Prior authorization codes
MDwise
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 0001U | 0003U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0003U | 0005U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0004M | 0006M | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0005U | 0007U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0006M | 0007M | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0007M | 0011M | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0007U | 0008U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0008U | 0009U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0009U | 0010U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0010U | 0016U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0011M | 0012M | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0012M | 0013M | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0013M | 0017M | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 00144 | Cornea Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0016U | 0017U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0017M | 0001U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0017U | 0018U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0018U | 0019U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0019U | 0022U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0022U | 0023U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0023U | 0026U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0026U | 0027U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0027U | 0029U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0029U | 0030U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0030U | 0031U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0031U | 0032U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0032U | 0033U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0033U | 0034U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0034U | 0036U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0036U | 0037U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0037U | 0040U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0040U | 0045U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0045U | 0046U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0046U | 0047U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0047U | 0048U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0048U | 0049U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0049U | 0050U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0050U | 0053U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0053U | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0055U | 0060U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0060U | 0068U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0068U | 0069U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0069U | 0070U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0070U | 0071U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0071U | 0072U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0072U | 0073U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0073U | 0074U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0074U | 0075U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0075U | 0076U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0076U | 0078U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0078U | 0079U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0079U | 0084U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0084U | 0086U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0086U | 0087U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0087U | 0088U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0088U | 0089U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0089U | 0090U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0090U | 0094U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0094U | 0094U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0096U | 0101U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0101U | 0102U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0102U | 0103U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0103U | 0105U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0105U | 0109U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0109U | 0111U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0111U | 0112U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0112U | 0113U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0113U | 0114U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0114U | 0118U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0118U | 0120U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0120U | 0129U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0129U | 0130U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0130U | 0131U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0131U | 0132U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0132U | 0133U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0133U | 0134U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0134U | 0135U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0135U | 0136U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0136U | 0137U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0137U | 0138U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0138U | 0140U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0140U | 0141U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0141U | 0142U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0142U | 0152U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0152U | 0153U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0153U | 0154U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0154U | 0155U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0155U | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0156U | 0157U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0157U | 0158U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0158U | 0159U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0159U | 0160U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0160U | 0161U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0161U | 0162U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0162U | 0169U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0169U | 0170U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0170U | 0171U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0171U | 0172U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0172U | 0172U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0173U | 0175U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0175U | 0177U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0177U | 0179U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0179U | 0180U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0180U | 0181U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0181U | 0182U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0182U | 0183U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0183U | 0184U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0184U | 0185U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0185U | 0186U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0186U | 0187U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0187U | 0188U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0188U | 0189U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0189U | 0190U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0190U | 0192U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0192U | 0193U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0193U | 0194U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0194U | 0195U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0195U | 0196U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0196U | 0197U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0197U | 0198U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0198U | 0199U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0199U | 0200U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0200U | 0201U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0201U | 0203U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0203U | 0204U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0204U | 0205U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0205U | 0209U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0209U | 0211U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0211U | 0212U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0212U | 0213U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0213U | 0214U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0214U | 0215U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0215U | 0216U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0216U | 0217U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0217U | 0218U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0218U | 0219U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0219U | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0221U | 0222U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0222U | 0227U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0227U | 0228U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0228U | 0229U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0229U | 0230U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0230U | 0231U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0231U | 0232U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0232U | 0233U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0233U | 0234U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0234U | 0235U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0235U | 0236U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0236U | 0237U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0237U | 0238U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0238U | 0239U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0239U | 0242U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0242U | 0244U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0244U | 0245U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0245U | 0246U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0246U | 0250U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0250U | 0252U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0252U | 0253U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0253U | 0254U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0254U | 0258U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0258U | 0260U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0260U | 0262U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0262U | 0264U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0264U | 0265U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0265U | 0266U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0266U | 0267U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0267U | 0268U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0268U | 0269U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0269U | 0270U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0270U | 0271U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0271U | 0272U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0272U | 0273U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0273U | 0274U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0274U | 0276U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0276U | 0277U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0277U | 0278U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0278U | 0279u | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0282U | 0285U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0285U | 0286U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0286U | 0287U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0287U | 0288U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0288U | 0289U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0289U | 0290U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0290U | 0291U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0291U | 0292U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0292U | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0293U | 0294U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0294U | 0296U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0296U | 0297U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0297U | 0298U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0298U | 0299U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0299U | 0300U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0300U | 0301U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0301U | 0302U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0302U | 0306U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0306U | 0307U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0307U | 0313U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0313U | 0314U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0314U | 0315U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0315U | 0317U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0317U | 0318U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0318U | 0319U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0319U | 0320U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0320U | 0326U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0326U | 0327U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0327U | 0329U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0329U | 0331U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0331U | 0332U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0332U | 0333U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0333U | 0335U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0335U | 0336U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0336U | 0339U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0339U | 0340U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0340U | 0341U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0341U | 0343U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0343U | 0345U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0345U | 0347U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0347U | 0348U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0348U | 0349U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0349U | 0350U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0350U | 0355U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0355U | 