Musculoskeletal and Pain Management Program …

•190+ board-certified medical directors • Diverse representation of medical specialties • 450 nurses with diverse specialties and experience • Dedicated nursing and physician

  Programs, Management, Board, Pain, Musculoskeletal, Musculoskeletal and pain management program

CT Abdomen and Pelvis - General Imaging Request

1.Date of most recent office visit or other contact with physician: Don't Know Phone call with office staff Phone call with physician Don't know

  Pelvis

CT Chest, Abdomen and Pelvis Imaging Request

Don't Know. Phone call with office staff Phone call with physician Don't Know 3.Is abodminal or pelvic pain present? Yes. No Don't Know: 4.Where is the location of pain?

  Chest, Request, Imaging, Abdomen, Pelvis, Abdomen and pelvis imaging request

er emb mm/dd/yyyy - eviCore

Member requires treatment for a different condition Additional care for same condition treated in the last 60 days 2. What is the primary diagnosis?

  Yyyy, Er emb mm dd yyyy

eviCore healthcare and Cigna Integrated Oncology ...

1 eviCore healthcare and Cigna Integrated Oncology Management Program Frequently Asked Questions Who is eviCore healthcare? eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides

  Programs, Management, Frequently, Healthcare, Integrated, Oncology, Cigna, Healthcare and cigna integrated oncology, Healthcare and cigna integrated oncology management program frequently

er emb mm/dd/yyyy - eviCore

Reduced strength full range Can't move against gravity Hand function. Reduced strength full range Fingertips don't reach palm Normal strength Normal strength Raises with bent knee Unable

  Yyyy, Mm dd yyyy

eviCore Radiation Therapy 2019 Guidelines

for Radiation Oncology (ASTRO) Evidence-Based Guidelines, or supported by other acceptable peer-reviewed publications. As such, eviCore will not automatically certify a case based solely on the fact that it

Cigna Medical Coverage Policies – Radiology Cardiac Imaging

IMAGING STUDY Estimate of Effective Radiation Dose . Sestamibi myocardial perfusion study (MPI) 9-12 mSv PET myocardial perfusion study: Rubidium-82

  Imaging, Perfusion

Bone Metastases Radiation Therapy Physician Worksheet (As ...

Bone Metastases Radiation Therapy Physician Worksheet (As of 23 July 2018) 6. What is the reason for treatment? Select all that apply. Extension into viscera or a soft tissue component

Radiation Therapy Coding Guidelines - eviCore

viCore e Radiation Therapy Coding Guidelines These guidelines summarize definitions and appropriate use of several CPT® codes. These guidelines are not meant to be all -inclusive, but are meant to be used in conjunction with the other coding resources and AMA Current Procedural Terminology (CPT) code book.

  Coding, Current, Terminology, Procedural, Current procedural terminology

SPINAL INJECTION PROCEDURES - Low Back Pain | …

Epidural Steroid Injections What is an epidural steroid injection? The epidural steroid injection is the placement of cortisone, a powerful anti-inflammatory agent, into the epidural space

  Procedures, Injection, Spinal, Steroid, Epidural, Spinal injection procedures, Epidural steroid injections, Epidural steroid

Local Coverage Determination for Paravertebral …

Local Coverage Determination (LCD) for Paravertebral Facet Joint Blocks (L29252) Contractor Information Contractor Name First Coast Service Options,

  Coverage, Determination, Local, Paravertebral, Local coverage determination for paravertebral, Facet

New Patient Intake Form - Northwest Pain Care, Inc

3 What activities make your pain worse? ☐ Standing ☐ Walking ☐ Lifting ☐ Sitting ☐ Laying ☐ Sleeping ☐ Working ☐ Twisting ☐ Exercise ☐ Pain Meds

  Form, Patients, Intake, New patient intake form

CHRONIC INTRACTABLE PAIN MANAGEMENT - …

January 2011 2 The information contained in this document is provided for informational purposes only and represents no statement, promise, or …

  Management, Chronic, Pain, Chronic intractable pain management, Intractable

2018 MDwise Excel Network Hoosier Healthwise …

2018 MDwise Excel Network Hoosier Healthwise Medical Services that Require Prior Authorization Medical services that require Prior Authorization

  Mdwise

HUMANA Pain Management Prior Authorization …

HUMANA Pain Management Prior Authorization Request Form ** Please complete and Fax this request form along with all supporting clinical documentation to OrthoNet at 1 …

  Management, Authorization, Pain, Prior, Humana, Humana pain management prior authorization

ASRA/ESRA/INS/AAPM/WIP/NANS guidelines for …

3 Directors of ASRA recommended that the Regional Anesthesia and Pain Medicine journal (RAPM) appoint a committee to develop separate guidelines for pain.1 The committee has an

  Guidelines, Wip nans guidelines for, Nans