Claim Editing Update Report: 4th Quarter 2017

Transcription

1 Claim Editing Update Report: 4th Quarter 2017 Page Section 1 McKesson Pair Additions pair edits added to the McKesson KnowledgePack Update. Site-specific modifier override indicators for denied/paid code combination. Y = does override; N = does not override; N/A = does not apply to the code combination. 24 McKesson Pair Rationale s Rationale descriptions for the rationale codes included in the McKesson Pair Additions section. 31 McKesson Pair Expirations pair edits closed from the McKesson KnowledgePack Update. 42 V23.3 Additions Edits added in new version of. Provides brief policy for each edit. 84 V23.3 Expirations Edits that were closed in new version of. 85 V23.2 Changes Changes to modifier overrides (new override = 1 or no longer overrides = 0) for existing code pairs and changes to existing edits' effective and/or expiration date. 89 OCE V23.3 Additions Edits added in new version of OCE/. 125 OCE V23.3 Expirations Edits that were closed in new version of OCE/. 126 OCE V23.3 Changes Changes to modifier overrides (new override = 1 or no longer overrides = 0) for existing code pairs and changes to existing edits' effective and/or expiration date. An independent licensee of the Blue Cross and Blue Shield Association

2 Instructions PLEASE REVIEW THE FOLLOWING IMPORTANT INFORMATION The information contained in this report is intended to expedite review of Horizon BCBSNJ rd quarter edit changes. Edits in the workbook are sorted first by denied code then by paid code in ascending numeric order. A '#' sign immediately Edit source abbreviations are defined below. Edits: code pair edits are code pairs that should not be reported together for a number of reasons explained in the National Correct Coding Initiative Coding Manual for Medicare Services. The Additions tab contains new edits added by (with policy statement). The Expirations tab contains edits expired by. The Deletions tab contains edits deleted by. The Changes tab contains edits modified by. Changes can include 1) ( "GB Indicator") modifications represented with a 'Modified' record and an 'Added' record, or 2) edit effective or expiration date modifications represented in one 'Modified' record. NOTE: An indicator of "1" = a modifier indicated by can be used to allow payment for both codes. "0" = No modifier can be used to bypass the edit pair. OCE/ Edits: edits incorporated into Outpatient Editor (OCE). The OCE/ Additions tab contains new edits added by OCE/ (with policy statement). The OCE/ Expirations tab contains edits expired by OCE/. The Deletions tab contains edits deleted by OCE/. The OCE/ Changes tab contains edits modified by OCE/. Changes can include 1) (OCE/ "GB Indicator") modifications represented with a 'Modified' record and an 'Added' record, or 2) edit effective or expiration date modifications represented in one 'Modified' record. NOTE: An indicator of "1" = a modifier indicated by OCE/ can be used to allow payment for both codes. "0" = No modifier can be used to bypass the edit pair. McKesson Pairs: This includes code pairs based on three of the rule types in the CXT UNBUN_PAIRS rule. These rule types are Incidental (INC), Mutually Exclusive (ME), and Parent/Child (ULT_PARENT) editing. An Edit Rationale number is provided with each McKesson Pair addition, which can be used to refer to the Edit Report Rationale worksheet where they are listed in numeric order. This Edit Rationale number is specific to this report only. General Information: s -25, -57, and -59 are intended to indicate that a service/procedure that would normally be included in payment for another service/procedure should, for specific reasons, not be denied when submitted with one of these modifiers. By default, modifier -25 will override any edit within the McKesson Pair Additions tab where the RULE_TYPE is ME or INC as well as any edit described in the McKesson Visits tab. By default, modifier -57 will override any edit described in the McKesson Visits tab. By default, modifier -59 will override any edit within the McKesson Pair Additions tab where the RULE_TYPE is ME, INC, or ULT_PARENT." Source Abbreviation Source Name Source Abbreviation Source Name AAOS American Academy of Orothopaedic Surgeons AUA American Urological Association. ACC American College of Cardiology. Correct Coding Initiative. ACOG American College of Obstetricians and Gynecologists. CCN External physician consultants. ACR American College of Radiology. CMS Centers for Medicare and Medicaid Services (CMS) coding guidelines. ACS American College of Surgeons DMEPOS DME Prosthetic, Orthotic, Supplies Fee Schedule AMA CPT coding guidelines. HPP Health Plan AMA RBRVS AMA RBRVS Data Manager PPP Internal physicians. ASA American Society of Anesthesiologists. SMFM Society for Maternal-Fetal Medicine. ASM American Society for Microbiology. STS Society of Thoracic Surgeons. ClaimsXten is a trademark of McKesson Corporation. CPT copyright 2017 American Medical Association. All rights reserved All other product and company names may be trademarks or registered trademarks of their respective companies.

