Posts tagged: Not

cpt codes not covered by medicare

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By , November 18, 2017 3:50 pm


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cpt codes not covered by medicare

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Medicare Coverage Database – Centers for Medicare & Medicaid …

www.cms.gov

Apr 28, 2017 … The Medicare Coverage Database (MCD) contains all National … is no National
Coverage Determination (NCD) or when there is a need to …

Items and Services Not Covered Under Medicare – CMS.gov

www.cms.gov

applicable exceptions (items and services that may be covered). The discussion
is … list of all items and services Medicare may or may not cover. Please note: …

How to Use the Medicare Coverage Database – CMS.gov

www.cms.gov

“The searchable Medicare Coverage Database allows me to learn about any …
Medicare Contractors develop LCDs when there is no NCD or when there is a
need to … CPT/HCPCS codes, you also must enter a keyword because national …

Medicare Vision Services – CMS.gov

www.cms.gov

cover routine vision services, such as eyeglasses and eye exams. Medicare …
CPT codes, descriptions and other data only are … Medicare does not cover.

Medicare National Coverage Determinations (NCD) Coding Policy …

www.cms.gov

Jan 1, 2017 … 10-CM codes to the list of ICD-10-CM codes that Do Not. Support Medical.
Necessity for the. Blood Counts. (190.15) NCD. *Transmittal #3628.

Medicare Claims Processing Manual – CMS.gov

www.cms.gov

67.2.1 – Billing No Cost Items Due to Recall, Replacement, or Free Sample ….
200.2 – ICD-9 Diagnosis Codes for Vagus Nerve Stimulation (Covered since DOS
.

How Medicare Covers Self-Administered Drugs … – Medicare.gov

www.medicare.gov

Medicare Part B (Medical Insurance) generally covers care you get in a hospital
… If you get self-administered drugs that aren't covered by Medicare Part B while
in a … appointment, your Medicare drug plan may not pay you back for that drug.

Training Objectives – Dphhs

dphhs.mt.gov

Dec 24, 2015 … Recognize difference among types of Medicare coverage. 2. Understand
concepts … Identify appropriate diagnosis codes and CPT immunization service
…. or assets – help paying for some or all costs not covered by Medicare.

Coverage and Payment for Genetic Laboratory Tests – Office of …

oig.hhs.gov

memorandum for CMS's use in informing Medicare coverage and payment ….
Until 2012, Medicare did not use single CPT codes for genetic tests as it does.

Your Guide to Medicare's Preventive Services – Medicare.gov

www.medicare.gov

disease by exercising, eating well, keeping a healthy weight, and not … 2-year
calendar of the Medicare-covered tests and screenings you're eligible for, and.

CGMS: Codes for Billing Medicare

choosehealth.utah.gov

Name the 2 CPT procedure codes used by providers to bill … Medicare has not
established a national coverage …. Professional CGM Medicare Coverage.

TRICARE For Life Handbook

go.usa.gov

May 2, 2017 … prior authorizations, but they do not provide referrals for TFL beneficiaries. …
TRICARE For Life is Medicare-wraparound coverage for TRICARE.

billing resource manual – Georgia Department of Community Health

dch.georgia.gov

Phase I of this ongoing project is for new providers that do not currently have an
…. WHAT IF…the Medicaid Member is also eligible for Medicare? ….. CPT Code.

ODM Hospital Billing Guidelines – Ohio Department of Medicaid

medicaid.ohio.gov

Oct 1, 2015 … Transfer between Acute Care and Medicare Distinct Part Psychiatric Units ………….
……… 19. 2.2.2 ….. Appendix I – Covered and Non-Covered Revenue Codes . …..
value code 02 (hospital has no semi-private rooms) must be present … The total
amount of charges related to the revenue code and/or CPT/.

Professional Services Billing Manual – South Dakota Department of …

dss.sd.gov

SD Medicaid for Recipients. 1-800-597-1603. Medicare. 1-800-633-4227.
Division of Medical Services ….. COVERED SERVICES AND PROCEDURE
CODES .

