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IDAHO MEDICAID MEDICAL CARE UNIT PRIOR AUTHORIZATION LIST Effective July 1, 2011, the following codes, including all “unlisted” CPT® and ICD-9 procedure codes, require a prior authorization for both inpatient and ou
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Document Date: 2011-08-18 12:25:14


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electromagnetic hearing device / /

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hernia / varicocele / HIV / /

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photodynamic therapy / Otoplasty / surgery / breast implant / physical therapy / Breast operation / Breast reconstruction / Mastectomy / Incision / rhytidectomy / Mammoplasty / face lift / /

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Medical Care Unit / /

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