3 McKesson Pair Additions Rule Type Rationale Horizon Revised INC CORRECT SKIN COLOR 6.0 CM/< RADIATION THERAPY PLANNING /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION THERAPY PLANNING /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION THERAPY PLANNING /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< SET RADIATION THERAPY FIELD /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< SET RADIATION THERAPY FIELD /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< SET RADIATION THERAPY FIELD /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RESPIRATOR MOTION MGMT SIMUL /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< D RADIOTHERAPY PLAN /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION THERAPY DOSE PLAN /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIOTHERAPY DOSE PLAN IMRT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< TELETHX ISODOSE PLAN SIMPLE /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< TELETHX ISODOSE PLAN CPLX /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< BRACHYTX ISODOSE PLAN SIMPLE /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< BRACHYTX ISODOSE INTERMED /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< BRACHYTX ISODOSE COMPLEX /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< SPECIAL TELETX PORT PLAN /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< SPECIAL RADIATION DOSIMETRY /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION TREATMENT AID(S) /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION TREATMENT AID(S) /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION TREATMENT AID(S) /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION PHYSICS CONSULT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< DESIGN MLC DEVICE FOR IMRT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION PHYSICS CONSULT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< SRS MULTISOURCE /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< SRS LINEAR BASED /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< SBRT DELIVERY /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< NTSTY MODUL RAD TX DLVR SMPL /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< NTSTY MODUL RAD TX DLVR CPLX /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< GUIDANCE FOR RADIAJ TX DLVR /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIOLOGY PORT IMAGES(S) /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< NEUTRON BEAM TX SIMPLE /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< NEUTRON BEAM TX COMPLEX /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< IO RAD TX DELIVERY BY X-RAY /1/2017 1

4 McKesson Pair Additions Rule Type Rationale Horizon Revised INC CORRECT SKIN COLOR 6.0 CM/< IO RAD TX DELIVER BY ELCTRNS /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION TX MANAGEMENT X /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION THERAPY MANAGEMENT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< STEREOTACTIC RADIATION TRMT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< SBRT MANAGEMENT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< IO RADIATION TX MANAGEMENT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< SPECIAL RADIATION TREATMENT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< PROTON TRMT SIMPLE W/O COMP /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< PROTON TRMT SIMPLE W/COMP /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< PROTON TRMT INTERMEDIATE /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< PROTON TREATMENT COMPLEX /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< INFUSE RADIOACTIVE MATERIALS /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< APPLY INTRCAV RADIAT SIMPLE /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< APPLY INTRCAV RADIAT INTERM /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< APPLY INTRCAV RADIAT COMPL /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< HDR RDNCL SKN SURF BRACHYTX /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< HDR RDNCL SKN SURF BRACHYTX /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< HDR RDNCL NTRSTL/ICAV BRCHTX /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< HDR RDNCL NTRSTL/ICAV BRCHTX /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< HDR RDNCL NTRSTL/ICAV BRCHTX /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< APPLY INTERSTIT RADIAT COMPL /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< APPLY SURF LDR RADIONUCLIDE /1/2017 INC CORRECT SKIN COLOR 6.0 CM/< RADIATION HANDLING /1/2017 INC CORRECT SKN COLOR CM RADIATION THERAPY PLANNING /1/2017 INC CORRECT SKN COLOR CM RADIATION THERAPY PLANNING /1/2017 INC CORRECT SKN COLOR CM RADIATION THERAPY PLANNING /1/2017 INC CORRECT SKN COLOR CM SET RADIATION THERAPY FIELD /1/2017 INC CORRECT SKN COLOR CM SET RADIATION THERAPY FIELD /1/2017 INC CORRECT SKN COLOR CM SET RADIATION THERAPY FIELD /1/2017 INC CORRECT SKN COLOR CM RESPIRATOR MOTION MGMT SIMUL /1/2017 INC CORRECT SKN COLOR CM D RADIOTHERAPY PLAN /1/2017 INC CORRECT SKN COLOR CM RADIATION THERAPY DOSE PLAN /1/2017 2

