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PROVISION IDS NPV NIGHT PSYCH VISIT NPVS NIGHT PSYCH VISIT IP SECONDARY LEVEL NRB NURSERY ROOM AND BOARD NRSI NURSING SERVICES - IP NRSO NURSING SERVICES - OP NTFH MEDICAL NUTRITION THERAPY, RE-ASSESSMENT OP HOSP NTFI MEDICAL NUTRITION THERAPY, RE-ASSESSMENT IP HOSP NTFO MEDICAL NUTRITION THERAPY, RE-ASSESSMENT OFFICE NTGH MEDICAL NUTRITION THERAPY, INITIAL, GROUP, OP HOSP NTGI MEDICAL NUTRITION THERAPY, INITIAL, GROUP, IP HOSP NTGO MEDICAL NUTRITION THERAPY, INITIAL, GROUP, OFFICE NTIH MEDICAL NUTRITION THERAPY, INITIAL, INDIVIDUAL, OP HOSP NTII MEDICAL NUTRITION THERAPY, INITIAL, INDIVIDUAL, IP HOSP NTIO MEDICAL NUTRITION THERAPY, INITIAL, INDIVIDUAL, OFFICE OBCD OB COMPLICATED - DEPENDENT OBCM OB COMPLICATED - MEMBER OBCS OB COMPLICATED - SPOUSE OBHD OB NORMAL - DEPENDENT - HOME OBHM OB NORMAL - MEMBER - HOME OBHS OB NORMAL - SPOUSE - HOME OBND OB NORMAL - DEPENDENT OBNM OB NORMAL - MEMBER OBNS OB NORMAL - SPOUSE OCLA OVARIAN CANCER SCREENING LAB - OP OCLI OVARIAN CANCER SCREENING LAB - IP OCSG OVARIAN CANCER SCREENING SURGERY - OP OCSI OVARIAN CANCER SCREENING SURGERY - IP OCXI OVARIAN CANCER SCREENING XRAY - IP OCXR OVARIAN CANCER SCREENING XRAY - OP ONER OUT OF NETWORK EMERGENCY ROOM OPDR OUTPATIENT DAYS REDUCTION PROVISION OPSG OP SURGERY ORGI HUMAN ORGAN TRANSPLANT - IP ORGO HUMAN ORGAN TRANSPLANT - OP ORIS ORGAN TRANSPLANT IP - SPECIAL LEVEL OROS ORGAN TRANSPLANT OP - SPECIAL LEVEL ORTA ORTHODONTIC CARE ORTB ORTHODONTIC RETENTION OSI ORTHOTICS - INPATIENT OSO ORTHOTICS - OUTPATIENT OSOH HANDLING AND/OR CONVEYANCE OF ORTHOTIC/PROSTHETIC OTDC 213D - OVER THE COUNTER DRUGS - COVERED OTDN 213D - OVER THE COUNTER DRUGS - NON-COVERED OVAD ATTENTION DEFICIT DISORDER / OFFICE VISIT OVAO OFFICE VISIT/ALLERGY TREATMENT OVAT OFFICE VISIT/ALLERGY TESTING OVBD OFFICE VISIT/BENIGN CHEMOTHERAPY DRUG OVBO OFFICE VISIT / BONE DENSITY TEST OVCL OFFICE VISIT/ROUTINE COLORECTAL CANCER SCREENING LAB OVCO OFFICE VISIT/CONSULTATION OP OVCT OFFICE VISIT / CAT SCAN OVCX OFFICE VISIT/ROUTINE COLORECTAL CANCER SCREENING XRAY Updated: 9/21/2012
PROVISION IDS OVCY OFFICE VISIT CALENDAR YEAR OVDE Office Visit/Durable Medical Equipment Purchase - OP OVDM OFFICE VISIT/DIABETIC MANAGEMENT OUTPATIENT OVDO OFFICE VISIT/DRUGS - OP OVDR Office Visit/Durable Medical Equipment Rental - OP OVDX OFFICE VISIT/DEEP XRAY OVEK OFFICE VISIT / EKG OVFO OFFICE VISIT/FUNCTIONAL OCCUPATIONAL THERAPY OP OVGD OFFICE VISIT / GARDISIL IMMUNIZATION OVHI OFFICE