Name of Manual - Blue Cross and Blue Shield of Minnesota

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Coding Policies and Guidelines (Behavioral Health) Code Description Units Who May Submit Misc 96150 Health and behavior assessment (e.g., healthfocused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment 96151 Health and behavior assessment (e.g., healthfocused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment 96152 Health and behavior intervention, each 15 minutes, face-to-face; individual 96153 Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients) 96154 Health and behavior intervention, each 15 minutes, face-to-face; family (with the patient present) 96155 Health and behavior intervention, each 15 minutes, face-to-face; family (without the patient present) 11-66 1 per 15 minutes 1 per 15 minutes 1 per 15 minutes 1 per 15 minutes 1 per 15 minutes 1 per 15 minutes MD, LP-Ph.D., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, NP, PA, LPCC MD, LP-Ph.D., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, NP, PA, LPCC MD, LP-Ph.D., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, NP, PA, LPCC MD, LP-Ph.D., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, NP, PA, LPCC MD, LP-Ph.D., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, NP, PA, LPCC MD, LP-Ph.D., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, NP, PA, LPCC MH/CD diagnosis is NOT primary diagnosis MH/CD diagnosis is NOT primary diagnosis MH/CD diagnosis is NOT primary diagnosis MH/CD diagnosis is NOT primary diagnosis MH/CD diagnosis is NOT primary diagnosis MH/CD diagnosis is NOT primary diagnosis Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12
Code Description Units Who May Submit Misc 98960 Education and training for patient selfmanagement by a qualified, nonphysician health care professional using a standard curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient 98961 Education and training for patient selfmanagement by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients 98962 Education and training for patient selfmanagement by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients 99201- 99205 99211- 99215 99217- 99220 1 per 30 minutes 1 per 30 minutes 1 per 30 minutes MD, LP-PhD., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, NP, PA, LPCC MD, LP-Ph.D., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, NP, PA, LPCC MD, LP-PhD., LP-MA, LICSW, CNS- Psych, PMHNP, LMFT, NP, PA, LPCC Office or other outpatient E/M – new patient 1 per visit MD, NP, CNS, CNS-psych, PMHNP, PA Coding Policies and Guidelines (Behavioral Health) Limited coverage for: PMAP/MNCare Diabetes dx BH dx Prenatal Limited coverage for: PMAP/MNCare Diabetes dx BH dx Prenatal Limited coverage for: PMAP/MNCare Diabetes dx BH dx Prenatal Office or other outpatient E/M – established patient 1 per visit MD, NP, CNS, CNS-psych, PMHNP, PA Hospital observation services, initial 1 per visit MD, NP, CNS, CNS-psych, PMHNP, PA Routine dx not allowed Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12 11-67
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Blue Cross and Blue Shield of Minne
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Recent Chapter changes: Chapter 11
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Chapter 11 - Coding Policies and Gu
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Durable Medical Equipment Date Topi
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Medical Emergency Date Topic Change
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Rehabilitative Services Date Topic
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Table of Contents Chapter 1 At Your
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Introduction Provider Policy and Pr
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How to Contact Us At Your Service P
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At Your Service Claims Address Subm
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Care Management Numbers and Address
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Care Management Numbers and Address
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Company Phone Number Address Public
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At Your Service Provider Identifica
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ID Cards At Your Service Introducti
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Electronic Commerce Overview An imp
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Remote Access Services (continued)
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Provider Communications Provider Co
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Health Plan Members have the Follow
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Provider Agreements Participation a
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Provider Agreements Responsibilitie
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Provider Agreements Provider Number
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Provider Agreements Accounting for
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Provider Agreements Carrier Replace
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Table of Contents Chapter 3 Quality
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Quality Improvement Leadership Rati
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Quality Improvement Telephone Care:
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Quality Improvement Quality of Care
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Quality Improvement Written Policie
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Quality Improvement Written Policie
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Quality Improvement Patient Safety
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Quality Improvement Medical Record
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Quality Improvement Institute for C
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Quality Improvement Quality Improve
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Quality Improvement Physical Facili
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Quality Improvement Treatment Recor
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Integrated Health Management Progra
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Integrated Health Management Provid
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Integrated Health Management Utiliz
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Integrated Health Management Medica
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Integrated Health Management Overvi
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Integrated Health Management Pre-Ce
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Integrated Health Management Decisi
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Integrated Health Management Defini
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Integrated Health Management For Lo
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Integrated Health Management Appeal
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Integrated Health Management Case &
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Integrated Health Management Diseas
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Integrated Health Management Focuse
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Integrated Health Management Specia
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Integrated Health Management Overvi
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Integrated Health Management Sample
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Health Care Options Prepaid Medical
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Health Care Options Member ID Cards
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Health Care Options Blue Cross and
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Health Care Options Double Gold Dou
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Health Care Options Medicare Basic
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Health Care Options Platinum Blue S
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Health Care Options MedicareBlue PP
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Health Care Options Inquiries and C
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Health Care Options Additional info
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Health Care Options Minnesota Senio
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Health Care Options MinnesotaCare P
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Health Care Options BlueLinkTPA Blu
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Health Care Options Delta Dental Hi
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Health Care Options Prime Therapeut
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Health Care Options Workers' Compen
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Health Care Options HICF 1500 Form
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Health Care Options Networks Blue C
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Blue Plus Member Information Introd
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Blue Plus Member Rights and Respons
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Blue Plus Member Rights and Respons
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Blue Plus Member Benefits Members
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Blue Plus Quality of Care Complaint
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Blue Plus Referral Points Remember
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Blue Plus Referral Not Required We
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Blue Plus Standing Referral Minneso
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Blue Plus Clarifications of Terms (
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Blue Plus [Date] [Name of patient]
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Blue Plus Special Member Benefits O
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Blue Plus OB/GYN Open Access Diagno
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Blue Plus OB/GYN Open Access Diagno
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BlueCard® Claim Status Inquiry ...
