| 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 |
|---|---|---|---|---|---|
| 72 | FP0072 : Acute Severe Asthma with Acute respiratory failure | 4,000 | 2,000 | Previous Discharge Summary | (Clinical Evaluation, PFT, CBC-Mandatory) |
| 73 | FP0073 : COPD Respiratory Failure (infective exacerbation) | 4,000 | 2,000 | Previous Discharge Summary | (Clinical Evaluation,CBC,Chest X-ray-Mandatory), PFT |
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