Medicare Prior Authorization List Effective January 1, 2021

Substance Use Disorder Treatment/Rehabilitation Bronchial Thermoplasty : Outpatient procedure for the treatment of ... Skilled Nursing Facility (SNF) Hyperbaric O2 Therapy . Includes HBO therapy administered in a ... J3304 INJECT TRIAMCINOLONE ACETONIDE PF ER MS F 1 MG J3357 USTEKINUMAB FOR SUBQ INJECTION 1 MG J3380 INJECTION VEDOLIZUMAB …

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