On this page is a compilation of the obsolete pages as they correspond to the revision date. "Click " on a date to see the manual chapter page(s) prior to the revision.

Pages replaced from 10/25/2021 revision – Section 4.4 – Provider Requirements

Pages replaced from 07/16/2021 revision – Table of Contents

Pages replaced from 07/16/2021 revision – Section 4.0 – Overview

Pages replaced from 07/16/2021 revision – Section 4.1 – Covered Services

Pages replaced from 07/16/2021 revision – Section 4.2 – Beneficiary Requirements

Pages replaced from 07/16/2021 revision – Section 4.3 – Service Authorization Process

Pages replaced from 07/16/2021 revision – Section 4.5 – Reimbursement

Pages replaced from 07/16/2021 revision – Section 4.6 – Coordination of Care

Pages replaced from 07/16/2021 revision – Appendix A – Contact Information

Pages replaced from 07/16/2021 revision – Appendix D – Plan of Care Instructions and Forms

Pages replaced from 01/26/2021 revision – Section 4.1 – Covered Services

Pages replaced from 01/26/2021 revision – Section 4.4 – Provider Requirements

Pages replaced from 04/28/2020 revision – Section 4.1 – Covered Services

Pages replaced from 02/11/2020 revision – Section 4.3 – Service Authorization Process

Pages replaced from 01/16/2020 revision – Appendix A – Contact Information

Pages replaced from 11/18/2019 revision – Section 4.1 – Covered Services

Pages replaced from 11/18/2019 revision – Section 4.6 – Coordination of Care

Pages replaced from 09/19/2019 revision – Table of Contents

Pages replaced from 05/23/2019 revision – Table of Contents

Pages replaced from 05/23/2019 revision – Section 4.4 – Provider Requirements

Pages replaced from 01/15/2019 revision – Section 4.1 – Covered Services

Pages replaced from 02/01/2018 revision – Table of Contents

Pages replaced from 02/01/2018 revision – Section 4.0 – Overview

Pages replaced from 02/01/2018 revision – Section 4.1 – Covered Services

Pages replaced from 02/01/2018 revision – Section 4.2 – Recipient Requirements

Pages replaced from 02/01/2018 revision – Section 4.3 – Service Authorization Process

Pages replaced from 02/01/2018 revision – Section 4.4 – Provider Requirements

Pages replaced from 02/01/2018 revision – Section 4.5 - Reimbursement

Pages replaced from 02/01/2018 revision – Appendix A – Contact Information

Pages replaced from 02/01/2018 revision – Appendix C – Claims Filing

Page replaced from 11/13/2017 revision – Section 4 – Appendix B – Billing Codes

Pages replaced from 11/02/2017 revision – Table of Contents

Pages replaced from 11/02/2017 revision – Section 4.1 – Covered Services

Page replaced from 11/02/2017 revision – Section 4.5 – Reimbursement

Page replaced from 11/02/2017 revision – Section 4 – Appendix A – Contact Information

Page replaced from 11/02/2017 revision – Section 4 – Appendix B – Billing Codes

Pages replaced from 05/01/2017 revision – Section 4.3 – Service Authorization Process

Page replaced from 05/01/2017 revision – Section 4.5 – Reimbursement

Pages replaced from 05/01/2017 revision – Section 4 – Appendix B – Billing Codes

Pages replaced from 05/01/2017 revision – Section 4 - Appendix C – Claims Filing

Pages replaced from 02/24/2017 revision – Section 4.1 – Covered Services

Pages replaced from 02/16/2017 revision – Section 4 - Appendix B – Billing Codes

Page replaced from 01/18/2017 revision – Section 4.0 – Overview

Pages replaced from 01/18/2017 revision – Section 4 - Appendix B – Billing Codes

Pages replaced from 01/01/2017 revision – Section 4.1 – Covered Services

Page replaced from 01/01/2017 revision – Section 4 - Appendix B – Billing Codes

Page replaced from 07/14/2016 revision – Title Page

Pages replaced from 07/14/2016 revision – Section 4.1 Covered Services

Pages replaced from 07/14/2016 revision – Section 4.3 Service

Page replaced from 09/28/2015 revision – Title Page

Pages replaced from 09/28/2015 revision – Appendix C – Claims Filing

Page replaced from 10/27/2014 revision – Section 4.2 – Recipient Requirements

Pages replaced from 10/23/2014 revision – Section 4.3 – Service Authorization Process

Page replaced from 10/23/2014 revision – Appendix B – Billing Codes

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