4a, Col 004, lines 002,005,006,008,009,015: 37) Wellcare uses cookies. \ w|p&buSa!HTNH8zEl&~taFZ>qy|Zu_i-gF7*K_xhM |ykr\5fOy6wAT)+EhK4 9IOfUFJ?!A9Hkz Gv&v>QeIY1.?yL.Tv?{!% Hand pulling book from library archive shelf. Physical, Occupational, and Speech Therapy Services (PDF) CP.MP.49: June 30, 2021: . Family Planning Services have two main components, frequency limitations and modifier requirements. https://dbhdd.georgia.gov/community-provider-manuals, https://www.myamerigroup.com/ga/georgia-home.html, https://dbhdd.georgia.gov/access-services, Mental Health and Substance Use Disorder Parity. All rights reserved. 0 Speech_Audio_COVID_Rate_Ext FS to 1-31-22.pdf. Outpatient - Site of Service - Maximum Allowable Payment. Primary: (404) 657-5468. In response to the Centers for Medicare & Medicaid Services (CMS) approval of Medicaid Section 1135 Waivers for COVID-19, the State of Georgia Department of Community Health will expedite new enrollment applications until further notice. They are routinely updated to promote accurate coding and policy clarification. These proprietary policies are not a guarantee of payment. DCH also administers Medicaid-reimbursed behavioral health services for children and eligible adults in Georgia through four (4) Care Management Organizations (CMOs). You do not have JavaScript Enabled on this browser. Webinar: Medicare Advantage Compliance and Therapy Services, Webinar: Scheduling to Increase Revenue and Reduce Cancellations, Webinar: The Business of Providing PT/OT to Medicare Patients Recorded September 22, 2022, Webinar: Medicare Documentation and Billing Physical and Occupational Therapy September 8, 2022, Webinar: Remote Therapeutic Monitoring July 20, 2022, Webinar: HIPAA Recognized Security Practices, Webinar: Creating a PT/OT Bonus Plan for Your Practice, Webinar: Medicare PT/OT Services and NCCI, Webinar: Defending Your Therapy Practice from Medicare Audits, Webinar: Advising PT/OT Patients about Cannabis: Medical Marijuana and CBD, Webinar: HIPAA Risk Assessments and Mitigation, Webinar: Effective Compliance and Billing Audits for Therapy Practices, Webinar: Financial and Productivity Benchmarking for Outpatient Physical and Hand Therapy, Webinar: Adult Scoliosis Recognition and Physical Therapy Interventions, Webinar: 2022 Billing and Coding Updated for PT/OT, Webinar: CQ-CO Modifiers and Medicare in 2022, Webinar: PT/OT Burnout Resilience & Balance, Webinar: Medicare ABNs and Therapy Services, Webinar: Osteoarthritis Management by Physical Therapists, Webinar: Effective Compliance Plans for Therapy Practices, Webinar: Manual Therapy Principles of the Shoulder, Webinar: HIPAA for Physical and Occupational Therapy, Webinar: Tricare Compliance for PT and OT, Webinar: Documentation of Skilled Therapy, Webinar: Hip Stability and its Effects on Balance and Fall Prevention, Webinar: Managing Conflict Resolution for PTs and OTs, Webinar: Core Stability and its Effects on Balance and Fall Prevention, Webinar: Posture, Aging and Orthopedic Effects on Balance, Webinar: Pills and Spills An Assessment of Medications and Fall Risk in Older Patients, Alabama PT Identification and Notifications, Alabama PT Board Position Statements and Forms, Alabama OT Identification and Notification, Alabama OT Board Position Statements and Forms, Alabama SLP Board Position 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Therapy Providers, Delaware Medicaid Coverage of Therapy Services, Florida Telehealth Out-of-State Providers, Florida Medicaid Coverage of Therapy Services, Florida Covid-19 Resources For Therapy Providers, Florida PT Board Position Statements and Forms, Florida Occupational Therapy Practice Issues, Florida OT Board Position Statements and Forms, Georgia PT Notifications and Identification, Georgia PT Principles of Conduct for Physical Therapists, Georgia PT Principles of Conduct for Physical Therapy Assistants, Georgia