|
SERIAL NUMBER
|
Procedure
|
1st Qtr
|
Per Qtr (for next 3 Qtrs)
|
Requirements while submitting for follow-up Preauth
|
Requirements while submitting for follow-up Claims
|
|
106
|
FP0106 : Hypopitutarism
|
3,500
|
1,500
|
Previous Discharge Summary
|
(Clinical Evaluation, Related Pituitary Hormone Levels-Mandatory)/CT
|
|
107
|
FP0107 : pituitary - Acromegaly
|
2,000
|
1,500
|
Previous Discharge Summary
|
(Clinical Evaluation, Related Pituitary Hormone Levels-Mandatory)
|
|
108
|
FP0108 : Delayed Puberty Hypogonadism (ex. Turners synd,klienfelter synd)
|
2,500
|
1,500
|
Previous Discharge Summary
|
(Clinical Evaluation-Mandatory)
|
|
