Opps 20230101
Opps 20230101
Opps 20230101
Outpatient Prosp
Effective dates of se
U
Li
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
0 0
0 0
1 1 E
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
0 0
0 0
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
0 0
0 0
0 0
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
1 1 E
0 0
0 0
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
0 0
1 1 E
0 0
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
0 0
0 0
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
1 1 F 28.55
1 1 E
1 1 F 18.06
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
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0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
0 0
1 1 E
0 0
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 A
1 1 A
1 1 E
1 1 E
1 1 E
0 0
1 1 A
1 1 A
1 1 A
1 1 A
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
0 0
1 1 E
0 0
0 0
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 A
0 0
0 0
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1 E
0 0
0 0
1 1 E
0 0
0 0
0 0
1 1 E
1 1 E
1 1 E
1 1 E
1 1 E
0 0
1 1 E
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
re Authority (HCA)
ent Systems (OPPS)
after January 01, 2023
2023
Codes
COMMENTS
*PA required if for Transhealth
Please see the Physician-Related Billing Guide
For HCA approved Bariatric Services only
*PA required if for Transhealth, per policy eff 11/01/2021
*PA required if for Transhealth, per policy eff 11/01/2021
COE
COE
COE
COE
COE
COE
*PA required if for Transhealth
COE
*PA required if for Transhealth
EPA age 21+. No PA age <21. Only covered for Intraoperative or postoperative pain management with EP
CPA age 21+. No PA age <21 EPA**
EPA age 21+. No PA age <21. Only covered for Intraoperative or postoperative pain management with EP
CPA age 21+. No PA age <21 EPA**
EPA age 21+. No PA age <21. Only covered for Intraoperative or postoperative pain management with EP
PA/EPA age 21+. No PA age <21
EPA age 21+. No PA age <21. Only covered for Intraoperative or postoperative pain management with EP
PA/EPA age 21+. No PA age <21
1 per lifetime. Please see Professional Services Billing Guide for limitations
1 per lifetime. Please see Professional Services Billing Guide for limitations
Please see Applied Behavioral Analysis (ABA) Billing Guide for coverage
Invoice Required
Invoice Required
Invoice Required
Invoice Required. See OPPS billing guide and PHYS billing guide for policy
Invoice Required
Payable in OPPS only
65+ years of age
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
0 through 20 years of age
21+ years of age
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
0 through 20 years of age
21+ years of age
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
0 through 20 years of age
21+ years of age
21+ years of age
0 through 20 years of age
0 through 20 years of age
21+ years of age
0 through 20 years of age
21+ years of age
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
PA age 7-12. No PA age < 7
PA age 7-12. No PA age < 7
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
DENTAL
21+ years of age
0 through 20 years of age
DENTAL
DENTAL
DENTAL
DENTAL
Please see the Physician-Related Billing Guide
Please see the Physician-Related Billing Guide
Please see Applied Behavioral Analysis (ABA) Billing Guide for coverage
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
CPA/PA all ages
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
HG-Take-home Naloxone 4g nasal spray. Eff 01/01/2022
TG-Take-home Naloxone 4g nasal spray. Eff 01/01/2022
Invoice Required
Invoice Required
Invoice Required
Outpatient Prescription Drug Program. Billable by pharmacy only
Invoice Required
Invoice Required
Invoice Required
See OPPS/PHYS billing guides for policy. May require invoice
See OPPS/PHYS billing guides for policy. May require invoice
Invoice Required
Invoice Required
Invoice Required
Invoice Required
Invoice Required
INVOICE REQUIRED
Payable in OPPS only
Payable in OPPS only
Payable in OPPS only
Payable in OPPS only
COV
0
1
PRICING*
A
E
F
AUTH*
CPA
EPA
PA
COMMENTS
ABA
BR
COE
CVP
DENTAL
PROFESSIONAL SERVICES
TELEHEALTH
MID-QUARTER UPDATES
SPC
C
NC
**If a code is not listed, it is not covered under the Outpatient Hosp
**MUE is based on CMS guidelines, and does not guarantee Med
OUTPATIENT FEE SCHEDULE LEGEND
Return to Fee Schedule
* A single unit in OPPS equals the national average units per episode of care
Procedure code paid by acquisition cost - Invoice Required
Procedure code paid via EAPG pricing
Procedure code paid via fee established by HCA
Please see Applied Behavioral Analysis (ABA) Billing Guide for coverage
By Report
Allowed only in HCA approved Center of Excellence
Vaccine Free from DOH Child Vaccine Program
Refer to the dental fee schedule and the dental Medicaid Provider Guide for information on what is covered in dental and any
coverage, including prior authorization.
