType":"CPT"},{"id":6272,"precertRequired":false,"billingCode":"87561","codeType":"CPT"},{"id":6273,"precertRequired":false,"billingCode":"87562","codeType":"CPT"},{"id":6274,"precertRequired":false,"billingCode":"87580","codeType":"CPT"},{"id":6275,"precertRequired":false,"billingCode":"87581","codeType":"CPT"},{"id":6276,"precertRequired":false,"billingCode":"87582","codeType":"CPT"},{"id":6277,"precertRequired":false,"billingCode":"87590","codeType":"CPT"},{"id":6278,"precertRequired":false,"billingCode":"87591","codeType":"CPT"},{"id":6279,"precertRequired":false,"billingCode":"87592","codeType":"CPT"},{"id":6280,"precertRequired":false,"billingCode":"87623","codeType":"CPT"},{"id":6281,"precertRequired":false,"billingCode":"87624","codeType":"CPT"},{"id":6282,"precertRequired":false,"billingCode":"87625","codeType":"CPT"},{"id":6283,"precertRequired":false,"billingCode":"87631","codeType":"CPT"},{"id":6284,"precertRequired":false,"billingCode":"87632","codeType":"CPT"},{"id":6285,"precertRequired":false,"billingCode":"87633","codeType":"CPT"},{"id":6286,"precertRequired":false,"billingCode":"87634","codeType":"CPT"},{"id":6287,"precertRequired":false,"billingCode":"87640","codeType":"CPT"},{"id":6288,"precertRequired":false,"billingCode":"87641","codeType":"CPT"},{"id":6289,"precertRequired":false,"billingCode":"87650","codeType":"CPT"},{"id":6290,"precertRequired":false,"billingCode":"87651","codeType":"CPT"},{"id":6291,"precertRequired":false,"billingCode":"87652","codeType":"CPT"},{"id":6292,"precertRequired":false,"billingCode":"87653","codeType":"CPT"},{"id":6293,"precertRequired":false,"billingCode":"87660","codeType":"CPT"},{"id":6294,"precertRequired":false,"billingCode":"87661","codeType":"CPT"},{"id":6295,"precertRequired":false,"billingCode":"87662","codeType":"CPT"},{"id":6296,"precertRequired":false,"billingCode":"87797","codeType":"CPT"},{"id":6299,"precertRequired":false,"billingCode":"87800","codeType":"CPT"},{"id":6300,"precertRequired":false,"billingCode":"87801","codeType":"CPT"},{"id":6301,"precertRequired":false,"billingCode":"87802","codeType":"CPT"},{"id":6302,"precertRequired":false,"billingCode":"87803","codeType":"CPT"},{"id":6303,"precertRequired":false,"billingCode":"87804","codeType":"CPT"},{"id":6304,"precertRequired":false,"billingCode":"87806","codeType":"CPT"},{"id":6305,"precertRequired":false,"billingCode":"87807","codeType":"CPT"},{"id":6306,"precertRequired":false,"billingCode":"87808","codeType":"CPT"},{"id":6307,"precertRequired":false,"billingCode":"87809","codeType":"CPT"},{"id":6308,"precertRequired":false,"billingCode":"87810","codeType":"CPT"},{"id":6309,"precertRequired":false,"billingCode":"87850","codeType":"CPT"},{"id":6310,"precertRequired":false,"billingCode":"87880","codeType":"CPT"},{"id":6312,"precertRequired":false,"billingCode":"87900","codeType":"CPT"},{"id":6313,"precertRequired":false,"billingCode":"87901","codeType":"CPT"},{"id":6314,"precertRequired":false,"billingCode":"87902","codeType":"CPT"},{"id":6315,"precertRequired":false,"billingCode":"87903","codeType":"CPT"},{"id":6316,"precertRequired":false,"billingCode":"87904","codeType":"CPT"},{"id":6317,"precertRequired":false,"billingCode":"87905","codeType":"CPT"},{"id":6318,"precertRequired":false,"billingCode":"87906","codeType":"CPT"},{"id":6319,"precertRequired":false,"billingCode":"87910","codeType":"CPT"},{"id":6320,"precertRequired":false,"billingCode":"87912","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6348,"precertRequired":false,"billingCode":"88142","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6409,"precertRequired":false,"billingCode":"88312","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":9855,"precertRequired":false,"billingCode":"S3645","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":4704,"description":"Age-appropriate immunizations and HIV-specific immunizations","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":6512,"precertRequired":false,"billingCode":"90371","codeType":"CPT"},{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":6532,"precertRequired":false,"billingCode":"90632","codeType":"CPT"},{"id":6533,"precertRequired":false,"billingCode":"90636","codeType":"CPT"},{"id":6541,"precertRequired":false,"billingCode":"90662","codeType":"CPT"},{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6547,"precertRequired":false,"billingCode":"90686","codeType":"CPT"},{"id":6548,"precertRequired":false,"billingCode":"90688","codeType":"CPT"},{"id":6549,"precertRequired":false,"billingCode":"90697","codeType":"CPT"},{"id":6550,"precertRequired":false,"billingCode":"90698","codeType":"CPT"},{"id":6551,"precertRequired":false,"billingCode":"90707","codeType":"CPT"},{"id":6554,"precertRequired":false,"billingCode":"90715","codeType":"CPT"},{"id":6557,"precertRequired":false,"billingCode":"90723","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":6561,"precertRequired":false,"billingCode":"90736","codeType":"CPT"},{"id":6562,"precertRequired":false,"billingCode":"90739","codeType":"CPT"},{"id":6563,"precertRequired":false,"billingCode":"90740","codeType":"CPT"},{"id":6564,"precertRequired":false,"billingCode":"90746","codeType":"CPT"},{"id":6565,"precertRequired":false,"billingCode":"90747","codeType":"CPT"},{"id":6566,"precertRequired":false,"billingCode":"90748","codeType":"CPT"},{"id":8112,"precertRequired":false,"billingCode":"G0008","codeType":"HCPCS"},{"id":8113,"precertRequired":false,"billingCode":"G0009","codeType":"HCPCS"},{"id":8114,"precertRequired":false,"billingCode":"G0010","codeType":"HCPCS"},{"id":9852,"precertRequired":false,"billingCode":"S0039","codeType":"HCPCS"},{"id":9853,"precertRequired":true,"billingCode":"S0104","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4705,"description":"Screening services, including but are not limited to:  Sexually transmitted infections [STIs], cervical cancer, bone density, hepatitis, etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":4772,"precertRequired":false,"billingCode":"76977","codeType":"CPT"},{"id":4798,"precertRequired":false,"billingCode":"77078","codeType":"CPT"},{"id":4799,"precertRequired":false,"billingCode":"77080","codeType":"CPT"},{"id":4800,"precertRequired":false,"billingCode":"77081","codeType":"CPT"},{"id":4802,"precertRequired":false,"billingCode":"77085","codeType":"CPT"},{"id":4927,"precertRequired":false,"billingCode":"78350","codeType":"CPT"},{"id":4928,"precertRequired":false,"billingCode":"78351","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8224,"precertRequired":false,"billingCode":"G0472","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"},{"id":8241,"precertRequired":false,"billingCode":"G0499","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4706,"description":"Medication management to include education, prescribing and monitoring of FDA approved medications.   All routine medications will be provided by the VA as prescribed by the community Infectious Disease consultant in accordance with VA national medication formulary and non-formulary request process.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7197,"precertRequired":false,"billingCode":"96373","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7219,"precertRequired":false,"billingCode":"96521","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4707,"description":"Assessment of ongoing sexual and drug-use behaviors, and counseling or other interventions to reduce transmission behaviors","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":7463,"precertRequired":false,"billingCode":"99411","codeType":"CPT"},{"id":7464,"precertRequired":false,"billingCode":"99412","codeType":"CPT"},{"id":9024,"precertRequired":false,"billingCode":"S9445","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4708,"description":"Follow-up imaging as relevant to the patient condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"},{"id":13320,"precertRequired":true,"billingCode":"70470","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":4709,"description":"Follow-up studies as relevant to the patient condition on the consult","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":6638,"precertRequired":false,"billingCode":"91200","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":9766,"precertRequired":false,"billingCode":"76391","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4710,"description":"Interventional procedures to treat decompensated cirrhosis, including but not limited to: paracentesis, TIPS shunts, and tunneled drainage catheter","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"94-Interventional radiology"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":2622,"precertRequired":false,"billingCode":"37182","codeType":"CPT"},{"id":2623,"precertRequired":false,"billingCode":"37183","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3250,"precertRequired":false,"billingCode":"47382","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3337,"precertRequired":false,"billingCode":"49083","codeType":"CPT"},{"id":3338,"precertRequired":false,"billingCode":"49084","codeType":"CPT"},{"id":3358,"precertRequired":false,"billingCode":"49405","codeType":"CPT"},{"id":3363,"precertRequired":false,"billingCode":"49418","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":9153,"precertRequired":false,"billingCode":"10004","codeType":"CPT"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9155,"precertRequired":false,"billingCode":"10006","codeType":"CPT"},{"id":9156,"precertRequired":true,"billingCode":"10007","codeType":"CPT"},{"id":9157,"precertRequired":true,"billingCode":"10008","codeType":"CPT"},{"id":9158,"precertRequired":true,"billingCode":"10009","codeType":"CPT"},{"id":9159,"precertRequired":true,"billingCode":"10010","codeType":"CPT"},{"id":9160,"precertRequired":true,"billingCode":"10011","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085H0002X"},{"HPTC":"2085R0204X"}]},{"id":4711,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":70,"precertRequired":false,"billingCode":"00702","codeType":"CPT"},{"id":80,"precertRequired":false,"billingCode":"00792","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":198,"precertRequired":false,"billingCode":"01930","codeType":"CPT"},{"id":199,"precertRequired":false,"billingCode":"01931","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":4712,"description":"Pre-procedure medical clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4713,"description":"Inpatient or observation admission for procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4714,"description":"Inpatient or observation admission for procedure complications ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4724,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":4725,"description":"Infusion therapy in clinic or hydration as clinically indicated for the referred condition on the consult.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":2540,"precertRequired":false,"billingCode":"36260","codeType":"CPT"},{"id":2541,"precertRequired":false,"billingCode":"36261","codeType":"CPT"},{"id":2542,"precertRequired":false,"billingCode":"36262","codeType":"CPT"},{"id":2591,"precertRequired":false,"billingCode":"36600","codeType":"CPT"},{"id":2593,"precertRequired":false,"billingCode":"36620","codeType":"CPT"},{"id":2594,"precertRequired":false,"billingCode":"36625","codeType":"CPT"},{"id":2595,"precertRequired":false,"billingCode":"36640","codeType":"CPT"},{"id":3905,"precertRequired":false,"billingCode":"62355","codeType":"CPT"},{"id":7187,"precertRequired":false,"billingCode":"96360","codeType":"CPT"},{"id":7188,"precertRequired":false,"billingCode":"96361","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7192,"precertRequired":false,"billingCode":"96368","codeType":"CPT"},{"id":7193,"precertRequired":false,"billingCode":"96369","codeType":"CPT"},{"id":7194,"precertRequired":false,"billingCode":"96370","codeType":"CPT"},{"id":7195,"precertRequired":false,"billingCode":"96371","codeType":"CPT"},{"id":7505,"precertRequired":true,"billingCode":"99507","codeType":"CPT"},{"id":7511,"precertRequired":false,"billingCode":"99601","codeType":"CPT"},{"id":7512,"precertRequired":false,"billingCode":"99602","codeType":"CPT"},{"id":8936,"precertRequired":false,"billingCode":"S5010","codeType":"HCPCS"},{"id":8937,"precertRequired":false,"billingCode":"S5012","codeType":"HCPCS"},{"id":8938,"precertRequired":false,"billingCode":"S5013","codeType":"HCPCS"},{"id":8939,"precertRequired":false,"billingCode":"S5014","codeType":"HCPCS"},{"id":8940,"precertRequired":false,"billingCode":"S5035","codeType":"HCPCS"},{"id":8941,"precertRequired":false,"billingCode":"S5036","codeType":"HCPCS"},{"id":9034,"precertRequired":false,"billingCode":"S9500","codeType":"HCPCS"},{"id":9035,"precertRequired":false,"billingCode":"S9501","codeType":"HCPCS"},{"id":9036,"precertRequired":false,"billingCode":"S9502","codeType":"HCPCS"},{"id":9670,"precertRequired":true,"billingCode":"62350","codeType":"CPT"},{"id":9671,"precertRequired":true,"billingCode":"62351","codeType":"CPT"},{"id":9672,"precertRequired":true,"billingCode":"62360","codeType":"CPT"},{"id":9673,"precertRequired":true,"billingCode":"62361","codeType":"CPT"},{"id":9674,"precertRequired":true,"billingCode":"62362","codeType":"CPT"},{"id":9675,"precertRequired":true,"billingCode":"62365","codeType":"CPT"},{"id":9676,"precertRequired":true,"billingCode":"62367","codeType":"CPT"},{"id":9677,"precertRequired":true,"billingCode":"62368","codeType":"CPT"},{"id":9678,"precertRequired":true,"billingCode":"62369","codeType":"CPT"},{"id":9679,"precertRequired":true,"billingCode":"62370","codeType":"CPT"},{"id":13292,"precertRequired":true,"billingCode":"A4305","codeType":"HCPCS"},{"id":13306,"precertRequired":true,"billingCode":"A4222","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]}]}},{"Seoc":{"id":609,"seocKey":66,"name":"Infectious Disease_PRCT","seocId":"MSC_INFECTIOUS DISEASE_1.0.5_PRCT","versionNumber":"1.0.5","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"07-28-2019","endDate":"01-24-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.    Diagnostic imaging relevant to the referred patient condition on the consult \r\n3.    Diagnostic studies/procedures relevant to the referred condition on the consult including but not limited to: fibroscan, liver biopsy, MR Elastography.  EGD is included for medically necessary esophageal/gastric variceal surveillance and for acute issues related to portal hypertension. This does not include routine upper gastrointestinal endoscopy or colonoscopy for non-hepatic related conditions. \r\n4.   Labs and pathology services relevant to the referred patient condition on the consult\r\n5.   Follow-up visits for this episode of care\r\n6.   Age-appropriate immunizations and HIV-specific immunizations\r\n7.   Screening services, including but are not limited to:  Sexually transmitted infections [STIs], cervical cancer, bone density, hepatitis, etc.\r\n8.   Medication management to include education, prescribing and monitoring of FDA approved medications.   All routine medications will be provided by the VA as prescribed by the community Infectious Disease consultant in accordance with VA national medication formulary and non-formulary request process.\r\n9.   Assessment of ongoing sexual and drug-use behaviors, and counseling or other interventions to reduce transmission behaviors\r\n10. Follow-up imaging as relevant to the patient condition on the consult\r\n11.  Follow-up studies as relevant to the patient condition on the consult\r\n12.  Interventional procedures to treat decompensated cirrhosis, including but not limited to: paracentesis, TIPS shunts, and tunneled drainage catheter \r\n13.   Anesthesia consultation related to the procedure \r\n14.   Pre-procedure medical clearance as indicated (including H+P/labs, EKG, CXR) \r\n15.  Inpatient or observation admission for procedure\r\n16.  Inpatient or observation admission for procedure complications \r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure","maxAllowableVisits":null,"disclaimer":"* HCC surveillance should be done in accordance with American Association for the Study of Liver Disease [AASLD] guidance. Surveillance modalities can include ultrasound, CT, or MRI, with or without AFP. \r\n* Treating providers should follow the CDC guidelines in reference to HIV and HIV PrEP\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","QASP":"General Care","categoryOfCare":"INFECTIOUS DISEASE","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0200X"}],"services":[{"id":3375,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":3376,"description":"Diagnostic imaging relevant to the referred patient condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3377,"description":"Diagnostic studies/procedures relevant to the referred condition on the consult including but not limited to: fibroscan, liver biopsy, MR Elastography.  EGD is included for medically necessary esophageal/gastric variceal surveillance and for acute issues related to portal hypertension. This does not include routine upper gastrointestinal endoscopy or colonoscopy for non-hepatic related conditions.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":6638,"precertRequired":false,"billingCode":"91200","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":9766,"precertRequired":false,"billingCode":"76391","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":3378,"description":"Labs and pathology services relevant to the referred patient condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5016,"precertRequired":false,"billingCode":"80081","codeType":"CPT"},{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5217,"precertRequired":true,"billingCode":"81256","codeType":"CPT"},{"id":5379,"precertRequired":false,"billingCode":"82088","codeType":"CPT"},{"id":5380,"precertRequired":false,"billingCode":"82103","codeType":"CPT"},{"id":5381,"precertRequired":false,"billingCode":"82104","codeType":"CPT"},{"id":5382,"precertRequired":false,"billingCode":"82105","codeType":"CPT"},{"id":5393,"precertRequired":false,"billingCode":"82140","codeType":"CPT"},{"id":5395,"precertRequired":false,"billingCode":"82150","codeType":"CPT"},{"id":5401,"precertRequired":false,"billingCode":"82172","codeType":"CPT"},{"id":5405,"precertRequired":false,"billingCode":"82232","codeType":"CPT"},{"id":5408,"precertRequired":false,"billingCode":"82247","codeType":"CPT"},{"id":5439,"precertRequired":false,"billingCode":"82390","codeType":"CPT"},{"id":5446,"precertRequired":false,"billingCode":"82465","codeType":"CPT"},{"id":5453,"precertRequired":false,"billingCode":"82525","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5467,"precertRequired":false,"billingCode":"82595","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5507,"precertRequired":false,"billingCode":"82784","codeType":"CPT"},{"id":5508,"precertRequired":false,"billingCode":"82785","codeType":"CPT"},{"id":5509,"precertRequired":false,"billingCode":"82787","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5528,"precertRequired":false,"billingCode":"82962","codeType":"CPT"},{"id":5531,"precertRequired":false,"billingCode":"82977","codeType":"CPT"},{"id":5540,"precertRequired":false,"billingCode":"83010","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5570,"precertRequired":false,"billingCode":"83516","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5578,"precertRequired":false,"billingCode":"83550","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5597,"precertRequired":false,"billingCode":"83690","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5623,"precertRequired":false,"billingCode":"83915","codeType":"CPT"},{"id":5643,"precertRequired":false,"billingCode":"84075","codeType":"CPT"},{"id":5645,"precertRequired":false,"billingCode":"84080","codeType":"CPT"},{"id":5671,"precertRequired":false,"billingCode":"84155","codeType":"CPT"},{"id":5674,"precertRequired":false,"billingCode":"84160","codeType":"CPT"},{"id":5676,"precertRequired":false,"billingCode":"84165","codeType":"CPT"},{"id":5720,"precertRequired":false,"billingCode":"84439","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5726,"precertRequired":false,"billingCode":"84450","codeType":"CPT"},{"id":5727,"precertRequired":false,"billingCode":"84460","codeType":"CPT"},{"id":5729,"precertRequired":false,"billingCode":"84478","codeType":"CPT"},{"id":5735,"precertRequired":false,"billingCode":"84485","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5873,"precertRequired":false,"billingCode":"86038","codeType":"CPT"},{"id":5874,"precertRequired":false,"billingCode":"86039","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5900,"precertRequired":false,"billingCode":"86255","codeType":"CPT"},{"id":5901,"precertRequired":false,"billingCode":"86256","codeType":"CPT"},{"id":5913,"precertRequired":false,"billingCode":"86317","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5931,"precertRequired":false,"billingCode":"86355","codeType":"CPT"},{"id":5933,"precertRequired":false,"billingCode":"86357","codeType":"CPT"},{"id":5934,"precertRequired":false,"billingCode":"86359","codeType":"CPT"},{"id":5935,"precertRequired":false,"billingCode":"86360","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5954,"precertRequired":false,"billingCode":"86592","codeType":"CPT"},{"id":5955,"precertRequired":false,"billingCode":"86593","codeType":"CPT"},{"id":5956,"precertRequired":false,"billingCode":"86602","codeType":"CPT"},{