For Providers:
Pre-certification Worksheets

Updated July 1, 2010

• Capsular endoscopy
• Cardio-defibrillator
• DME: apnea, cardiac, uterine and oximetry monitors
• DME: compression, medication, feeding, insulin and suction pumps
• DME: hospital bed/special mattress
• DME: stimulator/CPM machine/TENS unit
• DME: wheelchair
• DME: other items
• Home health care/hospice
• Infusion
• Hyperbaric oxygen
• Spinal/Neurological Procedures
• Inpatient Medical Pre-Review Program
• Inpatient Rehabilitation Review
• Meniscal allograft transplant
• MRI, CT, PET and SPECT Scans
• MRI of knee
• Sinus Surgeries
• Outpatient surgery
• Physical therapy/occupational therapy, chiropractic, osteopathic manipulative therapy