CMS 1500 Billing Instructions – Maryland Medicaid – Maryland.gov

mmcp.dhmh.maryland.gov

Oct 1, 2015 … Only ICD-10-CM codes for claims with dates of service …. services that are not
covered by fee-for-service Medicaid. ….. the CPT code range of 70000-89999,
rendered on the same day, must be combined and entered.

Illinois Department of Healthcare and Family Services – Illinois.gov

www.illinois.gov

Sep 24, 2015 … Current Procedural Terminology (CPT) code for the LARC insertion in … ICD-9-
CM diagnosis codes will not be accepted on electronic and paper …. Medicare
crossovers (Medicare payable claims) are subject to a filing …

Provider Bulletin – MO.gov

dss.mo.gov

Jan 26, 2017 … HCPCS codes that were deleted by Centers for Medicare & Medicaid Services (
CMS) for. 2017 are not payable for dates of service January 1, 2017 and after
and will … For MHD coverage information, including fees and restrictions, please
… A number of new radiology CPT codes for mammography coding …

Physician Service Codes – Mass.Gov

www.mass.gov

Nov 9, 2016 … even if it is not designated as covered or payable in the Physician Manual. •.
Section 602 lists CPT codes that are not payable under MassHealth. •. Section
603 lists …… the Centers for Medicare & Medicaid Services website at.

MSA 17-01 – State of Michigan

www.michigan.gov

Jan 27, 2017 … Subject: Current Procedural Terminology (CPT) and Healthcare Common …
Refer to HCPCS code books and the Centers for Medicare … procedure code not
listed will not be covered at this time, except for reporting codes.

code cpt 11451 denial not covered when performed in this setting?

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By , November 9, 2017 8:48 am


AARP health insurance plans (PDF download)

Medicare replacement (PDF download)

AARP MedicareRx Plans United Healthcare (PDF download)

AARP life insurance (PDF download)

medicare benefits (PDF download)

medicare part b (PDF download)


code cpt 11451 denial not covered when performed in this setting?

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Ambulatory Surgery Centers – Colorado.gov

www.colorado.gov

Dec 1, 2014 … products, supplies, and services not included in the CPT codes, such as
ambulance services and durable …. setting. When multiple procedures are
performed, the procedure with the … If eligibility is not verified, payment may be
denied. …. 11451. 14040. 20200. 21805. 24138. 26100. 27202. 27709. 28406.

Provider Bulletin – Colorado.gov

www.colorado.gov

Jan 1, 2010 … Current Procedural Terminology (CPT) and HCPCS Level II codes published …
Medicaid clients may not be billed for charges that exceed the Medicaid
allowance. … procedures performed at the same surgical setting. … be denied. ….
11451. 15135. 21100. 24066. 26113. 27502. 28108. 31526. 37609.

CMS Manual System – CMS.gov

www.cms.gov

Jul 1, 2007 … No additional funding will be provided by CMS; contractor activities ….
Notification of an Integrated Outpatient Code Editor (OCE) for the … The OCE will
perform three … Classification (APC) number for each service covered under
OPPS, and return …. A claim denial means that the provider can not resubmit.

Claims – ForwardHealth Portal – State of Wisconsin

www.forwardhealth.wi.gov

Nov 1, 2013 … Providers should not submit provider-based billing claims through ….
ClaimCheck review does not change Medicaid or BadgerCare Plus policy on
covered services … Incidental procedures are those procedures performed at the
same time … deny procedure code 99212 as a preoperative visit because it is …

Physician – ForwardHealth Portal

www.forwardhealth.wi.gov

Mar 1, 2016 … Providers should not submit provider-based billing claims through ….
ClaimCheck review does not change Medicaid or BadgerCare Plus policy on
covered services … Incidental procedures are those procedures performed at the
same time … deny procedure code 99212 as a preoperative visit because it is …

Outpatient Mental Health – ForwardHealth Portal – State of Wisconsin

www.forwardhealth.wi.gov

Mar 1, 2016 … Providers should not submit provider-based billing claims through ….
ClaimCheck review does not change Medicaid or BadgerCare Plus policy on
covered services … Incidental procedures are those procedures performed at the
same time … deny procedure code 99212 as a preoperative visit because it is …

Medical Fee Schedule Effective January 1, 2016 – Maine.gov

www.maine.gov

Jan 1, 2016 … consistent with the most current medical coding and billing systems, including the
… performed has been altered by some specific circumstance but not … chapter
should refer to the most current CPT® which contains the complete and … from
the same health care provider have been controverted or denied.