"id":5957,"precertRequired":false,"billingCode":"86603","codeType":"CPT"},{"id":5958,"precertRequired":false,"billingCode":"86606","codeType":"CPT"},{"id":5959,"precertRequired":false,"billingCode":"86609","codeType":"CPT"},{"id":5960,"precertRequired":false,"billingCode":"86611","codeType":"CPT"},{"id":5961,"precertRequired":false,"billingCode":"86612","codeType":"CPT"},{"id":5962,"precertRequired":false,"billingCode":"86615","codeType":"CPT"},{"id":5963,"precertRequired":false,"billingCode":"86617","codeType":"CPT"},{"id":5964,"precertRequired":false,"billingCode":"86618","codeType":"CPT"},{"id":5965,"precertRequired":false,"billingCode":"86619","codeType":"CPT"},{"id":5966,"precertRequired":false,"billingCode":"86622","codeType":"CPT"},{"id":5967,"precertRequired":false,"billingCode":"86625","codeType":"CPT"},{"id":5968,"precertRequired":false,"billingCode":"86628","codeType":"CPT"},{"id":5969,"precertRequired":false,"billingCode":"86631","codeType":"CPT"},{"id":5970,"precertRequired":false,"billingCode":"86632","codeType":"CPT"},{"id":5971,"precertRequired":false,"billingCode":"86635","codeType":"CPT"},{"id":5972,"precertRequired":false,"billingCode":"86638","codeType":"CPT"},{"id":5973,"precertRequired":false,"billingCode":"86641","codeType":"CPT"},{"id":5974,"precertRequired":false,"billingCode":"86644","codeType":"CPT"},{"id":5975,"precertRequired":false,"billingCode":"86645","codeType":"CPT"},{"id":5976,"precertRequired":false,"billingCode":"86648","codeType":"CPT"},{"id":5977,"precertRequired":false,"billingCode":"86651","codeType":"CPT"},{"id":5978,"precertRequired":false,"billingCode":"86652","codeType":"CPT"},{"id":5979,"precertRequired":false,"billingCode":"86653","codeType":"CPT"},{"id":5980,"precertRequired":false,"billingCode":"86654","codeType":"CPT"},{"id":5981,"precertRequired":false,"billingCode":"86658","codeType":"CPT"},{"id":5982,"precertRequired":false,"billingCode":"86663","codeType":"CPT"},{"id":5983,"precertRequired":false,"billingCode":"86664","codeType":"CPT"},{"id":5984,"precertRequired":false,"billingCode":"86665","codeType":"CPT"},{"id":5985,"precertRequired":false,"billingCode":"86666","codeType":"CPT"},{"id":5986,"precertRequired":false,"billingCode":"86668","codeType":"CPT"},{"id":5987,"precertRequired":false,"billingCode":"86671","codeType":"CPT"},{"id":5988,"precertRequired":false,"billingCode":"86674","codeType":"CPT"},{"id":5989,"precertRequired":false,"billingCode":"86677","codeType":"CPT"},{"id":5990,"precertRequired":false,"billingCode":"86682","codeType":"CPT"},{"id":5991,"precertRequired":false,"billingCode":"86684","codeType":"CPT"},{"id":5992,"precertRequired":false,"billingCode":"86687","codeType":"CPT"},{"id":5993,"precertRequired":false,"billingCode":"86688","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":5995,"precertRequired":false,"billingCode":"86692","codeType":"CPT"},{"id":5996,"precertRequired":false,"billingCode":"86694","codeType":"CPT"},{"id":5997,"precertRequired":false,"billingCode":"86695","codeType":"CPT"},{"id":5998,"precertRequired":false,"billingCode":"86696","codeType":"CPT"},{"id":5999,"precertRequired":false,"billingCode":"86698","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6003,"precertRequired":false,"billingCode":"86704","codeType":"CPT"},{"id":6004,"precertRequired":false,"billingCode":"86705","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6006,"precertRequired":false,"billingCode":"86707","codeType":"CPT"},{"id":6007,"precertRequired":false,"billingCode":"86708","codeType":"CPT"},{"id":6008,"precertRequired":false,"billingCode":"86709","codeType":"CPT"},{"id":6009,"precertRequired":false,"billingCode":"86710","codeType":"CPT"},{"id":6010,"precertRequired":false,"billingCode":"86711","codeType":"CPT"},{"id":6011,"precertRequired":false,"billingCode":"86713","codeType":"CPT"},{"id":6012,"precertRequired":false,"billingCode":"86717","codeType":"CPT"},{"id":6013,"precertRequired":false,"billingCode":"86720","codeType":"CPT"},{"id":6014,"precertRequired":false,"billingCode":"86723","codeType":"CPT"},{"id":6015,"precertRequired":false,"billingCode":"86727","codeType":"CPT"},{"id":6016,"precertRequired":false,"billingCode":"86732","codeType":"CPT"},{"id":6017,"precertRequired":false,"billingCode":"86735","codeType":"CPT"},{"id":6018,"precertRequired":false,"billingCode":"86738","codeType":"CPT"},{"id":6019,"precertRequired":false,"billingCode":"86741","codeType":"CPT"},{"id":6020,"precertRequired":false,"billingCode":"86744","codeType":"CPT"},{"id":6021,"precertRequired":false,"billingCode":"86747","codeType":"CPT"},{"id":6022,"precertRequired":false,"billingCode":"86750","codeType":"CPT"},{"id":6023,"precertRequired":false,"billingCode":"86753","codeType":"CPT"},{"id":6024,"precertRequired":false,"billingCode":"86756","codeType":"CPT"},{"id":6025,"precertRequired":false,"billingCode":"86757","codeType":"CPT"},{"id":6026,"precertRequired":false,"billingCode":"86759","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6028,"precertRequired":false,"billingCode":"86765","codeType":"CPT"},{"id":6029,"precertRequired":false,"billingCode":"86768","codeType":"CPT"},{"id":6030,"precertRequired":false,"billingCode":"86771","codeType":"CPT"},{"id":6031,"precertRequired":false,"billingCode":"86774","codeType":"CPT"},{"id":6032,"precertRequired":false,"billingCode":"86777","codeType":"CPT"},{"id":6033,"precertRequired":false,"billingCode":"86778","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6037,"precertRequired":false,"billingCode":"86788","codeType":"CPT"},{"id":6038,"precertRequired":false,"billingCode":"86789","codeType":"CPT"},{"id":6039,"precertRequired":false,"billingCode":"86790","codeType":"CPT"},{"id":6040,"precertRequired":false,"billingCode":"86793","codeType":"CPT"},{"id":6041,"precertRequired":false,"billingCode":"86794","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6044,"precertRequired":false,"billingCode":"86804","codeType":"CPT"},{"id":6105,"precertRequired":false,"billingCode":"87003","codeType":"CPT"},{"id":6106,"precertRequired":false,"billingCode":"87015","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"},{"id":6108,"precertRequired":false,"billingCode":"87045","codeType":"CPT"},{"id":6109,"precertRequired":false,"billingCode":"87046","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6112,"precertRequired":false,"billingCode":"87073","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6114,"precertRequired":false,"billingCode":"87076","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6120,"precertRequired":false,"billingCode":"87101","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6122,"precertRequired":false,"billingCode":"87103","codeType":"CPT"},{"id":6123,"precertRequired":false,"billingCode":"87106","codeType":"CPT"},{"id":6124,"precertRequired":false,"billingCode":"87107","codeType":"CPT"},{"id":6125,"precertRequired":false,"billingCode":"87109","codeType":"CPT"},{"id":6126,"precertRequired":false,"billingCode":"87110","codeType":"CPT"},{"id":6127,"precertRequired":false,"billingCode":"87116","codeType":"CPT"},{"id":6128,"precertRequired":false,"billingCode":"87118","codeType":"CPT"},{"id":6129,"precertRequired":false,"billingCode":"87140","codeType":"CPT"},{"id":6130,"precertRequired":false,"billingCode":"87143","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6132,"precertRequired":false,"billingCode":"87149","codeType":"CPT"},{"id":6133,"precertRequired":false,"billingCode":"87150","codeType":"CPT"},{"id":6134,"precertRequired":false,"billingCode":"87152","codeType":"CPT"},{"id":6135,"precertRequired":false,"billingCode":"87153","codeType":"CPT"},{"id":6136,"precertRequired":false,"billingCode":"87158","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6139,"precertRequired":false,"billingCode":"87168","codeType":"CPT"},{"id":6140,"precertRequired":false,"billingCode":"87169","codeType":"CPT"},{"id":6141,"precertRequired":false,"billingCode":"87172","codeType":"CPT"},{"id":6142,"precertRequired":false,"billingCode":"87176","codeType":"CPT"},{"id":6143,"precertRequired":false,"billingCode":"87177","codeType":"CPT"},{"id":6144,"precertRequired":false,"billingCode":"87181","codeType":"CPT"},{"id":6145,"precertRequired":false,"billingCode":"87184","codeType":"CPT"},{"id":6146,"precertRequired":false,"billingCode":"87185","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6148,"precertRequired":false,"billingCode":"87187","codeType":"CPT"},{"id":6149,"precertRequired":false,"billingCode":"87188","codeType":"CPT"},{"id":6150,"precertRequired":false,"billingCode":"87190","codeType":"CPT"},{"id":6151,"precertRequired":false,"billingCode":"87197","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6153,"precertRequired":false,"billingCode":"87206","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6155,"precertRequired":false,"billingCode":"87209","codeType":"CPT"},{"id":6156,"precertRequired":false,"billingCode":"87210","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6158,"precertRequired":false,"billingCode":"87230","codeType":"CPT"},{"id":6159,"precertRequired":false,"billingCode":"87250","codeType":"CPT"},{"id":6160,"precertRequired":false,"billingCode":"87252","codeType":"CPT"},{"id":6161,"precertRequired":false,"billingCode":"87253","codeType":"CPT"},{"id":6162,"precertRequired":false,"billingCode":"87254","codeType":"CPT"},{"id":6163,"precertRequired":false,"billingCode":"87255","codeType":"CPT"},{"id":6164,"precertRequired":false,"billingCode":"87260","codeType":"CPT"},{"id":6165,"precertRequired":false,"billingCode":"87265","codeType":"CPT"},{"id":6166,"precertRequired":false,"billingCode":"87267","codeType":"CPT"},{"id":6167,"precertRequired":false,"billingCode":"87269","codeType":"CPT"},{"id":6168,"precertRequired":false,"billingCode":"87270","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6173,"precertRequired":false,"billingCode":"87275","codeType":"CPT"},{"id":6174,"precertRequired":false,"billingCode":"87276","codeType":"CPT"},{"id":6175,"precertRequired":false,"billingCode":"87278","codeType":"CPT"},{"id":6176,"precertRequired":false,"billingCode":"87279","codeType":"CPT"},{"id":6177,"precertRequired":false,"billingCode":"87280","codeType":"CPT"},{"id":6178,"precertRequired":false,"billingCode":"87281","codeType":"CPT"},{"id":6179,"precertRequired":false,"billingCode":"87283","codeType":"CPT"},{"id":6180,"precertRequired":false,"billingCode":"87285","codeType":"CPT"},{"id":6181,"precertRequired":false,"billingCode":"87290","codeType":"CPT"},{"id":6183,"precertRequired":false,"billingCode":"87300","codeType":"CPT"},{"id":6184,"precertRequired":false,"billingCode":"87301","codeType":"CPT"},{"id":6185,"precertRequired":false,"billingCode":"87305","codeType":"CPT"},{"id":6186,"precertRequired":false,"billingCode":"87320","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6191,"precertRequired":false,"billingCode":"87332","codeType":"CPT"},{"id":6192,"precertRequired":false,"billingCode":"87335","codeType":"CPT"},{"id":6193,"precertRequired":false,"billingCode":"87336","codeType":"CPT"},{"id":6194,"precertRequired":false,"billingCode":"87337","codeType":"CPT"},{"id":6195,"precertRequired":false,"billingCode":"87338","codeType":"CPT"},{"id":6196,"precertRequired":false,"billingCode":"87339","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6198,"precertRequired":false,"billingCode":"87341","codeType":"CPT"},{"id":6199,"precertRequired":false,"billingCode":"87350","codeType":"CPT"},{"id":6200,"precertRequired":false,"billingCode":"87380","codeType":"CPT"},{"id":6201,"precertRequired":false,"billingCode":"87385","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6203,"precertRequired":false,"billingCode":"87390","codeType":"CPT"},{"id":6204,"precertRequired":false,"billingCode":"87391","codeType":"CPT"},{"id":6205,"precertRequired":false,"billingCode":"87400","codeType":"CPT"},{"id":6206,"precertRequired":false,"billingCode":"87420","codeType":"CPT"},{"id":6207,"precertRequired":false,"billingCode":"87425","codeType":"CPT"},{"id":6208,"precertRequired":false,"billingCode":"87427","codeType":"CPT"},{"id":6209,"precertRequired":false,"billingCode":"87430","codeType":"CPT"},{"id":6210,"precertRequired":false,"billingCode":"87449","codeType":"CPT"},{"id":6211,"precertRequired":false,"billingCode":"87450","codeType":"CPT"},{"id":6212,"precertRequired":false,"billingCode":"87451","codeType":"CPT"},{"id":6213,"precertRequired":false,"billingCode":"87471","codeType":"CPT"},{"id":6214,"precertRequired":false,"billingCode":"87472","codeType":"CPT"},{"id":6215,"precertRequired":false,"billingCode":"87475","codeType":"CPT"},{"id":6216,"precertRequired":false,"billingCode":"87476","codeType":"CPT"},{"id":6217,"precertRequired":false,"billingCode":"87480","codeType":"CPT"},{"id":6218,"precertRequired":false,"billingCode":"87481","codeType":"CPT"},{"id":6219,"precertRequired":false,"billingCode":"87482","codeType":"CPT"},{"id":6220,"precertRequired":false,"billingCode":"87483","codeType":"CPT"},{"id":6221,"precertRequired":false,"billingCode":"87485","codeType":"CPT"},{"id":6222,"precertRequired":false,"billingCode":"87486","codeType":"CPT"},{"id":6223,"precertRequired":false,"billingCode":"87487","codeType":"CPT"},{"id":6224,"precertRequired":false,"billingCode":"87490","codeType":"CPT"},{"id":6225,"precertRequired":false,"billingCode":"87491","codeType":"CPT"},{"id":6226,"precertRequired":false,"billingCode":"87492","codeType":"CPT"},{"id":6227,"precertRequired":false,"billingCode":"87493","codeType":"CPT"},{"id":6228,"precertRequired":false,"billingCode":"87495","codeType":"CPT"},{"id":6229,"precertRequired":false,"billingCode":"87496","codeType":"CPT"},{"id":6230,"precertRequired":false,"billingCode":"87497","codeType":"CPT"},{"id":6231,"precertRequired":false,"billingCode":"87498","codeType":"CPT"},{"id":6232,"precertRequired":false,"billingCode":"87500","codeType":"CPT"},{"id":6233,"precertRequired":false,"billingCode":"87501","codeType":"CPT"},{"id":6234,"precertRequired":false,"billingCode":"87502","codeType":"CPT"},{"id":6235,"precertRequired":false,"billingCode":"87503","codeType":"CPT"},{"id":6236,"precertRequired":false,"billingCode":"87505","codeType":"CPT"},{"id":6237,"precertRequired":false,"billingCode":"87506","codeType":"CPT"},{"id":6238,"precertRequired":false,"billingCode":"87507","codeType":"CPT"},{"id":6239,"precertRequired":false,"billingCode":"87510","codeType":"CPT"},{"id":6240,"precertRequired":false,"billingCode":"87511","codeType":"CPT"},{"id":6241,"precertRequired":false,"billingCode":"87512","codeType":"CPT"},{"id":6242,"precertRequired":false,"billingCode":"87516","codeType":"CPT"},{"id":6243,"precertRequired":false,"billingCode":"87517","codeType":"CPT"},{"id":6244,"precertRequired":false,"billingCode":"87520","codeType":"CPT"},{"id":6245,"precertRequired":false,"billingCode":"87521","codeType":"CPT"},{"id":6246,"precertRequired":false,"billingCode":"87522","codeType":"CPT"},{"id":6247,"precertRequired":false,"billingCode":"87525","codeType":"CPT"},{"id":6248,"precertRequired":false,"billingCode":"87526","codeType":"CPT"},{"id":6249,"precertRequired":false,"billingCode":"87527","codeType":"CPT"},{"id":6250,"precertRequired":false,"billingCode":"87528","codeType":"CPT"},{"id":6251,"precertRequired":false,"billingCode":"87529","codeType":"CPT"},{"id":6252,"precertRequired":false,"billingCode":"87530","codeType":"CPT"},{"id":6253,"precertRequired":false,"billingCode":"87531","codeType":"CPT"},{"id":6254,"precertRequired":false,"billingCode":"87532","codeType":"CPT"},{"id":6255,"precertRequired":false,"billingCode":"87533","codeType":"CPT"},{"id":6256,"precertRequired":false,"billingCode":"87534","codeType":"CPT"},{"id":6257,"precertRequired":false,"billingCode":"87535","codeType":"CPT"},{"id":6258,"precertRequired":false,"billingCode":"87536","codeType":"CPT"},{"id":6259,"precertRequired":false,"billingCode":"87537","codeType":"CPT"},{"id":6260,"precertRequired":false,"billingCode":"87538","codeType":"CPT"},{"id":6261,"precertRequired":false,"billingCode":"87539","codeType":"CPT"},{"id":6262,"precertRequired":false,"billingCode":"87540","codeType":"CPT"},{"id":6263,"precertRequired":false,"billingCode":"87541","codeType":"CPT"},{"id":6264,"precertRequired":false,"billingCode":"87542","codeType":"CPT"},{"id":6265,"precertRequired":false,"billingCode":"87550","codeType":"CPT"},{"id":6266,"precertRequired":false,"billingCode":"87551","codeType":"CPT"},{"id":6267,"precertRequired":false,"billingCode":"87552","codeType":"CPT"},{"id":6268,"precertRequired":false,"billingCode":"87555","codeType":"CPT"},{"id":6269,"precertRequired":false,"billingCode":"87556","codeType":"CPT"},{"id":6270,"precertRequired":false,"billingCode":"87557","codeType":"CPT"},{"id":6271,"precertRequired":false,"billingCode":"87560","codeType":"CPT"},{"id":6272,"precertRequired":false,"billingCode":"87561","codeType":"CPT"},{"id":6273,"precertRequired":false,"billingCode":"87562","codeType":"CPT"},{"id":6274,"precertRequired":false,"billingCode":"87580","codeType":"CPT"},{"id":6275,"precertRequired":false,"billingCode":"87581","codeType":"CPT"},{"id":6276,"precertRequired":false,"billingCode":"87582","codeType":"CPT"},{"id":6277,"precertRequired":false,"billingCode":"87590","codeType":"CPT"},{"id":6278,"precertRequired":false,"billingCode":"87591","codeType":"CPT"},{"id":6279,"precertRequired":false,"billingCode":"87592","codeType":"CPT"},{"id":6280,"precertRequired":false,"billingCode":"87623","codeType":"CPT"},{"id":6281,"precertRequired":false,"billingCode":"87624","codeType":"CPT"},{"id":6282,"precertRequired":false,"billingCode":"87625","codeType":"CPT"},{"id":6283,"precertRequired":false,"billingCode":"87631","codeType":"CPT"},{"id":6284,"precertRequired":false,"billingCode":"87632","codeType":"CPT"},{"id":6285,"precertRequired":false,"billingCode":"87633","codeType":"CPT"},{"id":6286,"precertRequired":false,"billingCode":"87634","codeType":"CPT"},{"id":6287,"precertRequired":false,"billingCode":"87640","codeType":"CPT"},{"id":6288,"precertRequired":false,"billingCode":"87641","codeType":"CPT"},{"id":6289,"precertRequired":false,"billingCode":"87650","codeType":"CPT"},{"id":6290,"precertRequired":false,"billingCode":"87651","codeType":"CPT"},{"id":6291,"precertRequired":false,"billingCode":"87652","codeType":"CPT"},{"id":6292,"precertRequired":false,"billingCode":"87653","codeType":"CPT"},{"id":6293,"precertRequired":false,"billingCode":"87660","codeType":"CPT"},{"id":6294,"precertRequired":false,"billingCode":"87661","codeType":"CPT"},{"id":6295,"precertRequired":false,"billingCode":"87662","codeType":"CPT"},{"id":6296,"precertRequired":false,"billingCode":"87797","codeType":"CPT"},{"id":6299,"precertRequired":false,"billingCode":"87800","codeType":"CPT"},{"id":6300,"precertRequired":false,"billingCode":"87801","codeType":"CPT"},{"id":6301,"precertRequired":false,"billingCode":"87802","codeType":"CPT"},{"id":6302,"precertRequired":false,"billingCode":"87803","codeType":"CPT"},{"id":6303,"precertRequired":false,"billingCode":"87804","codeType":"CPT"},{"id":6304,"precertRequired":false,"billingCode":"87806","codeType":"CPT"},{"id":6305,"precertRequired":false,"billingCode":"87807","codeType":"CPT"},{"id":6306,"precertRequired":false,"billingCode":"87808","codeType":"CPT"},{"id":6307,"precertRequired":false,"billingCode":"87809","codeType":"CPT"},{"id":6308,"precertRequired":false,"billingCode":"87810","codeType":"CPT"},{"id":6309,"precertRequired":false,"billingCode":"87850","codeType":"CPT"},{"id":6310,"precertRequired":false,"billingCode":"87880","codeType":"CPT"},{"id":6312,"precertRequired":false,"billingCode":"87900","codeType":"CPT"},{"id":6313,"precertRequired":false,"billingCode":"87901","codeType":"CPT"},{"id":6314,"precertRequired":false,"billingCode":"87902","codeType":"CPT"},{"id":6315,"precertRequired":false,"billingCode":"87903","codeType":"CPT"},{"id":6316,"precertRequired":false,"billingCode":"87904","codeType":"CPT"},{"id":6317,"precertRequired":false,"billingCode":"87905","codeType":"CPT"},{"id":6318,"precertRequired":false,"billingCode":"87906","codeType":"CPT"},{"id":6319,"precertRequired":false,"billingCode":"87910","codeType":"CPT"},{"id":6320,"precertRequired":false,"billingCode":"87912","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6348,"precertRequired":false,"billingCode":"88142","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":9855,"precertRequired":false,"billingCode":"S3645","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":3379,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":3380,"description":"Age-appropriate immunizations and HIV-specific immunizations","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":6512,"precertRequired":false,"billingCode":"90371","codeType":"CPT"},{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":6532,"precertRequired":false,"billingCode":"90632","codeType":"CPT"},{"id":6533,"precertRequired":false,"billingCode":"90636","codeType":"CPT"},{"id":6541,"precertRequired":false,"billingCode":"90662","codeType":"CPT"},{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6547,"precertRequired":false,"billingCode":"90686","codeType":"CPT"},{"id":6548,"precertRequired":false,"billingCode":"90688","codeType":"CPT"},{"id":6549,"precertRequired":false,"billingCode":"90697","codeType":"CPT"},{"id":6550,"precertRequired":false,"billingCode":"90698","codeType":"CPT"},{"id":6551,"precertRequired":false,"billingCode":"90707","codeType":"CPT"},{"id":6554,"precertRequired":false,"billingCode":"90715","codeType":"CPT"},{"id":6557,"precertRequired":false,"billingCode":"90723","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":6561,"precertRequired":false,"billingCode":"90736","codeType":"CPT"},{"id":6562,"precertRequired":false,"billingCode":"90739","codeType":"CPT"},{"id":6563,"precertRequired":false,"billingCode":"90740","codeType":"CPT"},{"id":6564,"precertRequired":false,"billingCode":"90746","codeType":"CPT"},{"id":6565,"precertRequired":false,"billingCode":"90747","codeType":"CPT"},{"id":6566,"precertRequired":false,"billingCode":"90748","codeType":"CPT"},{"id":8112,"precertRequired":false,"billingCode":"G0008","codeType":"HCPCS"},{"id":8113,"precertRequired":false,"billingCode":"G0009","codeType":"HCPCS"},{"id":8114,"precertRequired":false,"billingCode":"G0010","codeType":"HCPCS"},{"id":9806,"precertRequired":true,"billingCode":"J0287","codeType":"HCPCS"},{"id":9807,"precertRequired":true,"billingCode":"J0289","codeType":"HCPCS"},{"id":9809,"precertRequired":false,"billingCode":"J0390","codeType":"HCPCS"},{"id":9820,"precertRequired":false,"billingCode":"J1460","codeType":"HCPCS"},{"id":9822,"precertRequired":false,"billingCode":"J1560","codeType":"HCPCS"},{"id":9824,"precertRequired":false,"billingCode":"J1571","codeType":"HCPCS"},{"id":9825,"precertRequired":false,"billingCode":"J1573","codeType":"HCPCS"},{"id":9842,"precertRequired":true,"billingCode":"J3485","codeType":"HCPCS"},{"id":9852,"precertRequired":false,"billingCode":"S0039","codeType":"HCPCS"},{"id":9853,"precertRequired":true,"billingCode":"S0104","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":3381,"description":"Screening services, including but are not limited to:  Sexually transmitted infections [STIs], cervical cancer, bone density, hepatitis, etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":4772,"precertRequired":false,"billingCode":"76977","codeType":"CPT"},{"id":4798,"precertRequired":false,"billingCode":"77078","codeType":"CPT"},{"id":4799,"precertRequired":false,"billingCode":"77080","codeType":"CPT"},{"id":4800,"precertRequired":false,"billingCode":"77081","codeType":"CPT"},{"id":4802,"precertRequired":false,"billingCode":"77085","codeType":"CPT"},{"id":4927,"precertRequired":false,"billingCode":"78350","codeType":"CPT"},{"id":4928,"precertRequired":false,"billingCode":"78351","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8224,"precertRequired":false,"billingCode":"G0472","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"},{"id":8241,"precertRequired":false,"billingCode":"G0499","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":3382,"description":"Medication management to include education, prescribing and monitoring of FDA approved medications.   