0356U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0356U | 0362U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0362U | 0363U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0363U | 0364U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0364U | 0368U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0368U | 0378U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0378U | 0379U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0379U | 0380U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0380U | 0388U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0388U | 0389U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0389U | 0391U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0391U | 0392U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0392U | 0396U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0396U | 0400U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0400U | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0401U | 0403U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0403U | 0405U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0405U | 0409U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0409U | 0410U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0410U | 0411U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0411U | 0413U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0413U | 0414U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0414U | 0417U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0417U | 0419U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0419U | 0420U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0420U | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0422U | 0423U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0423U | 0424U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0424U | 0425U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0425U | 0426U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0426U | 0428U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0428U | 0433U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0433U | 0434U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0434U | 0437U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0437U | 0438U | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0438U | G9143 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0466T | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0467T | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 0468T | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 11200 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 11201 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 11920 | Cosmetic Tattooing | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 11921 | Cosmetic Tattooing | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 11922 | Cosmetic Tattooing | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 11950 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 11951 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 11952 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 11954 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 11960 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15771 | Gender Affirmation Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15775 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15776 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15780 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15781 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15782 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15783 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15786 | Cosmetic Skin Procedures 15787, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15832, 15833, 15834, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15787 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15788 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15789 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15792 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15793 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15819 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15820 | Blepharoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15821 | Blepharoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15822 | Blepharoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15823 | Blepharoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15824 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15825 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15826 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15828 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15829 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15830 | Panniculectomy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15832 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15833 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15834 | Cosmetic Skin Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15835 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15836 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15837 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15838 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15839 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15847 | Panniculectomy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15876 | Lipectomy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15877 | Lipectomy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15878 | Lipectomy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 15879 | Lipectomy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 17106 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 17107 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 17108 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 17340 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 17360 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 17380 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 17999 | Gender Affirmation Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19300 | Surgical Treatment for Male Gynecomastia | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19303 | Gender Affirmation Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19316 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19318 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19324 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19325 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19328 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19330 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19340 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19342 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19350 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19355 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19357 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19361 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19364 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19366 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19367 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19368 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19369 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19370 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19371 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19380 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 19396 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21025 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21026 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21029 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21030 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21031 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21032 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21040 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21044 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21045 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21046 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21047 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21048 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21049 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21050 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21060 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21070 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21073 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21081 | 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21110 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21116 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21120 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21121 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21122 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21123 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21125 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21127 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21137 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21138 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21139 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21141 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21142 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21143 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21145 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21146 | 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21206, 21208, 21210, 21215, 21244, 21245, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21147 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21150 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21151 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21154 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21155 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21159 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21160 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21172 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21175 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21179 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21180 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21181 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21182 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21183 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21184 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21188 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21193 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21194 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21195 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21196 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21198 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21199 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21206 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21208 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21209 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21210 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21215 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21230 | Reconstructive Face Procedures 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21295, 21296, 21299, 40500, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21240 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21242 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21243 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21244 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21245 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery 21246, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21081, 21440, 21445, 21497, 30545, 30560, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21246 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21247 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21248 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21249 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21255 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21256 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21260 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21261 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21263 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21267 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21268 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21270 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21275 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21295 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21296 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21299 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21440 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21445 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21480 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21485 | Temporomandibular Joint Syndrome (TMJ) Treatment | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21490 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21497 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21685 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21740 | Pectus / Carinatum Reconstructive Repair | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21741 | Pectus / Carinatum Reconstructive Repair | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21742 | Pectus / Carinatum Reconstructive Repair | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 21743 | Pectus / Carinatum Reconstructive Repair | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 29800 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 29804 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30120 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30150 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30160 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30400 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30410 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30420 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30430 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30435 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30450 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30460 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30462 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30468 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30469 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30520 | Septoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30540 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30545 