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Complex Medical ReviewsComplex Medical Reviews

Topic Publication Date
Blepharoplasty (HCPCS Codes 15820-15823): Complex Medical Review – Kentucky and Ohio-- Continue 08.14.17
Cardiac Rehabilitation (HCPCS Code 93798): Complex Medical Review – Kentucky and Ohio-- Continue 08.14.17
Cataract Removal (HCPCS Codes 66982, 66983, 66984): Complex Medical Review – Kentucky -- Continue 08.14.17
Cataract Removal (HCPCS Codes 66982, 66983, 66984): Complex Medical Review – Ohio-- Discontinue 08.14.17
Resource Utilization Group (RUG) Codes RUA, RUB and RUC: Complex Review - Kentucky and Ohio –  Continue 08.14.17
Blepharoplasty (HCPCS Codes 15820-15823): Complex Medical Review – Kentucky and Ohio – Continue 05.22.17
Major Joint Replacement (Medicare Severity Diagnosis Related Group (MS-DRG) 470): Complex Medical Review – Kentucky – Discontinued 05.22.17
Cataract Removal (HCPCS Codes 66984, 66983, 66982): Complex Medical Review – Kentucky and Ohio – Continue 05.22.17
Spinal Injections (HCPCS Code 62311): Complex Medical Review – Ohio – Discontinued 05.22.17
Cardiac Rehabilitation (HCPCS Code 93798): Complex Medical Review – Kentucky and Ohio – Continued 05.22.17
Resource Utilization Group (RUG) Codes RUA, RUB and RUC: Complex Review – Ohio  –  Continued 04.13.17
Major Joint Replacement (Medicare Severity Diagnosis Related Group (MS-DRG) 470): Complex Medical Review – Kentucky – Continued 02.28.17
Cataract Removal (HCPCS Codes 66984, 66983, 66982): Complex Medical Review – Kentucky and Ohio – Continued 02.28.17
Spinal Injections (HCPCS Code 62311): Complex Medical Review – Ohio – Continued 02.28.17
Cardiac Rehabilitation (HCPCS Code 93798): Complex Medical Review – Kentucky and Ohio – Continued 02.28.17
Major Joint Replacement (Medical Severity Diagnosis Related Group (MS-DRG) 470): Complex Medical Review – Kentucky - Continued 12.13.16
Major Joint Replacement (Medical Severity Diagnosis Related Group (MS-DRG) 470): Complex Medical Review – Ohio - Discontinue 12.13.16
Cataract Removal (CPT Codes 66984, 66983, 66982): Complex Medical Review – Kentucky and Ohio – Continue 12.13.16
Spinal Injections (CPT Code 62311): Complex Medical Review – Ohio - Continue 12.13.16
Cataract Removal (HCPCS Codes 66984, 66983, 66982): Complex Medical Review – Kentucky and Ohio – Continue 08.11.16
Major Joint Replacement (Medical Severity Diagnosis Related Group (MS-DRG) 470): Complex Medical Review – Kentucky and Ohio – Continue 08.11.16
Outpatient Cardiac Rehabilitation with Continuous ECG Monitoring (CPT Code 93798): Probe Medical Review – Kentucky and Ohio 08.11.16
Resource Utilization Group (RUG) Codes RUA, RUB and RUC: Complex Review – Ohio – Continue 08.11.16
Spinal Injections (HCPCS Code 62311): Complex Medical Review – Ohio – Continue 08.11.16
Urinary Stent Placement (HCPCS Code 52332): Complex Review – Kentucky and Ohio – Discontinue 08.11.16
Resource Utilization Group (RUG) Codes RUA, RUB and RUC: Complex Review – Ohio Documentation Findings 07.27.16
Cataract Removal (HCPCS Codes 66984, 66983, 66982): Complex Medical Review – Kentucky and Ohio—Continue 06.09.16
