Molina Healthcare Michigan policy
End Stage Renal DiseaseMaximum Units of Service and Modifier Policy
End Stage Renal DiseaseMaximum Units of Service and Modifier Policy is a public Molina Healthcare Michigan policy (policy PI205). It lists 19 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
View the original policy (PDF) ↗
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- Policy number
- PI205
- Line of business
- Medicaid
- States
- MI
- Source
- www.molinahealthcare.com
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes. Open official prior authorization lists to check the member’s product.
| Code | Other Molina Healthcare Michigan policies |
|---|---|
| 90935 | Policies naming 90935 |
| 90937 | Policies naming 90937 |
| 90945 | Policies naming 90945 |
| 90947 | Policies naming 90947 |
| 90951 | Policies naming 90951 |
| 90952 | Policies naming 90952 |
| 90989 | Policies naming 90989 |
| 90993 | Policies naming 90993 |
| 90999 | Policies naming 90999 |
| E1629 | Policies naming E1629 |
| J0879 | Policies naming J0879 |
| J0882 | Policies naming J0882 |
| J0887 | Policies naming J0887 |
| J1439 | Policies naming J1439 |
| J1756 | Policies naming J1756 |
| J2916 | Policies naming J2916 |
| L2989 | Policies naming L2989 |
| Q4081 | Policies naming Q4081 |
| Q5105 | Policies naming Q5105 |
All Molina Healthcare Michigan policies · Molina Healthcare Michigan prior authorization CPT list