All routine medications will be provided by the VA as prescribed by the community Infectious Disease consultant in accordance with VA national medication formulary and non-formulary request process.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7197,"precertRequired":false,"billingCode":"96373","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7219,"precertRequired":false,"billingCode":"96521","codeType":"CPT"},{"id":8389,"precertRequired":false,"billingCode":"J0696","codeType":"HCPCS"},{"id":8391,"precertRequired":false,"billingCode":"J0713","codeType":"HCPCS"},{"id":8396,"precertRequired":false,"billingCode":"J0878","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8441,"precertRequired":false,"billingCode":"J1642","codeType":"HCPCS"},{"id":8442,"precertRequired":false,"billingCode":"J1644","codeType":"HCPCS"},{"id":8511,"precertRequired":false,"billingCode":"J3370","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8592,"precertRequired":false,"billingCode":"J9040","codeType":"HCPCS"},{"id":8609,"precertRequired":false,"billingCode":"J9151","codeType":"HCPCS"},{"id":8633,"precertRequired":false,"billingCode":"J9215","codeType":"HCPCS"},{"id":9804,"precertRequired":false,"billingCode":"J0278","codeType":"HCPCS"},{"id":9806,"precertRequired":true,"billingCode":"J0287","codeType":"HCPCS"},{"id":9807,"precertRequired":true,"billingCode":"J0289","codeType":"HCPCS"},{"id":9808,"precertRequired":false,"billingCode":"J0295","codeType":"HCPCS"},{"id":9810,"precertRequired":false,"billingCode":"J0690","codeType":"HCPCS"},{"id":9811,"precertRequired":false,"billingCode":"J0692","codeType":"HCPCS"},{"id":9812,"precertRequired":false,"billingCode":"J0744","codeType":"HCPCS"},{"id":9814,"precertRequired":false,"billingCode":"J1324","codeType":"HCPCS"},{"id":9815,"precertRequired":false,"billingCode":"J1335","codeType":"HCPCS"},{"id":9818,"precertRequired":false,"billingCode":"J1450","codeType":"HCPCS"},{"id":9830,"precertRequired":false,"billingCode":"J2185","codeType":"HCPCS"},{"id":9837,"precertRequired":false,"billingCode":"J2543","codeType":"HCPCS"},{"id":9842,"precertRequired":true,"billingCode":"J3485","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":3383,"description":"Assessment of ongoing sexual and drug-use behaviors, and counseling or other interventions to reduce transmission behaviors","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":7463,"precertRequired":false,"billingCode":"99411","codeType":"CPT"},{"id":7464,"precertRequired":false,"billingCode":"99412","codeType":"CPT"},{"id":9024,"precertRequired":false,"billingCode":"S9445","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":3384,"description":"Follow-up imaging as relevant to the patient condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3385,"description":"Follow-up studies as relevant to the patient condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":6638,"precertRequired":false,"billingCode":"91200","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":9766,"precertRequired":false,"billingCode":"76391","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":3386,"description":"Interventional procedures to treat decompensated cirrhosis, including but not limited to: paracentesis, TIPS shunts, and tunneled drainage catheter","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"94-Interventional radiology"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":2622,"precertRequired":false,"billingCode":"37182","codeType":"CPT"},{"id":2623,"precertRequired":false,"billingCode":"37183","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3250,"precertRequired":false,"billingCode":"47382","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3338,"precertRequired":false,"billingCode":"49084","codeType":"CPT"},{"id":3358,"precertRequired":false,"billingCode":"49405","codeType":"CPT"},{"id":3363,"precertRequired":false,"billingCode":"49418","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":9153,"precertRequired":false,"billingCode":"10004","codeType":"CPT"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9155,"precertRequired":false,"billingCode":"10006","codeType":"CPT"},{"id":9156,"precertRequired":true,"billingCode":"10007","codeType":"CPT"},{"id":9157,"precertRequired":true,"billingCode":"10008","codeType":"CPT"},{"id":9158,"precertRequired":true,"billingCode":"10009","codeType":"CPT"},{"id":9159,"precertRequired":true,"billingCode":"10010","codeType":"CPT"},{"id":9160,"precertRequired":true,"billingCode":"10011","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085H0002X"},{"HPTC":"2085R0204X"}]},{"id":3387,"description":"Anesthesia consultation related to the procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":70,"precertRequired":false,"billingCode":"00702","codeType":"CPT"},{"id":80,"precertRequired":false,"billingCode":"00792","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":198,"precertRequired":false,"billingCode":"01930","codeType":"CPT"},{"id":199,"precertRequired":false,"billingCode":"01931","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":3388,"description":"Pre-procedure medical clearance as indicated (including H+P/labs, EKG, CXR)","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":3389,"description":"Inpatient or observation admission for procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":3390,"description":"Inpatient or observation admission for procedure complications ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]}]}},{"Seoc":{"id":337,"seocKey":66,"name":"Infectious Disease_PRCT","seocId":"MSC_INFECTIOUS DISEASE_1.0.4_PRCT","versionNumber":"1.0.4","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"03-15-2019","endDate":"07-28-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.    Diagnostic imaging relevant to the referred patient condition on the consult \r\n3.    Diagnostic studies/procedures relevant to the referred condition on the consult including but not limited to: fibroscan, liver biopsy, MR Elastography.  EGD is included for medically necessary esophageal/gastric variceal surveillance and for acute issues related to portal hypertension. This does not include routine upper gastrointestinal endoscopy or colonoscopy for non-hepatic related conditions. \r\n4.   Labs and pathology services relevant to the referred patient condition on the consult\r\n5.   Follow-up visits for this episode of care\r\n6.   Age-appropriate immunizations and HIV-specific immunizations\r\n7.   Screening services, including but are not limited to:  Sexually transmitted infections [STIs], cervical cancer, bone density, hepatitis, etc.\r\n8.   Medication management to include education, prescribing and monitoring of FDA approved medications.   All routine medications will be provided by the VA as prescribed by the community Infectious Disease consultant in accordance with VA national medication formulary and non-formulary request process.\r\n9.   Assessment of ongoing sexual and drug-use behaviors, and counseling or other interventions to reduce transmission behaviors\r\n10. Follow-up imaging as relevant to the patient condition on the consult\r\n11.  Follow-up studies as relevant to the patient condition on the consult\r\n12.  Interventional procedures to treat decompensated cirrhosis, including but not limited to: paracentesis, TIPS shunts, and tunneled drainage catheter \r\n13.   Anesthesia consultation related to the procedure \r\n14.   Pre-procedure medical clearance as indicated (including H+P/labs, EKG, CXR) \r\n15.  Inpatient or observation admission for procedure\r\n16.  Inpatient or observation admission for procedure complications \r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* HCC surveillance should be done in accordance with American Association for the Study of Liver Disease [AASLD] guidance. Surveillance modalities can include ultrasound, CT, or MRI, with or without AFP. \r\n* Treating providers should follow the CDC guidelines in reference to HIV and HIV PrEP\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"INFECTIOUS DISEASE","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0200X"}],"services":[{"id":1607,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1608,"description":"Diagnostic imaging relevant to the referred patient condition on the consult ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1609,"description":"Diagnostic studies/procedures relevant to the referred condition on the consult including but not limited to: fibroscan, liver biopsy, MR Elastography.  EGD is included for medically necessary esophageal/gastric variceal surveillance and for acute issues related to portal hypertension. This does not include routine upper gastrointestinal endoscopy or colonoscopy for non-hepatic related conditions. ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":6638,"precertRequired":false,"billingCode":"91200","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":9766,"precertRequired":false,"billingCode":"76391","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1610,"description":"Labs and pathology services relevant to the referred patient condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5016,"precertRequired":false,"billingCode":"80081","codeType":"CPT"},{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5217,"precertRequired":true,"billingCode":"81256","codeType":"CPT"},{"id":5379,"precertRequired":false,"billingCode":"82088","codeType":"CPT"},{"id":5380,"precertRequired":false,"billingCode":"82103","codeType":"CPT"},{"id":5381,"precertRequired":false,"billingCode":"82104","codeType":"CPT"},{"id":5382,"precertRequired":false,"billingCode":"82105","codeType":"CPT"},{"id":5393,"precertRequired":false,"billingCode":"82140","codeType":"CPT"},{"id":5395,"precertRequired":false,"billingCode":"82150","codeType":"CPT"},{"id":5401,"precertRequired":false,"billingCode":"82172","codeType":"CPT"},{"id":5405,"precertRequired":false,"billingCode":"82232","codeType":"CPT"},{"id":5408,"precertRequired":false,"billingCode":"82247","codeType":"CPT"},{"id":5439,"precertRequired":false,"billingCode":"82390","codeType":"CPT"},{"id":5446,"precertRequired":false,"billingCode":"82465","codeType":"CPT"},{"id":5453,"precertRequired":false,"billingCode":"82525","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5467,"precertRequired":false,"billingCode":"82595","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5507,"precertRequired":false,"billingCode":"82784","codeType":"CPT"},{"id":5508,"precertRequired":false,"billingCode":"82785","codeType":"CPT"},{"id":5509,"precertRequired":false,"billingCode":"82787","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5528,"precertRequired":false,"billingCode":"82962","codeType":"CPT"},{"id":5531,"precertRequired":false,"billingCode":"82977","codeType":"CPT"},{"id":5540,"precertRequired":false,"billingCode":"83010","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5570,"precertRequired":false,"billingCode":"83516","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5578,"precertRequired":false,"billingCode":"83550","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5597,"precertRequired":false,"billingCode":"83690","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5623,"precertRequired":false,"billingCode":"83915","codeType":"CPT"},{"id":5643,"precertRequired":false,"billingCode":"84075","codeType":"CPT"},{"id":5645,"precertRequired":false,"billingCode":"84080","codeType":"CPT"},{"id":5671,"precertRequired":false,"billingCode":"84155","codeType":"CPT"},{"id":5674,"precertRequired":false,"billingCode":"84160","codeType":"CPT"},{"id":5676,"precertRequired":false,"billingCode":"84165","codeType":"CPT"},{"id":5720,"precertRequired":false,"billingCode":"84439","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5726,"precertRequired":false,"billingCode":"84450","codeType":"CPT"},{"id":5727,"precertRequired":false,"billingCode":"84460","codeType":"CPT"},{"id":5729,"precertRequired":false,"billingCode":"84478","codeType":"CPT"},{"id":5735,"precertRequired":false,"billingCode":"84485","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5873,"precertRequired":false,"billingCode":"86038","codeType":"CPT"},{"id":5874,"precertRequired":false,"billingCode":"86039","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5900,"precertRequired":false,"billingCode":"86255","codeType":"CPT"},{"id":5901,"precertRequired":false,"billingCode":"86256","codeType":"CPT"},{"id":5913,"precertRequired":false,"billingCode":"86317","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5931,"precertRequired":false,"billingCode":"86355","codeType":"CPT"},{"id":5933,"precertRequired":false,"billingCode":"86357","codeType":"CPT"},{"id":5934,"precertRequired":false,"billingCode":"86359","codeType":"CPT"},{"id":5935,"precertRequired":false,"billingCode":"86360","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5954,"precertRequired":false,"billingCode":"86592","codeType":"CPT"},{"id":5955,"precertRequired":false,"billingCode":"86593","codeType":"CPT"},{"id":5956,"precertRequired":false,"billingCode":"86602","codeType":"CPT"},{"id":5957,"precertRequired":false,"billingCode":"86603","codeType":"CPT"},{"id":5958,"precertRequired":false,"billingCode":"86606","codeType":"CPT"},{"id":5959,"precertRequired":false,"billingCode":"86609","codeType":"CPT"},{"id":5960,"precertRequired":false,"billingCode":"86611","codeType":"CPT"},{"id":5961,"precertRequired":false,"billingCode":"86612","codeType":"CPT"},{"id":5962,"precertRequired":false,"billingCode":"86615","codeType":"CPT"},{"id":5963,"precertRequired":false,"billingCode":"86617","codeType":"CPT"},{"id":5964,"precertRequired":false,"billingCode":"86618","codeType":"CPT"},{"id":5965,"precertRequired":false,"billingCode":"86619","codeType":"CPT"},{"id":5966,"precertRequired":false,"billingCode":"86622","codeType":"CPT"},{"id":5967,"precertRequired":false,"billingCode":"86625","codeType":"CPT"},{"id":5968,"precertRequired":false,"billingCode":"86628","codeType":"CPT"},{"id":5969,"precertRequired":false,"billingCode":"86631","codeType":"CPT"},{"id":5970,"precertRequired":false,"billingCode":"86632","codeType":"CPT"},{"id":5971,"precertRequired":false,"billingCode":"86635","codeType":"CPT"},{"id":5972,"precertRequired":false,"billingCode":"86638","codeType":"CPT"},{"id":5973,"precertRequired":false,"billingCode":"86641","codeType":"CPT"},{"id":5974,"precertRequired":false,"billingCode":"86644","codeType":"CPT"},{"id":5975,"precertRequired":false,"billingCode":"86645","codeType":"CPT"},{"id":5976,"precertRequired":false,"billingCode":"86648","codeType":"CPT"},{"id":5977,"precertRequired":false,"billingCode":"86651","codeType":"CPT"},{"id":5978,"precertRequired":false,"billingCode":"86652","codeType":"CPT"},{"id":5979,"precertRequired":false,"billingCode":"86653","codeType":"CPT"},{"id":5980,"precertRequired":false,"billingCode":"86654","codeType":"CPT"},{"id":5981,"precertRequired":false,"billingCode":"86658","codeType":"CPT"},{"id":5982,"precertRequired":false,"billingCode":"86663","codeType":"CPT"},{"id":5983,"precertRequired":false,"billingCode":"86664","codeType":"CPT"},{"id":5984,"precertRequired":false,"billingCode":"86665","codeType":"CPT"},{"id":5985,"precertRequired":false,"billingCode":"86666","codeType":"CPT"},{"id":5986,"precertRequired":false,"billingCode":"86668","codeType":"CPT"},{"id":5987,"precertRequired":false,"billingCode":"86671","codeType":"CPT"},{"id":5988,"precertRequired":false,"billingCode":"86674","codeType":"CPT"},{"id":5989,"precertRequired":false,"billingCode":"86677","codeType":"CPT"},{"id":5990,"precertRequired":false,"billingCode":"86682","codeType":"CPT"},{"id":5991,"precertRequired":false,"billingCode":"86684","codeType":"CPT"},{"id":5992,"precertRequired":false,"billingCode":"86687","codeType":"CPT"},{"id":5993,"precertRequired":false,"billingCode":"86688","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":5995,"precertRequired":false,"billingCode":"86692","codeType":"CPT"},{"id":5996,"precertRequired":false,"billingCode":"86694","codeType":"CPT"},{"id":5997,"precertRequired":false,"billingCode":"86695","codeType":"CPT"},{"id":5998,"precertRequired":false,"billingCode":"86696","codeType":"CPT"},{"id":5999,"precertRequired":false,"billingCode":"86698","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6003,"precertRequired":false,"billingCode":"86704","codeType":"CPT"},{"id":6004,"precertRequired":false,"billingCode":"86705","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6006,"precertRequired":false,"billingCode":"86707","codeType":"CPT"},{"id":6007,"precertRequired":false,"billingCode":"86708","codeType":"CPT"},{"id":6008,"precertRequired":false,"billingCode":"86709","codeType":"CPT"},{"id":6009,"precertRequired":false,"billingCode":"86710","codeType":"CPT"},{"id":6010,"precertRequired":false,"billingCode":"86711","codeType":"CPT"},{"id":6011,"precertRequired":false,"billingCode":"86713","codeType":"CPT"},{"id":6012,"precertRequired":false,"billingCode":"86717","codeType":"CPT"},{"id":6013,"precertRequired":false,"billingCode":"86720","codeType":"CPT"},{"id":6014,"precertRequired":false,"billingCode":"86723","codeType":"CPT"},{"id":6015,"precertRequired":false,"billingCode":"86727","codeType":"CPT"},{"id":6016,"precertRequired":false,"billingCode":"86732","codeType":"CPT"},{"id":6017,"precertRequired":false,"billingCode":"86735","codeType":"CPT"},{"id":6018,"precertRequired":false,"billingCode":"86738","codeType":"CPT"},{"id":6019,"precertRequired":false,"billingCode":"86741","codeType":"CPT"},{"id":6020,"precertRequired":false,"billingCode":"86744","codeType":"CPT"},{"id":6021,"precertRequired":false,"billingCode":"86747","codeType":"CPT"},{"id":6022,"precertRequired":false,"billingCode":"86750","codeType":"CPT"},{"id":6023,"precertRequired":false,"billingCode":"86753","codeType":"CPT"},{"id":6024,"precertRequired":false,"billingCode":"86756","codeType":"CPT"},{"id":6025,"precertRequired":false,"billingCode":"86757","codeType":"CPT"},{"id":6026,"precertRequired":false,"billingCode":"86759","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6028,"precertRequired":false,"billingCode":"86765","codeType":"CPT"},{"id":6029,"precertRequired":false,"billingCode":"86768","codeType":"CPT"},{"id":6030,"precertRequired":false,"billingCode":"86771","codeType":"CPT"},{"id":6031,"precertRequired":false,"billingCode":"86774","codeType":"CPT"},{"id":6032,"precertRequired":false,"billingCode":"86777","codeType":"CPT"},{"id":6033,"precertRequired":false,"billingCode":"86778","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6037,"precertRequired":false,"billingCode":"86788","codeType":"CPT"},{"id":6038,"precertRequired":false,"billingCode":"86789","codeType":"CPT"},{"id":6039,"precertRequired":false,"billingCode":"86790","codeType":"CPT"},{"id":6040,"precertRequired":false,"billingCode":"86793