PrimeWest Health policy
Medical, Dental & Pharmacy > Dental > Non-Covered Services
Medical, Dental & Pharmacy > Dental > Non-Covered Services is a public PrimeWest Health policy (policy PW_11-18_440, effective Nov 1, 2018). It lists 2 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
- Payer
- PrimeWest Health
- Policy number
- PW_11-18_440
- Effective
- Nov 1, 2018
- Line of business
- Medicaid
- States
- MN
- Source
- www.primewest.org
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes.
| Code | Other PrimeWest Health policies |
|---|---|
| D0150 | Policies naming D0150 |
| D0180 | Policies naming D0180 |