5 McKesson Pair Additions Rule Type Rationale Horizon Revised INC CORRECT SKN COLOR CM RADIOTHERAPY DOSE PLAN IMRT /1/2017 INC CORRECT SKN COLOR CM TELETHX ISODOSE PLAN SIMPLE /1/2017 INC CORRECT SKN COLOR CM TELETHX ISODOSE PLAN CPLX /1/2017 INC CORRECT SKN COLOR CM BRACHYTX ISODOSE PLAN SIMPLE /1/2017 INC CORRECT SKN COLOR CM BRACHYTX ISODOSE INTERMED /1/2017 INC CORRECT SKN COLOR CM BRACHYTX ISODOSE COMPLEX /1/2017 INC CORRECT SKN COLOR CM SPECIAL TELETX PORT PLAN /1/2017 INC CORRECT SKN COLOR CM SPECIAL RADIATION DOSIMETRY /1/2017 INC CORRECT SKN COLOR CM RADIATION TREATMENT AID(S) /1/2017 INC CORRECT SKN COLOR CM RADIATION TREATMENT AID(S) /1/2017 INC CORRECT SKN COLOR CM RADIATION TREATMENT AID(S) /1/2017 INC CORRECT SKN COLOR CM RADIATION PHYSICS CONSULT /1/2017 INC CORRECT SKN COLOR CM DESIGN MLC DEVICE FOR IMRT /1/2017 INC CORRECT SKN COLOR CM RADIATION PHYSICS CONSULT /1/2017 INC CORRECT SKN COLOR CM SRS MULTISOURCE /1/2017 INC CORRECT SKN COLOR CM SRS LINEAR BASED /1/2017 INC CORRECT SKN COLOR CM SBRT DELIVERY /1/2017 INC CORRECT SKN COLOR CM NTSTY MODUL RAD TX DLVR SMPL /1/2017 INC CORRECT SKN COLOR CM NTSTY MODUL RAD TX DLVR CPLX /1/2017 INC CORRECT SKN COLOR CM GUIDANCE FOR RADIAJ TX DLVR /1/2017 INC CORRECT SKN COLOR CM RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKN COLOR CM RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKN COLOR CM RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKN COLOR CM RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKN COLOR CM RADIOLOGY PORT IMAGES(S) /1/2017 INC CORRECT SKN COLOR CM NEUTRON BEAM TX SIMPLE /1/2017 INC CORRECT SKN COLOR CM NEUTRON BEAM TX COMPLEX /1/2017 INC CORRECT SKN COLOR CM IO RAD TX DELIVERY BY X-RAY /1/2017 INC CORRECT SKN COLOR CM IO RAD TX DELIVER BY ELCTRNS /1/2017 INC CORRECT SKN COLOR CM RADIATION TX MANAGEMENT X /1/2017 INC CORRECT SKN COLOR CM RADIATION THERAPY MANAGEMENT /1/2017 INC CORRECT SKN COLOR CM STEREOTACTIC RADIATION TRMT /1/2017 INC CORRECT SKN COLOR CM SBRT MANAGEMENT /1/2017 INC CORRECT SKN COLOR CM IO RADIATION TX MANAGEMENT /1/2017 INC CORRECT SKN COLOR CM SPECIAL RADIATION TREATMENT /1/2017 INC CORRECT SKN COLOR CM PROTON TRMT SIMPLE W/O COMP /1/2017 INC CORRECT SKN COLOR CM PROTON TRMT SIMPLE W/COMP /1/2017 3

6 McKesson Pair Additions Rule Type Rationale Horizon Revised INC CORRECT SKN COLOR CM PROTON TRMT INTERMEDIATE /1/2017 INC CORRECT SKN COLOR CM PROTON TREATMENT COMPLEX /1/2017 INC CORRECT SKN COLOR CM HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKN COLOR CM HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKN COLOR CM HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKN COLOR CM HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKN COLOR CM HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKN COLOR CM INFUSE RADIOACTIVE MATERIALS /1/2017 INC CORRECT SKN COLOR CM APPLY INTRCAV RADIAT SIMPLE /1/2017 INC CORRECT SKN COLOR CM APPLY INTRCAV RADIAT INTERM /1/2017 INC CORRECT SKN COLOR CM APPLY INTRCAV RADIAT COMPL /1/2017 INC CORRECT SKN COLOR CM HDR RDNCL SKN SURF BRACHYTX /1/2017 INC CORRECT SKN COLOR CM HDR RDNCL SKN SURF BRACHYTX /1/2017 INC CORRECT SKN COLOR CM HDR RDNCL NTRSTL/ICAV BRCHTX /1/2017 INC CORRECT SKN COLOR CM HDR RDNCL NTRSTL/ICAV BRCHTX /1/2017 INC CORRECT SKN COLOR CM HDR RDNCL NTRSTL/ICAV BRCHTX /1/2017 INC CORRECT SKN COLOR CM APPLY INTERSTIT RADIAT COMPL /1/2017 INC CORRECT SKN COLOR CM APPLY SURF LDR RADIONUCLIDE /1/2017 INC CORRECT SKN COLOR CM RADIATION HANDLING /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION THERAPY PLANNING /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION THERAPY PLANNING /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION THERAPY PLANNING /1/2017 INC CORRECT SKIN COLOR EA 20.0CM SET RADIATION THERAPY FIELD /1/2017 INC CORRECT SKIN COLOR EA 20.0CM SET RADIATION THERAPY FIELD /1/2017 INC CORRECT SKIN COLOR EA 20.0CM SET RADIATION THERAPY FIELD /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RESPIRATOR MOTION MGMT SIMUL /1/2017 INC CORRECT SKIN COLOR EA 20.0CM D RADIOTHERAPY PLAN /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION THERAPY DOSE PLAN /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIOTHERAPY DOSE PLAN IMRT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM TELETHX ISODOSE PLAN SIMPLE /1/2017 INC CORRECT SKIN COLOR EA 20.0CM TELETHX ISODOSE PLAN CPLX /1/2017 INC CORRECT SKIN COLOR EA 20.0CM BRACHYTX ISODOSE PLAN SIMPLE /1/2017 INC CORRECT SKIN COLOR EA 20.0CM BRACHYTX ISODOSE INTERMED /1/2017 INC CORRECT SKIN COLOR EA 20.0CM BRACHYTX ISODOSE COMPLEX /1/2017 INC CORRECT SKIN COLOR EA 20.0CM SPECIAL TELETX PORT PLAN /1/2017 INC CORRECT SKIN COLOR EA 20.0CM SPECIAL RADIATION DOSIMETRY /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION TREATMENT AID(S) /1/2017 4