","codeType":"CPT"},{"id":6041,"precertRequired":false,"billingCode":"86794","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6044,"precertRequired":false,"billingCode":"86804","codeType":"CPT"},{"id":6105,"precertRequired":false,"billingCode":"87003","codeType":"CPT"},{"id":6106,"precertRequired":false,"billingCode":"87015","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"},{"id":6108,"precertRequired":false,"billingCode":"87045","codeType":"CPT"},{"id":6109,"precertRequired":false,"billingCode":"87046","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6112,"precertRequired":false,"billingCode":"87073","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6114,"precertRequired":false,"billingCode":"87076","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6120,"precertRequired":false,"billingCode":"87101","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6122,"precertRequired":false,"billingCode":"87103","codeType":"CPT"},{"id":6123,"precertRequired":false,"billingCode":"87106","codeType":"CPT"},{"id":6124,"precertRequired":false,"billingCode":"87107","codeType":"CPT"},{"id":6125,"precertRequired":false,"billingCode":"87109","codeType":"CPT"},{"id":6126,"precertRequired":false,"billingCode":"87110","codeType":"CPT"},{"id":6127,"precertRequired":false,"billingCode":"87116","codeType":"CPT"},{"id":6128,"precertRequired":false,"billingCode":"87118","codeType":"CPT"},{"id":6129,"precertRequired":false,"billingCode":"87140","codeType":"CPT"},{"id":6130,"precertRequired":false,"billingCode":"87143","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6132,"precertRequired":false,"billingCode":"87149","codeType":"CPT"},{"id":6133,"precertRequired":false,"billingCode":"87150","codeType":"CPT"},{"id":6134,"precertRequired":false,"billingCode":"87152","codeType":"CPT"},{"id":6135,"precertRequired":false,"billingCode":"87153","codeType":"CPT"},{"id":6136,"precertRequired":false,"billingCode":"87158","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6139,"precertRequired":false,"billingCode":"87168","codeType":"CPT"},{"id":6140,"precertRequired":false,"billingCode":"87169","codeType":"CPT"},{"id":6141,"precertRequired":false,"billingCode":"87172","codeType":"CPT"},{"id":6142,"precertRequired":false,"billingCode":"87176","codeType":"CPT"},{"id":6143,"precertRequired":false,"billingCode":"87177","codeType":"CPT"},{"id":6144,"precertRequired":false,"billingCode":"87181","codeType":"CPT"},{"id":6145,"precertRequired":false,"billingCode":"87184","codeType":"CPT"},{"id":6146,"precertRequired":false,"billingCode":"87185","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6148,"precertRequired":false,"billingCode":"87187","codeType":"CPT"},{"id":6149,"precertRequired":false,"billingCode":"87188","codeType":"CPT"},{"id":6150,"precertRequired":false,"billingCode":"87190","codeType":"CPT"},{"id":6151,"precertRequired":false,"billingCode":"87197","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6153,"precertRequired":false,"billingCode":"87206","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6155,"precertRequired":false,"billingCode":"87209","codeType":"CPT"},{"id":6156,"precertRequired":false,"billingCode":"87210","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6158,"precertRequired":false,"billingCode":"87230","codeType":"CPT"},{"id":6159,"precertRequired":false,"billingCode":"87250","codeType":"CPT"},{"id":6160,"precertRequired":false,"billingCode":"87252","codeType":"CPT"},{"id":6161,"precertRequired":false,"billingCode":"87253","codeType":"CPT"},{"id":6162,"precertRequired":false,"billingCode":"87254","codeType":"CPT"},{"id":6163,"precertRequired":false,"billingCode":"87255","codeType":"CPT"},{"id":6164,"precertRequired":false,"billingCode":"87260","codeType":"CPT"},{"id":6165,"precertRequired":false,"billingCode":"87265","codeType":"CPT"},{"id":6166,"precertRequired":false,"billingCode":"87267","codeType":"CPT"},{"id":6167,"precertRequired":false,"billingCode":"87269","codeType":"CPT"},{"id":6168,"precertRequired":false,"billingCode":"87270","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6173,"precertRequired":false,"billingCode":"87275","codeType":"CPT"},{"id":6174,"precertRequired":false,"billingCode":"87276","codeType":"CPT"},{"id":6175,"precertRequired":false,"billingCode":"87278","codeType":"CPT"},{"id":6176,"precertRequired":false,"billingCode":"87279","codeType":"CPT"},{"id":6177,"precertRequired":false,"billingCode":"87280","codeType":"CPT"},{"id":6178,"precertRequired":false,"billingCode":"87281","codeType":"CPT"},{"id":6179,"precertRequired":false,"billingCode":"87283","codeType":"CPT"},{"id":6180,"precertRequired":false,"billingCode":"87285","codeType":"CPT"},{"id":6181,"precertRequired":false,"billingCode":"87290","codeType":"CPT"},{"id":6183,"precertRequired":false,"billingCode":"87300","codeType":"CPT"},{"id":6184,"precertRequired":false,"billingCode":"87301","codeType":"CPT"},{"id":6185,"precertRequired":false,"billingCode":"87305","codeType":"CPT"},{"id":6186,"precertRequired":false,"billingCode":"87320","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6191,"precertRequired":false,"billingCode":"87332","codeType":"CPT"},{"id":6192,"precertRequired":false,"billingCode":"87335","codeType":"CPT"},{"id":6193,"precertRequired":false,"billingCode":"87336","codeType":"CPT"},{"id":6194,"precertRequired":false,"billingCode":"87337","codeType":"CPT"},{"id":6195,"precertRequired":false,"billingCode":"87338","codeType":"CPT"},{"id":6196,"precertRequired":false,"billingCode":"87339","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6198,"precertRequired":false,"billingCode":"87341","codeType":"CPT"},{"id":6199,"precertRequired":false,"billingCode":"87350","codeType":"CPT"},{"id":6200,"precertRequired":false,"billingCode":"87380","codeType":"CPT"},{"id":6201,"precertRequired":false,"billingCode":"87385","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6203,"precertRequired":false,"billingCode":"87390","codeType":"CPT"},{"id":6204,"precertRequired":false,"billingCode":"87391","codeType":"CPT"},{"id":6205,"precertRequired":false,"billingCode":"87400","codeType":"CPT"},{"id":6206,"precertRequired":false,"billingCode":"87420","codeType":"CPT"},{"id":6207,"precertRequired":false,"billingCode":"87425","codeType":"CPT"},{"id":6208,"precertRequired":false,"billingCode":"87427","codeType":"CPT"},{"id":6209,"precertRequired":false,"billingCode":"87430","codeType":"CPT"},{"id":6210,"precertRequired":false,"billingCode":"87449","codeType":"CPT"},{"id":6211,"precertRequired":false,"billingCode":"87450","codeType":"CPT"},{"id":6212,"precertRequired":false,"billingCode":"87451","codeType":"CPT"},{"id":6213,"precertRequired":false,"billingCode":"87471","codeType":"CPT"},{"id":6214,"precertRequired":false,"billingCode":"87472","codeType":"CPT"},{"id":6215,"precertRequired":false,"billingCode":"87475","codeType":"CPT"},{"id":6216,"precertRequired":false,"billingCode":"87476","codeType":"CPT"},{"id":6217,"precertRequired":false,"billingCode":"87480","codeType":"CPT"},{"id":6218,"precertRequired":false,"billingCode":"87481","codeType":"CPT"},{"id":6219,"precertRequired":false,"billingCode":"87482","codeType":"CPT"},{"id":6220,"precertRequired":false,"billingCode":"87483","codeType":"CPT"},{"id":6221,"precertRequired":false,"billingCode":"87485","codeType":"CPT"},{"id":6222,"precertRequired":false,"billingCode":"87486","codeType":"CPT"},{"id":6223,"precertRequired":false,"billingCode":"87487","codeType":"CPT"},{"id":6224,"precertRequired":false,"billingCode":"87490","codeType":"CPT"},{"id":6225,"precertRequired":false,"billingCode":"87491","codeType":"CPT"},{"id":6226,"precertRequired":false,"billingCode":"87492","codeType":"CPT"},{"id":6227,"precertRequired":false,"billingCode":"87493","codeType":"CPT"},{"id":6228,"precertRequired":false,"billingCode":"87495","codeType":"CPT"},{"id":6229,"precertRequired":false,"billingCode":"87496","codeType":"CPT"},{"id":6230,"precertRequired":false,"billingCode":"87497","codeType":"CPT"},{"id":6231,"precertRequired":false,"billingCode":"87498","codeType":"CPT"},{"id":6232,"precertRequired":false,"billingCode":"87500","codeType":"CPT"},{"id":6233,"precertRequired":false,"billingCode":"87501","codeType":"CPT"},{"id":6234,"precertRequired":false,"billingCode":"87502","codeType":"CPT"},{"id":6235,"precertRequired":false,"billingCode":"87503","codeType":"CPT"},{"id":6236,"precertRequired":false,"billingCode":"87505","codeType":"CPT"},{"id":6237,"precertRequired":false,"billingCode":"87506","codeType":"CPT"},{"id":6238,"precertRequired":false,"billingCode":"87507","codeType":"CPT"},{"id":6239,"precertRequired":false,"billingCode":"87510","codeType":"CPT"},{"id":6240,"precertRequired":false,"billingCode":"87511","codeType":"CPT"},{"id":6241,"precertRequired":false,"billingCode":"87512","codeType":"CPT"},{"id":6242,"precertRequired":false,"billingCode":"87516","codeType":"CPT"},{"id":6243,"precertRequired":false,"billingCode":"87517","codeType":"CPT"},{"id":6244,"precertRequired":false,"billingCode":"87520","codeType":"CPT"},{"id":6245,"precertRequired":false,"billingCode":"87521","codeType":"CPT"},{"id":6246,"precertRequired":false,"billingCode":"87522","codeType":"CPT"},{"id":6247,"precertRequired":false,"billingCode":"87525","codeType":"CPT"},{"id":6248,"precertRequired":false,"billingCode":"87526","codeType":"CPT"},{"id":6249,"precertRequired":false,"billingCode":"87527","codeType":"CPT"},{"id":6250,"precertRequired":false,"billingCode":"87528","codeType":"CPT"},{"id":6251,"precertRequired":false,"billingCode":"87529","codeType":"CPT"},{"id":6252,"precertRequired":false,"billingCode":"87530","codeType":"CPT"},{"id":6253,"precertRequired":false,"billingCode":"87531","codeType":"CPT"},{"id":6254,"precertRequired":false,"billingCode":"87532","codeType":"CPT"},{"id":6255,"precertRequired":false,"billingCode":"87533","codeType":"CPT"},{"id":6256,"precertRequired":false,"billingCode":"87534","codeType":"CPT"},{"id":6257,"precertRequired":false,"billingCode":"87535","codeType":"CPT"},{"id":6258,"precertRequired":false,"billingCode":"87536","codeType":"CPT"},{"id":6259,"precertRequired":false,"billingCode":"87537","codeType":"CPT"},{"id":6260,"precertRequired":false,"billingCode":"87538","codeType":"CPT"},{"id":6261,"precertRequired":false,"billingCode":"87539","codeType":"CPT"},{"id":6262,"precertRequired":false,"billingCode":"87540","codeType":"CPT"},{"id":6263,"precertRequired":false,"billingCode":"87541","codeType":"CPT"},{"id":6264,"precertRequired":false,"billingCode":"87542","codeType":"CPT"},{"id":6265,"precertRequired":false,"billingCode":"87550","codeType":"CPT"},{"id":6266,"precertRequired":false,"billingCode":"87551","codeType":"CPT"},{"id":6267,"precertRequired":false,"billingCode":"87552","codeType":"CPT"},{"id":6268,"precertRequired":false,"billingCode":"87555","codeType":"CPT"},{"id":6269,"precertRequired":false,"billingCode":"87556","codeType":"CPT"},{"id":6270,"precertRequired":false,"billingCode":"87557","codeType":"CPT"},{"id":6271,"precertRequired":false,"billingCode":"87560","codeType":"CPT"},{"id":6272,"precertRequired":false,"billingCode":"87561","codeType":"CPT"},{"id":6273,"precertRequired":false,"billingCode":"87562","codeType":"CPT"},{"id":6274,"precertRequired":false,"billingCode":"87580","codeType":"CPT"},{"id":6275,"precertRequired":false,"billingCode":"87581","codeType":"CPT"},{"id":6276,"precertRequired":false,"billingCode":"87582","codeType":"CPT"},{"id":6277,"precertRequired":false,"billingCode":"87590","codeType":"CPT"},{"id":6278,"precertRequired":false,"billingCode":"87591","codeType":"CPT"},{"id":6279,"precertRequired":false,"billingCode":"87592","codeType":"CPT"},{"id":6280,"precertRequired":false,"billingCode":"87623","codeType":"CPT"},{"id":6281,"precertRequired":false,"billingCode":"87624","codeType":"CPT"},{"id":6282,"precertRequired":false,"billingCode":"87625","codeType":"CPT"},{"id":6283,"precertRequired":false,"billingCode":"87631","codeType":"CPT"},{"id":6284,"precertRequired":false,"billingCode":"87632","codeType":"CPT"},{"id":6285,"precertRequired":false,"billingCode":"87633","codeType":"CPT"},{"id":6286,"precertRequired":false,"billingCode":"87634","codeType":"CPT"},{"id":6287,"precertRequired":false,"billingCode":"87640","codeType":"CPT"},{"id":6288,"precertRequired":false,"billingCode":"87641","codeType":"CPT"},{"id":6289,"precertRequired":false,"billingCode":"87650","codeType":"CPT"},{"id":6290,"precertRequired":false,"billingCode":"87651","codeType":"CPT"},{"id":6291,"precertRequired":false,"billingCode":"87652","codeType":"CPT"},{"id":6292,"precertRequired":false,"billingCode":"87653","codeType":"CPT"},{"id":6293,"precertRequired":false,"billingCode":"87660","codeType":"CPT"},{"id":6294,"precertRequired":false,"billingCode":"87661","codeType":"CPT"},{"id":6295,"precertRequired":false,"billingCode":"87662","codeType":"CPT"},{"id":6296,"precertRequired":false,"billingCode":"87797","codeType":"CPT"},{"id":6299,"precertRequired":false,"billingCode":"87800","codeType":"CPT"},{"id":6300,"precertRequired":false,"billingCode":"87801","codeType":"CPT"},{"id":6301,"precertRequired":false,"billingCode":"87802","codeType":"CPT"},{"id":6302,"precertRequired":false,"billingCode":"87803","codeType":"CPT"},{"id":6303,"precertRequired":false,"billingCode":"87804","codeType":"CPT"},{"id":6304,"precertRequired":false,"billingCode":"87806","codeType":"CPT"},{"id":6305,"precertRequired":false,"billingCode":"87807","codeType":"CPT"},{"id":6306,"precertRequired":false,"billingCode":"87808","codeType":"CPT"},{"id":6307,"precertRequired":false,"billingCode":"87809","codeType":"CPT"},{"id":6308,"precertRequired":false,"billingCode":"87810","codeType":"CPT"},{"id":6309,"precertRequired":false,"billingCode":"87850","codeType":"CPT"},{"id":6310,"precertRequired":false,"billingCode":"87880","codeType":"CPT"},{"id":6312,"precertRequired":false,"billingCode":"87900","codeType":"CPT"},{"id":6313,"precertRequired":false,"billingCode":"87901","codeType":"CPT"},{"id":6314,"precertRequired":false,"billingCode":"87902","codeType":"CPT"},{"id":6315,"precertRequired":false,"billingCode":"87903","codeType":"CPT"},{"id":6316,"precertRequired":false,"billingCode":"87904","codeType":"CPT"},{"id":6317,"precertRequired":false,"billingCode":"87905","codeType":"CPT"},{"id":6318,"precertRequired":false,"billingCode":"87906","codeType":"CPT"},{"id":6319,"precertRequired":false,"billingCode":"87910","codeType":"CPT"},{"id":6320,"precertRequired":false,"billingCode":"87912","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6348,"precertRequired":false,"billingCode":"88142","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":9855,"precertRequired":false,"billingCode":"S3645","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1611,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1612,"description":"Age-appropriate immunizations and HIV-specific immunizations","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":6512,"precertRequired":false,"billingCode":"90371","codeType":"CPT"},{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":6532,"precertRequired":false,"billingCode":"90632","codeType":"CPT"},{"id":6533,"precertRequired":false,"billingCode":"90636","codeType":"CPT"},{"id":6541,"precertRequired":false,"billingCode":"90662","codeType":"CPT"},{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6547,"precertRequired":false,"billingCode":"90686","codeType":"CPT"},{"id":6548,"precertRequired":false,"billingCode":"90688","codeType":"CPT"},{"id":6549,"precertRequired":false,"billingCode":"90697","codeType":"CPT"},{"id":6550,"precertRequired":false,"billingCode":"90698","codeType":"CPT"},{"id":6551,"precertRequired":false,"billingCode":"90707","codeType":"CPT"},{"id":6554,"precertRequired":false,"billingCode":"90715","codeType":"CPT"},{"id":6557,"precertRequired":false,"billingCode":"90723","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":6561,"precertRequired":false,"billingCode":"90736","codeType":"CPT"},{"id":6562,"precertRequired":false,"billingCode":"90739","codeType":"CPT"},{"id":6563,"precertRequired":false,"billingCode":"90740","codeType":"CPT"},{"id":6564,"precertRequired":false,"billingCode":"90746","codeType":"CPT"},{"id":6565,"precertRequired":false,"billingCode":"90747","codeType":"CPT"},{"id":6566,"precertRequired":false,"billingCode":"90748","codeType":"CPT"},{"id":8112,"precertRequired":false,"billingCode":"G0008","codeType":"HCPCS"},{"id":8113,"precertRequired":false,"billingCode":"G0009","codeType":"HCPCS"},{"id":8114,"precertRequired":false,"billingCode":"G0010","codeType":"HCPCS"},{"id":9806,"precertRequired":true,"billingCode":"J0287","codeType":"HCPCS"},{"id":9807,"precertRequired":true,"billingCode":"J0289","codeType":"HCPCS"},{"id":9809,"precertRequired":false,"billingCode":"J0390","codeType":"HCPCS"},{"id":9820,"precertRequired":false,"billingCode":"J1460","codeType":"HCPCS"},{"id":9822,"precertRequired":false,"billingCode":"J1560","codeType":"HCPCS"},{"id":9824,"precertRequired":false,"billingCode":"J1571","codeType":"HCPCS"},{"id":9825,"precertRequired":false,"billingCode":"J1573","codeType":"HCPCS"},{"id":9842,"precertRequired":true,"billingCode":"J3485","codeType":"HCPCS"},{"id":9852,"precertRequired":false,"billingCode":"S0039","codeType":"HCPCS"},{"id":9853,"precertRequired":true,"billingCode":"S0104","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1613,"description":"Screening services, including but are not limited to:  Sexually transmitted infections [STIs], cervical cancer, bone density, hepatitis, etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":4772,"precertRequired":false,"billingCode":"76977","codeType":"CPT"},{"id":4798,"precertRequired":false,"billingCode":"77078","codeType":"CPT"},{"id":4799,"precertRequired":false,"billingCode":"77080","codeType":"CPT"},{"id":4800,"precertRequired":false,"billingCode":"77081","codeType":"CPT"},{"id":4802,"precertRequired":false,"billingCode":"77085","codeType":"CPT"},{"id":4927,"precertRequired":false,"billingCode":"78350","codeType":"CPT"},{"id":4928,"precertRequired":false,"billingCode":"78351","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8224,"precertRequired":false,"billingCode":"G0472","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"},{"id":8241,"precertRequired":false,"billingCode":"G0499","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1614,"description":"Medication management to include education, prescribing and monitoring of FDA approved medications.   All routine medications will be provided by the VA as prescribed by the community Infectious Disease consultant in accordance with VA national medication formulary and non-formulary request process.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7197,"precertRequired":false,"billingCode":"96373","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7219,"precertRequired":false,"billingCode":"96521","codeType":"CPT"},{"id":8389,"precertRequired":false,"billingCode":"J0696","codeType":"HCPCS"},{"id":8391,"precertRequired":false,"billingCode":"J0713","codeType":"HCPCS"},{"id":8396,"precertRequired":false,"billingCode":"J0878","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8441,"precertRequired":false,"billingCode":"J1642","codeType":"HCPCS"},{"id":8442,"precertRequired":false,"billingCode":"J1644","codeType":"HCPCS"},{"id":8511,"precertRequired":false,"billingCode":"J3370","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8592,"precertRequired":false,"billingCode":"J9040","codeType":"HCPCS"},{"id":8609,"precertRequired":false,"billingCode":"J9151","codeType":"HCPCS"},{"id":8633,"precertRequired":false,"billingCode":"J9215","codeType":"HCPCS"},{"id":9804,"precertRequired":false,"billingCode":"J0278","codeType":"HCPCS"},{"id":9806,"precertRequired":true,"billingCode":"J0287","codeType":"HCPCS"},{"id":9807,"precertRequired":true,"billingCode":"J0289","codeType":"HCPCS"},{"id":9808,"precertRequired":false,"billingCode":"J0295","codeType":"HCPCS"},{"id":9810,"precertRequired":false,"billingCode":"J0690","codeType":"HCPCS"},{"id":9811,"precertRequired":false,"billingCode":"J0692","codeType":"HCPCS"},{"id":9812,"precertRequired":false,"billingCode":"J0744","codeType":"HCPCS"},{"id":9814,"precertRequired":false,"billingCode":"J1324","codeType":"HCPCS"},{"id":9815,"precertRequired":false,"billingCode":"J1335","codeType":"HCPCS"},{"id":9818,"precertRequired":false,"billingCode":"J1450","codeType":"HCPCS"},{"id":9830,"precertRequired":false,"billingCode":"J2185","codeType":"HCPCS"},{"id":9837,"precertRequired":false,"billingCode":"J2543","codeType":"HCPCS"},{"id":9842,"precertRequired":true,"billingCode":"J3485","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1615,"description":" Assessment of ongoing sexual and drug-use behaviors, and counseling or other interventions to reduce transmission behaviors","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":7463,"precertRequired":false,"billingCode":"99411","codeType":"CPT"},{"id":7464,"precertRequired":false,"billingCode":"99412","codeType":"CPT"},{"id":9024,"precertRequired":false,"billingCode":"S9445","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1616,"description":"Follow-up imaging as relevant to the patient condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1617,"description":"Follow-up studies as relevant to the patient condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":6638,"precertRequired":false,"billingCode":"91200","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":9766,"precertRequired":false,"billingCode":"76391","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1618,"description":" Interventional procedures to treat decompensated cirrhosis, including but not limited to: paracentesis, TIPS shunts, and tunneled drainage catheter ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"94-Interventional radiology"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":2622,"precertRequired":false,"billingCode":"37182","codeType":"CPT"},{"id":2623,"precertRequired":false,"billingCode":"37183","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3250,"precertRequired":false,"billingCode":"47382","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3338,"precertRequired":false,"billingCode":"49084","codeType":"CPT"},{"id":3358,"precertRequired":false,"billingCode":"49405","codeType":"CPT"},{"id":3363,"precertRequired":false,"billingCode":"49418","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":9153,"precertRequired":false,"billingCode":"10004","codeType":"CPT"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9155,"precertRequired":false,"billingCode":"10006","codeType":"CPT"},{"id":9156,"precertRequired":true,"billingCode":"10007","codeType":"CPT"},{"id":9157,"precertRequired":true,"billingCode":"10008","codeType":"CPT"},{"id":9158,"precertRequired":true,"billingCode":"10009","codeType":"CPT"},{"id":9159,"precertRequired":true,"billingCode":"10010","codeType":"CPT"},{"id":9160,"precertRequired":true,"billingCode":"10011","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085H0002X"},{"HPTC":"2085R0204X"}]},{"id":1619,"description":" Anesthesia consultation related to the procedure ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":70,"precertRequired":false,"billingCode":"00702","codeType":"CPT"},{"id":80,"precertRequired":false,"billingCode":"00792","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":198,"precertRequired":false,"billingCode":"01930","codeType":"CPT"},{"id":199,"precertRequired":false,"billingCode":"01931","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1620,"description":"Pre-procedure medical clearance as indicated (including H+P/labs, EKG, CXR) ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1621,"description":"Inpatient or observation admission for procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1622,"description":" Inpatient or observation admission for procedure complications ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]}]}},{"Seoc":{"id":322,"seocKey":66,"name":"Infectious Disease_PRCT","seocId":"MSC_INFECTIOUS DISEASE_1.0.3_PRCT","versionNumber":"1.0.3","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.","effectiveDate":"03-12-2019","endDate":"03-15-2019","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.    Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2.    Diagnostic imaging relevant to the referred patient condition on the consult \r\n3.    Diagnostic studies/procedures relevant to the referred condition on the consult including but not limited to: fibroscan, liver biopsy, MR Elastography.  EGD is included for medically necessary esophageal/gastric variceal surveillance and for acute issues related to portal hypertension. This does not include routine upper gastrointestinal endoscopy or colonoscopy for non-hepatic related conditions. \r\n4.   Labs and pathology services relevant to the referred patient condition on the consult\r\n5.   Follow-up visits for this episode of care\r\n6.   Age-appropriate immunizations and HIV-specific immunizations\r\n7.   Screening services, including but are not limited to:  Sexually transmitted infections [STIs], cervical cancer, bone density, hepatitis, etc.\r\n8.   Medication management to include education, prescribing and monitoring of FDA approved medications.   All routine medications will be provided by the VA as prescribed by the community Infectious Disease consultant in accordance with VA national medication formulary and non-formulary request process.\r\n9.   Assessment of ongoing sexual and drug-use behaviors, and counseling or other interventions to reduce transmission behaviors\r\n10. Follow-up imaging as relevant to the patient condition on the consult\r\n11.  Follow-up studies as relevant to the patient condition on the consult\r\n12.  Interventional procedures to treat decompensated cirrhosis, including but not limited to: paracentesis, TIPS shunts, and tunneled drainage catheter \r\n13.   Anesthesia consultation related to the procedure \r\n14.   Pre-procedure medical clearance as indicated (including H+P/labs, EKG, CXR) \r\n15.  Inpatient or observation admission for procedure\r\n16.  Inpatient or observation admission for procedure complications \r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure","maxAllowableVisits":null,"disclaimer":"*Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n*DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n*All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\n* HCC surveillance should be done in accordance with American Association for the Study of Liver Disease [AASLD] guidance. Surveillance modalities can include ultrasound, CT, or MRI, with or without AFP. \r\n* Treating providers should follow the CDC guidelines in reference to HIV and HIV PrEP\r\n* Urgent/emergent prescriptions can be provided for a 14-day supply only. \r\n* The Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"INFECTIOUS DISEASE","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0200X"}],"services":[{"id":1415,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1516,"description":"Diagnostic imaging relevant to the referred patient condition on the consult ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4442,"precertRequired":false,"billingCode":"71260","codeType":"CPT"},{"id":4443,"precertRequired":true,"billingCode":"71270","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1517,"description":"Diagnostic studies/procedures relevant to the referred condition on the consult including but not limited to: fibroscan, liver biopsy, MR Elastography.  EGD is included for medically necessary esophageal/gastric variceal surveillance and for acute issues related to portal hypertension. This does not include routine upper gastrointestinal endoscopy or colonoscopy for non-hepatic related conditions. ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":6638,"precertRequired":false,"billingCode":"91200","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":9766,"precertRequired":false,"billingCode":"76391","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1518,"description":"Labs and pathology services relevant to the referred patient condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5014,"precertRequired":false,"billingCode":"80074","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5016,"precertRequired":false,"billingCode":"80081","codeType":"CPT"},{"id":5051,"precertRequired":false,"billingCode":"80202","codeType":"CPT"},{"id":5058,"precertRequired":false,"billingCode":"80307","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5217,"precertRequired":true,"billingCode":"81256","codeType":"CPT"},{"id":5379,"precertRequired":false,"billingCode":"82088","codeType":"CPT"},{"id":5380,"precertRequired":false,"billingCode":"82103","codeType":"CPT"},{"id":5381,"precertRequired":false,"billingCode":"82104","codeType":"CPT"},{"id":5382,"precertRequired":false,"billingCode":"82105","codeType":"CPT"},{"id":5393,"precertRequired":false,"billingCode":"82140","codeType":"CPT"},{"id":5395,"precertRequired":false,"billingCode":"82150","codeType":"CPT"},{"id":5401,"precertRequired":false,"billingCode":"82172","codeType":"CPT"},{"id":5405,"precertRequired":false,"billingCode":"82232","codeType":"CPT"},{"id":5408,"precertRequired":false,"billingCode":"82247","codeType":"CPT"},{"id":5439,"precertRequired":false,"billingCode":"82390","codeType":"CPT"},{"id":5446,"precertRequired":false,"billingCode":"82465","codeType":"CPT"},{"id":5453,"precertRequired":false,"billingCode":"82525","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5463,"precertRequired":false,"billingCode":"82565","codeType":"CPT"},{"id":5467,"precertRequired":false,"billingCode":"82595","codeType":"CPT"},{"id":5496,"precertRequired":false,"billingCode":"82728","codeType":"CPT"},{"id":5507,"precertRequired":false,"billingCode":"82784","codeType":"CPT"},{"id":5508,"precertRequired":false,"billingCode":"82785","codeType":"CPT"},{"id":5509,"precertRequired":false,"billingCode":"82787","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5528,"precertRequired":false,"billingCode":"82962","codeType":"CPT"},{"id":5531,"precertRequired":false,"billingCode":"82977","codeType":"CPT"},{"id":5540,"precertRequired":false,"billingCode":"83010","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5570,"precertRequired":false,"billingCode":"83516","codeType":"CPT"},{"id":5577,"precertRequired":false,"billingCode":"83540","codeType":"CPT"},{"id":5578,"precertRequired":false,"billingCode":"83550","codeType":"CPT"},{"id":5584,"precertRequired":false,"billingCode":"83615","codeType":"CPT"},{"id":5597,"precertRequired":false,"billingCode":"83690","codeType":"CPT"},{"id":5607,"precertRequired":false,"billingCode":"83735","codeType":"CPT"},{"id":5623,"precertRequired":false,"billingCode":"83915","codeType":"CPT"},{"id":5643,"precertRequired":false,"billingCode":"84075","codeType":"CPT"},{"id":5645,"precertRequired":false,"billingCode":"84080","codeType":"CPT"},{"id":5671,"precertRequired":false,"billingCode":"84155","codeType":"CPT"},{"id":5674,"precertRequired":false,"billingCode":"84160","codeType":"CPT"},{"id":5676,"precertRequired":false,"billingCode":"84165","codeType":"CPT"},{"id":5720,"precertRequired":false,"billingCode":"84439","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5726,"precertRequired":false,"billingCode":"84450","codeType":"CPT"},{"id":5727,"precertRequired":false,"billingCode":"84460","codeType":"CPT"},{"id":5729,"precertRequired":false,"billingCode":"84478","codeType":"CPT"},{"id":5735,"precertRequired":false,"billingCode":"84485","codeType":"CPT"},{"id":5744,"precertRequired":false,"billingCode":"84550","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5855,"precertRequired":false,"billingCode":"85651","codeType":"CPT"},{"id":5856,"precertRequired":false,"billingCode":"85652","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5873,"precertRequired":false,"billingCode":"86038","codeType":"CPT"},{"id":5874,"precertRequired":false,"billingCode":"86039","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5900,"precertRequired":false,"billingCode":"86255","codeType":"CPT"},{"id":5901,"precertRequired":false,"billingCode":"86256","codeType":"CPT"},{"id":5913,"precertRequired":false,"billingCode":"86317","codeType":"CPT"},{"id":5921,"precertRequired":false,"billingCode":"86334","codeType":"CPT"},{"id":5931,"precertRequired":false,"billingCode":"86355","codeType":"CPT"},{"id":5933,"precertRequired":false,"billingCode":"86357","codeType":"CPT"},{"id":5934,"precertRequired":false,"billingCode":"86359","codeType":"CPT"},{"id":5935,"precertRequired":false,"billingCode":"86360","codeType":"CPT"},{"id":5938,"precertRequired":false,"billingCode":"86376","codeType":"CPT"},{"id":5946,"precertRequired":false,"billingCode":"86480","codeType":"CPT"},{"id":5954,"precertRequired":false,"billingCode":"86592","codeType":"CPT"},{"id":5955,"precertRequired":false,"billingCode":"86593","codeType":"CPT"},{"id":5956,"precertRequired":false,"billingCode":"86602","codeType":"CPT"},{"id":5957,"precertRequired":false,"billingCode":"86603","codeType":"CPT"},{"id":5958,"precertRequired":false,"billingCode":"86606","codeType":"CPT"},{"id":5959,"precertRequired":false,"billingCode":"86609","codeType":"CPT"},{"id":5960,"precertRequired":false,"billingCode":"86611","codeType":"CPT"},{"id":5961,"precertRequired":false,"billingCode":"86612","codeType":"CPT"},{"id":5962,"precertRequired":false,"billingCode":"86615","codeType":"CPT"},{"id":5963,"precertRequired":false,"billingCode":"86617","codeType":"CPT"},{"id":5964,"precertRequired":false,"billingCode":"86618","codeType":"CPT"},{"id":5965,"precertRequired":false,"billingCode":"86619","codeType":"CPT"},{"id":5966,"precertRequired":false,"billingCode":"86622","codeType":"CPT"},{"id":5967,"precertRequired":false,"billingCode":"86625","codeType":"CPT"},{"id":5968,"precertRequired":false,"billingCode":"86628","codeType":"CPT"},{"id":5969,"precertRequired":false,"billingCode":"86631","codeType":"CPT"},{"id":5970,"precertRequired":false,"billingCode":"86632","codeType":"CPT"},{"id":5971,"precertRequired":false,"billingCode":"86635","codeType":"CPT"},{"id":5972,"precertRequired":false,"billingCode":"86638","codeType":"CPT"},{"id":5973,"precertRequired":false,"billingCode":"86641","codeType":"CPT"},{"id":5974,"precertRequired":false,"billingCode":"86644","codeType":"CPT"},{"id":5975,"precertRequired":false,"billingCode":"86645","codeType":"CPT"},{"id":5976,"precertRequired":false,"billingCode":"86648","codeType":"CPT"},{"id":5977,"precertRequired":false,"billingCode":"86651","codeType":"CPT"},{"id":5978,"precertRequired":false,"billingCode":"86652","codeType":"CPT"},{"id":5979,"precertRequired":false,"billingCode":"86653","codeType":"CPT"},{"id":5980,"precertRequired":false,"billingCode":"86654","codeType":"CPT"},{"id":5981,"precertRequired":false,"billingCode":"86658","codeType":"CPT"},{"id":5982,"precertRequired":false,"billingCode":"86663","codeType":"CPT"},{"id":5983,"precertRequired":false,"billingCode":"86664","codeType":"CPT"},{"id":5984,"precertRequired":false,"billingCode":"86665","codeType":"CPT"},{"id":5985,"precertRequired":false,"billingCode":"86666","codeType":"CPT"},{"id":5986,"precertRequired":false,"billingCode":"86668","codeType":"CPT"},{"id":5987,"precertRequired":false,"billingCode":"86671","codeType":"CPT"},{"id":5988,"precertRequired":false,"billingCode":"86674","codeType":"CPT"},{"id":5989,"precertRequired":false,"billingCode":"86677","codeType":"CPT"},{"id":5990,"precertRequired":false,"billingCode":"86682","codeType":"CPT"},{"id":5991,"precertRequired":false,"billingCode":"86684","codeType":"CPT"},{"id":5992,"precertRequired":false,"billingCode":"86687","codeType":"CPT"},{"id":5993,"precertRequired":false,"billingCode":"86688","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":5995,"precertRequired":false,"billingCode":"86692","codeType":"CPT"},{"id":5996,"precertRequired":false,"billingCode":"86694","codeType":"CPT"},{"id":5997,"precertRequired":false,"billingCode":"86695","codeType":"CPT"},{"id":5998,"precertRequired":false,"billingCode":"86696","codeType":"CPT"},{"id":5999,"precertRequired":false,"billingCode":"86698","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6003,"precertRequired":false,"billingCode":"86704","codeType":"CPT"},{"id":6004,"precertRequired":false,"billingCode":"86705","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6006,"precertRequired":false,"billingCode":"86707","codeType":"CPT"},{"id":6007,"precertRequired":false,"billingCode":"86708","codeType":"CPT"},{"id":6008,"precertRequired":false,"billingCode":"86709","codeType":"CPT"},{"id":6009,"precertRequired":false,"billingCode":"86710","codeType":"CPT"},{"id":6010,"precertRequired":false,"billingCode":"86711","codeType":"CPT"},{"id":6011,"precertRequired":false,"billingCode":"86713","codeType":"CPT"},{"id":6012,"precertRequired":false,"billingCode":"86717","codeType":"CPT"},{"id":6013,"precertRequired":false,"billingCode":"86720","codeType":"CPT"},{"id":6014,"precertRequired":false,"billingCode":"86723","codeType":"CPT"},{"id":6015,"precertRequired":false,"billingCode":"86727","codeType":"CPT"},{"id":6016,"precertRequired":false,"billingCode":"86732","codeType":"CPT"},{"id":6017,"precertRequired":false,"billingCode":"86735","codeType":"CPT"},{"id":6018,"precertRequired":false,"billingCode":"86738","codeType":"CPT"},{"id":6019,"precertRequired":false,"billingCode":"86741","codeType":"CPT"},{"id":6020,"precertRequired":false,"billingCode":"86744","codeType":"CPT"},{"id":6021,"precertRequired":false,"billingCode":"86747","codeType":"CPT"},{"id":6022,"precertRequired":false,"billingCode":"86750","codeType":"CPT"},{"id":6023,"precertRequired":false,"billingCode":"86753","codeType":"CPT"},{"id":6024,"precertRequired":false,"billingCode":"86756","codeType":"CPT"},{"id":6025,"precertRequired":false,"billingCode":"86757","codeType":"CPT"},{"id":6026,"precertRequired":false,"billingCode":"86759","codeType":"CPT"},{"id":6027,"precertRequired":false,"billingCode":"86762","codeType":"CPT"},{"id":6028,"precertRequired":false,"billingCode":"86765","codeType":"CPT"},{"id":6030,"precertRequired":false,"billingCode":"86771","codeType":"CPT"},{"id":6031,"precertRequired":false,"billingCode":"86774","codeType":"CPT"},{"id":6032,"precertRequired":false,"billingCode":"86777","codeType":"CPT"},{"id":6033,"precertRequired":false,"billingCode":"86778","codeType":"CPT"},{"id":6034,"precertRequired":false,"billingCode":"86780","codeType":"CPT"},{"id":6035,"precertRequired":false,"billingCode":"86784","codeType":"CPT"},{"id":6036,"precertRequired":false,"billingCode":"86787","codeType":"CPT"},{"id":6037,"precertRequired":false,"billingCode":"86788","codeType":"CPT"},{"id":6038,"precertRequired":false,"billingCode":"86789","codeType":"CPT"},{"id":6039,"precertRequired":false,"billingCode":"86790","codeType":"CPT"},{"id":6040,"precertRequired":false,"billingCode":"86793","codeType":"CPT"},{"id":6041,"precertRequired":false,"billingCode":"86794","codeType":"CPT"},{"id":6043,"precertRequired":false,"billingCode":"86803","codeType":"CPT"},{"id":6044,"precertRequired":false,"billingCode":"86804","codeType":"CPT"},{"id":6071,"precertRequired":false,"billingCode":"86889","codeType":"CPT"},{"id":6105,"precertRequired":false,"billingCode":"87003","codeType":"CPT"},{"id":6106,"precertRequired":false,"billingCode":"87015","codeType":"CPT"},{"id":6107,"precertRequired":false,"billingCode":"87040","codeType":"CPT"},{"id":6108,"precertRequired":false,"billingCode":"87045","codeType":"CPT"},{"id":6109,"precertRequired":false,"billingCode":"87046","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6111,"precertRequired":false,"billingCode":"87071","codeType":"CPT"},{"id":6112,"precertRequired":false,"billingCode":"87073","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6114,"precertRequired":false,"billingCode":"87076","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":6118,"precertRequired":false,"billingCode":"87086","codeType":"CPT"},{"id":6119,"precertRequired":false,"billingCode":"87088","codeType":"CPT"},{"id":6120,"precertRequired":false,"billingCode":"87101","codeType":"CPT"},{"id":6121,"precertRequired":false,"billingCode":"87102","codeType":"CPT"},{"id":6122,"precertRequired":false,"billingCode":"87103","codeType":"CPT"},{"id":6123,"precertRequired":false,"billingCode":"87106","codeType":"CPT"},{"id":6124,"precertRequired":false,"billingCode":"87107","codeType":"CPT"},{"id":6125,"precertRequired":false,"billingCode":"87109","codeType":"CPT"},{"id":6126,"precertRequired":false,"billingCode":"87110","codeType":"CPT"},{"id":6127,"precertRequired":false,"billingCode":"87116","codeType":"CPT"},{"id":6128,"precertRequired":false,"billingCode":"87118","codeType":"CPT"},{"id":6129,"precertRequired":false,"billingCode":"87140","codeType":"CPT"},{"id":6130,"precertRequired":false,"billingCode":"87143","codeType":"CPT"},{"id":6131,"precertRequired":false,"billingCode":"87147","codeType":"CPT"},{"id":6132,"precertRequired":false,"billingCode":"87149","codeType":"CPT"},{"id":6133,"precertRequired":false,"billingCode":"87150","codeType":"CPT"},{"id":6134,"precertRequired":false,"billingCode":"87152","codeType":"CPT"},{"id":6135,"precertRequired":false,"billingCode":"87153","codeType":"CPT"},{"id":6136,"precertRequired":false,"billingCode":"87158","codeType":"CPT"},{"id":6137,"precertRequired":false,"billingCode":"87164","codeType":"CPT"},{"id":6138,"precertRequired":false,"billingCode":"87166","codeType":"CPT"},{"id":6139,"precertRequired":false,"billingCode":"87168","codeType":"CPT"},{"id":6140,"precertRequired":false,"billingCode":"87169","codeType":"CPT"},{"id":6141,"precertRequired":false,"billingCode":"87172","codeType":"CPT"},{"id":6142,"precertRequired":false,"billingCode":"87176","codeType":"CPT"},{"id":6143,"precertRequired":false,"billingCode":"87177","codeType":"CPT"},{"id":6144,"precertRequired":false,"billingCode":"87181","codeType":"CPT"},{"id":6145,"precertRequired":false,"billingCode":"87184","codeType":"CPT"},{"id":6146,"precertRequired":false,"billingCode":"87185","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6148,"precertRequired":false,"billingCode":"87187","codeType":"CPT"},{"id":6149,"precertRequired":false,"billingCode":"87188","codeType":"CPT"},{"id":6150,"precertRequired":false,"billingCode":"87190","codeType":"CPT"},{"id":6151,"precertRequired":false,"billingCode":"87197","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6153,"precertRequired":false,"billingCode":"87206","codeType":"CPT"},{"id":6154,"precertRequired":false,"billingCode":"87207","codeType":"CPT"},{"id":6155,"precertRequired":false,"billingCode":"87209","codeType":"CPT"},{"id":6156,"precertRequired":false,"billingCode":"87210","codeType":"CPT"},{"id":6157,"precertRequired":false,"billingCode":"87220","codeType":"CPT"},{"id":6158,"precertRequired":false,"billingCode":"87230","codeType":"CPT"},{"id":6159,"precertRequired":false,"billingCode":"87250","codeType":"CPT"},{"id":6160,"precertRequired":false,"billingCode":"87252