MassHealth Transmittal Letter FAS-28 January 2015 TO – Mass.Gov

www.mass.gov

Jan 2, 2015 … If the appropriate service code used to bill for such a … updated regulations
provide that the claim will be denied unless at … an existing illness or injury and
was not performed for the purpose of sterilization; or ….. specifically states, for
each MassHealth coverage type, which services are covered and which.

1 of 254

medicaidprovider.mt.gov

… paid by APC method that have a zero fee are either bundled or not covered
services. … Codes noted as "not allowed" will cause the claim line to deny. …
Inpatient Only: These services are not payable in an outpatient setting …
publication of CPT). ….. 11451. T. REMOVAL SWEAT GLAND LESION. 05074.
19.1832. APC.

Medicaid Managed Care RFP 1-3-2008 – CT.gov

www.ct.gov

Jul 1, 2008 … of final selection of participating insurers/premium-setting? Rate increases for …
DSS please identify the specific dental codes that will be used and the
corresponding rates for …. not eligible, the claim should be denied and should
appear in the …. The premium billing and collection will be performed by the.

list of adj codes not covered by veterans

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By , October 21, 2017 7:19 am


AARP health insurance plans (PDF download)

Medicare replacement (PDF download)

AARP MedicareRx Plans United Healthcare (PDF download)

AARP life insurance (PDF download)

medicare benefits (PDF download)

medicare part b (PDF download)


list of adj codes not covered by veterans

PDF download:

How To Read A Rating Decision – California Department of Veterans …

www.calvet.ca.gov

In order for an advocate to adequately advise a veteran as to whether or not a VA
rating decision is … If the advocate determines that the reason for denial was a
lack of evidence to support … Applicable dates, such as dates covered by …
Some raters simply quote the Schedule of Rating Decisions diagnostic code for
the.

Claim Adjustment Reason Codes and Remittance … – Mass.Gov

www.mass.gov

May 2, 2017 … Claim Adjustment Reason Codes and Remittance Advice Remark Codes (
CARCs and …. SECOND MODIFIER NOT COVERED 182 …… THIS DRUG/
SERVICE/SUPPLY IS NOT INCLUDED IN THE FEE SCHEDULE OR.

Remittance Advice Remark and Claims Adjustment Reason Code …

www.cms.gov

Apr 6, 2015 … This article was prepared as a service to the public and is not intended to grant
rights or … Remittance Advice Remark Code (RARC) lists that are effective April 1
, 2015. …. N734 The patient is eligible for these medical services only when …
supplies furnished to a Medicare-eligible veteran through a facility.

EOB Code Description Rejection Code Group Code Reason Code …

www.lni.wa.gov

current fee schedule for valid code. … 065 Only one adjustment form should be
submitted listing all … Replacement and repair of this item is not covered by. L&I.

Department of Veterans Affairs (VA) – CMS.gov

www.cms.gov

For veterans eligible to receive both VA health and Medicare benefits and also …
CMS MAC must verify that the services provided are covered benefits, certify …
adjustment reason codes 1 (deductible) and/or 2 (coinsurance) will be used to …
of VA Part A-equivalent no-pay claims, adjudicated for the MRA Project, contain.

Guidebook Fee Basis Data – Health Economics Resource Center …

www.herc.research.va.gov

Development Service, U.S. Department of Veterans Affairs (ECN 99017-1). We
gratefully ….. 63. Appendix L. Adjustment Code (ADJCD1 and ADJCD2) Values .
…. procedure PROC CONTENTS to generate a list of all variables. Results
appear in … Diagnosis codes do not appear on the pharmacy (PHR) file.
Guidebook: Fee …

Medical Debts – Department of Veterans Affairs

www.va.gov

U.S. Code, VA regulations and Volume XII, Chapter 1. … Veteran is then billed for
the portion of the co-payment not covered by the insurance … than the claim and
requiring an accounting adjustment. ….. An electronic copy of the offset list is.

