441.78.1 Physicians’ services. |
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441.78.2 Prescribed outpatient drugs. |
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441.78.3 Inpatient hospital services. |
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441.78.4 Dentists. |
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441.78.5 Podiatrists. |
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441.78.6 Optometrists. |
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441.78.7 Opticians. |
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441.78.8 Chiropractors. |
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441.78.9 Home health agencies. |
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441.78.10 Durable medical equipment (DME), prosthetic devices and medical supplies. |
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441.78.11 Ambulance service. |
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441.78.12 Behavioral health intervention. |
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441.78.13 Nonemergency medical transportation. |
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441.78.14 Hearing aids. |
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441.78.15 Orthopedic shoes. |
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441.78.16 Community mental health centers. |
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441.78.17 Physical therapists. |
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441.78.18 Screening centers. |
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441.78.19 Rehabilitation agencies. |
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441.78.20 Independent laboratories. |
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441.78.21 Rural health clinics. |
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441.78.22 Family planning clinics. |
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441.78.23 Other clinic services. |
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441.78.24 Psychologists. |
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441.78.25 Maternal health centers. |
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441.78.26 Ambulatory surgical center services. |
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441.78.27 Home- and community-based habilitation services. |
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441.78.28 List of medical services and equipment requiring prior authorization, preprocedure review or preadmission review. |
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441.78.29 Behavioral health services. |
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441.78.30 Birth centers. |
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441.78.31 Hospital outpatient services. |
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441.78.32 Area education agencies. |
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441.78.33 Case management services. |
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441.78.34 HCBS health and disability waiver services. |
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441.78.35 Occupational therapist services. |
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441.78.36 Hospice services. |
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441.78.37 HCBS elderly waiver services. |
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441.78.38 HCBS AIDS/HIV waiver services. |
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441.78.39 Federally qualified health centers. |
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441.78.40 Advanced registered nurse practitioners. |
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441.78.41 HCBS intellectual disability waiver services. |
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441.78.42 Pharmacists providing covered vaccines. |
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441.78.43 HCBS brain injury waiver services. |
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441.78.44 Lead inspection services. |
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441.78.45 Assertive community treatment. |
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441.78.46 Physical disability waiver service. |
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441.78.47 Pharmaceutical case management services. |
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441.78.48 Public health agencies. |
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441.78.49 Infant and toddler program services. |
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441.78.50 Local education agency services. |
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441.78.51 Indian health service 638 facility services. |
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441.78.52 HCBS children’s mental health waiver services. |
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441.78.53 Health home services. |
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441.78.54 Speech-language pathology services. |
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441.78.55 Services rendered via telehealth. |
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441.78.56 Community-based neurobehavioral rehabilitation services. |
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441.78.57 Child care medical services. |
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441.78.58 Qualified Medicare beneficiary (QMB) provider services. |
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441.78.59 Health insurance premium payment (HIPP) provider services. |
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441.78.60 Crisis response services. |
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441.78.61 Subacute mental health services. |
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