","codeType":"CPT"},{"id":6161,"precertRequired":false,"billingCode":"87253","codeType":"CPT"},{"id":6162,"precertRequired":false,"billingCode":"87254","codeType":"CPT"},{"id":6163,"precertRequired":false,"billingCode":"87255","codeType":"CPT"},{"id":6164,"precertRequired":false,"billingCode":"87260","codeType":"CPT"},{"id":6165,"precertRequired":false,"billingCode":"87265","codeType":"CPT"},{"id":6166,"precertRequired":false,"billingCode":"87267","codeType":"CPT"},{"id":6167,"precertRequired":false,"billingCode":"87269","codeType":"CPT"},{"id":6168,"precertRequired":false,"billingCode":"87270","codeType":"CPT"},{"id":6169,"precertRequired":false,"billingCode":"87271","codeType":"CPT"},{"id":6170,"precertRequired":false,"billingCode":"87272","codeType":"CPT"},{"id":6171,"precertRequired":false,"billingCode":"87273","codeType":"CPT"},{"id":6172,"precertRequired":false,"billingCode":"87274","codeType":"CPT"},{"id":6173,"precertRequired":false,"billingCode":"87275","codeType":"CPT"},{"id":6174,"precertRequired":false,"billingCode":"87276","codeType":"CPT"},{"id":6175,"precertRequired":false,"billingCode":"87278","codeType":"CPT"},{"id":6176,"precertRequired":false,"billingCode":"87279","codeType":"CPT"},{"id":6177,"precertRequired":false,"billingCode":"87280","codeType":"CPT"},{"id":6178,"precertRequired":false,"billingCode":"87281","codeType":"CPT"},{"id":6179,"precertRequired":false,"billingCode":"87283","codeType":"CPT"},{"id":6180,"precertRequired":false,"billingCode":"87285","codeType":"CPT"},{"id":6181,"precertRequired":false,"billingCode":"87290","codeType":"CPT"},{"id":6183,"precertRequired":false,"billingCode":"87300","codeType":"CPT"},{"id":6184,"precertRequired":false,"billingCode":"87301","codeType":"CPT"},{"id":6185,"precertRequired":false,"billingCode":"87305","codeType":"CPT"},{"id":6186,"precertRequired":false,"billingCode":"87320","codeType":"CPT"},{"id":6187,"precertRequired":false,"billingCode":"87324","codeType":"CPT"},{"id":6188,"precertRequired":false,"billingCode":"87327","codeType":"CPT"},{"id":6189,"precertRequired":false,"billingCode":"87328","codeType":"CPT"},{"id":6190,"precertRequired":false,"billingCode":"87329","codeType":"CPT"},{"id":6191,"precertRequired":false,"billingCode":"87332","codeType":"CPT"},{"id":6192,"precertRequired":false,"billingCode":"87335","codeType":"CPT"},{"id":6193,"precertRequired":false,"billingCode":"87336","codeType":"CPT"},{"id":6194,"precertRequired":false,"billingCode":"87337","codeType":"CPT"},{"id":6195,"precertRequired":false,"billingCode":"87338","codeType":"CPT"},{"id":6196,"precertRequired":false,"billingCode":"87339","codeType":"CPT"},{"id":6197,"precertRequired":false,"billingCode":"87340","codeType":"CPT"},{"id":6198,"precertRequired":false,"billingCode":"87341","codeType":"CPT"},{"id":6199,"precertRequired":false,"billingCode":"87350","codeType":"CPT"},{"id":6200,"precertRequired":false,"billingCode":"87380","codeType":"CPT"},{"id":6201,"precertRequired":false,"billingCode":"87385","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6203,"precertRequired":false,"billingCode":"87390","codeType":"CPT"},{"id":6204,"precertRequired":false,"billingCode":"87391","codeType":"CPT"},{"id":6205,"precertRequired":false,"billingCode":"87400","codeType":"CPT"},{"id":6206,"precertRequired":false,"billingCode":"87420","codeType":"CPT"},{"id":6207,"precertRequired":false,"billingCode":"87425","codeType":"CPT"},{"id":6208,"precertRequired":false,"billingCode":"87427","codeType":"CPT"},{"id":6209,"precertRequired":false,"billingCode":"87430","codeType":"CPT"},{"id":6210,"precertRequired":false,"billingCode":"87449","codeType":"CPT"},{"id":6211,"precertRequired":false,"billingCode":"87450","codeType":"CPT"},{"id":6212,"precertRequired":false,"billingCode":"87451","codeType":"CPT"},{"id":6213,"precertRequired":false,"billingCode":"87471","codeType":"CPT"},{"id":6214,"precertRequired":false,"billingCode":"87472","codeType":"CPT"},{"id":6215,"precertRequired":false,"billingCode":"87475","codeType":"CPT"},{"id":6216,"precertRequired":false,"billingCode":"87476","codeType":"CPT"},{"id":6217,"precertRequired":false,"billingCode":"87480","codeType":"CPT"},{"id":6218,"precertRequired":false,"billingCode":"87481","codeType":"CPT"},{"id":6219,"precertRequired":false,"billingCode":"87482","codeType":"CPT"},{"id":6220,"precertRequired":false,"billingCode":"87483","codeType":"CPT"},{"id":6221,"precertRequired":false,"billingCode":"87485","codeType":"CPT"},{"id":6222,"precertRequired":false,"billingCode":"87486","codeType":"CPT"},{"id":6223,"precertRequired":false,"billingCode":"87487","codeType":"CPT"},{"id":6224,"precertRequired":false,"billingCode":"87490","codeType":"CPT"},{"id":6225,"precertRequired":false,"billingCode":"87491","codeType":"CPT"},{"id":6226,"precertRequired":false,"billingCode":"87492","codeType":"CPT"},{"id":6227,"precertRequired":false,"billingCode":"87493","codeType":"CPT"},{"id":6228,"precertRequired":false,"billingCode":"87495","codeType":"CPT"},{"id":6229,"precertRequired":false,"billingCode":"87496","codeType":"CPT"},{"id":6230,"precertRequired":false,"billingCode":"87497","codeType":"CPT"},{"id":6231,"precertRequired":false,"billingCode":"87498","codeType":"CPT"},{"id":6232,"precertRequired":false,"billingCode":"87500","codeType":"CPT"},{"id":6233,"precertRequired":false,"billingCode":"87501","codeType":"CPT"},{"id":6234,"precertRequired":false,"billingCode":"87502","codeType":"CPT"},{"id":6235,"precertRequired":false,"billingCode":"87503","codeType":"CPT"},{"id":6236,"precertRequired":false,"billingCode":"87505","codeType":"CPT"},{"id":6237,"precertRequired":false,"billingCode":"87506","codeType":"CPT"},{"id":6238,"precertRequired":false,"billingCode":"87507","codeType":"CPT"},{"id":6239,"precertRequired":false,"billingCode":"87510","codeType":"CPT"},{"id":6240,"precertRequired":false,"billingCode":"87511","codeType":"CPT"},{"id":6241,"precertRequired":false,"billingCode":"87512","codeType":"CPT"},{"id":6242,"precertRequired":false,"billingCode":"87516","codeType":"CPT"},{"id":6243,"precertRequired":false,"billingCode":"87517","codeType":"CPT"},{"id":6244,"precertRequired":false,"billingCode":"87520","codeType":"CPT"},{"id":6245,"precertRequired":false,"billingCode":"87521","codeType":"CPT"},{"id":6246,"precertRequired":false,"billingCode":"87522","codeType":"CPT"},{"id":6247,"precertRequired":false,"billingCode":"87525","codeType":"CPT"},{"id":6248,"precertRequired":false,"billingCode":"87526","codeType":"CPT"},{"id":6249,"precertRequired":false,"billingCode":"87527","codeType":"CPT"},{"id":6250,"precertRequired":false,"billingCode":"87528","codeType":"CPT"},{"id":6251,"precertRequired":false,"billingCode":"87529","codeType":"CPT"},{"id":6252,"precertRequired":false,"billingCode":"87530","codeType":"CPT"},{"id":6253,"precertRequired":false,"billingCode":"87531","codeType":"CPT"},{"id":6254,"precertRequired":false,"billingCode":"87532","codeType":"CPT"},{"id":6255,"precertRequired":false,"billingCode":"87533","codeType":"CPT"},{"id":6256,"precertRequired":false,"billingCode":"87534","codeType":"CPT"},{"id":6257,"precertRequired":false,"billingCode":"87535","codeType":"CPT"},{"id":6258,"precertRequired":false,"billingCode":"87536","codeType":"CPT"},{"id":6259,"precertRequired":false,"billingCode":"87537","codeType":"CPT"},{"id":6260,"precertRequired":false,"billingCode":"87538","codeType":"CPT"},{"id":6261,"precertRequired":false,"billingCode":"87539","codeType":"CPT"},{"id":6262,"precertRequired":false,"billingCode":"87540","codeType":"CPT"},{"id":6263,"precertRequired":false,"billingCode":"87541","codeType":"CPT"},{"id":6264,"precertRequired":false,"billingCode":"87542","codeType":"CPT"},{"id":6265,"precertRequired":false,"billingCode":"87550","codeType":"CPT"},{"id":6266,"precertRequired":false,"billingCode":"87551","codeType":"CPT"},{"id":6267,"precertRequired":false,"billingCode":"87552","codeType":"CPT"},{"id":6268,"precertRequired":false,"billingCode":"87555","codeType":"CPT"},{"id":6269,"precertRequired":false,"billingCode":"87556","codeType":"CPT"},{"id":6270,"precertRequired":false,"billingCode":"87557","codeType":"CPT"},{"id":6271,"precertRequired":false,"billingCode":"87560","codeType":"CPT"},{"id":6272,"precertRequired":false,"billingCode":"87561","codeType":"CPT"},{"id":6273,"precertRequired":false,"billingCode":"87562","codeType":"CPT"},{"id":6274,"precertRequired":false,"billingCode":"87580","codeType":"CPT"},{"id":6275,"precertRequired":false,"billingCode":"87581","codeType":"CPT"},{"id":6276,"precertRequired":false,"billingCode":"87582","codeType":"CPT"},{"id":6277,"precertRequired":false,"billingCode":"87590","codeType":"CPT"},{"id":6278,"precertRequired":false,"billingCode":"87591","codeType":"CPT"},{"id":6279,"precertRequired":false,"billingCode":"87592","codeType":"CPT"},{"id":6280,"precertRequired":false,"billingCode":"87623","codeType":"CPT"},{"id":6281,"precertRequired":false,"billingCode":"87624","codeType":"CPT"},{"id":6282,"precertRequired":false,"billingCode":"87625","codeType":"CPT"},{"id":6283,"precertRequired":false,"billingCode":"87631","codeType":"CPT"},{"id":6284,"precertRequired":false,"billingCode":"87632","codeType":"CPT"},{"id":6285,"precertRequired":false,"billingCode":"87633","codeType":"CPT"},{"id":6286,"precertRequired":false,"billingCode":"87634","codeType":"CPT"},{"id":6287,"precertRequired":false,"billingCode":"87640","codeType":"CPT"},{"id":6288,"precertRequired":false,"billingCode":"87641","codeType":"CPT"},{"id":6289,"precertRequired":false,"billingCode":"87650","codeType":"CPT"},{"id":6290,"precertRequired":false,"billingCode":"87651","codeType":"CPT"},{"id":6291,"precertRequired":false,"billingCode":"87652","codeType":"CPT"},{"id":6292,"precertRequired":false,"billingCode":"87653","codeType":"CPT"},{"id":6293,"precertRequired":false,"billingCode":"87660","codeType":"CPT"},{"id":6294,"precertRequired":false,"billingCode":"87661","codeType":"CPT"},{"id":6295,"precertRequired":false,"billingCode":"87662","codeType":"CPT"},{"id":6296,"precertRequired":false,"billingCode":"87797","codeType":"CPT"},{"id":6299,"precertRequired":false,"billingCode":"87800","codeType":"CPT"},{"id":6300,"precertRequired":false,"billingCode":"87801","codeType":"CPT"},{"id":6301,"precertRequired":false,"billingCode":"87802","codeType":"CPT"},{"id":6302,"precertRequired":false,"billingCode":"87803","codeType":"CPT"},{"id":6303,"precertRequired":false,"billingCode":"87804","codeType":"CPT"},{"id":6304,"precertRequired":false,"billingCode":"87806","codeType":"CPT"},{"id":6305,"precertRequired":false,"billingCode":"87807","codeType":"CPT"},{"id":6306,"precertRequired":false,"billingCode":"87808","codeType":"CPT"},{"id":6307,"precertRequired":false,"billingCode":"87809","codeType":"CPT"},{"id":6308,"precertRequired":false,"billingCode":"87810","codeType":"CPT"},{"id":6309,"precertRequired":false,"billingCode":"87850","codeType":"CPT"},{"id":6310,"precertRequired":false,"billingCode":"87880","codeType":"CPT"},{"id":6312,"precertRequired":false,"billingCode":"87900","codeType":"CPT"},{"id":6313,"precertRequired":false,"billingCode":"87901","codeType":"CPT"},{"id":6314,"precertRequired":false,"billingCode":"87902","codeType":"CPT"},{"id":6315,"precertRequired":false,"billingCode":"87903","codeType":"CPT"},{"id":6316,"precertRequired":false,"billingCode":"87904","codeType":"CPT"},{"id":6317,"precertRequired":false,"billingCode":"87905","codeType":"CPT"},{"id":6318,"precertRequired":false,"billingCode":"87906","codeType":"CPT"},{"id":6319,"precertRequired":false,"billingCode":"87910","codeType":"CPT"},{"id":6320,"precertRequired":false,"billingCode":"87912","codeType":"CPT"},{"id":6341,"precertRequired":false,"billingCode":"88112","codeType":"CPT"},{"id":6348,"precertRequired":false,"billingCode":"88142","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6410,"precertRequired":false,"billingCode":"88313","codeType":"CPT"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":8214,"precertRequired":false,"billingCode":"G0435","codeType":"HCPCS"},{"id":9773,"precertRequired":false,"billingCode":"85716","codeType":"CPT"},{"id":9855,"precertRequired":false,"billingCode":"S3645","codeType":"HCPCS"},{"id":9857,"precertRequired":false,"billingCode":"86766","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1519,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1520,"description":"Age-appropriate immunizations and HIV-specific immunizations","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":6512,"precertRequired":false,"billingCode":"90371","codeType":"CPT"},{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":6532,"precertRequired":false,"billingCode":"90632","codeType":"CPT"},{"id":6533,"precertRequired":false,"billingCode":"90636","codeType":"CPT"},{"id":6541,"precertRequired":false,"billingCode":"90662","codeType":"CPT"},{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6547,"precertRequired":false,"billingCode":"90686","codeType":"CPT"},{"id":6548,"precertRequired":false,"billingCode":"90688","codeType":"CPT"},{"id":6549,"precertRequired":false,"billingCode":"90697","codeType":"CPT"},{"id":6550,"precertRequired":false,"billingCode":"90698","codeType":"CPT"},{"id":6551,"precertRequired":false,"billingCode":"90707","codeType":"CPT"},{"id":6554,"precertRequired":false,"billingCode":"90715","codeType":"CPT"},{"id":6557,"precertRequired":false,"billingCode":"90723","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":6561,"precertRequired":false,"billingCode":"90736","codeType":"CPT"},{"id":6562,"precertRequired":false,"billingCode":"90739","codeType":"CPT"},{"id":6563,"precertRequired":false,"billingCode":"90740","codeType":"CPT"},{"id":6564,"precertRequired":false,"billingCode":"90746","codeType":"CPT"},{"id":6565,"precertRequired":false,"billingCode":"90747","codeType":"CPT"},{"id":6566,"precertRequired":false,"billingCode":"90748","codeType":"CPT"},{"id":8112,"precertRequired":false,"billingCode":"G0008","codeType":"HCPCS"},{"id":8113,"precertRequired":false,"billingCode":"G0009","codeType":"HCPCS"},{"id":8114,"precertRequired":false,"billingCode":"G0010","codeType":"HCPCS"},{"id":9806,"precertRequired":true,"billingCode":"J0287","codeType":"HCPCS"},{"id":9807,"precertRequired":true,"billingCode":"J0289","codeType":"HCPCS"},{"id":9809,"precertRequired":false,"billingCode":"J0390","codeType":"HCPCS"},{"id":9820,"precertRequired":false,"billingCode":"J1460","codeType":"HCPCS"},{"id":9822,"precertRequired":false,"billingCode":"J1560","codeType":"HCPCS"},{"id":9824,"precertRequired":false,"billingCode":"J1571","codeType":"HCPCS"},{"id":9825,"precertRequired":false,"billingCode":"J1573","codeType":"HCPCS"},{"id":9842,"precertRequired":true,"billingCode":"J3485","codeType":"HCPCS"},{"id":9852,"precertRequired":false,"billingCode":"S0039","codeType":"HCPCS"},{"id":9853,"precertRequired":true,"billingCode":"S0104","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1521,"description":"Screening services, including but are not limited to:  Sexually transmitted infections [STIs], cervical cancer, bone density, hepatitis, etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":4772,"precertRequired":false,"billingCode":"76977","codeType":"CPT"},{"id":4798,"precertRequired":false,"billingCode":"77078","codeType":"CPT"},{"id":4799,"precertRequired":false,"billingCode":"77080","codeType":"CPT"},{"id":4800,"precertRequired":false,"billingCode":"77081","codeType":"CPT"},{"id":4802,"precertRequired":false,"billingCode":"77085","codeType":"CPT"},{"id":4927,"precertRequired":false,"billingCode":"78350","codeType":"CPT"},{"id":4928,"precertRequired":false,"billingCode":"78351","codeType":"CPT"},{"id":6116,"precertRequired":false,"billingCode":"87081","codeType":"CPT"},{"id":6117,"precertRequired":false,"billingCode":"87084","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8224,"precertRequired":false,"billingCode":"G0472","codeType":"HCPCS"},{"id":8225,"precertRequired":false,"billingCode":"G0475","codeType":"HCPCS"},{"id":8226,"precertRequired":false,"billingCode":"G0476","codeType":"HCPCS"},{"id":8241,"precertRequired":false,"billingCode":"G0499","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1522,"description":"Medication management to include education, prescribing and monitoring of FDA approved medications.   All routine medications will be provided by the VA as prescribed by the community Infectious Disease consultant in accordance with VA national medication formulary and non-formulary request process.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":2570,"precertRequired":false,"billingCode":"36569","codeType":"CPT"},{"id":2582,"precertRequired":false,"billingCode":"36589","codeType":"CPT"},{"id":2586,"precertRequired":false,"billingCode":"36593","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7190,"precertRequired":false,"billingCode":"96366","codeType":"CPT"},{"id":7191,"precertRequired":false,"billingCode":"96367","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7197,"precertRequired":false,"billingCode":"96373","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":7219,"precertRequired":false,"billingCode":"96521","codeType":"CPT"},{"id":8389,"precertRequired":false,"billingCode":"J0696","codeType":"HCPCS"},{"id":8391,"precertRequired":false,"billingCode":"J0713","codeType":"HCPCS"},{"id":8396,"precertRequired":false,"billingCode":"J0878","codeType":"HCPCS"},{"id":8428,"precertRequired":false,"billingCode":"J1442","codeType":"HCPCS"},{"id":8441,"precertRequired":false,"billingCode":"J1642","codeType":"HCPCS"},{"id":8442,"precertRequired":false,"billingCode":"J1644","codeType":"HCPCS"},{"id":8511,"precertRequired":false,"billingCode":"J3370","codeType":"HCPCS"},{"id":8522,"precertRequired":false,"billingCode":"J7030","codeType":"HCPCS"},{"id":8523,"precertRequired":false,"billingCode":"J7040","codeType":"HCPCS"},{"id":8525,"precertRequired":true,"billingCode":"J7050","codeType":"HCPCS"},{"id":8592,"precertRequired":false,"billingCode":"J9040","codeType":"HCPCS"},{"id":8609,"precertRequired":false,"billingCode":"J9151","codeType":"HCPCS"},{"id":8633,"precertRequired":false,"billingCode":"J9215","codeType":"HCPCS"},{"id":9804,"precertRequired":false,"billingCode":"J0278","codeType":"HCPCS"},{"id":9806,"precertRequired":true,"billingCode":"J0287","codeType":"HCPCS"},{"id":9807,"precertRequired":true,"billingCode":"J0289","codeType":"HCPCS"},{"id":9808,"precertRequired":false,"billingCode":"J0295","codeType":"HCPCS"},{"id":9810,"precertRequired":false,"billingCode":"J0690","codeType":"HCPCS"},{"id":9811,"precertRequired":false,"billingCode":"J0692","codeType":"HCPCS"},{"id":9812,"precertRequired":false,"billingCode":"J0744","codeType":"HCPCS"},{"id":9814,"precertRequired":false,"billingCode":"J1324","codeType":"HCPCS"},{"id":9815,"precertRequired":false,"billingCode":"J1335","codeType":"HCPCS"},{"id":9818,"precertRequired":false,"billingCode":"J1450","codeType":"HCPCS"},{"id":9830,"precertRequired":false,"billingCode":"J2185","codeType":"HCPCS"},{"id":9837,"precertRequired":false,"billingCode":"J2543","codeType":"HCPCS"},{"id":9842,"precertRequired":true,"billingCode":"J3485","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1523,"description":" Assessment of ongoing sexual and drug-use behaviors, and counseling or other interventions to reduce transmission behaviors","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":7457,"precertRequired":false,"billingCode":"99403","codeType":"CPT"},{"id":7458,"precertRequired":false,"billingCode":"99404","codeType":"CPT"},{"id":7463,"precertRequired":false,"billingCode":"99411","codeType":"CPT"},{"id":7464,"precertRequired":false,"billingCode":"99412","codeType":"CPT"},{"id":9024,"precertRequired":false,"billingCode":"S9445","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1524,"description":"Follow-up imaging as relevant to the patient condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4398,"precertRequired":false,"billingCode":"70450","codeType":"CPT"},{"id":4399,"precertRequired":false,"billingCode":"70460","codeType":"CPT"},{"id":4400,"precertRequired":false,"billingCode":"70470","codeType":"CPT"},{"id":4421,"precertRequired":true,"billingCode":"70551","codeType":"CPT"},{"id":4422,"precertRequired":true,"billingCode":"70552","codeType":"CPT"},{"id":4423,"precertRequired":true,"billingCode":"70553","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":4441,"precertRequired":true,"billingCode":"71250","codeType":"CPT"},{"id":4553,"precertRequired":false,"billingCode":"73630","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4692,"precertRequired":false,"billingCode":"76000","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4898,"precertRequired":false,"billingCode":"78201","codeType":"CPT"},{"id":4899,"precertRequired":false,"billingCode":"78202","codeType":"CPT"},{"id":4900,"precertRequired":false,"billingCode":"78205","codeType":"CPT"},{"id":4901,"precertRequired":false,"billingCode":"78206","codeType":"CPT"},{"id":4902,"precertRequired":false,"billingCode":"78215","codeType":"CPT"},{"id":4903,"precertRequired":false,"billingCode":"78216","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":1525,"description":"Follow-up studies as relevant to the patient condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":246,"precertRequired":false,"billingCode":"11042","codeType":"CPT"},{"id":247,"precertRequired":false,"billingCode":"11043","codeType":"CPT"},{"id":2787,"precertRequired":false,"billingCode":"43233","codeType":"CPT"},{"id":2788,"precertRequired":true,"billingCode":"43235","codeType":"CPT"},{"id":2789,"precertRequired":false,"billingCode":"43236","codeType":"CPT"},{"id":2792,"precertRequired":true,"billingCode":"43239","codeType":"CPT"},{"id":2794,"precertRequired":false,"billingCode":"43241","codeType":"CPT"},{"id":2796,"precertRequired":false,"billingCode":"43243","codeType":"CPT"},{"id":2797,"precertRequired":false,"billingCode":"43244","codeType":"CPT"},{"id":2798,"precertRequired":false,"billingCode":"43245","codeType":"CPT"},{"id":2799,"precertRequired":false,"billingCode":"43246","codeType":"CPT"},{"id":2800,"precertRequired":false,"billingCode":"43247","codeType":"CPT"},{"id":2801,"precertRequired":false,"billingCode":"43248","codeType":"CPT"},{"id":2802,"precertRequired":true,"billingCode":"43249","codeType":"CPT"},{"id":2803,"precertRequired":false,"billingCode":"43250","codeType":"CPT"},{"id":2804,"precertRequired":false,"billingCode":"43251","codeType":"CPT"},{"id":2805,"precertRequired":false,"billingCode":"43252","codeType":"CPT"},{"id":2807,"precertRequired":false,"billingCode":"43254","codeType":"CPT"},{"id":2808,"precertRequired":false,"billingCode":"43255","codeType":"CPT"},{"id":2809,"precertRequired":false,"billingCode":"43257","codeType":"CPT"},{"id":2817,"precertRequired":false,"billingCode":"43266","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3880,"precertRequired":true,"billingCode":"62270","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6422,"precertRequired":false,"billingCode":"88342","codeType":"CPT"},{"id":6458,"precertRequired":false,"billingCode":"89051","codeType":"CPT"},{"id":6638,"precertRequired":false,"billingCode":"91200","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":7281,"precertRequired":false,"billingCode":"97597","codeType":"CPT"},{"id":9766,"precertRequired":false,"billingCode":"76391","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1526,"description":" Interventional procedures to treat decompensated cirrhosis, including but not limited to: paracentesis, TIPS shunts, and tunneled drainage catheter ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"94-Interventional radiology"}],"billingCodes":[{"id":221,"precertRequired":false,"billingCode":"10021","codeType":"CPT"},{"id":2622,"precertRequired":false,"billingCode":"37182","codeType":"CPT"},{"id":2623,"precertRequired":false,"billingCode":"37183","codeType":"CPT"},{"id":3224,"precertRequired":false,"billingCode":"47000","codeType":"CPT"},{"id":3225,"precertRequired":false,"billingCode":"47001","codeType":"CPT"},{"id":3250,"precertRequired":false,"billingCode":"47382","codeType":"CPT"},{"id":3336,"precertRequired":false,"billingCode":"49082","codeType":"CPT"},{"id":3338,"precertRequired":false,"billingCode":"49084","codeType":"CPT"},{"id":3358,"precertRequired":false,"billingCode":"49405","codeType":"CPT"},{"id":3363,"precertRequired":false,"billingCode":"49418","codeType":"CPT"},{"id":7189,"precertRequired":false,"billingCode":"96365","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7198,"precertRequired":false,"billingCode":"96374","codeType":"CPT"},{"id":7199,"precertRequired":false,"billingCode":"96375","codeType":"CPT"},{"id":9153,"precertRequired":false,"billingCode":"10004","codeType":"CPT"},{"id":9154,"precertRequired":false,"billingCode":"10005","codeType":"CPT"},{"id":9155,"precertRequired":false,"billingCode":"10006","codeType":"CPT"},{"id":9156,"precertRequired":true,"billingCode":"10007","codeType":"CPT"},{"id":9157,"precertRequired":true,"billingCode":"10008","codeType":"CPT"},{"id":9158,"precertRequired":true,"billingCode":"10009","codeType":"CPT"},{"id":9159,"precertRequired":true,"billingCode":"10010","codeType":"CPT"},{"id":9160,"precertRequired":true,"billingCode":"10011","codeType":"CPT"},{"id":9161,"precertRequired":true,"billingCode":"10012","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085H0002X"},{"HPTC":"2085R0204X"}]},{"id":1527,"description":" Anesthesia consultation related to the procedure ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":70,"precertRequired":false,"billingCode":"00702","codeType":"CPT"},{"id":80,"precertRequired":false,"billingCode":"00792","codeType":"CPT"},{"id":194,"precertRequired":false,"billingCode":"01922","codeType":"CPT"},{"id":198,"precertRequired":false,"billingCode":"01930","codeType":"CPT"},{"id":199,"precertRequired":false,"billingCode":"01931","codeType":"CPT"},{"id":7334,"precertRequired":false,"billingCode":"99152","codeType":"CPT"},{"id":7335,"precertRequired":false,"billingCode":"99153","codeType":"CPT"},{"id":7336,"precertRequired":false,"billingCode":"99156","codeType":"CPT"},{"id":7337,"precertRequired":false,"billingCode":"99157","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":1528,"description":"Pre-procedure medical clearance as indicated (including H+P/labs, EKG, CXR) ","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5153,"precertRequired":false,"billingCode":"81099","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"},{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1529,"description":"Inpatient or observation admission for procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1530,"description":" Inpatient or observation admission for procedure complications ** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial procedure","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]}]}},{"Seoc":{"id":268,"seocKey":66,"name":"Infectious Disease_PRCT","seocId":"MSC_INFECTIOUS DISEASE_1.0.2_PRCT","versionNumber":"1.0.2","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"01-02-2019","endDate":"03-12-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic studies, labs and pathology services relevant to the patient complaint/condition\r\n3. Follow-up visits for this episode of care","maxAllowableVisits":null,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"INFECTIOUS DISEASE","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207RI0200X"}],"services":[{"id":1109,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":6532,"precertRequired":false,"billingCode":"90632","codeType":"CPT"},{"id":6533,"precertRequired":false,"billingCode":"90636","codeType":"CPT"},{"id":6536,"precertRequired":false,"billingCode":"90656","codeType":"CPT"},{"id":6538,"precertRequired":false,"billingCode":"90658","codeType":"CPT"},{"id":6540,"precertRequired":false,"billingCode":"90661","codeType":"CPT"},{"id":6541,"precertRequired":false,"billingCode":"90662","codeType":"CPT"},{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6551,"precertRequired":false,"billingCode":"90707","codeType":"CPT"},{"id":6553,"precertRequired":false,"billingCode":"90714","codeType":"CPT"},{"id":6554,"precertRequired":false,"billingCode":"90715","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":6561,"precertRequired":false,"billingCode":"90736","codeType":"CPT"},{"id":6564,"precertRequired":false,"billingCode":"90746","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":9024,"precertRequired":false,"billingCode":"S9445","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":1110,"description":"Diagnostic studies, labs and pathology services relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":1111,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":6,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"207RI0200X"}]}]}},{"Seoc":{"id":36,"seocKey":66,"name":"Infectious Disease_PRCT","seocId":"MSC_INFECTIOUS DISEASE_1.0.1_PRCT","versionNumber":"1.0.1","description":"This authorization covers services associated with all medical care listed below for the referred condition.","effectiveDate":"11-01-2017","endDate":"01-02-2019","duration":90,"REV":false,"PRCT":true,"proceduralOverview":"1. Initial outpatient evaluation and treatment for the referred condition indicated on the consult\r\n2. Diagnostic studies, labs and pathology services relevant to the patient complaint/condition\r\n3. Follow-up visits for this episode of care","maxAllowableVisits":999,"disclaimer":"**Additional consultations needed relevant to the patient complaint/condition require VA review and approval.\r\n**DME, prosthetics and orthotics orders must be submitted to the local VA facility prosthetics department for provision.\r\n**All routine medications must be faxed/sent to the VA to be dispensed by the VA.\r\nUrgent/emergent prescriptions can be provided for a 14-day supply only.\r\nThe Veteran will be required to pay out of pocket for any urgent/emergent medications and can submit a reimbursement request to their local VA facility.","QASP":"General Care","categoryOfCare":"INFECTIOUS DISEASE","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"103GC0700X"}],"services":[{"id":223,"description":"Initial outpatient evaluation and treatment for the referred condition indicated on the consult","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[{"id":6524,"precertRequired":false,"billingCode":"90471","codeType":"CPT"},{"id":6525,"precertRequired":false,"billingCode":"90472","codeType":"CPT"},{"id":6532,"precertRequired":false,"billingCode":"90632","codeType":"CPT"},{"id":6533,"precertRequired":false,"billingCode":"90636","codeType":"CPT"},{"id":6536,"precertRequired":false,"billingCode":"90656","codeType":"CPT"},{"id":6538,"precertRequired":false,"billingCode":"90658","codeType":"CPT"},{"id":6540,"precertRequired":false,"billingCode":"90661","codeType":"CPT"},{"id":6541,"precertRequired":false,"billingCode":"90662","codeType":"CPT"},{"id":6545,"precertRequired":false,"billingCode":"90670","codeType":"CPT"},{"id":6551,"precertRequired":false,"billingCode":"90707","codeType":"CPT"},{"id":6553,"precertRequired":false,"billingCode":"90714","codeType":"CPT"},{"id":6554,"precertRequired":false,"billingCode":"90715","codeType":"CPT"},{"id":6558,"precertRequired":false,"billingCode":"90732","codeType":"CPT"},{"id":6561,"precertRequired":false,"billingCode":"90736","codeType":"CPT"},{"id":6564,"precertRequired":false,"billingCode":"90746","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7422,"precertRequired":false,"billingCode":"99354","codeType":"CPT"},{"id":7423,"precertRequired":false,"billingCode":"99355","codeType":"CPT"},{"id":7426,"precertRequired":false,"billingCode":"99358","codeType":"CPT"},{"id":7427,"precertRequired":false,"billingCode":"99359","codeType":"CPT"},{"id":7455,"precertRequired":false,"billingCode":"99401","codeType":"CPT"},{"id":7456,"precertRequired":false,"billingCode":"99402","codeType":"CPT"},{"id":9024,"precertRequired":false,"billingCode":"S9445","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207RI0200X"}]},{"id":224,"description":"Diagnostic studies, labs and pathology services relevant to the patient complaint/condition","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":5952,"precertRequired":false,"billingCode":"86580","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":225,"description":"Follow-up visits for this episode of care","frequency":null,"frequencyType":"","visits":6,"codeRequired":"ANY","clinicalServices":[{"clinicalService":"44-Infectious disease"}],"billingCodes":[],"serviceHptcs":[{"HPTC":"207RI0200X"}]}]}},{"Seoc":{"id":1709,"seocKey":67,"name":"Infertility-Female_PRCT","seocId":"MSC_INFERTILITY-FEMALE_1.3.6_PRCT","versionNumber":"1.3.6","description":"This authorization covers services associated with all medical care listed below for the referred condition on the consult.  Note: Separate referral/authorization required for IVF/ART. IVF/ART requires special eligibility and authorization.  Excluded services: donor sperm, donor eggs, donor embryos and surrogacy.  Female Veterans may purchase donor sperm for IUI at their own expense.","effectiveDate":"01-24-2020","endDate":null,"duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for infertility as indicated on the consult\r\n2.  Diagnostic imaging relevant to the referred condition on the consult\r\n3.  Lab and pathology services relevant to the referred condition on the consult\r\n4.  Diagnostic studies relevant to the referred condition on the consult\r\n5.  Procedures including but not limited to: ovarian stimulation, correction of a structural defect preventing successful pregnancy, Tubal Reanastomosis etc.\r\n6.   Anesthesia consultation per the referred condition indicated on the consult\r\n7.   Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR, echo). \r\n8.  Inpatient or observation admission for surgical procedure if indicated.\r\n9.  Inpatient or observation admission for complications per the referred condition indicated on the consult\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.\r\n10.  Intrauterine insemination (IUI)     \r\nNote:  Maximum of six (6) ovulatory cycles per pregnancy. Additional treatment cycles would require additional authorizations\r\nNote: Female Veterans may purchase donor sperm for IUI at their own expense.  \r\n11.    Cryopreservation techniques for medically indicated conditions.\r\nNote: Any Veteran initiating change of location requests for transportation of cryopreserved specimens will incur the cost of transportation.  \r\n12.  Follow-up visits for this episode of care as clinically indicated","maxAllowableVisits":null,"disclaimer":"* Cryopreservation storage is approved for up to 5 years for cryopreserved eggs or sperm only (no embryo) under the infertility benefit.  Cryopreservation storage services are to be payed utilizing a national contract.   Any Veteran initiating change of location requests for transportation of cryopreserved specimens will incur the cost of transportation. \r\n*The collection and processing of sperm for IUI is a covered benefit.    \r\n* Separate referral/authorization required for IVF/ART and coverage of the spouse of an eligible Veteran with service-connected infertility. IVF/ART requires special eligibility and authorization.  Excluded services: donor sperm, donor eggs, donor embryos and surrogacy.\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","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207V00000X"},{"hptc":"207VE0102X"}],"services":[{"id":4851,"description":"Initial outpatient evaluation and treatment for infertility as indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":4852,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4740,"precertRequired":false,"billingCode":"76815","codeType":"CPT"},{"id":4741,"precertRequired":false,"billingCode":"76816","codeType":"CPT"},{"id":4742,"precertRequired":false,"billingCode":"76817","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4768,"precertRequired":false,"billingCode":"76946","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":4853,"description":"Lab and pathology services relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5127,"precertRequired":false,"billingCode":"80418","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5590,"precertRequired":false,"billingCode":"83655","codeType":"CPT"},{"id":5606,"precertRequired":false,"billingCode":"83727","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5660,"precertRequired":false,"billingCode":"84135","codeType":"CPT"},{"id":5661,"precertRequired":false,"billingCode":"84138","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5666,"precertRequired":false,"billingCode":"84146","codeType":"CPT"},{"id":5718,"precertRequired":false,"billingCode":"84436","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5731,"precertRequired":false,"billingCode":"84480","codeType":"CPT"},{"id":5732,"precertRequired":false,"billingCode":"84481","codeType":"CPT"},{"id":5733,"precertRequired":false,"billingCode":"84482","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":5995,"precertRequired":false,"billingCode":"86692","codeType":"CPT"},{"id":5996,"precertRequired":false,"billingCode":"86694","codeType":"CPT"},{"id":5997,"precertRequired":false,"billingCode":"86695","codeType":"CPT"},{"id":5998,"precertRequired":false,"billingCode":"86696","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6003,"precertRequired":false,"billingCode":"86704","codeType":"CPT"},{"id":6004,"precertRequired":false,"billingCode":"86705","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6006,"precertRequired":false,"billingCode":"86707","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequired":false,"billingCode":"87070","codeType":"CPT"},{"id":6113,"precertRequired":false,"billingCode":"87075","codeType":"CPT"},{"id":6115,"precertRequired":false,"billingCode":"87077","codeType":"CPT"},{"id":6147,"precertRequired":false,"billingCode":"87186","codeType":"CPT"},{"id":6152,"precertRequired":false,"billingCode":"87205","codeType":"CPT"},{"id":6202,"precertRequired":false,"billingCode":"87389","codeType":"CPT"},{"id":6203,"precertRequired":false,"billingCode":"87390","codeType":"CPT"},{"id":6204,"precertRequired":false,"billingCode":"87391","codeType":"CPT"},{"id":6226,"precertRequired":false,"billingCode":"87492","codeType":"CPT"},{"id":6277,"precertRequired":false,"billingCode":"87590","codeType":"CPT"},{"id":6278,"precertRequired":false,"billingCode":"87591","codeType":"CPT"},{"id":6279,"precertRequired":false,"billingCode":"87592","codeType":"CPT"},{"id":6304,"precertRequired":false,"billingCode":"87806","codeType":"CPT"},{"id":6309,"precertRequired":false,"billingCode":"87850","codeType":"CPT"},{"id":6390,"precertRequired":false,"billingCode":"88269","codeType":"CPT"},{"id":6397,"precertRequired":false,"billingCode":"88283","codeType":"CPT"},{"id":6402,"precertRequired":false,"billingCode":"88300","codeType":"CPT"},{"id":6403,"precertRequired":false,"billingCode":"88302","codeType":"CPT"},{"id":6404,"precertRequired":false,"billingCode":"88304","codeType":"CPT"},{"id":6405,"precertRequired":false,"billingCode":"88305","codeType":"CPT"},{"id":6406,"precertRequired":false,"billingCode":"88307","codeType":"CPT"},{"id":6407,"precertRequired":false,"billingCode":"88309","codeType":"CPT"},{"id":6408,"precertRequired":false,"billingCode":"88311","codeType":"CPT"},{"id":6467,"precertRequired":true,"billingCode":"89250","codeType":"CPT"},{"id":6478,"precertRequired":true,"billingCode":"89268","codeType":"CPT"},{"id":6479,"precertRequired":true,"billingCode":"89272","codeType":"CPT"},{"id":6480,"precertRequired":true,"billingCode":"89280","codeType":"CPT"},{"id":6481,"precertRequired":true,"billingCode":"89281","codeType":"CPT"},{"id":6497,"precertRequired":true,"billingCode":"89344","codeType":"CPT"},{"id":6501,"precertRequired":true,"billingCode":"89354","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":8212,"precertRequired":false,"billingCode":"G0432","codeType":"HCPCS"},{"id":8213,"precertRequired":false,"billingCode":"G0433","codeType":"HCPCS"},{"id":11550,"precertRequired":false,"billingCode":"0003U","codeType":"CPT"},{"id":11958,"precertRequired":false,"billingCode":"G0434","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"291U00000X"}]},{"id":4854,"description":"Diagnostic studies relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":5154,"precertRequired":false,"billingCode":"81105","codeType":"CPT"},{"id":5155,"precertRequired":false,"billingCode":"81106","codeType":"CPT"},{"id":5156,"precertRequired":false,"billingCode":"81107","codeType":"CPT"},{"id":5157,"precertRequired":false,"billingCode":"81108","codeType":"CPT"},{"id":5158,"precertRequired":false,"billingCode":"81109","codeType":"CPT"},{"id":5159,"precertRequired":false,"billingCode":"81110","codeType":"CPT"},{"id":5160,"precertRequired":false,"billingCode":"81111","codeType":"CPT"},{"id":5161,"precertRequired":false,"billingCode":"81112","codeType":"CPT"},{"id":5163,"precertRequired":true,"billingCode":"81162","codeType":"CPT"},{"id":5178,"precertRequired":true,"billingCode":"81212","codeType":"CPT"},{"id":5181,"precertRequired":true,"billingCode":"81215","codeType":"CPT"},{"id":5182,"precertRequired":true,"billingCode":"81216","codeType":"CPT"},{"id":5183,"precertRequired":true,"billingCode":"81217","codeType":"CPT"},{"id":5186,"precertRequired":true,"billingCode":"81220","codeType":"CPT"},{"id":5187,"precertRequired":true,"billingCode":"81221","codeType":"CPT"},{"id":5188,"precertRequired":true,"billingCode":"81222","codeType":"CPT"},{"id":5189,"precertRequired":true,"billingCode":"81223","codeType":"CPT"},{"id":5190,"precertRequired":true,"billingCode":"81224","codeType":"CPT"},{"id":5195,"precertRequired":true,"billingCode":"81229","codeType":"CPT"},{"id":5296,"precertRequired":true,"billingCode":"81400","codeType":"CPT"},{"id":5297,"precertRequired":true,"billingCode":"81401","codeType":"CPT"},{"id":5298,"precertRequired":true,"billingCode":"81402","codeType":"CPT"},{"id":5299,"precertRequired":true,"billingCode":"81403","codeType":"CPT"},{"id":5300,"precertRequired":true,"billingCode":"81404","codeType":"CPT"},{"id":5301,"precertRequired":true,"billingCode":"81405","codeType":"CPT"},{"id":5302,"precertRequired":true,"billingCode":"81406","codeType":"CPT"},{"id":5303,"precertRequired":true,"billingCode":"81407","codeType":"CPT"},{"id":5304,"precertRequired":true,"billingCode":"81408","codeType":"CPT"},{"id":5337,"precertRequired":true,"billingCode":"81479","codeType":"CPT"},{"id":11500,"precertRequired":false,"billingCode":"81163","codeType":"CPT"},{"id":11501,"precertRequired":false,"billingCode":"81164","codeType":"CPT"},{"id":11502,"precertRequired":false,"billingCode":"81165","codeType":"CPT"},{"id":11503,"precertRequired":false,"billingCode":"81166","codeType":"CPT"},{"id":11504,"precertRequired":false,"billingCode":"81167","codeType":"CPT"},{"id":11917,"precertRequired":false,"billingCode":"G0452","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":4855,"description":"Procedures including but not limited to: ovarian stimulation, correction of a structural defect preventing successful pregnancy, Tubal Reanastomosis etc.