7 McKesson Pair Additions Rule Type Rationale Horizon Revised INC CORRECT SKIN COLOR EA 20.0CM RADIATION TREATMENT AID(S) /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION TREATMENT AID(S) /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION PHYSICS CONSULT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM DESIGN MLC DEVICE FOR IMRT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION PHYSICS CONSULT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM SRS MULTISOURCE /1/2017 INC CORRECT SKIN COLOR EA 20.0CM SRS LINEAR BASED /1/2017 INC CORRECT SKIN COLOR EA 20.0CM SBRT DELIVERY /1/2017 INC CORRECT SKIN COLOR EA 20.0CM NTSTY MODUL RAD TX DLVR SMPL /1/2017 INC CORRECT SKIN COLOR EA 20.0CM NTSTY MODUL RAD TX DLVR CPLX /1/2017 INC CORRECT SKIN COLOR EA 20.0CM GUIDANCE FOR RADIAJ TX DLVR /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION TREATMENT DELIVERY /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIOLOGY PORT IMAGES(S) /1/2017 INC CORRECT SKIN COLOR EA 20.0CM NEUTRON BEAM TX SIMPLE /1/2017 INC CORRECT SKIN COLOR EA 20.0CM NEUTRON BEAM TX COMPLEX /1/2017 INC CORRECT SKIN COLOR EA 20.0CM IO RAD TX DELIVERY BY X-RAY /1/2017 INC CORRECT SKIN COLOR EA 20.0CM IO RAD TX DELIVER BY ELCTRNS /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION TX MANAGEMENT X /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION THERAPY MANAGEMENT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM STEREOTACTIC RADIATION TRMT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM SBRT MANAGEMENT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM IO RADIATION TX MANAGEMENT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM SPECIAL RADIATION TREATMENT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM PROTON TRMT SIMPLE W/O COMP /1/2017 INC CORRECT SKIN COLOR EA 20.0CM PROTON TRMT SIMPLE W/COMP /1/2017 INC CORRECT SKIN COLOR EA 20.0CM PROTON TRMT INTERMEDIATE /1/2017 INC CORRECT SKIN COLOR EA 20.0CM PROTON TREATMENT COMPLEX /1/2017 INC CORRECT SKIN COLOR EA 20.0CM HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM HYPERTHERMIA TREATMENT /1/2017 INC CORRECT SKIN COLOR EA 20.0CM INFUSE RADIOACTIVE MATERIALS /1/2017 INC CORRECT SKIN COLOR EA 20.0CM APPLY INTRCAV RADIAT SIMPLE /1/2017 5