Please see Professional Services Billing Guide for limitations
For telehealth use: HCA does not pay facility fees for audio only telehealth
Special Payment Consideration - Effective dates have changed refer to "what's changed" tab for specifics
Covered
Non-Covered
**If a code is not listed, it is not covered under the Outpatient Hospital Fee Schedule**
**MUE is based on CMS guidelines, and does not guarantee Medicaid coverage**
AUTH CPT DESCRPT COV UNITS PRICING FEE
Invoice Required. See OPPS billing guide and PHYS billing guide for policy
0 through 20 years of age
0 through 20 years of age
0 through 20 years of age
0 through 20 years of age
0 through 20 years of age
0 through 20 years of age
0 through 20 years of age
0 through 20 years of age
0 through 20 years of age
2/23/2023
2/23/2023
2/21/2023
2/21/2023
2/21/2023
2/21/2023
2/21/2023
2/8/2023
1/26/2023
1/26/2023
1/26/2023
1/11/2023
1/11/2023
1/11/2023
1/10/2023
1/9/2023
1/5/2023
Washington State Health Care Authorit
Outpatient Specialty Drugs
Updated 01/05/2023
Eculizumab J1300 No
71394006501
N/A
71394041501
60923036302 07/01/2017 – 12/31/2017
60923028410
64406005801 N/A
50242010501 06/10/2019 – 12/31/2019
58468042601 04/01/2022 - 12/31/2999
71287021901 04/01/2021 - 12/31/2999
73292001101 04/01/2021-12/31/2999
71287011901 04/01/2018 - 12/31/2999
73475304105 01/01/2023 - 12/31/2999
71336100301 01/01/2023 - 12/31/2999
25682002501
25682002201 01/01/2022 - 12/31/2999
25682002801
47783010101 01/01/2022 - 12/31/2999
68135010001 01/01/2022 - 12/31/2999
68135002001 01/01/2022 - 12/31/2999
54092070001 01/01/2022 - 12/31/2999
54092070202 54092070203 01/01/2022 - 12/31/2999
72677055101 N/A
58468007001 01/01/2022 - 12/31/2999
25682000701 01/01/2022 - 12/31/2999
58468004101 58468004001 01/01/2022 - 12/31/2999
47783064401 01/01/2022 - 12/31/2999
68012035001 68012035002
71274035001 01/01/2022 - 12/31/2999
71274035002
63833082502 01/01/2022 - 12/31/2999
42227008105
01/01/2022 - 12/31/2999
42227008301
63833082802
01/01/2022 - 12/31/2999
63833082902
64406010101 64406010202 01/01/2022 - 12/31/2999
59572051501 59572051502 59572051503 N/A
58468016001
58468016002 01/01/2022 - 12/31/2999
58468042601 N/A
71287021901 N/A
73292001101 N/A
59572071101
07/01/2020 - 12/31/2999
59572077501
50242010501 01/01/2020 - 12/31/2999
68135005890
68135075620 01/01/2019 – 12/31/2999
68135067340
68135081102 01/01/2019 - 12/31/2999
00078084619 01/01/2019 - 12/31/2999
00078084619
69794010201
69794020301 01/01/2019 - 12/31/2999
69794030401
71394006501
01/01/2019 - 12/31/2999
71394041501
64406005801 01/01/2018 - 12/31/2999
60923036302
01/01/2018 - 12/31/2999
60923028410
68135081102 N/A
70510217101
N/A
70510217102
00078084619
N/A
00078084619
71287011901 01/01/2018 – 03/31/2018
Outpatient Hospital Date Span
N/A
N/A
N/A
N/A
N/A
N/A
10/01/2022 - 12/31/2999
10/01/2022 - 12/31/2999
10/01/2021 - 12/31/2999
10/01/2021 - 12/31/2999
10/01/2021 - 12/31/2999
10/01/2019 - 12/31/2999
1/1/2022 - 12/31/2999
1/1/2022 - 12/31/2999
07/16/2021 - 12/31/2999
07/01/2022 - 12/31/2999
07/01/2022 - 12/31/2999
07/01/2022 - 09/30/2022
07/01/2022 - 09/30/2022
07/01/2021 - 12/31/2999
07/01/2021 - 12/31/2999
07/01/2021 - 12/31/2999
07/01/2021 - 09/30/2021
07/01/2021 - 09/30/2021
07/01/2020 - 12/31/2999
07/01/2020 - 12/31/2999
07/01/2020 - 12/31/2999
07/01/2020 - 12/31/2999
07/01/2019 – 12/31/2999
07/01/2019 - 12/31/2999
07/01/2019 - 09/30/2019
07/01/2019 – 06/30/2020
07/01/2018 - 12/31/2018
07/01/2017 – 12/31/2017
07/01/2017 - 12/31/2017
06/10/2019 – 12/31/2019
04/01/2022 - 12/31/2999
04/01/2021 - 12/31/2999
04/01/2021 - 12/31/2999
04/01/2018 - 12/31/2999
01/01/2023 - 12/31/2999
01/01/2023 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 12/31/2999
01/01/2022 - 03/31/2022
01/01/2021 - 03/31/2021
01/01/2021 - 03/31/2021
01/01/2020 - 12/31/2999
01/01/2020 - 12/31/2999
01/01/2019 – 12/31/2999
01/01/2019 - 12/31/2999
01/01/2019 - 12/31/2999
01/01/2019 - 12/31/2999
01/01/2019 - 12/31/2999
01/01/2018 - 12/31/2999
01/01/2018 - 12/31/2999
01/01/2018 - 12/31/2019
01/01/2018 -- 12/31/2018
01/01/2018 - 12/31/2018
01/01/2018 – 03/31/2018
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