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":3658,"precertRequired":false,"billingCode":"58120","codeType":"CPT"},{"id":3659,"precertRequired":false,"billingCode":"58140","codeType":"CPT"},{"id":3660,"precertRequired":false,"billingCode":"58145","codeType":"CPT"},{"id":3661,"precertRequired":false,"billingCode":"58146","codeType":"CPT"},{"id":3686,"precertRequired":false,"billingCode":"58340","codeType":"CPT"},{"id":3687,"precertRequired":false,"billingCode":"58345","codeType":"CPT"},{"id":3688,"precertRequired":false,"billingCode":"58350","codeType":"CPT"},{"id":3694,"precertRequired":false,"billingCode":"58540","codeType":"CPT"},{"id":3699,"precertRequired":false,"billingCode":"58545","codeType":"CPT"},{"id":3700,"precertRequired":false,"billingCode":"58546","codeType":"CPT"},{"id":3706,"precertRequired":false,"billingCode":"58555","codeType":"CPT"},{"id":3707,"precertRequired":false,"billingCode":"58558","codeType":"CPT"},{"id":3708,"precertRequired":false,"billingCode":"58559","codeType":"CPT"},{"id":3709,"precertRequired":false,"billingCode":"58560","codeType":"CPT"},{"id":3710,"precertRequired":false,"billingCode":"58561","codeType":"CPT"},{"id":3711,"precertRequired":false,"billingCode":"58562","codeType":"CPT"},{"id":3725,"precertRequired":false,"billingCode":"58660","codeType":"CPT"},{"id":3727,"precertRequired":false,"billingCode":"58662","codeType":"CPT"},{"id":3728,"precertRequired":true,"billingCode":"58670","codeType":"CPT"},{"id":3730,"precertRequired":false,"billingCode":"58672","codeType":"CPT"},{"id":3731,"precertRequired":false,"billingCode":"58673","codeType":"CPT"},{"id":3736,"precertRequired":false,"billingCode":"58740","codeType":"CPT"},{"id":3737,"precertRequired":false,"billingCode":"58750","codeType":"CPT"},{"id":3738,"precertRequired":false,"billingCode":"58752","codeType":"CPT"},{"id":3740,"precertRequired":false,"billingCode":"58770","codeType":"CPT"},{"id":3760,"precertRequired":false,"billingCode":"58970","codeType":"CPT"},{"id":3786,"precertRequired":false,"billingCode":"59160","codeType":"CPT"},{"id":7166,"precertRequired":false,"billingCode":"96040","codeType":"CPT"},{"id":7196,"precertRequired":false,"billingCode":"96372","codeType":"CPT"},{"id":7323,"precertRequired":true,"billingCode":"99070","codeType":"CPT"},{"id":8116,"precertRequired":false,"billingCode":"G0101","codeType":"HCPCS"},{"id":8127,"precertRequired":false,"billingCode":"G0123","codeType":"HCPCS"},{"id":8128,"precertRequired":false,"billingCode":"G0124","codeType":"HCPCS"},{"id":8133,"precertRequired":false,"billingCode":"G0141","codeType":"HCPCS"},{"id":8134,"precertRequired":false,"billingCode":"G0143","codeType":"HCPCS"},{"id":8135,"precertRequired":false,"billingCode":"G0144","codeType":"HCPCS"},{"id":8136,"precertRequired":false,"billingCode":"G0145","codeType":"HCPCS"},{"id":8137,"precertRequired":false,"billingCode":"G0147","codeType":"HCPCS"},{"id":8138,"precertRequired":false,"billingCode":"G0148","codeType":"HCPCS"},{"id":8721,"precertRequired":false,"billingCode":"P3000","codeType":"HCPCS"},{"id":8722,"precertRequired":false,"billingCode":"P3001","codeType":"HCPCS"},{"id":8769,"precertRequired":false,"billingCode":"Q0091","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":4856,"description":"Anesthesia consultation per the referred condition indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"05-Anesthesiology"}],"billingCodes":[{"id":94,"precertRequired":false,"billingCode":"00840","codeType":"CPT"},{"id":131,"precertRequired":false,"billingCode":"00940","codeType":"CPT"},{"id":136,"precertRequired":false,"billingCode":"00952","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207L00000X"},{"HPTC":"207LC0200X"},{"HPTC":"207LP2900X"},{"HPTC":"207LA0401X"},{"HPTC":"207LH0002X"},{"HPTC":"207LP3000X"}]},{"id":4857,"description":"Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR, echo).","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":4431,"precertRequired":false,"billingCode":"71045","codeType":"CPT"},{"id":4432,"precertRequired":false,"billingCode":"71046","codeType":"CPT"},{"id":4433,"precertRequired":false,"billingCode":"71047","codeType":"CPT"},{"id":4434,"precertRequired":false,"billingCode":"71048","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5011,"precertRequired":false,"billingCode":"80055","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":6821,"precertRequired":false,"billingCode":"93000","codeType":"CPT"},{"id":6822,"precertRequired":false,"billingCode":"93005","codeType":"CPT"},{"id":6823,"precertRequired":false,"billingCode":"93010","codeType":"CPT"},{"id":6870,"precertRequired":false,"billingCode":"93306","codeType":"CPT"},{"id":6871,"precertRequired":false,"billingCode":"93307","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":4858,"description":"Inpatient or observation admission for surgical procedure if indicated.","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":4859,"description":"Inpatient or observation admission for complications per the referred condition indicated on the consult\r\n** Notify the referring VA of admission status to initiate and facilitate care coordination and discharge planning.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7355,"precertRequired":false,"billingCode":"99217","codeType":"CPT"},{"id":7356,"precertRequired":false,"billingCode":"99218","codeType":"CPT"},{"id":7357,"precertRequired":false,"billingCode":"99219","codeType":"CPT"},{"id":7358,"precertRequired":false,"billingCode":"99220","codeType":"CPT"},{"id":7359,"precertRequired":false,"billingCode":"99221","codeType":"CPT"},{"id":7360,"precertRequired":false,"billingCode":"99222","codeType":"CPT"},{"id":7361,"precertRequired":false,"billingCode":"99223","codeType":"CPT"},{"id":7362,"precertRequired":false,"billingCode":"99224","codeType":"CPT"},{"id":7363,"precertRequired":false,"billingCode":"99225","codeType":"CPT"},{"id":7364,"precertRequired":false,"billingCode":"99226","codeType":"CPT"},{"id":7369,"precertRequired":false,"billingCode":"99231","codeType":"CPT"},{"id":7370,"precertRequired":false,"billingCode":"99232","codeType":"CPT"},{"id":7371,"precertRequired":false,"billingCode":"99233","codeType":"CPT"},{"id":7372,"precertRequired":false,"billingCode":"99234","codeType":"CPT"},{"id":7373,"precertRequired":false,"billingCode":"99235","codeType":"CPT"},{"id":7374,"precertRequired":false,"billingCode":"99236","codeType":"CPT"},{"id":7376,"precertRequired":false,"billingCode":"99238","codeType":"CPT"},{"id":7377,"precertRequired":false,"billingCode":"99239","codeType":"CPT"},{"id":7424,"precertRequired":false,"billingCode":"99356","codeType":"CPT"},{"id":7425,"precertRequired":false,"billingCode":"99357","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":4860,"description":"Intrauterine insemination (IUI)     \r\nNote:  Maximum of six (6) ovulatory cycles per pregnancy. Additional treatment cycles would require additional authorizations\r\nNote: Female Veterans may purchase donor sperm for IUI at their own expense.","frequency":null,"frequencyType":"","visits":6,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":3683,"precertRequired":true,"billingCode":"58321","codeType":"CPT"},{"id":3684,"precertRequired":false,"billingCode":"58322","codeType":"CPT"},{"id":3685,"precertRequired":true,"billingCode":"58323","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":4861,"description":"Cryopreservation techniques for medically indicated conditions.\r\nNote: Transportation services of cryopreserved specimens for couples actively in treatment will not be charged to the Veteran but, directly to the VA. However, for any Veteran initiating change of location requests for transportation of cryopreserved specimens, the Veteran will incur the cost of transportation.","frequency":null,"frequencyType":"","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":6494,"precertRequired":true,"billingCode":"89337","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":4862,"description":"Follow-up visits for this episode of care as clinically indicated","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]}]}},{"Seoc":{"id":552,"seocKey":67,"name":"Infertility-Female_PRCT","seocId":"MSC_INFERTILITY-FEMALE_1.3.5_PRCT","versionNumber":"1.3.5","description":"Description: This authorization covers services associated with all medical care listed below for the referred condition on the consult.  Note: Separate referral/authorization required for IVF/ART. IVF/ART requires special eligibility and authorization.  Excluded services: donor sperm, donor eggs, donor embryos and surrogacy.  Female Veterans may purchase donor sperm for IUI at their own expense.","effectiveDate":"07-28-2019","endDate":"01-24-2020","duration":365,"REV":false,"PRCT":true,"proceduralOverview":"1.  Initial outpatient evaluation and treatment for infertility as indicated on the consult\r\n2.  Diagnostic imaging relevant to the referred condition on the consult\r\n3.  Lab and pathology services relevant to the referred condition on the consult\r\n4.  Diagnostic studies relevant to the referred condition on the consult\r\n5.  Procedures including but not limited to: ovarian stimulation, correction of a structural defect preventing successful pregnancy, Tubal Reanastomosis etc.\r\n6.   Anesthesia consultation per the referred condition indicated on the consult\r\n7.   Pre-operative medical and cardiac clearance as indicated (including H+P/labs, EKG, CXR, echo). \r\n8.  Inpatient or observation admission for surgical procedure if indicated.\r\n9.  Inpatient or observation admission for complications per the referred condition indicated on the consult\r\n** VA notification within 72 hours to Facility Community Care Office who initiated the referral is required for complications related to the initial surgery/procedure\r\n10.  Intrauterine insemination (IUI)     \r\nNote:  Maximum of six (6) ovulatory cycles per pregnancy. Additional treatment cycles would require additional authorizations\r\nNote: Female Veterans may purchase donor sperm for IUI at their own expense.  \r\n11.  Cryopreservation techniques for medically indicated conditions.\r\nNote: Transportation services of cryopreserved specimens for couples actively in treatment will not be charged to the Veteran but, directly to the VA. However, for any Veteran initiating change of location requests for transportation of cryopreserved specimens, the Veteran will incur the cost of transportation. \r\n12.  Follow-up visits for this episode of care as clinically indicated","maxAllowableVisits":null,"disclaimer":"* Medically indicated Cryopreservation is approved for up to 5 years for cryopreserved eggs or sperm under the infertility benefit.  Cryopreservation services are to be direct billed to local VA Medical Center.  Transportation services of cryopreserved specimens for couples actively in treatment will not be charged to the Veteran but, directly to the VA. However, for any Veteran initiating change of location requests for transportation of cryopreserved specimens, the Veteran will incur the cost of transportation. \r\n* Separate referral/authorization required for IVF/ART and coverage of the spouse of an eligible Veteran with service-connected infertility. IVF/ART requires special eligibility and authorization.  Excluded services: donor sperm, donor eggs, donor embryos and surrogacy.\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","QASP":"General Care","categoryOfCare":"MEDICINE NOS","serviceLine":"Medical Specialty Care","hptcs":[{"hptc":"207V00000X"},{"hptc":"207VE0102X"}],"services":[{"id":3177,"description":"Initial outpatient evaluation and treatment for infertility as indicated on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"16-Obstetrics/gynecology"}],"billingCodes":[{"id":7345,"precertRequired":false,"billingCode":"99201","codeType":"CPT"},{"id":7346,"precertRequired":false,"billingCode":"99202","codeType":"CPT"},{"id":7347,"precertRequired":false,"billingCode":"99203","codeType":"CPT"},{"id":7348,"precertRequired":false,"billingCode":"99204","codeType":"CPT"},{"id":7349,"precertRequired":false,"billingCode":"99205","codeType":"CPT"},{"id":7350,"precertRequired":false,"billingCode":"99211","codeType":"CPT"},{"id":7351,"precertRequired":false,"billingCode":"99212","codeType":"CPT"},{"id":7352,"precertRequired":false,"billingCode":"99213","codeType":"CPT"},{"id":7353,"precertRequired":false,"billingCode":"99214","codeType":"CPT"},{"id":7354,"precertRequired":false,"billingCode":"99215","codeType":"CPT"},{"id":8222,"precertRequired":false,"billingCode":"G0463","codeType":"HCPCS"}],"serviceHptcs":[{"HPTC":"207VF0040X"},{"HPTC":"207VG0400X"},{"HPTC":"207VM0101X"},{"HPTC":"207VB0002X"},{"HPTC":"207VX0201X"},{"HPTC":"207VE0102X"},{"HPTC":"207VC0200X"},{"HPTC":"207VH0002X"},{"HPTC":"207VX0000X"},{"HPTC":"207V00000X"}]},{"id":3178,"description":"Diagnostic imaging relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"30-Diagnostic radiology"}],"billingCodes":[{"id":4484,"precertRequired":false,"billingCode":"72170","codeType":"CPT"},{"id":4485,"precertRequired":false,"billingCode":"72190","codeType":"CPT"},{"id":4487,"precertRequired":false,"billingCode":"72192","codeType":"CPT"},{"id":4488,"precertRequired":false,"billingCode":"72193","codeType":"CPT"},{"id":4489,"precertRequired":false,"billingCode":"72194","codeType":"CPT"},{"id":4490,"precertRequired":false,"billingCode":"72195","codeType":"CPT"},{"id":4491,"precertRequired":false,"billingCode":"72196","codeType":"CPT"},{"id":4492,"precertRequired":false,"billingCode":"72197","codeType":"CPT"},{"id":4568,"precertRequired":false,"billingCode":"74018","codeType":"CPT"},{"id":4569,"precertRequired":false,"billingCode":"74019","codeType":"CPT"},{"id":4570,"precertRequired":false,"billingCode":"74021","codeType":"CPT"},{"id":4572,"precertRequired":false,"billingCode":"74150","codeType":"CPT"},{"id":4573,"precertRequired":false,"billingCode":"74160","codeType":"CPT"},{"id":4574,"precertRequired":false,"billingCode":"74170","codeType":"CPT"},{"id":4577,"precertRequired":false,"billingCode":"74176","codeType":"CPT"},{"id":4578,"precertRequired":false,"billingCode":"74177","codeType":"CPT"},{"id":4579,"precertRequired":false,"billingCode":"74178","codeType":"CPT"},{"id":4580,"precertRequired":false,"billingCode":"74181","codeType":"CPT"},{"id":4581,"precertRequired":false,"billingCode":"74182","codeType":"CPT"},{"id":4582,"precertRequired":false,"billingCode":"74183","codeType":"CPT"},{"id":4628,"precertRequired":false,"billingCode":"74740","codeType":"CPT"},{"id":4629,"precertRequired":false,"billingCode":"74742","codeType":"CPT"},{"id":4724,"precertRequired":false,"billingCode":"76700","codeType":"CPT"},{"id":4725,"precertRequired":false,"billingCode":"76705","codeType":"CPT"},{"id":4740,"precertRequired":false,"billingCode":"76815","codeType":"CPT"},{"id":4741,"precertRequired":false,"billingCode":"76816","codeType":"CPT"},{"id":4742,"precertRequired":false,"billingCode":"76817","codeType":"CPT"},{"id":4751,"precertRequired":false,"billingCode":"76830","codeType":"CPT"},{"id":4752,"precertRequired":false,"billingCode":"76831","codeType":"CPT"},{"id":4753,"precertRequired":false,"billingCode":"76856","codeType":"CPT"},{"id":4754,"precertRequired":false,"billingCode":"76857","codeType":"CPT"},{"id":4766,"precertRequired":true,"billingCode":"76942","codeType":"CPT"},{"id":4768,"precertRequired":false,"billingCode":"76946","codeType":"CPT"}],"serviceHptcs":[{"HPTC":"2085R0202X"}]},{"id":3179,"description":"Lab and pathology services relevant to the referred condition on the consult","frequency":null,"frequencyType":"week","visits":999,"codeRequired":"YES","clinicalServices":[{"clinicalService":"69-Clinical laboratory (billing independently)"}],"billingCodes":[{"id":2544,"precertRequired":false,"billingCode":"36415","codeType":"CPT"},{"id":2545,"precertRequired":false,"billingCode":"36416","codeType":"CPT"},{"id":5006,"precertRequired":false,"billingCode":"80047","codeType":"CPT"},{"id":5007,"precertRequired":false,"billingCode":"80048","codeType":"CPT"},{"id":5008,"precertRequired":false,"billingCode":"80050","codeType":"CPT"},{"id":5010,"precertRequired":false,"billingCode":"80053","codeType":"CPT"},{"id":5012,"precertRequired":false,"billingCode":"80061","codeType":"CPT"},{"id":5015,"precertRequired":false,"billingCode":"80076","codeType":"CPT"},{"id":5123,"precertRequired":false,"billingCode":"80414","codeType":"CPT"},{"id":5124,"precertRequired":false,"billingCode":"80415","codeType":"CPT"},{"id":5127,"precertRequired":false,"billingCode":"80418","codeType":"CPT"},{"id":5131,"precertRequired":false,"billingCode":"80426","codeType":"CPT"},{"id":5142,"precertRequired":false,"billingCode":"81000","codeType":"CPT"},{"id":5143,"precertRequired":false,"billingCode":"81001","codeType":"CPT"},{"id":5144,"precertRequired":false,"billingCode":"81002","codeType":"CPT"},{"id":5145,"precertRequired":false,"billingCode":"81003","codeType":"CPT"},{"id":5147,"precertRequired":false,"billingCode":"81005","codeType":"CPT"},{"id":5148,"precertRequired":false,"billingCode":"81007","codeType":"CPT"},{"id":5149,"precertRequired":false,"billingCode":"81015","codeType":"CPT"},{"id":5150,"precertRequired":false,"billingCode":"81020","codeType":"CPT"},{"id":5151,"precertRequired":false,"billingCode":"81025","codeType":"CPT"},{"id":5152,"precertRequired":false,"billingCode":"81050","codeType":"CPT"},{"id":5459,"precertRequired":false,"billingCode":"82550","codeType":"CPT"},{"id":5484,"precertRequired":true,"billingCode":"82670","codeType":"CPT"},{"id":5511,"precertRequired":false,"billingCode":"82803","codeType":"CPT"},{"id":5512,"precertRequired":false,"billingCode":"82805","codeType":"CPT"},{"id":5513,"precertRequired":false,"billingCode":"82810","codeType":"CPT"},{"id":5519,"precertRequired":false,"billingCode":"82945","codeType":"CPT"},{"id":5521,"precertRequired":false,"billingCode":"82947","codeType":"CPT"},{"id":5535,"precertRequired":true,"billingCode":"83001","codeType":"CPT"},{"id":5536,"precertRequired":true,"billingCode":"83002","codeType":"CPT"},{"id":5551,"precertRequired":false,"billingCode":"83036","codeType":"CPT"},{"id":5563,"precertRequired":false,"billingCode":"83090","codeType":"CPT"},{"id":5590,"precertRequired":false,"billingCode":"83655","codeType":"CPT"},{"id":5606,"precertRequired":false,"billingCode":"83727","codeType":"CPT"},{"id":5618,"precertRequired":false,"billingCode":"83874","codeType":"CPT"},{"id":5620,"precertRequired":false,"billingCode":"83880","codeType":"CPT"},{"id":5660,"precertRequired":false,"billingCode":"84135","codeType":"CPT"},{"id":5661,"precertRequired":false,"billingCode":"84138","codeType":"CPT"},{"id":5664,"precertRequired":true,"billingCode":"84144","codeType":"CPT"},{"id":5666,"precertRequired":false,"billingCode":"84146","codeType":"CPT"},{"id":5718,"precertRequired":false,"billingCode":"84436","codeType":"CPT"},{"id":5722,"precertRequired":false,"billingCode":"84443","codeType":"CPT"},{"id":5730,"precertRequired":false,"billingCode":"84479","codeType":"CPT"},{"id":5731,"precertRequired":false,"billingCode":"84480","codeType":"CPT"},{"id":5732,"precertRequired":false,"billingCode":"84481","codeType":"CPT"},{"id":5733,"precertRequired":false,"billingCode":"84482","codeType":"CPT"},{"id":5734,"precertRequired":false,"billingCode":"84484","codeType":"CPT"},{"id":5760,"precertRequired":false,"billingCode":"84702","codeType":"CPT"},{"id":5761,"precertRequired":false,"billingCode":"84703","codeType":"CPT"},{"id":5762,"precertRequired":false,"billingCode":"84704","codeType":"CPT"},{"id":5767,"precertRequired":false,"billingCode":"85007","codeType":"CPT"},{"id":5772,"precertRequired":false,"billingCode":"85018","codeType":"CPT"},{"id":5773,"precertRequired":false,"billingCode":"85025","codeType":"CPT"},{"id":5774,"precertRequired":false,"billingCode":"85027","codeType":"CPT"},{"id":5779,"precertRequired":false,"billingCode":"85046","codeType":"CPT"},{"id":5850,"precertRequired":false,"billingCode":"85610","codeType":"CPT"},{"id":5851,"precertRequired":false,"billingCode":"85611","codeType":"CPT"},{"id":5861,"precertRequired":false,"billingCode":"85730","codeType":"CPT"},{"id":5880,"precertRequired":false,"billingCode":"86140","codeType":"CPT"},{"id":5883,"precertRequired":false,"billingCode":"86147","codeType":"CPT"},{"id":5994,"precertRequired":false,"billingCode":"86689","codeType":"CPT"},{"id":5995,"precertRequired":false,"billingCode":"86692","codeType":"CPT"},{"id":5996,"precertRequired":false,"billingCode":"86694","codeType":"CPT"},{"id":5997,"precertRequired":false,"billingCode":"86695","codeType":"CPT"},{"id":5998,"precertRequired":false,"billingCode":"86696","codeType":"CPT"},{"id":6000,"precertRequired":false,"billingCode":"86701","codeType":"CPT"},{"id":6001,"precertRequired":false,"billingCode":"86702","codeType":"CPT"},{"id":6002,"precertRequired":false,"billingCode":"86703","codeType":"CPT"},{"id":6003,"precertRequired":false,"billingCode":"86704","codeType":"CPT"},{"id":6004,"precertRequired":false,"billingCode":"86705","codeType":"CPT"},{"id":6005,"precertRequired":false,"billingCode":"86706","codeType":"CPT"},{"id":6006,"precertRequired":false,"billingCode":"86707","codeType":"CPT"},{"id":6074,"precertRequired":false,"billingCode":"86900","codeType":"CPT"},{"id":6110,"precertRequire