VHA Directive 1161, Productivity and Staffing in Outpatient Clinical …

www.va.gov

Jun 7, 2013 … DISTRIBUTION: E-mailed to the VHA Publications Distribution List … outpatient
CPT codes contained within the National Patient Care … For psychologists, FTE
adjusted for time spent in direct clinical care was … HCPCS, may also be used in
mental health settings for services not covered in the CPT codes.

ESC with Detailed Descriptions – Pennsylvania Department of …

www.dhs.pa.gov

255 THE BILLING PROVIDER SERVICE LOCATION CODE IS NOT A VALID
SERVICE … 283 THE CLAIM NUMBER OF COVERED DAYS IS NOT IN A VALID
FORMAT …. 550 THE CLAIM ADJUSTMENT BILLED WAS NOT PROCESSED …..
PROVIDER HAS BEEN LOCATED ON THE PRECLUDED PROVIDER LIST.

THE GUIDE TO DATA STANDARDS (Part A: Human … – OPM

www.opm.gov

Nov 15, 2014 … PRIOR LOCALITY ADJUSTMENT. 406 … RETIREMENT PREVIOUS COVERAGE
INDICATOR. 470 … VETERANS PREFERENCE FOR RIF INDICATOR. 513 … For
a listing of codes and explanations see The Guide to Data Standards, Part A: HR
Data … Organization does not make HR submissions to OPM.

MO HealthNet Professional Billing Book – Missouri Department of …

dss.mo.gov

Jun 21, 2013 … that would not normally be covered under the MO HealthNet program; to request
information ….. November 11, 2013 Veteran's Day ….. listing the claim, the RA
lists an “Adjustment Reason Code” to explain a payment, denial.

Application for Admission to a New Jersey Veterans Memorial Home

www.nj.gov

Appendix A – New Jersey Administrative Code (N.J.A.C.) 5A: 5 – Chapter 5 … o
List of any surgical procedures, date procedure was performed, and prognosis ….
This authorization is subject to revocation at any time except to the extent that the
… The Veterans Health Administration may not condition treatment, payment, …

Form 21-22 – Mississippi State Veterans Affairs Board

www.vab.ms.gov

CLAIMANT'S TELEPHONE NUMBERS (Include Area Code) … appointed
representative will not charge any fee or compensation for service rendered …
appointed as my representative may revoke this appointment at any time, subject
to 38 CFR 20.608. …. to provide your SSN by itself will not result in the denial of
benefits.

State Benefits for Georgia Veterans – Georgia Department of …

veterans.georgia.gov

No veterans' benefits are granted automatically – you must apply for them! … In
doing so, we pledge to stay current and adjust quickly and carefully to new laws,
…. Driver's Licenses is found in Official Code of Georgia Annotated. Title 40,
Chapter ….. A spouse or surviving spouse is not eligible for a Georgia ID card if
he/she …

SNAP Guidance on Non-Citizen Eligibility – USDA Food and …

www.fns.usda.gov

The reasons why some non-citizen households do not participate in SNAP even
… Individuals who are eligible for benefits may not apply …. Code of Federal
Regulations ….. visa or later adjust to special immigrant status after entering the
U.S. … honorably discharged veterans whose discharge is not due to immigration
.

ADVA – Alabama Department of Veterans Affairs

www.va.alabama.gov

Code of Alabama, Section 31-5A-8 states, "admission to and discharges from …
These veterans will not be placed on a waiting list or placed before wartime
veterans. … The below listed items are examples of non-covered charges and are
the responsibility of the ….. BEHAVIOR ADJUSTMENT (Check all those that apply
):.

Outpatient Hospital Prospective Payment Billing Manual – PEIA

www.peia.wv.gov

Otherwise, the annual update schedule will be followed for adjustment to the
reimbursement rates … Veterans Administration (VA) hospitals. …. PEIA. This
chart does not represent all HCPCS coding subject to OPPS, but will be
expanded at a.

The Servicemembers Civil Relief Act (SCRA) – Department of Justice

www.justice.gov

Aug 27, 2014 … servicemembers who have been called up for active duty is not required, nor ….. '
Servicemember'—Persons covered by the SCRA include members of the “
uniformed services” … service” is not further defined in Section 101 of Title 10,
U.S. Code, although … military service” under the Veterans Benefits Act).