8 McKesson Pair Additions Rule Type Rationale Horizon Revised INC CORRECT SKIN COLOR EA 20.0CM APPLY INTRCAV RADIAT INTERM /1/2017 INC CORRECT SKIN COLOR EA 20.0CM APPLY INTRCAV RADIAT COMPL /1/2017 INC CORRECT SKIN COLOR EA 20.0CM HDR RDNCL SKN SURF BRACHYTX /1/2017 INC CORRECT SKIN COLOR EA 20.0CM HDR RDNCL SKN SURF BRACHYTX /1/2017 INC CORRECT SKIN COLOR EA 20.0CM HDR RDNCL NTRSTL/ICAV BRCHTX /1/2017 INC CORRECT SKIN COLOR EA 20.0CM HDR RDNCL NTRSTL/ICAV BRCHTX /1/2017 INC CORRECT SKIN COLOR EA 20.0CM HDR RDNCL NTRSTL/ICAV BRCHTX /1/2017 INC CORRECT SKIN COLOR EA 20.0CM APPLY INTERSTIT RADIAT COMPL /1/2017 INC CORRECT SKIN COLOR EA 20.0CM APPLY SURF LDR RADIONUCLIDE /1/2017 INC CORRECT SKIN COLOR EA 20.0CM RADIATION HANDLING /1/2017 INC NIPPLE EXPLORATION REMOVAL OF BREAST TISSUE /1/2017 INC NIPPLE EXPLORATION P-MASTECTOMY W/LN REMOVAL /1/2017 INC NIPPLE EXPLORATION MAST SIMPLE COMPLETE /1/2017 INC NIPPLE EXPLORATION MAST RADICAL /1/2017 INC NIPPLE EXPLORATION MAST RAD URBAN TYPE /1/2017 INC NIPPLE EXPLORATION MAST MOD RAD /1/2017 ME NECK SPINE FUSION CERVICAL LAMINOPLSTY 2/> SEG /1/2017 ME NECK SPINE FUSION C-LAMINOPLASTY W/GRAFT/PLATE /1/2017 ME SPINE FUSION EXTRA SEGMENT CERVICAL LAMINOPLSTY 2/> SEG /1/2017 ME SPINE FUSION EXTRA SEGMENT C-LAMINOPLASTY W/GRAFT/PLATE /1/2017 ME INSERT SPINE FIXATION DEVICE CERVICAL LAMINOPLSTY 2/> SEG /1/2017 ME INSERT SPINE FIXATION DEVICE C-LAMINOPLASTY W/GRAFT/PLATE /1/2017 ME INSERT SPINE FIXATION DEVICE CERVICAL LAMINOPLSTY 2/> SEG /1/2017 ME INSERT SPINE FIXATION DEVICE C-LAMINOPLASTY W/GRAFT/PLATE /1/2017 ME INSERT SPINE FIXATION DEVICE CERVICAL LAMINOPLSTY 2/> SEG /1/2017 ME INSERT SPINE FIXATION DEVICE C-LAMINOPLASTY W/GRAFT/PLATE /1/2017 INC REMOVE SHOULDER FB DEEP RECONSTRUCT SHOULDER JOINT /1/2017 INC REMOVE SHOULDER FB DEEP RECONSTRUCT SHOULDER JOINT /1/2017 INC SHOULDER PROSTHESIS REMOVAL RECONSTRUCT SHOULDER JOINT /1/2017 INC SHOULDER PROSTHESIS REMOVAL RECONSTRUCT SHOULDER JOINT /1/2017 INC SHOULDER PROSTHESIS REMOVAL RECONSTRUCT SHOULDER JOINT /1/2017 INC SHOULDER PROSTHESIS REMOVAL RECONSTRUCT SHOULDER JOINT /1/2017 INC REPAIR ELBOW PERC REVISE ULNAR NERVE AT ELBOW /1/2017 INC REPAIR ELBOW W/DEB OPEN REVISE ULNAR NERVE AT ELBOW /1/2017 INC REPAIR ELBOW DEB/ATTCH OPEN REVISE ULNAR NERVE AT ELBOW /1/2017 ME ABLATE INF TURBINATE SUPERF ABLATE INF TURBINATE SUBMUC /1/2017 INC COLONOSCOPY W/LESION REMOVAL COLONOSCOPY W/ABLATION /1/2017 6