PT Responsibilities and Delegation, Georgia OT Identification and Notification, Georgia Covid-19 Resources for Therapy Providers, Hawaii Covid-19 Resources for Therapy Providers, Hawaii Workers Compensation Fee Schedules, Hawaii Medicaid Coverage of Therapy Services, Idaho Covid-19 Resources for Therapy Providers, Idaho Medicaid Coverage of Therapy Services, Illinois SLP Rigid and Flexible Laryngoscopes, Illinois Covid-19 Resources for Therapy Providers, Illinois 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Medicaid Coverage of Therapy Services, Maryland Workers Compensation Fee Schedules, Massachusetts OT Supervision and Delegation, Massachusetts Covid-19 Resources for Therapy Providers, Massachusetts Medicaid Coverage of Therapy Services, Massachusetts Medicaid Therapy Fee Schedules, Massachusetts Medicaid Outpatient Therapy, Massachusetts Medicaid Provider Enrollment, Massachusetts Workers Compensation Fee Schedules, Michigan Covid-19 Resources for Therapy Providers, Michigan Medicaid Coverage of Therapy Services, Michigan Workers Compensation Fee Schedules, Minnesota Covid-19 Resources for Therapy Providers, Minnesota Medicaid Coverage of Therapy Services, Minnesota Workers Compensation Fee Schedules, Mississippi Covid-19 Resources for Therapy Providers, Mississippi Medicaid Coverage of Therapy Services, Mississippi Medicaid Therapy Fee Schedules, Mississippi Workers Compensation Fee Schedules, Missouri Covid-19 Resources for Therapy Providers, Missouri Medicaid Coverage of Therapy Services, Missouri Workers Compensation Fee Schedules, Montana Covid-19 Resources for Therapy Providers, Montana Medicaid Coverage of Therapy Services, Montana Workers Compensation Fee Schedules, Nebraska Covid-19 Resources for Therapy Providers, Nebraska Medicaid Coverage of Therapy Services, Nebraska Workers Compensation Fee Schedules, Nevada Covid-19 Resources for Therapy Providers, Nevada Medicaid Coverage of Therapy Services, Nevada Workers Compensation Fee Schedules, New Hampshire Covid-19 Resources for Therapy Providers, New Hampshire Medicaid Coverage of Therapy Services, New Hampshire Medicaid Therapy Fee Schedules, New Hampshire Medicaid Outpatient Therapy, New Hampshire Medicaid Provider Enrollment, New Hampshire Workers Compensation Fee Schedules, Use of a Computer to Prepare Patient Records, New Jersey OT Identification and Notification, New Jersey Covid-19 Resources for Therapy Providers, New Jersey Medicaid Coverage of Therapy Services, New Jersey Medicaid Therapy Fee Schedules, New Jersey Workers Compensation Fee Schedules, New Mexico Covid-19 Resources for Therapy Providers, New Mexico Medicaid Coverage of Therapy Services, New Mexico Workers Compensation Fee Schedules, New York Covid-19 Resources for Therapy Providers, New York Medicaid Coverage of Therapy Services, New York Workers Compensation Fee Schedules, North Carolina PT Continuing Education Activities, North Carolina PT General Scope of Practice, North Carolina PT Additional PT Practices, North Carolina PT Additional PTA Practices, North Carolina PT Supervision and Delegation, North Carolina PT Supervision and Documentation, North Carolina PT Identification and Notification, North Carolina PT Licensure by Endorsement, North Carolina OT Identification and Notification, North Carolina Covid-19 Resources for Therapy Providers, North Carolina Medicaid Coverage of Therapy Services, North Carolina Medicaid Outpatient Therapy, North Carolina Medicaid Provider Enrollment, North Carolina Pediatric 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Fee Schedules, Texas PT Board Position Statements and Forms, Texas OT Identification and Notifications, Texas Medicaid Coverage of Therapy Services, Texas Medicaid Outpatient Therapy for Children, Texas Medicaid Coverage of PT, OT, and SLP Therapy Service for Adults, Texas Medicaid Therapy Frequency and Duration Criteria, Texas Medicaid Co-Treatment