Major Joint Replacement (Diagnosis Related Group (DRG) 470): Complex Medical Review – Kentucky and Ohio 05.06.16
Spinal Injections (HCPCS Code 62311): Complex Medical Review – Ohio, Continue 05.06.16
Urinary Stent Placement (HCPCS Code 52332): Complex Review – Kentucky and Ohio - Continue 05.06.16
Gallbladder Removal (HCPCS Code 47562): Complex Medical Review – Kentucky and Ohio - Discontinued 02.01.16
Immune Globulin Injection (HCPCS Code J1569): Complex Medical Review – Ohio – Discontinue 02.01.16
Infliximab Injection (HCPCS Code J1745): Complex Medical Review –Kentucky and Ohio – Discontinue 02.01.16
Major Joint Replacement (Medical Severity Diagnosis Related Group (MS-DRG) 470): Complex Medical Review – Kentucky and Ohio 11.02.15
Major Joint Replacement (Medical Severity Diagnosis Related Group (MS-DRG) 470): Complex Medical Review – Kentucky and Ohio 11.02.15
Inpatient Services for Respiratory Failure – Medical Severity Diagnosis Related Group (MS-DRG) 189: Complex Review, Kentucky – Continue Complex Review 11.02.15
Cataract Removal (CPT Codes 66984, 66983, 66982): Complex Medical Review – Kentucky — Continue 11.02.15
Urinary Stent Placement (CPT Code 52332): Complex Review – Ohio - Continue Complex Review 11.02.15
Outpatient Services for Rituximab Injection - (HCPCS Code J9310) – Ohio - Discontinued 11.02.15
Inpatient Services for Respiratory Failure-Diagnosis Related Group (DRG) 189: Kentucky – Continue Complex Review 04.28.15
Major Joint Replacement (Diagnosis Related Group (DRG) 470): Complex Medical Review – Kentucky and Ohio 04.28.15
Outpatient Services for Infliximab Injection (HCPCS Code J1745): Complex Review, Kentucky/Ohio - Continued 01.05.15
Outpatient Services for Immune Globulin Injection (HCPCS Code J1569): Complex Review, Ohio - Continued 01.05.15
Urinary Stent Placement (CPT Code 52332): Probe Medical Review, Ohio - Advance to Targeted Medical Review 01.05.15
Cataract Removal (HCPCS Codes 66984, 66983, 66982): Probe Medical Review,  Kentucky and Ohio – Advanced to Targeted Review 11.21.14
Outpatient Services for Rituximab Injection (HCPCS code J9310): Ohio – Advance to Targeted Medical Review 11.21.14
Outpatient Services for Immune Globulin Injection (HCPCS Code J1569): Probe Medical Review, Kentucky – Advanced to Targeted Review 11.21.14
Major Joint Replacement (Diagnosis Related Group (DRG) 470): Complex Medical Review, Kentucky and Ohio - Continued 11.21.14
Inpatient Services for Respiratory Failure-Diagnosis Related Group (DRG) 189: Complex Review, Kentucky – Continued 11.21.14
Inpatient Services for Respiratory Failure-Diagnosis Related Group (DRG) 189: Complex Review, Ohio – Discontinued 11.21.14
CPT Code 93798 (Cardiac Rehabilitation) - Kentucky 06.13.13
CPT Code 93798 (Cardiac Rehabilitation) - Kentucky - Discontinued 11.01.13
CPT Code 93798 (Cardiac Rehabilitation) - Ohio 05.24.13
CPT Code 93798 (Cardiac Rehabilitation) - Ohio 05.31.12
CPT Code 93798 (Cardiac Rehabilitation) - Ohio - Discontinued 10.16.13
HCPCS Code G0424 (Pulmonary Rehabilitation) - Kentucky 11.04.13
HCPCS Code G0424 (Pulmonary Rehabilitation) - Kentucky 04.23.13
