Musculoskeletal and Pain Management Program …

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?

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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

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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 Musculoskeletal Program Interventional Pain ...

1 July 2016 Cigna Musculoskeletal Program Interventional Pain Management . Frequently Asked Questions . Note: Prior authorization requests should only include those codes for the current Interventional

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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

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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.

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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

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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?

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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

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HealthSelect of Texas Preauthorization Requirements

HealthSelectSM of Texas In-Area (Texas) PRIOR AUTHORIZATION & REFERRAL REQUIREMENTS LIST Effective September 1, 20 17 - July 31, 2018 - Updated April 9, 2018 To Remove 491 Outpatient Service Codes Retroactively to September 1, 2017

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California Prior Authorization Requirements - …

California Prior Authorization Requirements Health Net of California, Inc. and Health Net Life Insurance Company (Health Net) Direct Network1 HMO (including CommunityCare HMO), Point of

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Provider Manual Section 5.0 Utilization Management

Page 6 of 8 DME items with billable charges greater than $500 require an authorization. Requests for authorization of purchase MUST be received PRIOR to the end of the rental period.

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Office manual for health care professionals - Aetna

Quality health plans & benefits Healthier living Financial well-being Intelligent solutions . Office manual for health care professionals . Mid-America Regional Section

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