and Group Therapy, Texas Medicaid Definitions for Outpatient Therapy, Texas Covid-19 Resources for Therapy Providers, Utah Covid-19 Resources for Therapy Providers, Utah Medicaid Coverage of Therapy Services, Vermont Covid-19 Resources for Therapy Providers, Vermont Medicaid Coverage of Therapy Services, Vermont Workers Compensation Fee Schedules, Virginia OT Out-of-State Licensee Voluntary Practice, Virginia Covid-19 Resources for Therapy Providers, Virginia Medicaid Coverage of Therapy Services, Virginia Workers Compensation Fee Schedules, Washington OT Identification and Notification, Washington OT Exemption for Short-Term Practice, Washington OT Inactive and Retired Status, Washington Covid-19 Resources for Therapy Providers, Washington Medicaid Coverage of Therapy Services, Washington Medicaid Therapy Fee Schedules, Washington Workers Compensation Fee Schedules, West Virginia Covid-19 Resources for Therapy Providers, West Virginia Medicaid Coverage of Therapy Services, West Virginia Medicaid Therapy Fee Schedules, West Virginia Medicaid Outpatient Therapy, West Virginia Medicaid Provider Enrollment, West Virginia Workers Compensation Fee Schedules, Wisconsin Covid-19 Resources for Therapy Provider, Wisconsin Medicaid Coverage of Therapy Services, Wisconsin Workers Compensation Fee Schedules, Wyoming Physical Therapy Procedures and Modalities, Wyoming Covid-19 Resources for Therapy Providers, Wyoming Medicaid Coverage of Therapy Services, Wyoming Workers Compensation Fee Schedules, Merit-Based Incentive Payment System (MIPS), Measure 126: Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy, Measure 127: Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention, Measure 128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan, Measure 130: Documentation of Current Medications in the Medical Record, Measure 134: Preventive Care and Screening: Screening for Depression and Follow-Up Plan, Measure 181: Elder Maltreatment Screen and Follow-Up Plan, Measure 182: Functional Outcome Assessment, Measure 217: Functional Status Change for Patients with Knee Impairments, Measure 218: Functional Status Change for Patients with Hip Impairments, Measure 219: Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments, Measure 220: Functional Status Change for Patients with Low Back Impairments, Measure 221: Functional Status Change for Patients with Shoulder Impairments, Measure 222: Functional Status Change for Patients with Elbow, Wrist or Hand Impairments, Measure 223: Functional Status Change for Patients with General Orthopedic Impairments, Measure 226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention, Measure 281: Dementia Cognitive Assessment, Measure 282: Dementia: Functional Status Assessment, Measure 288: Dementia: Education and Support of Caregivers for Patients with Dementia, Measure 318: Falls Screening for Future Fall Risk, Measure 478: Functional Status Change for Patients with Neck Impairments, Measure 131: Pain Assessment and Follow-Up, Medicare Enrollment of Occupational Therapists, Medicare Enrollment of Physical Therapists, Medicare Coverage of Specific Modalities and Procedures, National Coverage Determinations for Therapy Services, Medicare Therapy Limitations and Noncovered Services, Medicare Documentation for Therapy Services, Levels of Appeals and Time Limits for Filing, Medicare Therapy Bill Type and Revenue Codes, Medicare Skilled Nursing Facilities Therapy Services, Medicare Home Health Conditions for Coverage, Security Rule - Administrative Safeguards, When Patient Authorization is Not Required, Early Intervention Referrals and Screening, Common Physical and Occupational Therapy Codes, NCCI Medically Unlikely Edits Therapy Services, NCCI Practitioner Edits Therapy Services Q3 2022, NCCI Practitioner Edits Therapy Services Q4 2022, NCCI Practitioner Edits Therapy Services Q1 2023, NCCI Hospital Edits Therapy Services