HCPCS Code G0424 (Pulmonary Rehabilitation) - Kentucky 10.16.13
HCPCS Code G0424 (Pulmonary Rehabilitation) - Kentucky 08.02.12
HCPCS Code G0424 (Pulmonary Rehabilitation) - Kentucky - Discontinued 03.24.14
HCPCS Code G0424 (Pulmonary Rehabilitation) - Ohio 11.25.13
HCPCS Code J9355 (Trastuzumab) - Kentucky - Discontinued 11.04.13
HCPCS Code J9355 (Trastuzumab) - Ohio - Continue 11.04.13
Inpatient Services for Cardiac Defibrillator Implant without MCC: Diagnosis Related Group (DRG) 227: Complex Review, Ohio – Discontinued 10.02.14
Inpatient Services for Respiratory Failure-Diagnosis Related Group (DRG) 189: Complex Review, Kentucky and Ohio – Continue Complex Review 10.02.14
Major Joint Replacement (Diagnosis Related Group (DRG) 470): Complex Medical Review – Kentucky and Ohio 09.26.14
MS-DRG 195 (Pneumonia and Pleurisy) - Ohio 10.16.13
MS-DRG Code 192 (COPD Without CC/MCC) - Kentucky 08.05.13
MS-DRG Code 192 (COPD Without CC/MCC) - Ohio 08.06.13
MS-DRG Code 195 (Simple Pneumonia and Pleurisy) - Kentucky and Ohio 12.09.13
MS-DRG Code 227 (Cardiac Defibrillator Implant Without MCC) - Ohio 11.25.13
MS-DRG Code 227 (Cardiac Defibrillator Implant Without MCC) - Ohio 11.04.13
MS-DRG Code 251 (Percutaneous Transluminal Coronary Angioplasty (PTCA) without Stent) - Kentucky and Ohio 12.09.13
MS-DRG Code 287 (Circulatory Disorders) - Kentucky and Ohio 07.23.12
MS-DRG Code 312 (Syncope & Collapse) - Kentucky 10.08.12
MS-DRG Code 312 (Syncope & Collapse) - Kentucky 11.14.13
MS-DRG Code 312 (Syncope and Collapse) - Kentucky 08.06.13
MS-DRG Code 552 (Medical Back Problems Without MCC) - Ohio 08.06.13
MS-DRG Code 552 (Medical Back Problems) - Kentucky 12.09.13
MS-DRG Code 552 (Medical Back Problems) - Kentucky and Ohio 11.04.13
MS-DRG Code 603 (Cellulitis Without MCC) - Kentucky and Ohio 07.23.12
MS-DRG Code 690 (Kidney and Urinary Tract Infections Without MCC) - Kentucky 10.05.12
MS-DRG Codes 192 (Chronic Obstructive Pulmonary Disease) - Kentucky and Ohio 11.14.13
MS-DRG Codes 243-244 (Permanent Cardiac Pacemaker) - Kentucky - Discontinued 10.16.13
MS-DRG Codes 253-254 (Other Vascular Procedures) - Ohio 05.24.13
MS-DRG Codes 302, 303, 313 (Chest Pain and Atherosclerosis) - Kentucky and Ohio 06.20.12
MS-DRG Codes 302, 303, and 313 (Chest Pain and Atherosclerosis) - Kentucky and Ohio 10.16.13
MS-DRG Codes 308-310 (Cardiac Arrhythmia) - Kentucky 05.31.12
MS-DRG Codes 391-392 (Esophagitis Gastroenteritis) - Kentucky and Ohio 05.31.12
MS-DRG Codes 391-392 (Esophagitis Gastroenteritis) - Ohio - Discontinued 10.16.13
MS-DRG Codes 640-641 (Nutritional Metabolic) - Kentucky and Ohio 06.20.12
Outpatient Services for Pulmonary Rehabilitation (HCPCS G0424) – Ohio - Discontinued 07.07.14
Outpatient Services for Rituximab Injection-(HCPCS Code) J9310 – Kentucky - Discontinued 07.07.14
Procedure Code 86.22 (Excisional Debridement) - Ohio 11.14.12
Procedure Code 86.22 (Excisional Debridement) - Ohio - Continued 10.16.13
Procedure Code 86.22 (Excisional Debridement) - Ohio - Discontinued 11.25.13
Trastuzumab (HCPCS Code J9355) – Ohio - Discontinued 07.07.14

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