Indiana Property Tax Benefits – Indiana state forms – IN.gov

forms.in.gov

(Indiana Code Cite) … mobile or manufactured home not assessed as real
property; …. year and remains eligible for the deduction for the following year is
not … 4) Combined adjusted gross income in year preceding year in which …. 6)
Surviving spouse of a veteran may receive this deduction if the veteran satisfied
the.

Federal Benefits for Veterans and Dep. 2010 – Maryland Veterans …

veterans.maryland.gov

Register Act. Under the provisions of 38 Code of Federal Regula … not be
provided to any Veteran or dependent wanted for an outstand … To be able to
register for an eBenefits account, Veterans must be list …. who are not otherwise
eligible for VA health care may still receive ….. Adjustment to vision loss
counseling. 3.

list of lab codes that aetna does not pay

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By , October 18, 2017 5:35 am


AARP health insurance plans (PDF download)

Medicare replacement (PDF download)

AARP MedicareRx Plans United Healthcare (PDF download)

AARP life insurance (PDF download)

medicare benefits (PDF download)

medicare part b (PDF download)


list of lab codes that aetna does not pay

PDF download:

Place of Service Codes for Professional Claims – CMS.gov

www.cms.gov

NOTE: Please direct questions related to billing place of service codes to your.
Medicare Administrative Contractor (MAC) for assistance, and not to.

2017 HCPCS Subject to CLIA edits – CMS.gov

www.cms.gov

2017 CPT-4 and HCPCS Codes Subject to CLIA Edits. Includes non-waived and
… The AMA does not directly or indirectly practice medicine or dispense …. Drug
screen class list a – Not payable by Medicare -. Discountinued 12/31/2016. 340.

Carrier Payment Denial – CMS.gov

www.cms.gov

Feb 4, 2005 … beneficiary of the reason(s) Medicare will not pay for the item and/or service. See
Pub 100 … The attachment lists each current claim adjustment reason code. The
first … 15 TS315 is the summary of non-lab charges. 16 TS316 …

Claim Adjustment Reason Codes and Remittance … – Mass.Gov

www.mass.gov

May 2, 2017 … MISSING/INCOMPLETE/INVALID PAY-TO PROVIDER PRIMARY IDENTIFIER.
0202 …. PROCEDURE CODE BILLED IS NOT CORRECT/VALID FOR THE …..
0478-BILL CPT CODES TO …. REVENUE CODE AND PROCEDURE CODE DO
NOT MATCH. …. IS NOT INCLUDED IN THE FEE SCHEDULE OR.

Health Care Claim Status Codes – Medi-Cal

files.medi-cal.ca.gov

Oct 6, 2008 … The recipient information billed on the claim does not correspond to … 286. Other
payer's Explanation of Benefits/payment information. …. Provider not Medicare
certified for lab procedure on date of service. ….. Billing error: Refer to injection
code drug list in the provider …. coverage letter from AETNA. 286.

SECTION 9 MATERNITY CARE AND DELIVERY

dss.mo.gov

No additional reimbursement will be paid for the completion … NOTE – If you are
not billing any of the global prenatal/delivery codes and you complete the Risk …

Aetna Open Access – OPM

www.opm.gov

Enrollment code for this Plan: … Important Notice from Aetna About Our
Prescription Drug Coverage and … This means you do not need to enroll in
Medicare Part D and pay extra for …… Keep and bring a list of all the medicines
you take.

Medicaid TPL Coverage Guide – State of New Jersey

www.newjersey.gov

Oct 1, 2011 … insurance pay for covered services first, and your Medicaid Health Plan generally
pays … Please note: Medicare providers who do not participate with Medicaid
have the … All Medicaid Health Plan ID cards will list a Medicaid Health Plan …
you visit a doctor, hospital, pharmacy, lab or other service provider.