VISIT/HOME INFUSION OVHT OFFICE VISIT/HEARING TEST OP OVIA OFFICE VISIT / IMMUNIZATION ADMINISTRATION FEE OVIH Office Visit/Inhalation Therapy - OP OVIJ OFFICE VISIT/INJECTIONS OVIM OFFICE VISIT/IMMUNIZATION OP OVIN OFFICE VISIT/INVITRO FERTILIZATION LAB OVIS OFFICE VISIT OVJA OFFICE VISIT / INJECTION ADMINISTRATION FEE OVLH OFFICE VISIT/LAB HANDLING AND/OR CONVEYANCE OVLO OFFICE VISIT/LAB OP OVMC OFFICE VISIT/MALIGNANT CHEMOTHERAPY OP OVMD OFFICE VISIT/MALIGNANT CHEMOTHERAPY DRUGS OVMG OFFICE VISIT/MAMMOGRAM - DIAGNOSTIC OP OVMM OFFICE VISIT/MUSCLE MANIPULATION OVMP OFFICE VISIT/DIAG. MEDICAL PROCEDURE - OP OVMS OFFICE VISIT/MEDICAL/SURGICAL SUPPLIES OP OVMT OFFICE VISIT/MECHANO THERAPY - OP OVNM Non-Serious Mental Illness Office Visit OVOL OFFICE VISIT / OVARIAN CANCER SCREENING LAB OVOP OFFICE VISIT - BILLED WITH PLACE OF TREATMENT 2 OVOS Office Visit/Orthotics - OP OVOV OFFICE VISIT/OFFICE VISIT OVOX OFFICE VISIT / OVARIAN CANCER SCREENING XRAY OVPA OFFICE VISIT/PATHOLOGY OP OVPC OFFICE VISIT/PREVENTIVE CARE OVPE OFFICE VISIT / PET SCAN OVPG OFFICE VISIT/CONTRACEPTIVE DRUGS OVPR OFFICE VISIT/PROSTATE SPECIFIC ANTIGEN TESTS-OP OVPS OFFICE VISIT/PAP SMEAR OP OVPT OFFICE VISIT/MEDICAL PROCEDURE - THERAPEUTIC OP OVPX OFFICE VISIT/PHYSICAL HISTORY OP OVRD OFFICE VISIT/ROUTINE DIAG.MEDICAL PROCEDURE OVRH OFFICE VISIT/ROUTINE LAB HANDLING AND/OR CONVEYANCE OVRI OFFICE VISIT/RADIOISOTOPE TEST OP OVRK OFFICE VISIT / ROUTINE EKG OVRL OFFICE VISIT/ROUTINE LABORATORY TEST OVRM OFFICE VISIT/ROUTINE MAMMOGRAM OVRP OFFICE VISIT/ROUTINE PAP SMEAR OVRX OFFICE VISIT/ROUTINE XRAY TEST OVSA OFFICE VISIT/ROUTINE PROSTATE SPECIFIC ANTIGEN (PSA) TEST OVSM Serious Mental Illness Office Visit OVSO OFFICE VISIT/SURGERY - OP Updated: 9/21/2012
Page 1 and 2: PROVISION IDS PROV. ID PROVISION DE
Page 3 and 4: PROVISION IDS ASCO ADDITIONAL SECON
Page 5 and 6: PROVISION IDS CGCO CONGENITAL/CONSU
Page 7 and 8: PROVISION IDS CVEA CLINIC VISIT OP
Page 9 and 10: PROVISION IDS EAKG EMERGENCY ACCIDE
Page 11 and 12: PROVISION IDS EMJA EMERGENCY MEDICA
Page 13 and 14: PROVISION IDS GPDO GROUP PSYCHOTHER
Page 15 and 16: PROVISION IDS IPO INDIVIDUAL PSYCHO
Page 17: PROVISION IDS MRII MRI (MAGNETIC RE
Page 21 and 22: PROVISION IDS PREB PREVENTIVE DENTA
Page 23 and 24: PROVISION IDS PXMC PHYSICAL EXAM/MA
Page 25 and 26: PROVISION IDS RSNG REPLACEMENT SING
Page 27 and 28: PROVISION IDS SRLO STERILIZATION RE
Page 29 and 30: PROVISION IDS WBMP WELL BABY/DIAG.

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