9 McKesson Pair Additions Rule Type Rationale Horizon Revised INC COLONOSCOPY W/LESION REMOVAL COLONOSCOPY W/ABLATION /1/2017 ME EXTENSIVE VULVA SURGERY EXTENSIVE VULVA SURGERY /1/2017 ME CLOSURE OF VAGINA REPAIR OF VAGINA /1/2017 ME REPAIR PARAVAG DEFECT OPEN VAG HYST W/URINARY REPAIR /1/2017 ME REPAIR PARAVAG DEFECT VAG VAG HYST W/URINARY REPAIR /1/2017 ME REMOVE CERVIX REPAIR BOWEL COLPOPEXY INTRAPERITONEAL /1/2017 INC PIERCE SKULL IMPLANT DEVICE PIERCE SKULL FOR BIOPSY /1/2017 INC PIERCE SKULL IMPLANT DEVICE PIERCE SKULL FOR DRAINAGE /1/2017 INC PIERCE SKULL IMPLANT DEVICE PIERCE SKULL & REMOVE CLOT /1/2017 INC PIERCE SKULL IMPLANT DEVICE PIERCE SKULL FOR DRAINAGE /1/2017 INC INCISE SKULL FOR BRAIN WOUND INCISE SKULL FOR SURGERY /1/2017 ME SCAN PROC CRANIAL EXTRA SRS CRANIAL LESION SIMPLE /1/2017 ME SCAN PROC CRANIAL EXTRA SRS CRAN LES SIMPLE ADDL /1/2017 ME SCAN PROC CRANIAL EXTRA SRS CRANIAL LESION COMPLEX /1/2017 ME SCAN PROC CRANIAL EXTRA SRS CRAN LES COMPLEX ADDL /1/2017 ME SCAN PROC SPINAL SCAN PROC CRANIAL INTRA /1/2017 ME SCAN PROC SPINAL SRS CRANIAL LESION SIMPLE /1/2017 ME SCAN PROC SPINAL SRS CRAN LES SIMPLE ADDL /1/2017 ME SCAN PROC SPINAL SRS CRANIAL LESION COMPLEX /1/2017 ME SCAN PROC SPINAL SRS CRAN LES COMPLEX ADDL /1/2017 ME REMOVE SPINAL LAMINA ADD-ON DECOMPRESS SPINAL CORD LMBR /1/2017 ME DECOMPRESS SPINE CORD ADD-ON REMOVE SPINE LAMINA 1 LMBR /1/2017 INC REVISE LOW BACK NERVE(S) REMOVE SPINE LAMINA 1 THRC /1/2018 INC REVISE LOW BACK NERVE(S) REMOVE SPINE LAMINA 1 LMBR /1/2018 INC REVISE LOW BACK NERVE(S) DECOMPRESS SPINAL CORD THRC /1/2018 INC REVISE LOW BACK NERVE(S) DECOMPRESS SPINAL CORD LMBR /1/2018 INC REVISE LOW BACK NERVE(S) DECOMPRESS SPINE CORD ADD-ON /1/2018 ME CT ANGIOGRAPH PELV W/O&W/DYE CT ANGIO LWR EXTR W/O&W/DYE /1/2017 INC US GUIDE TISSUE ABLATION 0440T ABLTJ PERC UXTR/PERPH NRV /1/2017 INC US GUIDE TISSUE ABLATION 0441T ABLTJ PERC LXTR/PERPH NRV /1/2017 INC US GUIDE TISSUE ABLATION 0442T ABLTJ PERC PLEX/TRNCL NRV /1/2017 INC CT GUIDE FOR TISSUE ABLATION 0440T ABLTJ PERC UXTR/PERPH NRV /1/2017 INC CT GUIDE FOR TISSUE ABLATION 0441T ABLTJ PERC LXTR/PERPH NRV /1/2017 INC CT GUIDE FOR TISSUE ABLATION 0442T ABLTJ PERC PLEX/TRNCL NRV /1/2017 INC MRI FOR TISSUE ABLATION 0440T ABLTJ PERC UXTR/PERPH NRV /1/2017 INC MRI FOR TISSUE ABLATION 0441T ABLTJ PERC LXTR/PERPH NRV /1/2017 INC MRI FOR TISSUE ABLATION 0442T ABLTJ PERC PLEX/TRNCL NRV /1/2017 7

10 McKesson Pair Additions Rule Type Rationale Horizon Revised ME RADIUM/RADIOISOTOPE THERAPY THORAX STEREO RAD TARGETW/TX /1/2017 ME DRUG SCREEN QUANTALCOHOLS G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREEN QUANTALCOHOLS G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREEN QUANTALCOHOLS G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREEN QUANTALCOHOLS G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREEN QUANTALCOHOLS G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ALCOHOLS BIOMARKERS 1OR 2 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ALCOHOLS BIOMARKERS 1OR 2 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ALCOHOLS BIOMARKERS 1OR 2 G0482 DRUG TEST DEF CLASSES /1/2017 ME ALCOHOLS BIOMARKERS 1OR 2 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ALCOHOLS BIOMARKERS 1OR 2 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ALCOHOLS BIOMARKERS 3/MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ALCOHOLS BIOMARKERS 3/MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ALCOHOLS BIOMARKERS 3/MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME ALCOHOLS BIOMARKERS 3/MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ALCOHOLS BIOMARKERS 3/MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREEN AMPHETAMINES 1/2 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREEN AMPHETAMINES 1/2 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREEN AMPHETAMINES 1/2 G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREEN AMPHETAMINES 1/2 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREEN AMPHETAMINES 1/2 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME AMPHETAMINES 3OR 4 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME AMPHETAMINES 3OR 4 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME AMPHETAMINES 3OR 4 G0482 DRUG TEST DEF CLASSES /1/2017 ME AMPHETAMINES 3OR 4 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME AMPHETAMINES 3OR 4 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME AMPHETAMINES 5 OR MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME AMPHETAMINES 5 OR MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME AMPHETAMINES 5 OR MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME AMPHETAMINES 5 OR MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME AMPHETAMINES 5 OR MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ANABOLIC STEROID 1 OR 2 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ANABOLIC STEROID 1 OR 2 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ANABOLIC STEROID 1 OR 2 G0482 DRUG TEST DEF CLASSES /1/2017 ME ANABOLIC STEROID 1 OR 2 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ANABOLIC STEROID 1 OR 2 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ANABOLIC STEROID 3 OR MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 8