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BlueCard® Identifying BlueCard ®
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BlueCard® Identifying BlueCard ®
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BlueCard® BlueCard Service Claims
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BlueCard® Prior Authorization and
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BlueCard® Electronic Data Intercha
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BlueCard® Claims Processed by the
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BlueCard® Overview (continued) 3.
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BlueCard® Claim Payment Guidelines
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BlueCard® Calls from Members and O
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BlueCard® Guidelines (continued) W
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BlueCard® Types of Medicare Advant
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BlueCard® Medicare Advantage Claim
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BlueCard® Reimbursement for Medica
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Claims Filing HCPCS/ Accommodation
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Claims Filing Administrative Simpli
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Claims Filing Claims with Attachmen
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Claims Filing Claims with Coordinat
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Claims Filing Claims with Coordinat
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Claims Filing 1500 HICF Form Profes
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Claims Filing Ordering Forms and Ma
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Claims Filing Site of Service (cont
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Claims Filing Institution (837I) /F
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Claims Filing Treatment Room Blue C
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Claims Filing Single facility claim
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Claims Filing Present on Admission
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Claims Filing Medicare Crossover Bl
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Claims Filing Cancel/Void and Repla
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Claims Filing Verifying Patient Eli
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Claims Filing Basic Character Set V
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Claims Filing Rural Health Clinics
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Claims Filing Coordination of Benef
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Claims Filing TEFRA The 1982 Tax Eq
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Claims Filing Employment As defined
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Claims Filing Surgical Technicians
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Reimbursement / Reconciliation Reim
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Reimbursement / Reconciliation Comp
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Reimbursement / Reconciliation Remi
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Acco
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Reimbursement / Reconciliation Fiel
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Appeals Provider Appeals Introducti
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Appeals Submitting Requests for Pos
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Appeals Coding Appeals (continued)
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Appeals Supporting Documentation (c
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Coding Policies and Guidelines (Cod
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Coding Policies and Guidelines (Mod
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Chapter 11 Coding Policies and Guid
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Part-time (Medically Directed) Anes
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Electroconvulsive Treatments Blue C
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Moderate (Conscious) Sedation Monit
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Coding Policies and Guidelines (Beh
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Coding Restrictions Code Restrictio
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CTSS Skills Training and Developmen
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Intensive Residential Treatment Ser
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IRTS Member Eligibility IRTS Access
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Adult Non-Residential Crisis Servic
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Coding Policies and Guidelines (Chi
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Coding Policies and Guidelines (Chi
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Coding Policies and Guidelines (Den
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Coding Policies and Guidelines (Den
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Prior Authorization Requirements Co
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Coding Policies and Guidelines (Dur
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Waivers and Upgraded/Deluxe DME Wai
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Hearing Aids (continued) Website Co
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Portable Oxygen Billing (continued)
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DME/Supply Internet Purchases Codin
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Coding Policies and Guidelines (Hom
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Elderly Waiver Program (continued)
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Referrals and Prior Authorization (
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Referrals and Prior Authorization (
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Adult Day Care Bath Services Coding
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Home Infusion (continued) Coding Po
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Coding Policies and Guidelines (Hom
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Rules and Regulations (continued) H
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Hospice Billing for Medicare Produc
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Coding Policies and Guidelines (Hos
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Coding Policies and Guidelines (Lab
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Papanicolaou Smears (continued) Dia
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Coding Policies and Guidelines (Mat
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Coding Policies and Guidelines (Pha
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Drugs Coding Policies and Guideline
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Drug Programs Coding Policies and G
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Coding Policies and Guidelines (Pub
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Coding Policies and Guidelines (Rad
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Physical Therapy Evaluation Codes C
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Hot and Cold Pack Exclusion TMJ Ort
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Massage and Manual Therapy Exclusio
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MHCP PT, OT, ST Authorization Proce
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Bilateral Services (continued) Codi
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Coding Policies and Guidelines (Sur
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Acne Treatment/ Skin Rejuvenation a
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Liposuction Edit Change Coding Poli
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Assistant Surgeons (continued) Assi
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Name of Manual - Blue Cross and Blue Shield of Minnesota

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