Q3 2022, NCCI Hospital Edits Therapy Services Q4 2022, NCCI Hospital Edits Therapy Services Q1 2023, End of Covid-19 Emergency Period - Medicare Therapy Waivers, Medicare Certification and Recertification Plan of Care FAQs, Multiple Procedure Payment Reduction (MPPR), Medicare Total Time Rule v. AMA 8-Minute Rule, Medicare Documentation Requirements for Therapy Services, Medicare Documentation Requirements for Therapy Practices, New Section: Medicare Therapy Limitations and Noncovered Services, Medicare Telehealth Services During Covid-19 Emergency Period, New Section: Outpatient Rehabilitation Facilities. CPT copyright American Medical Association. An official website of the State of Georgia. Members: 800-498-2071 These reimbursement policies apply to our Georgia Medicaid plans. The payment rate for out-of-state enrolled hospitals will not exceed 65% of covered charges. In addition, Peach State Health Planmay from time to time employ a vendor that applies payment policies to specific services; in such circumstances, the vendors guidelines may also be used to determine whether a service has been correctly coded. In addition, Peach State Health Planmay from time to time delegate utilization management of specific services; in such circumstances, the delegated vendors guidelines may also be used to support medical necessity and other coverage determinations. %%EOF Speech Therapy and Audiology Fee Schedule - Jan. 5, 2022 - PDF. . 04/01/2023. Appropriate Use and Safety Edits: Attachment A(PDF), Pharmacy Prior Authorization and Medical Necessity Criteria (PDF). hVQo8+zz$[! % Providers and their office staff are encouraged to use self-service channels to verify member eligibility. Additionally, laws and regulations and insurance and payer policies are subject to change. An official website of the State of Georgia. Acthar Gel) (PDF), Ribavirin (Copegus, Moderiba, Rebetol, Ribasphere) (PDF), Rifabutin (Mycobutin), Rifabutin/Omeprazole/Amoxicillin (Talicia) (PDF), Risperidone Long-Acting Injection (Risperdal Consta) (PDF), Rituximab (Rituxan), Rituxan/Hyaluronidase (Rituxan Hycela) (PDF), Sapropterin Dihydrochloride (Kuvan) (PDF), Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors (PDF), Sucroferric Oxyhydroxide (Velphoro) (PDF), Tezacaftor/Ivacaftor; Ivacaftor (Symdeko) (PDF), Timothy grass pollen allergen extract (Grastek) (PDF), Tobramycin (Bethkis, Kitabis Pak, TOBI, TOBI Podhaler) (PDF), Tofacitinib (Xeljanz, Xeljanz Poor girl.XR) (PDF), Topical Diclofenac (Solaraze, Flector) (PDF), Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase (PDF), Treprostinil (Orenitram, Remodulin, Tyvaso) (PDF), Triamcinolone ER Injection (Zilretta) (PDF), triptorelin pamoate (Trelstar, Triptodur) (PDF), Valproate Sodium for Intravenous Injection (Depacon) (PDF), vincristine sulfate liposome injection (Marqibo) (PDF), Voretigene neparvovec-rzyl (Luxturna) (PDF), Age Limit for Tazarotene (Tazorac, Arazlo) (PDF), Benzodiazepine Use in Pediatric Seizure Disorders (PDF), Buprenorphine-Naloxone (Bunavail, Cassipa, Suboxone, Zubsolv) (PDF), Dasabuvir Ombitasvir Paritaprevir Ritonavir (Viekira XR, Viekira Pak)(PDF), Dasabuvir/Ombitasvir/Paritaprevir/Ritonavir (Viekira XR, Viekira Pak) (PDF), Epinephrine Injection Device - Quantity Limit Override (PDF), Factor IX Complex Human (Bebulin, Profilnine) (PDF), Factor VIII/von Willebrand Factor Complex (Human - Alphanate, Humate-P, Wilate) (PDF), Human Growth Hormone (Somapacitan, Somatropin) (PDF), euprolide acetate (Eligard, Lupaneta Pack, Lupron Depot, Lupron Depot-Ped) (PDF), Levofloxacin (Levaquin) in Pediatric Community Acquired Pneumonia(PDF), Methoxy polyethylene glycol-epoetin beta (Mircera) (PDF), Olanzapine Long-Acting Injection (Zyprexa Relprevv) (PDF), Pediatric Benzodiazepine Use in Chemotherapy Induced Nausea and Vomiting CINV(PDF), Psychotropic Medication Continuity of Care (COC)(PDF), Request for Medically