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f2f_order_pri: yes

hcpcs_code: K0840

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0839

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0838

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0837

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0836

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0835

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0829

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0828

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0827

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0826

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0825

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0824

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0823

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0822

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0821

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0820

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0816

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0815

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0814

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0813

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0808

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0807

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0806

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0802

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0801

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: yes

hcpcs_code: K0800

mac_jurisdiction: 04/17/2023

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: no

hcpcs_code: K0738

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0730

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0609

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0606

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0455

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0012

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0011

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0010

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0009

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0007

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0006

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0005

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0004

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: K0002

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2631

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2630

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2629

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2628

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2627

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2626

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2621

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2620

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2616

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2614

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2613

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2606

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2510

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2402

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2378

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2376

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2375

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2374

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2373

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2370

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2368

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2351

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2343

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2342

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2341

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2330

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2329

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2328

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2327

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2325

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2322

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2321

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2312

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2311

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2310

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2228

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2227

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2204

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2203

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2202

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2100

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E2000

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1406

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1405

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1392

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1391

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1390

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1296

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1295

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1280

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1270

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1240

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1238

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1237

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1236

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1235

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1234

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1233

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1232

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1226

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1224

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1223

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1222

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1221

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1200

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1195

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1190

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1180

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1172

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1171

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1170

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1161

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1160

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1150

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1110

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1100

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1093

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1092

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1088

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1087

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1084

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1083

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1070

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1060

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1050

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1037

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1036

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1035

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1030

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1012

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1010

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1008

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1007

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1006

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1005

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1004

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1003

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E1002

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E0988

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E0986

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: E0984

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: L2628

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: yes

hcpcs_code: E0747

mac_jurisdiction: 08/12/2024

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: no

hcpcs_code: E0193

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: yes

f2f_order_pri: no

hcpcs_code: A4352

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no

f2f_order_pri: no

hcpcs_code: A4342

mac_jurisdiction: N/A

on_master_list: yes

prior_auth_requir: no