ADD Effective 10/1/2023
Major Category I. C. - Magnetic Resonance Imaging (MRI)
- C9791 MRI HYPERPOLARIZED XENON129
Major Category II. A. - Dialysis, EPO, Aranesp, Other Related Services for ESRD
- J0889 DAPRODUSTAT ORAL 1MG ESRD
Major Category III. A. -Chemotherapy
- J9051 INJ, BORTEZOMIB (MAIA)
- J9064 INJ, CABAZITAXEL (SANDOZ)
Major Category III.D.-Customized Prosthetic Devices
- L5991 ADDITION TO LOWER EXTREMITY PROSTHESES, OSSEOINTEGRATED EXTERNAL PROSTHETIC CONNECTOR
Major Category III. E. - Certain blood clotting factors
- J7214 ALTUVIIIO PER FACTOR VIII IU
ADD Effective 9/11/2023
Major Category IV. B. - Vaccines (Pneumococcal, Flu, Hepatitis B, or Covid-19)
- 91318 DESCRIBING THE XXXX COVID-19 VACCINE, BIVALENT/MONOVALENT
- 91319 DESCRIBING THE XXXX COVID-19 VACCINE, BIVALENT/MONOVALENT
- 91320 DESCRIBING THE XXXX COVID-19 VACCINE, BIVALENT/MONOVALENT
- 91321 DESCRIBING THE XXXX COVID-19 VACCINE, BIVALENT/MONOVALENT
- 91322 DESCRIBING THE XXXX COVID-19 VACCINE, BIVALENT/MONOVALENT
TERMINATE Effective 9/12/2023
- 91312 SARSCOV2 VAC BVL 30MCG/0.3ML
- 91313 SARSCOV2 VAC BVL 50MCG/0.5ML
ADD Effective 9/11/2023
Major Category IV. C. - Vaccine Administration.
- 90480 DESCRIBING THE SERVICE TO ADMINISTER THE XXXX COVID-19 VACCINE, BIVALENT/MONOVALENT
ADD Effective 3/1/2020
Major Category V - Major Category V. A. - Therapies - INCLUSION
- 98966
- 98967
- 98968
– PHONE ASSESSMENT/MANAGEMENT SERVICES
ADD Effective 1/1/2021
- 98970
- 98971
- 98972
-E-VISIT CODES
- G2250 REMOTE EVALUATION OF VIDEO/IMAGE AND
- G2251 VIRTUAL CHECK-IN SERVICE