Necessary Drug Not on the PDL (PDF), Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) (PDF), Topical Steroid Use For Eosinophilic Esophagitis (PDF), Topical Tretinoin in Adult Acne Vulgaris (PDF), Hydroxyprogesterone Caproate (Makena) (PDF), Lost, Stolen, Spilled or Broken Medications(PDF), Maximum Allowable Cost (MAC) Requirement(PDF), Cost to Charge Adjustments on Clean ClaimReviews (PDF), Distinct Procedure Modifiers Policy (PDF), E&M Bundling with Labs and Radiology (PDF), E&M Services Billed with Treatment Room Revenue Codes (PDF), Hospital Visit Codes Billed with Labs (PDF), Leveling of Care: Evaluation and Management Overcoding (PDF), Leveling of Emergency Room Services (PDF), Modifier to Procedure Code Validation (PDF), Multiple Diagnostic Cardiovascular Procedure Payment Reduction (MDCR) (PDF), Multiple Procedure Reduction: Ophthalmology (PDF), Non-obstectrical Pelvic and Transvaginal Ultrasounds (PDF), Not Medically Necessary Inpatient Service (PDF), Polymerase Chain Reaction Respiratory Viral Panel Testing (PDF), Problem Oriented Visits with Preventative Services (PDF), Problem Oriented Visits with Surgical Procedures (PDF), Unbundling Adjustments on Clean Claim Reviews (PDF), Leveling Professional Fees for Emergency Room Services (PDF), Multiple Procedure Payment Reduction: Therapeutic Services (PDF), Reporting the Global Maternity Package (PDF), Problem Oriented Visits with Preventative Services(PDF), Fluticasone/Vilanterol (Breo Ellipta) (PDF). How do I know if I am in the right place? endobj If you are at an office or shared network, you can ask the network administrator to run a scan across the network looking for misconfigured or infected devices. endstream endobj 459 0 obj <>stream <> b. How you know. Effective January 24, 2021 a significant enhancement to our physician reimbursement policies that promote correct coding. occupational therapy, and services for individuals with speech, hearing and language disorders; . Under the FFS model, Georgia pays providers directly for each covered service received by a Medicaid beneficiary. Please note that the reimbursement rate sheets (R-32) are in alphabetical order. States have great flexibility in how Medicaid payments are made to . You will need Adobe Reader to open PDFs on this site. x[o9?@Z&s8,fvIyPl-y$Eo*^F%-jcuS\EF?D?x*W1%Q~S{O_y"xWE}z>FwRWR,~\^/>-/RO}WJ:}Vw^FQ+(lvP,Y6G}YQ^b|8>bw%[ggQ-.qh OHay_ R,~p]/z-,/z. E\Y?>Jvubzu{D|q,[-n;+wc`l^/[tzEO~yQ-B~nv{ Bxx:#(T~e ZZ. Speech Therapy and Language Disorder Rehabilitation GEORGIA MEDICAID MM-0714 Effective Date: 10/01/2020 Outpatient Speech Therapy and Language Disorder Rehabilitation B. These rates are inclusive of 13.37% Growth, Joint Commission & AHCA quality incentives and audited 2018 GL/PL Insurance Costs. Authorization for Cancer Treatment/New Century Health, 25-Hydroxyvitamin D Testing in Children and Adolescents (PDF), Allogeneic Hematopoietic Cell Transplants for Sickle Cell(PDF), Ambulatory Surgery Center Optimization (PDF), Cosmetic and Reconstructive Surgery (PDF), Diaphragmatic/Phrenic Nerve Stimulation (PDF), Drugs of Abuse: Definitive Testing (PDF), Facility-based Sleep Studies for Obstructive Sleep Apnea (PDF), Genetic Testing Aortopathies and Connective Tissue Disorder (PDF), Genetic Testing Dermatologic Conditions (PDF), Genetic Testing Epilepsy Neurodegenerative Neuromuscular Disorder (PDF), Genetic Testing Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (PDF), Genetic Testing Gastroenterologic Disorders (non-cancerous) (PDF), Genetic Testing General Approach to Genetic Testing (PDF), Genetic Testing Hematologic Conditions (non-cancerous) (PDF), Genetic Testing Hereditary Cancer Susceptibility (PDF), Genetic Testing Immune Autoimmune and Rheumatoid Disorders (PDF), Genetic Testing Metabolic Endocrine and Mitochondrial Disorders(PDF), Genetic Testing Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay(PDF), Genetic