11 McKesson Pair Additions Rule Type Rationale Horizon Revised ME ANABOLIC STEROID 3 OR MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ANABOLIC STEROID 3 OR MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME ANABOLIC STEROID 3 OR MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ANABOLIC STEROID 3 OR MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ANALGESICS NON-OPIOID 1 OR 2 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ANALGESICS NON-OPIOID 1 OR 2 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ANALGESICS NON-OPIOID 1 OR 2 G0482 DRUG TEST DEF CLASSES /1/2017 ME ANALGESICS NON-OPIOID 1 OR 2 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ANALGESICS NON-OPIOID 1 OR 2 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ANALGESICS NON-OPIOID 3-5 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ANALGESICS NON-OPIOID 3-5 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ANALGESICS NON-OPIOID 3-5 G0482 DRUG TEST DEF CLASSES /1/2017 ME ANALGESICS NON-OPIOID 3-5 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ANALGESICS NON-OPIOID 3-5 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ANALGESICS NON-OPIOID 6/MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ANALGESICS NON-OPIOID 6/MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ANALGESICS NON-OPIOID 6/MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME ANALGESICS NON-OPIOID 6/MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ANALGESICS NON-OPIOID 6/MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ANTIDEPRESSANTS CLASS 1 OR 2 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 1 OR 2 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 1 OR 2 G0482 DRUG TEST DEF CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 1 OR 2 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 1 OR 2 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ANTIDEPRESSANTS CLASS 3-5 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 3-5 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 3-5 G0482 DRUG TEST DEF CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 3-5 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 3-5 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ANTIDEPRESSANTS CLASS 6/MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 6/MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 6/MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 6/MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ANTIDEPRESSANTS CLASS 6/MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ANTIDEPRESSANT TRICYCLIC 1/2 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ANTIDEPRESSANT TRICYCLIC 1/2 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ANTIDEPRESSANT TRICYCLIC 1/2 G0482 DRUG TEST DEF CLASSES /1/2017 9

12 McKesson Pair Additions Rule Type Rationale Horizon Revised ME ANTIDEPRESSANT TRICYCLIC 1/2 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ANTIDEPRESSANT TRICYCLIC 1/2 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME ANTIDEPRESSANT TRICYCLIC 3-5 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME ANTIDEPRESSANT TRICYCLIC 3-5 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME ANTIDEPRESSANT TRICYCLIC 3-5 G0482 DRUG TEST DEF CLASSES /1/2017 ME ANTIDEPRESSANT TRICYCLIC 3-5 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME ANTIDEPRESSANT TRICYCLIC 3-5 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME TRICYCLIC & CYCLICALS 6/MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME TRICYCLIC & CYCLICALS 6/MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME TRICYCLIC & CYCLICALS 6/MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME TRICYCLIC & CYCLICALS 6/MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME TRICYCLIC & CYCLICALS 6/MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREENING BARBITURATES ASSAY OF PHENOBARBITAL /1/2017 ME DRUG SCREENING BARBITURATES G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREENING BARBITURATES G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREENING BARBITURATES G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREENING BARBITURATES G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREENING BARBITURATES G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME BENZODIAZEPINES1-12 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME BENZODIAZEPINES1-12 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME BENZODIAZEPINES1-12 G0482 DRUG TEST DEF CLASSES /1/2017 ME BENZODIAZEPINES1-12 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME BENZODIAZEPINES1-12 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME BENZODIAZEPINES 13 OR MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME BENZODIAZEPINES 13 OR MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME BENZODIAZEPINES 13 OR MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME BENZODIAZEPINES 13 OR MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME BENZODIAZEPINES 13 OR MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREENING BUPRENORPHINE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREENING BUPRENORPHINE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREENING BUPRENORPHINE G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREENING BUPRENORPHINE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREENING BUPRENORPHINE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME CANNABINOIDS NATURAL G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME CANNABINOIDS NATURAL G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME CANNABINOIDS NATURAL G0482 DRUG TEST DEF CLASSES /1/2017 ME CANNABINOIDS NATURAL G0483 DRUG TEST DEF 22+ CLASSES /1/