EOB Code Description Rejection Code Group Code Reason Code …

www.lni.wa.gov

Code. Reason. Code. Remark. Code. 001 Denied. Care beyond first 20 visits or
60 days requires … 013 Quality or level of service does not meet L&I standards. …
034 Number of hours paid per agreement with L&I Occupational …. 065 Only one
adjustment form should be submitted listing all ….. Do not bill with CPT codes.

billing resource manual – Georgia Department of Community Health

dch.georgia.gov

AETNA: PPO; HMO; Point of Service; Open Access; Medicare Advantage …
Phase I of this ongoing project is for new providers that do not currently have an
active and …. greater than the Medicaid maximum allowable amount, Medicaid
will not pay anything on …. CPT Code Modifier ICD-9 DX …. Hep B, 3 dose
schedule.

Professional Services Billing Manual – South Dakota Department of …

dss.sd.gov

CODES TO BE BILLED ON PHARMACY CLAIM FORM . ….. Problems or
questions concerning recipient eligibility requirements can be addressed by the
local field Division of … Participating providers agree to accept Medicaid payment
as payment in full for covered … The South Dakota Medicaid Provider Agreement
is NOT.

Benefits for better living – Pima County

webcms.pima.gov

your doctor does not belong to Aetna's network, you will pay more for your …
basis. Under Section 125 of the Internal Revenue Code, employees … The IRS
determines which expenses may be paid from an HSA. For a list ….. Lab and X-
ray.

open enrollment – Statewide Benefits – State of Delaware

ben.omb.delaware.gov

May 9, 2016 … 2016 Enrollment Action Checklist. … Plan Descriptions. Aetna HMO and
Consumer-Directed Health Gold Plan. ….. The letter code "AS" applies to Active
State Employees. …. If you do not have access to a computer, or have questions
about your benefits …. State of Delaware pays 90% and you pay 10% (in-.

Managed Care Manual for Medicaid Providers – Illinois.gov

www.illinois.gov

Further, this handbook does not alter or supersede any managed care … the
Medicaid Fee-For-Service program can be found in the HFS Provider Handbooks
. ….. Health Plan must pay 99 percent (99%) of all clean claims from Providers for
covered …. A list of Medicaid services can be found in 89 Ill. Adm. Code, Part 140.

surprise medical bills – NY.gov

www.governor.ny.gov

Mar 7, 2012 … bill from a specialist or other provider who the consumer did not know was ….
Consumers with PPO coverage are required to pay the difference between …
Aetna Health, Inc., Aetna Health Insurance of New York, Aetna Life … from UCR
reimbursement and towards a Medicare fee schedule; ….. Lab Services.

Illinois Workers' Compensation Commission Questions & Answers …

www.iwcc.il.gov

Jan 25, 2010 … how do they get paid when the supervising physician and hospital staff … The
IWCC used the CMS list of HOSF procedure codes (not …. is not covered under
work comp law, such as CPT 97010, they bill the patient. ….. Q: We submitted a
claim and received payment from Coventry that was priced by Aetna.

2016-17 TRS-ActiveCare Benefits Booklet – Texas.gov

www.trs.texas.gov

Sep 1, 2016 … Aetna provides claims payment services only and does not assume any … the
new Generics Only Preventive Therapy Drug List published by the Internal
Revenue Service (IRS). …. lab tests). Walk in clinics. Urgent Care Centers. After
deductible, plan pays …. based on the diagnosis and service codes billed.

State of Ohio Employee Benefits Guide – Ohio Department of …

das.ohio.gov

Jul 1, 2016 … Ohio will not be eligible at the time of hire and will instead be measured over a 12
-month …. Visit the Definitions and Required Documents Checklist at … Rather,
Aetna, Anthem and Medical Mutual are paid an administrative … Medical Third-
Party Administrator ZIP Code Chart. AETNA … and Lab Services.

Vision Benefits – Claim Instructions – Aetna Federal Plans

doa.alaska.gov

fraudulent claim for the payment of a loss is guilty of a crime and may be … and
shall be subject to a civil penalty not to exceed five thousand dollars and the
stated value …. of disease or injury or vision disorder, indicate procedure code
numbers … COMPLETING THIS SECTION A LABORATORY BILL CAN BE
ATTACHED.

provider fee manual – Maryland Medicaid – Maryland.gov

mmcp.dhmh.maryland.gov

Oct 9, 2012 … The Fee Manual primarily utilizes current CPT codes. Physicians must …
Medicare or AETNA), the provider must seek payment from that source first. …
does not post a fee schedule for Level-II HCPCS codes. Unbundling.



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