Testing Non-Invasive Prenatal Screening (NIPS)(PDF), Genetic Testing Preimplantation Genetic Testing(PDF), Genetic Testing Prenatal and Precon Carrier Screening(PDF), Genetic Testing Prenatal Diagnosis (via Amnio CVS or PUBS) and Pregnancy Loss(PDF), Genetic Testing Skeletal Dysplasia and Rare Bone Disorders(PDF), Helicobacter Pylori Serology Testing (PDF), Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (PDF), Implantable Wireless Pulmonary Artery Pressure Monitoring (PDF), Infant Apnea Monitors Clinical Policy (PDF), Intestinal and Multivisceral Transplant (PDF), Intradiscal Steroid Injections for Pain Management(PDF), IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures(PDF), Low-Frequency Ultrasound Therapy for Wound Management (PDF), Measurement of Serum 1,25-dihydroxyvitamin D (PDF), Neonatal Abstinence Syndrome Guidelines (PDF), Nerve Blocksand Neurolysis for Pain Management (PDF), Neuromuscular Electrical Stimulation (PDF), Nonmyeloablative Allogeneic Stem Cell Transplants (PDF), Oncology Circulating Tumor DNA and Circulating Tumor Cells (PDF), Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies (PDF), Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention (PDF), Phototherapy for Neonatal Hyperbilirubinemia(PDF), Physical, Occupational, and Speech Therapy Services (PDF), Physical, Occupational, Speech, and Feeding Therapy (PDF), Posterior Tibial Nerve Stimulation for Voiding Dysfunction (PDF), Reduction Mammoplasty and Gynecomastia Surgery (PDF), Sacroiliac Joint Interventions for Pain Management (PDF), Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins(PDF), Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy (PDF), Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management (PDF), Skin Substitutes for Chronic Wounds (PDF), Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (PDF), Stereotactic Body Radiation Therapy (PDF), Testing for Select Genitourinary Conditions (PDF), Total Parenteral Nutrition and Intradialytic Parenteral Nutrition (PDF), Transcather Closer of Patent Foramen Ovale (PDF), Transplant Service Documentation Requirements, Trigger Point Injections for Pain Management (PDF), Urinary Incontinence Devices and Treatments (PDF), IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures (PDF), Non-myeloablative Allogeneic Stem Cell Transplants (PDF), Physical, Occupation, and Speech Therapy Services, Sclerotherapy and chemical endovenous ablation for Varicose Veins(PDF), Transcatheter Closure of Patent Foramen Ovale (PDF), Behavioral Health Treatment Document Requirement(PDF), Deep Transcranial Magnetic Stimulation for Obsessive Compulsive Disorder (PDF), Substance Use Disorder Treatment and Services (PDF), Biofeedback for Behavioral Health Disorders (PDF), Transcranial Magnetic Stimulation for Treatment Resistant Major Depression (PDF), Adjacent Tissue Transfer Grafts involving Eyelid (PDF), Anterior Segment Photography with FA (PDF), Blepharoplasty, Ptosis and Canthoplasty (PDF), Dark Adaptation and Color Vision Examinations (92283/92284) (PDF), Destruction of a Localized Lesion of the Retina (PDF), Destruction of Localized Lesion of Choroid (PDF), Examination Guidelines for Diabetic Patients (PDF), Indocyanine Green (ICG) Angiography (PDF), Infracture of the Inferior Turbinate (PDF), Laser Iridotomy and Iridectomy for Glaucoma (PDF), Photodynamic and Intravitreal Therapies and Pharmaceuticals (PDF), Probing and Closure of the Lacrimal Duct System (PDF), Surgical Excision of Eyelid Lesions (PDF), Teleretinal Screening for Diabetic Retinopathy (PDF), Ado-Trastuzumab Emtansine (Kadcyla) (PDF), Age Limit Override (Codeine, Tramadol, Hydrocodone) (PDF), Alendronate (Binosto, Fosamax plus D) (PDF), Alpha-1 Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) (PDF), Antithymocyte Globulin (Thymoglobulin, Atgam) (PDF), Anti-Inhibitor Coagulant Complex, Human (Feiba) (PDF), Aprepitant (Emend, Cinvanti), Fosaprepitant (Emend for injection) (PDF), Aripiprazole Long-Acting Injections (Abilify Maintena, Aristada) (PDF), Baclofen (Gablofen, Lioresal, Ozobax) (PDF), Bevacizumab (Avastin, Mvasi, Zirabev) (PDF), Blocking Adjudication of Controlled Substance Prescriptions for Selected Prescribers(PDF), Brand Name Override and Non-Formulary Medications (PDF), Brexucabtagene Autoleucel (Tecartus)(PDF), Brinzolamide/Brimonidine (Simbrinza) (PDF), Budesonide Suspension (Pulmicort Respules) (PDF), Buprenorphine Implant/Injection (Probuphine, Sublocade) (PDF), Buprenorphine-Naloxone (Bunavail, Cassipa, Suboxone) (PDF), C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda) (PDF), C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda, Ruconest) (PDF), Cabozantinib (Cometriq, Cabometyx) (PDF), Ciprofloxacin-Dexamethasone (Ciprodex) (PDF), Ciprofloxacin/Fluocinolone (Otovel) (PDF), Clindamycin Phosphate/Benzoyl Peroxide (BenzaClin) (PDF), Clinical Pharmacy Services Inter-rater Reliability (PDF), Conjugated Estrogens/Bazedoxifene (Duavee) (PDF), Corticosteroid Intravitreal Implants (Iluvien, Ozurdex, Retisert, Yutiq) (PDF), Cysteamine oral (Cystagon, Procysbi) (PDF), Cytomegalovirus Immune Globulin (Cytogam)(PDF), Desmopressin Acetate (DDAVP, Stimate, Noctiva) (PDF), Dextromethorphan-Quinidine (Nuedexta) (PDF), Dimethyl Fumarate (Tecfidera), Diroximel Fumarate (Vumerity) (PDF), Dipeptidyl Peptidase-4 (DPP-4) Inhibitors (PDF), Doxepin (Silenor, Prudoxin, Zonalon) (PDF), Doxycycline Hyclate (Acticlate, Doryx), Doxycycline (Oracea) (PDF), Early and Periodic Screening, Diagnostic, and Treatment Benefit for Pediatric Members (PDF), Elexacaftor/Ivacaftor/Tezacaftor; Ivacaftor (Trikafta) (PDF), Emtricitabine/Tenofovir Alafenamide (Descovy)(PDF), Everolimus (Afinitor, Afinitor Disperz, Zortress) (PDF), Factor IX Complex, Human (Profilnine) (PDF), Factor VIIa, Recombinant (NovoSeven RT) (PDF), Factor VIIa, Recombinant (NovoSeven RT, SevenFact) (PDF), Factor XIII A-Subunit, Recombinant (Tretten) (PDF), Fam-trastuzumab Deruxtecan-nxki (Enhertu) (PDF), Fentanyl IR (Abstral, Actiq, Fentora, Lazanda, Subsys) (PDF), Filagrastim (Neupogen), Filagrastim-sndz (Zarxio), Tbo-filagrastim (Granix) (PDF), Formulary Medications without Specific Guidelines (PDF), Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (PDF), Granisetron (Kytril, Sancuso, Sustol) (PDF), histrelin acetate (Vantas, Supprelin LA) (PDF), Hydroxyprogesterone Caproate (Makena/compound), Indacaterol/Glycopyrrolate (Utibron Neohaler) (PDF), Infertility and Fertility Preservation (PDF), Infliximab (Remicade, Inflectra, Renflexis) (PDF), Insulin Delivery Systems (V-Go, OmniPod, InPen) (PDF), Interferon beta-1b (Betaseron, Extavia) (PDF), Intrathecal Baclofen (Gablofen, Lioresal) (PDF), Isotretinoin (Absorica, Absorica LD, Amnesteem, Claravis, Myorisan, Zenatane) (PDF), Itraconazole (Sporanox, Onmel, Tolsura) (PDF), Lesinurad (Zurampic), Lesinurad/Allopurinol (Duzallo) (PDF), leuprolide acetate (Eligard, Lupaneta Pack, Lupron Depot, Lupron Depot-Ped) (PDF), Levalbuterol (Xopenex HFA/Inhalation Solution) (PDF), Lidocaine Transdermal (Lidoderm, ZTlido) (PDF), Lutetium Lu 177 Dotatate (Lutathera)(PDF), Montelukast oral granules (Singulair) (PDF), Methotrexate (Otrexup, Rasuvo, Xatmep, Reditrex) (PDF), Methoxy polyethylene glycol-epoetin beta (Mircera) (PDF, Methylnaltrexone Bromide (Relistor) (PDF), Minocycline ER (Solodyn, Ximino, Minolira) and Microspheres (Arestin) (PDF), Moxetumomab pasudotox-tdfk (Lumoxiti) (PDF), Multiple Procedure Payment Reduction (MPPR) for Therapeutic Services (PDF), Nadofaragene Firadenovec (Instiladrin) (PDF), Naproxen oral suspension (Naprosyn) (PDF), Neomycin/Fluocinolone 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Corticotropin Injection (H.P. 64th bsb fort carson staff duty, 1984 olympic trials track and field results,

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