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30560 | Oral Surgery/Mandibular Surgery/Orthognathic Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 30620 | Rhinoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 31660 | Procedures to Treat Asthma | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 31661 | Procedures to Treat Asthma | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 32850 | Lung Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 32851 | Lung Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 32852 | Lung Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 32853 | Lung Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 32854 | Lung Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 32855 | Lung Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 32856 | Lung Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 33927 | Heart Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 33928 | Heart Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 33929 | Heart Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 33933 | Heart Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 33944 | Heart Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 33945 | Heart Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36465 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36466 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36468 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36470 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36471 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36473 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36474 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36475 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36476 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36478 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36479 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36482 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 36483 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 37700 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 37718 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 37722 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 37760 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 37765 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 37766 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 37780 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 37785 | Cosmetic Vein Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38205 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38206 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38207 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38209 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38210 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38211 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38212 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38213 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38214 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38215 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38240 | Marrow Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38241 | Marrow Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 38242 | Marrow Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 39208 | Stem Cell Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40500 | Reconstructive Face Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40510 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40520 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40527 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40530 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40804 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40805 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40806 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40818 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40840 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40842 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40843 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40844 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 40845 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41500 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41510 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41512 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41530 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41599 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41820 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41821 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41822 | 41823, 41825, 41826, 41827, 41828, 41830, 41850, 41870, 41872, 41874, 42120, 42299, 42300, 42305, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41823 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41825 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41826 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41827 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41828 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41830 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41850 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41870 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41872 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 41874 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42120 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42145 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42299 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42300 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42305 | 42310, 42320, 42330, 42335, 42340, 42400, 42405, 42408, 42409 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42310 | Oral Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42320 | Oral Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42330 | Oral Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42335 | Oral Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42340 | Oral Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42400 | Oral Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42405 | Oral Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42408 | Oral Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 42409 | Oral Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43644 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43645 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43647 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43648 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43659 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43770 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43771 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43772 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43773 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43774 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43775 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43842 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43843 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43845 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43846 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43847 | Bariatric Surgery | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43848 | Inpatient Hospital Services - All inpatient stays require authorization EXCEPT deliveries which require notification only. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43881 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43882 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43886 | Inpatient Hospital Services - All inpatient stays require authorization EXCEPT deliveries which require notification only. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43887 | Inpatient Hospital Services - All inpatient stays require authorization EXCEPT deliveries which require notification only. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43888 | Inpatient Hospital Services - All inpatient stays require authorization EXCEPT deliveries which require notification only. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 43999 | Inpatient Hospital Services - All inpatient stays require authorization EXCEPT deliveries which require notification only. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 44130 | Inpatient Hospital Services - All inpatient stays require authorization EXCEPT deliveries which require notification only. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 44132 | Intestine Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 44133 | Intestine Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 44135 | Intestine Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 44136 | Intestine Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 44137 | Intestine Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 44715 | Intestine Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 44720 | Intestine Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 44721 | Intestine Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 47135 | Liver Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 47136 | Liver Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 47143 | Liver Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 47144 | Liver Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 47145 | Liver Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 47146 | Liver Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 47147 | Liver Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 48160 | Islet Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 48550 | Pancreas Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 48551 | Pancreas Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 48552 | Pancreas Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 48554 | Pancreas Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 48556 | Pancreas Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50320 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50323 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50325 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50327 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50328 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50329 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50340 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50360 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50365 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50370 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 50380 | Kidney Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 53400 | Gender Affirmation Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 53405 | Gender Affirmation Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 53410 | Gender Affirmation Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 53415 | Gender Affirmation Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 53420 | Gender Affirmation Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 53425 | Gender Affirmation Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 53430 | Gender Affirmation Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 53445 | All codes including but not limited to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54125 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54130 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54135 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54400 | All codes including but not limited to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54401 | All codes including but not limited to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54405 | All codes including but not limited to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54406 | All codes including but not limited to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54410 | All codes including but not limited to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54411 | All codes including but not limited to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54416 | All codes including but not limited to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54417 | All codes including but not limited to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54520 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 54690 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 55175 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 55180 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 55899 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 55970 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 55980 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 56805 | Codes that are not performed for gender reaffirmation purposes and | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 57335 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58150 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58180 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58260 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58262 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58275 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58290 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58291 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58541 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58542 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58543 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58544 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58552 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58553 | do not require authorization for another category do not require | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58554 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58570 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58571 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58572 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58573 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58661 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58700 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58720 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58953 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58956 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 58999 | authorization | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59812 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59820 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59821 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59830 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59840 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59841 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59850 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59851 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59852 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59855 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59856 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59857 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59866 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59870 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59897 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59898 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 59899 | Termination of Pregnancy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61850 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61860 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61863 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61864 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61867 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61868 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61870 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61880 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61885 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61886 | Two separate authorizations are required; one for the trial and one | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 61888 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 63650 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 63655 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 63661 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 63662 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 63663 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 63664 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 63685 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 63688 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64550 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64555 | submit authorizations for both procedures. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64561 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64565 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64566 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64568 | for the permanent insertion of neurostimulators. Please ensure to | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64569 | submit authorizations for both procedures. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64570 | submit authorizations for both procedures. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64575 | submit authorizations for both procedures. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64580 | submit authorizations for both procedures. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64581 | submit authorizations for both procedures. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64582 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64583 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64584 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64585 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64590 | submit authorizations for both procedures. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 64595 | submit authorizations for both procedures. | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 65710 | Cornea Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 65730 | Cornea Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 65750 | Cornea Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 65755 | Cornea Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 65756 | Cornea Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67900 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67901 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67902 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67903 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67904 | Blepharoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67906 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67908 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67909 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67912 | Blepharoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67916 | Blepharoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67917 | Blepharoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67923 | Blepharoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 67924 | Blepharoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 69090 | Breast Reconstruction Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 69300 | Otoplasty | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81105 | 81106 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81106 | 81107 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81107 | 81108 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81108 | 81109 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81109 | 81110 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81110 | 81111 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81111 | 81112 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81112 | 81120 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81120 | 81121 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81121 | 81161 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81161 | 81162 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81162 | 81163 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81163 | 81164 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81164 | 81165 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81165 | 81166 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81166 | 81167 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81167 | 81168 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81168 | 81170 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81170 | 81171 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81171 | 81172 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81172 | 81173 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81173 | 81174 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81174 | 81175 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81175 | 81176 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81176 | 81177 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81177 | 81178 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81178 | 81179 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81179 | 81180 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81180 | 81181 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81181 | 81182 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81182 | 81183 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81183 | 81184 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81184 | 81185 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81185 | 81186 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81186 | 81187 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81187 | 81188 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81188 | 81189 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81189 | 81190 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81190 | 81191 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81191 | 81192 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81192 | 81193 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81193 | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81194 | 81200 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81200 | 81201 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81201 | 81202 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81202 | 81203 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81203 | 81204 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81204 | 81205 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81205 | 81206 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81206 | 81207 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81207 | 81208 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81208 | 81209 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81209 | 81210 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81210 | 81211 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81211 | 81212 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81212 | 81213 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81213 | 81214 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81214 | 81215 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81215 | 81216 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81216 | 81217 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81217 | 81218 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81218 | 81219 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81219 | 81220 no auth required, Medicaid, Community, and Health Advantage | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81220 | no auth required, Medicaid, Community, and Health Advantage | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81221 | 81222 Medicaid only - no auth required | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81222 | Medicaid only - no auth required | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81223 | Medicaid only - no auth required | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81224 | 81225 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81225 | 81226 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81226 | 81227 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81227 | 81228 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81228 | 81229 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81229 | 81230 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81230 | 81231 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81231 | 81232 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81232 | 81233 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81233 | 81234 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81234 | 81235 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81235 | 81236 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81236 | 81237 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81237 | 81238 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81238 | 81239 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81239 | 81240 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81240 | 81241 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81241 | 81242 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81242 | 81243 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81243 | 81244 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81244 | 81245 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81245 | 81246 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81246 | 81247 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81247 | 81248 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81248 | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81249 | 81250 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81250 | 81251 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81251 | 81252 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81252 | 81253 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81253 | 81254 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81254 | 81255 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81255 | 81256 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81256 | 81257 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81257 | 81258 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81258 | 81259 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81259 | 81260 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81260 | 81261 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81261 | 81262 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81262 | 81263 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81263 | 81264 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81264 | 81265 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81265 | 81266 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81266 | 81267 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81267 | 81268 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81268 | 81269 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81269 | 81270 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81270 | 81271 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81271 | 81272 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81272 | 81273 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81273 | 81274 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81274 | 81275 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81275 | 81276 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81276 | 81277 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81277 | 81278 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81278 | 81279 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81279 | 81283 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81283 | 81284 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81284 | 81285 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81285 | 81286 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81286 | 81287 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81287 | 81288 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81288 | 81289 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81289 | 81290 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81290 | 81291 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81291 | 81292 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81292 | 81293 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81293 | 81294 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81294 | 81295 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81295 | 81296 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81296 | 81297 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81297 | 81298 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81298 | 81299 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81299 | 81300 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81300 | 81301 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81301 | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81302 | 81303 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81303 | 81304 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81304 | 81305 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81305 | 81306 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81306 | 81307 