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 12/02/2024 revision - Section 23.6 – Claims Related Information
Pages replaced from 10/14/2024 revision - Section 23.5 – Prior Authorization
Pages replaced from 08/21/2023 revision - Section 23.6 – Claims Related Information
Pages replaced from 05/13/2024 revision – Title Page
Pages replaced from 12/12/2023 revision - Table of Contents
Pages replaced from 12/12/2023 revision - Section 23.0 – Overview
Pages replaced from 12/12/2023 revision - Section 23.1 – Description of Services
Pages replaced from 12/12/2023 revision - Section 23.4 – Provider Requirements
Pages replaced from 12/12/2023 revision - Section 23.7 – Acronyms
Pages replaced from 07/10/2023 revision - Section 23.0 – Overview
Pages replaced from 07/10/2023 revision - Section 23.1 – Description of Services
Pages replaced from 07/10/2023 revision - Section 23.2 – Service Limitations
Pages replaced from 07/10/2023 revision - Section 23.3 – Beneficiary Requirements
Pages replaced from 07/10/2023 revision - Section 23.4 – Provider Requirements
Pages replaced from 07/10/2023 revision - Section 23.5 – Prior Authorization
Pages replaced from 07/10/2023 revision - Section 23.6 – Claims Related Information
Pages replaced from 07/10/2023 revision - Section 23.7 – Acronyms
Pages replaced from 02/10/2023 revision - Section 23.0 – Overview
Pages replaced from 02/10/2023 revision - Section 23.1 – Description of Services
Pages replaced from 02/10/2023 revision - Section 23.2 – Service Limitations
Pages replaced from 02/10/2023 revision - Section 23.3 – Beneficiary Requirements
Pages replaced from 02/10/2023 revision - Section 23.4 – Provider Requirements
Pages replaced from 02/10/2023 revision - Section 23.5 – Prior Authorization
Pages replaced from 02/10/2023 revision - Section 23.6 – Claims Related Information
Pages replaced from 02/10/2023 revision - Section 23.7 – Acronyms
Pages replaced from 02/10/2023 revision - Appendix A – Regulatory Requirements
Pages replaced from 02/10/2023 revision - Appendix C – Procedure Codes and Rates
Pages replaced from 02/10/2023 revision - Appendix E – UB-04 Form and Instructions
Pages replaced from 01/17/2023 revision - Section 23.2 – Service Limitations
Pages replaced from 01/17/2023 revision – Section 23.5 – Prior Authorization
Pages replaced from 08/18/2021 revision – Table of Contents
Pages replaced from 08/18/2021 revision – Section 23.0 – Overview
Pages replaced from 08/18/2021 revision – Section 23.1 – Description of Services
Pages replaced from 08/18/2021 revision – Appendix D - Contact Referral Information
Pages replaced from 03/10/2021 revision – Appendix D – Contact Referral Information
Pages replaced from 03/04/2021 revision – Section 23.5 – Prior Authorization
Pages replaced from 03/04/2021 revision – Section 23.6 – Claims Related Information
Pages replaced from 06/20/2019 revision – Table of Contents
Pages replaced from 06/20/2019 revision – Section 23.4 – Provider Requirement
Pages replaced from 06/20/2019 revision – Section 23.5 – rior Authorization
Pages replaced from 06/20/2019 revision – Section 23.6 – aims Related Information
Pages replaced from 12/01/2018 revision – Title Page
Pages replaced from 12/01/2018 revision – Table of Contents
Pages replaced from 12/01/2018 revision – Section 23.0 – Overview
Pages replaced from 12/01/2018 revision – Section 23.1 – Description of Services
Pages replaced from 12/01/2018 revision - Section 23.2 – Service Limitations
Pages replaced from 12/01/2018 revision – Section 23.3 – Recipient Requirements
Pages replaced from 12/01/2018 revision – Section 23.4 – Provider Requirement
Pages replaced from 12/01/2018 revision – Section 23.5 – Prior Authorization
Pages replaced from 12/01/2018 revision – Section 23.6 – Claims Related Information
Pages replaced from 12/01/2018 revision – Appendix A – Regulatory Requirements
Pages replaced from 12/01/2018 revision – Appendix C – Procedure Codes and Rates
Pages replaced from 12/01/2018 revision – Appendix D – Contact/Referral Information
Pages replaced from 02/14/2018 revision – Appendix E – UB-04 Form and Instructions
Pages replaced from 08/04/2017 revision – Appendix C – Procedure Codes and Rates
Pages replaced from 06/28/2016 revision – Table of Contents
Page replaced from 06/17/2016 revision – Title Page
Pages replaced from 06/17/2016 revision – Section 23.6 – Claims Related Information
Pages replaced from 06/17/2016 revision – Appendix C – Procedure Codes and Rate
Page replaced from 09/25/2015 revision – Title Page
Pages replaced from 04/15/2015 revision – Appendix C – Procedure Codes and Rates
Pages replaced from 10/13/2014 revision – Appendix D – Contact Referral Information
Page replaced from 09/08/14 revision – Section 23.6 – Claims Related Information
Pages replaced from 01/24/14 revision – Appendix D – Contact/Referral Information
Pages replaced from 01/20/14 revision – Section 23.1 – Description of Services
Pages replaced from 01/20/14 revision – Section 23.2 – Service Limitations
Pages replaced from 04/16/2013 revision – Table of Contents
Pages replaced from 02/28/2013 revision – Section 23.0 – Overview
Pages replaced from 02/28/2013 revision – Section 23.1 – Description of Services
Pages replaced from 01/31/2013 revision – Appendix C - Procedure Codes and Rates
Pages replaced from 01/31/2013 revision – Appendix D - Contact/Referral Information
Pages replaced from 06/01/2012 revision – Section 23.6 – Claims Related Information
Pages replaced from 11/15/2011 revision – Section 23.5 – Prior Authorization
Pages replaced from 11/15/2011 revision – Appendix C – Procedure Codes and Rates
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