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81307 | 81308 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81308 | 81309 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81309 | 81310 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81310 | 81311 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81311 | 81312 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81312 | 81313 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81313 | 81314 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81314 | 81315 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81315 | 81316 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81316 | 81317 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81317 | 81318 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81318 | 81319 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81319 | 81320 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81320 | 81321 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81321 | 81322 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81322 | 81323 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81323 | 81324 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81324 | 81325 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81325 | 81326 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81326 | 81327 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81327 | 81328 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81328 | 81329 no auth required, Medicaid, Community, and Health Advantage | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81329 | no auth required, Medicaid, Community, and Health Advantage | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81330 | 81331 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81331 | 81332 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81332 | 81333 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81333 | 81334 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81334 | 81335 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81335 | 81336 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81336 | 81337 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81337 | 81338 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81338 | 81339 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81339 | 81340 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81340 | 81341 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81341 | 81342 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81342 | 81343 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81343 | 81344 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81344 | 81345 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81345 | 81346 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81346 | 81347 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81347 | 81348 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81348 | 81349 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81349 | 81350 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81350 | 81351 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81351 | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81352 | 81353 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81353 | 81355 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81355 | 81357 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81357 | 81360 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81360 | 81361 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81361 | 81362 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81362 | 81363 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81363 | 81364 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81364 | 81370 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81370 | 81371 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81371 | 81373 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81373 | 81374 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81374 | 81375 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81375 | 81376 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81376 | 81377 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81377 | 81378 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81378 | 81379 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81379 | 81380 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81380 | 81381 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81381 | 81382 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81382 | 81383 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81383 | 81400 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81400 | 81401 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81401 | 81402 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81402 | 81403 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81403 | 81404 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81404 | 81405 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81405 | 81406 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81406 | 81407 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81407 | 81408 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81408 | 81410 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81410 | 81411 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81411 | 81412 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81412 | 81413 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81413 | 81414 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81414 | 81415 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81415 | 81416 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81416 | 81417 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81417 | 81418 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81418 | 81419 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81419 | 81420 no auth required, Medicaid, Community, and Health Advantage | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81420 | no auth required, Medicaid, Community, and Health Advantage | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81422 | 81425 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81425 | 81426 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81426 | 81427 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81427 | 81430 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81430 | 81431 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81431 | 81432 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81432 | 81433 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81433 | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81434 | 81435 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81435 | 81436 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81436 | 81437 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81437 | 81438 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81438 | 81439 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81439 | 81440 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81440 | 81441 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81441 | 81442 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81442 | 81443 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81443 | 81445 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81445 | 81448 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81448 | 81449 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81449 | 81450 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81450 | 81451 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81451 | 81455 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81455 | 81456 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81456 | 81458 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81458 | 81459 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81459 | 81460 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81460 | 81462 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81462 | 81463 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81463 | 81464 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81464 | 81465 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81465 | 81470 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81470 | 81471 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81471 | 81479 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81479 | 81482 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81482 | 81493 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81493 | 81500 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81500 | 81504 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81504 | 81506 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81506 | 81507 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81507 | 81508 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81508 | 81509 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81509 | 81510 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81510 | 81511 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81511 | 81512 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81512 | 81513 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81513 | 81514 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81514 | 81518 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81518 | 81519 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81519 | 81520 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81520 | 81521 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81521 | 81522 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81522 | 81523 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81523 | 81525 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81525 | 81528 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81528 | 81529 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81529 | 81538 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81535 | 81536 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81536 | 81539 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81538 | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81539 | 81546 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81540 | 81541 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81541 | 81542 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81542 | 81546 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81546 | 81551 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81551 | 81552 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81552 | 81554 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81554 | 81560 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81560 | 81595 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81595 | 82533 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 81599 | 83497 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 82533 | 81535 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 83497 | 83516 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 83516 | 83516 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 83519 | 83950 No auth required if billed with a cancer diagnosis | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 83950 | No auth required if billed with a cancer diagnosis | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 83951 | No auth required if billed with a cancer diagnosis | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 83986 | 84157 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 84157 | 84182 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 84182 | 84182 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 84999 | 85291 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 85291 | No auth required for pregnant women over the age of 40 and services are provided in- | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86146 | * network for Medicaid, Community, and Health Advantage | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86147 | * network for Medicaid, Community, and Health Advantage | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86148 | * network for Medicaid, Community, and Health Advantage | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86200 | 86255 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86255 | 86255 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86256 | 86256 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86258 | 86321 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86321 | 86341 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86341 | 86341 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86362 | 86364 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86364 | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86431 | 86617 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86617 | 86618 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86618 | 86618 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86666 | 86753 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86753 | 86849 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 86849 | 87177 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 87177 | 87624 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 87624 | 87625 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 87625 | 87798 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 87798 | 88121 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88121 | 88187 No auth required if billed with a cancer diagnosis | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88187 | No auth required if billed with a cancer diagnosis | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88188 | No auth required if billed with a cancer diagnosis | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88189 | No auth required if billed with a cancer diagnosis | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88230 | 88233 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88233 | 88235 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88235 | 88237 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88237 | 88239 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88239 | 88240 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88240 | 88241 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88241 | 88245 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88245 | 88248 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88248 | 88249 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88249 | 88261 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88261 | 88262 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88262 | 88263 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88263 | 88264 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88264 | 88267 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88267 | 88269 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88269 | 88271 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88271 | 88272 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88272 | 88273 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88273 | 88274 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88274 | 88275 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88275 | 88280 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88280 | 88283 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88283 | 88285 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88285 | 88289 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88289 | 88291 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88291 | 88299 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88299 | 88346 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88346 | 88350 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88350 | 88360 No auth required if billed with a cancer diagnosis | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88360 | No auth required if billed with a cancer diagnosis | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88361 | No auth required if billed with a cancer diagnosis | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88363 | 88364 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88364 | 88365 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88365 | 88366 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88366 | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88367 | 88368 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88368 | 88369 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88369 | 88373 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88373 | 88374 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88374 | 88377 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88377 | 88387 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88387 | 88388 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88388 | 88399 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88399 | 88749 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 88749 | 89290 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 89290 | 89291 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 89291 | 0004M | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 90378 | Synagis palivizumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 90870 | Electroconvulsive Therapy | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| 93668 | Medical Rehabilitation | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0021 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0380 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0382 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0384 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0390 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0392 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0394 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0396 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0398 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0420 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0422 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0424 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0425 | Ambulance) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0426 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0428 | Ambulance Services (Medicare-covered non-emergency transport by | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0430 | Requires retro medical necessity review | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0431 | Requires retro medical necessity review | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0432 | Ambulance) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0433 | Ambulance) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0434 | Ambulance) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0435 | Requires retro medical necessity review | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0436 | Requires retro medical necessity review | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0888 | Ambulance) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A0999 | Ambulance) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A4421 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A4459 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A4467 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A4615 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A4619 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A4620 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A5083 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6412 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6501 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6502 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6503 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6504 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6505 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6506 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6507 | DME Purchase >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6508 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6509 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6510 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6511 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6512 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6513 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6545 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A6549 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A7522 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A9274 | Insulin Pumps | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A9543 | Zevalin ibritumomab tiuxetan Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| A9999 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4034 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4035 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4036 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4081 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4082 | All products which require authorization regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4083 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4087 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4088 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4102 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4149 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4150 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4152 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4153 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4154 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4155 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4157 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4158 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4159 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4160 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4161 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B4162 | B9002, B9004, B9006, B9998, B9999, E0236, E0240, E0241, E0243, E0244, E0245,E0265, E0277, E0301, E0302, E0303, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B9002 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B9004 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B9006 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B9998 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| B9999 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| C1813 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| C2622 | Male Enhancement and Device Procedures | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| C9084 | Zynlonta loncastuximab tesirine-lpyl Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| C9399 | Unclassified/ Non- Unclassified drugs or biologicals $ | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0236 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0240 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0241 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0243 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0244 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0245 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0265 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0277 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0301 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0302 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0303 | E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0457, E0482, E0625, E0635, E0637, E0638, E0639, E0641, E0642, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0304 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0316 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0328 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0329 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0371 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0372 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0373 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0439 | DME Rental >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0457 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0465 | DME Rental >$1000 (billed by line) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0466 | All products which require authoriztion regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0482 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0483 | All products which require authoriztion regardless of fee are listed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0625 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0635 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0637 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0638 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0639 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0641 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0642 | E0652, E0656, E0657, E0670, E0766, E0953, E0954, E0983, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0652 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0656 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0657 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0670 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0747 | Bone Stimulators | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0748 | Bone Stimulators | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0760 | Bone Stimulators | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0766 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0784 | Insulin Pumps | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0953 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0954 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0983 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E0986 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1002 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1003 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1004 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1005 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1006 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1007 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1008 | E1009, E1012, E1017, E1018, E1161, E1230, E1231, E1232, E1233, E1234, E1235, E1225, E1229, E1239, E1356, E1357, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1009 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1012 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1017 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1018 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1161 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1225 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1229 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1230 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1231 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1232 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1233 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1234 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1235 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1239 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1356 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1357 | E1399, E1639, E2230, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2311, E2312, E2313, E2324, E2327, E2328, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1399 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E1639 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2230 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2291 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2292 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2293 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2294 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2295 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2300 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2301 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2311 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2312 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2313 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2324 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2327 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2328 | E2330, E2331, E2358, E2378, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2330 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2331 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2358 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2378 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2402 | E2512, E2599, E2609, E2617, E2622, E2623, E2624, E2625, K0009, K0108, K0606, K0607, K0608, K0609, K0812, K0826, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2506 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2508 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2510 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2511 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2512 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2599 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2609 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2617 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2622 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2623 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2624 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| E2625 | K0005, K0009, K0108, K0607, K0608, K0609, K0802, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| G0341 | Islet Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| G0342 | Islet Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| G0343 | Islet Transplant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| G9143 | G9840 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| G9840 | G9841 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| G9841 | S3800 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0129 | Orencia IV abatacept Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0172 | Aduhelm aducanumab-avwa | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0180 | Fabrazyme agalsidase beta | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0202 | Lemtrada alemtuzumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0220 | Lumizyme alglucosidase alfa | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0221 | Lumizyme alglucosidase alfa | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0222 | Onpattro patisiran | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0224 | Oxlumo lumasiran | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0256 | Aralast NP alpha 1-proteinase inhibitor Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0257 | Glassia alpha 1-proteinase inhibitor | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0485 | Nulojix belatacept | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0490 | Benlysta belimumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0517 | Fasenra benralizumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0565 | Zinplava bezlotoxumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0567 | Brineura cerliponase alfa | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0584 | Crysvita burosumab-twza | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0585 | Botox onabotulinumtoxinA Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0586 | Dysport abobotulinumtoxin A | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0587 | Myobloc ramabotulinumtoxinB | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0588 | Xeomin incobotulinumtoxin A | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0593 | Takhzyro lanadelumab-flyo | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0596 | Ruconest c1 esterase inhibitor | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0597 | Berinert c1 esterase inhibitor | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0598 | Cinryze c1 esterase inhibitor (human) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0599 | Haegarda c1 esterase inhibitor subcutaneous | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0638 | Ilaris canakinumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0717 | Cimzia certolizumab pegol Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0775 | Xiaflex collagenase clostridium histolyticum | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0791 | Adakveo crizanlizumab-tmca Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0800 | H.P. Acthar Gel corticotropin Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0894 | Dacogen decitabine | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0896 | Reblozy luspatercept-aamt | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J0897 | Prolia denosumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1290 | Kalbitor ecallantide | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1300 | Soliris eculizumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1301 | Radicava edaravone Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1303 | Ultomiris ravulizumab-cwvz | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1305 | Evkeeza evinacumab-dgnb Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1322 | Vimizim elosulfase alfa | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1325 | Veletri epoprostenol | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1426 | Amondys-45 casimersen | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1427 | Viltepso viltolarsen Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1428 | Exondys 51 eteplirsen | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1429 | Vyondys 53 golodirsen Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1448 | Cosela trilaciclib | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1458 | Naglazyme galsulfase | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1459 | Privigen immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1460 | GamaSTAN S/D immune globulin J1560 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1554 | Asceniv immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1555 | Cuvitru immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1556 | Bivigam immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1557 | Gammaplex immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1558 | Xembify immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1559 | GamaSTAN S/D immune globulin J1560 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1560 | GamaSTAN S/D immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1561 | Gammaked immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1566 | Carimune NF immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1568 | Octagam immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1569 | Gammagard immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1575 | Hyqvia immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1599 | Panxyga immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1602 | Simponi ARIA golimumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1632 | Zulresso brexanolone | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1743 | Elaprase idursulfase | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1744 | Firazyr icatibant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1745 | Infliximab infliximab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1772 | Flebogamma DIF immune globulin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1786 | Cerezyme imiglucerase | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1823 | Uplizna inebilizumab-cdon | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1930 | Somatuline Depot lanreotide | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J1931 | Aldurazyme laronidase | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2182 | Nucala mepolizumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2323 | Tysabri natalizumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2326 | Spinraza nusinersen | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2350 | Ocrevus ocrelizumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2353 | Sandostatin LAR octreotide | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2357 | Xolair omalizumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2502 | Signifor LAR pasireotide | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2507 | Krystexxa pegloticase Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2562 | Mozobil plerixafor | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2783 | Elitek rasburicase | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2786 | Cinqair reslizumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2793 | Arcalyst rilonacept | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2820 | Leukine sargramostim | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2840 | Kanuma sebelipase alfa | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2860 | Sylvant siltuximab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J2941 | Growth Hormones somatropin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3032 | Vyepti eptinezumab-jjmr Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3060 | Elelyso taliglucerase alfa | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3111 | Evenity romosozumab-apqg Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3241 | Tepezza teprotumumab-trbw | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3245 | Ilumya tildrakizumab-asmn Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3262 | Actemra IV tocilizumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3285 | Remodulin treprostinil (injection) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3358 | Stelara (IV only) ustekinumab (IV only) Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3380 | Entyvio vedolizumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3385 | Vpriv velaglucerase alfa | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3396 | Visudyne verteporfin Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3397 | Mepsevil vestronidase alfa-vjbk | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3398 | Luxturna voretigene neparvovec-rzyl | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3399 | Zolgensma onasemnogene abeparvovec-xioi | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3489 | Reclast zoledronic acid | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3490 | specific Codes $ PA Unclassified drugs $ | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3590 | Required if billed Unclassified biologics $ | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J3591 | Unclassified drug or biological used for esrd on dialysis $ | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7170 | Hemlibra emicizumab-kxwh | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7175 | Coagadex coagulation factor X (human) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7179 | Vonvendi von Willebrand factor (recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7180 | Corifact factor XIII concentrate (human) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7181 | Tretten coagulatoin factor XIII A-subunit (recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7182 | NovoEight Factor VIII, (antihemophilic factor, recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7185 | Xyntha/Xyntha Solufus antihemophilic factor (recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7186 | Alphanate (human) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7188 | Obizur antihemophilic factor (recombinant), porcine sequence | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7189 | NovoSeven RT coagulation factor (VIIa (recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7190 | Koate-DVI antihemophilic factor (human) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7192 | Advate antihemophilic factor (recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7193 | AlphaNine SD coagulation factor IX (human) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7194 | Bebulin factor IX complex | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7195 | Benefix coagulatoin factor IX (recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7197 | Thrombate III antithrombin III (human) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7198 | Feiba NF anti-inhibitor coagulant complex | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7200 | Rixubis coagulation factor IX (recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7201 | Alprolix coagulation factor IX (recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7202 | Idelvion antihemophilic factor (recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7203 | Rebinyn coagulation factor IX (recombinant) GlucoPEGylated | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7204 | Esperoct antihemophilic factor (recombinant), glycopegylated-exei | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7205 | Eloctate antihemophilic factor (recombinant) , Fc fusion protein | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7207 | Adynovate antihemophilic factor (recombinant), PEGylated | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7208 | Jivi antihemophilic factor (recombinant), PEGylated-aucl1 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7209 | Nuwiq simoctocog alfa | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7210 | Afstyla antihemophilic factor (recombinant) single chain | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7211 | Kovaltry antihemophilic factor (recombinant) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7212 | SevenFact coagulation factor VII (recominant)-jncw | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7318 | Durolane sodium hyaluronate Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7320 | Genvisc 850 sodium hyaluronate | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7321 | Hyalgan sodium hyaluronate Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7322 | Hymovis sodium hyaluronate Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7323 | Euflexxa hyaluronate sodium Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7324 | Orthovisc sodium hyaluronate Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7325 | Synvisc/Synvisc One hylan G-F 20 Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7326 | Gel-One sodium hyaluronate | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7327 | Monovisc sodium hyaluronate Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7328 | Gelsyn-3 sodium hyaluronate | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7329 | TriVisc sodium hyaluronate Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7332 | Triluron hyaluronate sodium Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7352 | Scenesse afamelanotide | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7599 | Immunosuppressive drug, not otherwise classified $ | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7686 | Tyvaso treprostinil (inhaled) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7799 | Not otherwise classified drugs, other than inhalation drugs, $ | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J7999 | Compounded drug, not otherwise classified $ | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J8499 | amount exceeds $500 Prescription drug, oral, non-chemotherapeutic, nos $ | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9019 | Erwinaze asparaginase erwinia chrysanthemi Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9020 | Elspar asparaginase Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9021 | Rylaze asparaginase erwinia chrysanthemi (recombinant)-rywn Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9022 | tecentriq atezolizumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9023 | Bavencio avelumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9025 | Vidaza azacitidine | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9032 | Beleodaq belinostat | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9037 | Blenrep belantamab mafodotin-blmf Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9039 | Blincyto blinatumomab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9041 | Velcade bortezomib Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9042 | Adcetris brentuximab vedotin Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9043 | Jevtana ixabepilone Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9047 | Kyprolis carfilzomib Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9055 | Erbitux cetuximab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9057 | Aliqopa copanlisib Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9061 | Rybrevant IV amivantamab-vmjw Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9118 | Asparlas calaspargase pegol-mknl | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9119 | Libtayo cemiplimab-rwlc | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9144 | Darzalex Faspro da and hyaluronidase-fihj | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9145 | Darzalex daratumumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9153 | Vyxeos daunorubicin/cytarabine | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9173 | Imfinzi durvalumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9176 | Empliciti elotuzumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9177 | Padcev enfortumab vedotin-ejfv Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9179 | Halaven eribulin mesylate Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9203 | Mylotarg gemtuzumab ozogamicin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9204 | Poteligeo mogamulizumab-kpkc Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9205 | Onivyde irinotecan liposome injection Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9207 | Ixempra ixabepilone Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9210 | Gamifant emapalumab-lzsg Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9223 | Zepzelca lurbinectedin Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9227 | Sarclisa isatuximab-irfc Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9228 | Yervoy ipilimumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9229 | Besponsa inotuzumab ozogamicin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9247 | Pepaxto melphalan flufenamide Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9262 | Synribo omacetaxine mepesuccinate Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9264 | Abraxane paclitaxel-nab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9266 | Oncaspar pegaspargase | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9269 | Elzonris tagraxofusp-erzs | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9271 | Keytruda pembrolizumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9272 | Jemperli dostarlimab-gxly Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9285 | Lartruvo olaratumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9293 | Novantrone mitoxantrone hydrochloride | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9295 | Portrazza necitumumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9299 | Opdivo nivolumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9301 | Gazyva obinutuzumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9302 | Arzerra ofatumumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9303 | Vectibix panitumumab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9306 | Perjeta pertuzumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9307 | Folotyn pralatrexate | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9308 | Cyramza ramucirumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9309 | Polivy polatuzumab vedotin-piiq Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9311 | Rituxan Hycela rituximab/hyaluronidase human Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9312 | Rituxan rituximab Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9313 | Lumoxiti moxetumomab pasudotox-tdfk Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9316 | Phesgo pertuzumab, trastuzumab, and hyaluronidase-zzxf | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9317 | Trodelvy sacituzumab govitecan-hziy Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9318 | Romidespin romidespin Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9319 | Istodax romidespin Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9325 | Imlygic talimogene laherparepvec | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9330 | Torisel temsirolimus | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9349 | Monjuvi tafasitamab-cxlx | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9352 | Yondelis trabectedin Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9353 | Margenza margetuximab-cmkb Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9354 | Kadcyla ado-trastuzumab emtansine Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9356 | Herceptin trastuzumab and hyaluronidase-oysk Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9357 | Valstar valrubicin | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9358 | Enhertu fam-trastuzumab deruxtecan-nxki | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9371 | Marqibo vincristine sulfate Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9395 | Faslodex fulvestrant | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9400 | Zaltrap ziv-aflibercept Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9600 | Photofrin porfimer sodium | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| J9999 | Not otherwise classified, antineoplastic drugs $ | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0005 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0009 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0108 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0554 | Insulin Pumps | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0606 | K0828, K0829, K0830, K0831, K0839, K0840, K0850, K0851, K0852, K0853, K0854, K0855, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0607 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0608 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0609 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0802 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0807 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0808 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0812 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0813 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0814 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0815 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0816 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0820 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0821 | K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0822 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0823 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0824 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0825 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0826 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0827 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0828 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0829 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0830 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0831 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0835 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0836 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0837 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0838 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0839 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0840 | K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0841 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0842 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0843 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0848 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0849 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0850 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0851 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0852 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0853 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0854 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0855 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0856 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0857 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0858 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0859 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0860 | K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0861 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0862 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0863 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0864 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0868 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0869 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0870 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0871 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0877 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0878 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0879 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0880 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0884 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0885 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0886 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0890 | K0891, K0898, S8422, S8423, Q0479, S8425, S8426, S9379, T5001 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0891 | Dialysis no authorization needed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| K0898 | Dialysis no authorization needed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| L1685 | Prosthetics and Orthotics | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| L1686 | Prosthetics and Orthotics | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| L3915 | Prosthetics and Orthotics | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| L3916 | Prosthetics and Orthotics | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| L5848 | Prosthetics and Orthotics | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| L5856 | Prosthetics and Orthotics | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| L5857 | Prosthetics and Orthotics | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| L5858 | Prosthetics and Orthotics | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| L5859 | Prosthetics and Orthotics | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| L5987 | Prosthetics and Orthotics | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q0479 | Dialysis no authorization needed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q2041 | Yescarta axicabtagene ciloleucel Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q2042 | Kymriah tisangenlecleucel Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q2043 | Provenge sipuleucel-T Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q2053 | Tecartus brexucabtagene autoeucel | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q2054 | Breyanzi lisocabtagene maraleucel Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q2055 | Abecma idecabtagene vicleucel Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q4074 | Ventavis iloprost (inhaled) | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5103 | Inflectra infliximab-dyyb Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5104 | Renflexis infliximab-abda Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5109 | Ixifi infliximab-qbtx, biosimilar Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5112 | Ontruzant trastuzumab-dttb, biosimilar Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5113 | Herzuma trastuzumab-pkrb, biosimilar Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5114 | Ogivri trastuzumab-dkst, biosimilar Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5115 | Truxima rituximab-abbs, biosimilar Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5116 | Trazimera trastuzumab-qyyp, biosimilar Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5117 | Kanjinti trastuzumab-anns, biosimilar Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5118 | Zirabev bevacizumab-bvzr, biosimilar Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5119 | Ruxience rituximab-pvvr, biosimilar Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5121 | Avsola infliximab-axxq Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| Q5123 | Riabni rituximab-arrx, biosimilar Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S0013 | Spravato esketamine Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S0189 | Testopel testosterone pellet Y | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S2080 | Procedures to Correct Obstructive Sleep Apnea | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3800 | S3840 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3840 | S3841 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3841 | S3842 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3842 | S3844 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3844 | S3845 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3845 | S3846 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3846 | S3849 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3849 | S3850 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3850 | S3852 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3852 | S3853 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3853 | S3844 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3854 | S3861 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3861 | S3865 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3865 | S3866 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3866 | S3870 | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S3870 | Procedure Code Notes | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S8422 | Dialysis no authorization needed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S8423 | Dialysis no authorization needed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S8425 | Dialysis no authorization needed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S8426 | Dialysis no authorization needed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S9379 | Dialysis no authorization needed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| S9562 | Synagis palivizumab | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |
| T5001 | Dialysis no authorization needed | 2024-05-01 | Not listed | 97% | [PDF] Below is the preauthorization and notification list for MDwise ... |