13 McKesson Pair Additions Rule Type Rationale Horizon Revised ME CANNABINOIDS NATURAL G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME CANNABINOIDS SYNTHETIC 1-3 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME CANNABINOIDS SYNTHETIC 1-3 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME CANNABINOIDS SYNTHETIC 1-3 G0482 DRUG TEST DEF CLASSES /1/2017 ME CANNABINOIDS SYNTHETIC 1-3 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME CANNABINOIDS SYNTHETIC 1-3 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME CANNABINOIDS SYNTHETIC 4-6 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME CANNABINOIDS SYNTHETIC 4-6 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME CANNABINOIDS SYNTHETIC 4-6 G0482 DRUG TEST DEF CLASSES /1/2017 ME CANNABINOIDS SYNTHETIC 4-6 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME CANNABINOIDS SYNTHETIC 4-6 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME CANNABINOID SYNTHETIC 7/MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME CANNABINOID SYNTHETIC 7/MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME CANNABINOID SYNTHETIC 7/MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME CANNABINOID SYNTHETIC 7/MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME CANNABINOID SYNTHETIC 7/MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREENING COCAINE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREENING COCAINE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREENING COCAINE G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREENING COCAINE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREENING COCAINE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREENING FENTANYL G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREENING FENTANYL G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREENING FENTANYL G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREENING FENTANYL G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREENING FENTANYL G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME GABAPENTIN NON-BLOOD DRUG SCREEN QUANT GABAPENTIN /1/2017 ME GABAPENTIN NON-BLOOD G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME GABAPENTIN NON-BLOOD G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME GABAPENTIN NON-BLOOD G0482 DRUG TEST DEF CLASSES /1/2017 ME GABAPENTIN NON-BLOOD G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME GABAPENTIN NON-BLOOD G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME HEROIN METABOLITE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME HEROIN METABOLITE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME HEROIN METABOLITE G0482 DRUG TEST DEF CLASSES /1/2017 ME HEROIN METABOLITE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME HEROIN METABOLITE G0659 DRUG TEST DEF SIMPLE ALL CL /1/

14 McKesson Pair Additions Rule Type Rationale Horizon Revised ME KETAMINE AND NORKETAMINE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME KETAMINE AND NORKETAMINE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME KETAMINE AND NORKETAMINE G0482 DRUG TEST DEF CLASSES /1/2017 ME KETAMINE AND NORKETAMINE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME KETAMINE AND NORKETAMINE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREENING METHADONE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREENING METHADONE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREENING METHADONE G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREENING METHADONE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREENING METHADONE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME METHYLENEDIOXYAMPHETAMINES G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME METHYLENEDIOXYAMPHETAMINES G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME METHYLENEDIOXYAMPHETAMINES G0482 DRUG TEST DEF CLASSES /1/2017 ME METHYLENEDIOXYAMPHETAMINES G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME METHYLENEDIOXYAMPHETAMINES G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME METHYLPHENIDATE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME METHYLPHENIDATE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME METHYLPHENIDATE G0482 DRUG TEST DEF CLASSES /1/2017 ME METHYLPHENIDATE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME METHYLPHENIDATE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME OPIATES 1 OR MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME OPIATES 1 OR MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME OPIATES 1 OR MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME OPIATES 1 OR MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME OPIATES 1 OR MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME OPIOIDS & OPIATE ANALOGS 1/2 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME OPIOIDS & OPIATE ANALOGS 1/2 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME OPIOIDS & OPIATE ANALOGS 1/2 G0482 DRUG TEST DEF CLASSES /1/2017 ME OPIOIDS & OPIATE ANALOGS 1/2 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME OPIOIDS & OPIATE ANALOGS 1/2 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME OPIOIDS & OPIATE ANALOGS 3/4 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME OPIOIDS & OPIATE ANALOGS 3/4 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME OPIOIDS & OPIATE ANALOGS 3/4 G0482 DRUG TEST DEF CLASSES /1/2017 ME OPIOIDS & OPIATE ANALOGS 3/4 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME OPIOIDS & OPIATE ANALOGS 3/4 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME OPIOID &OPIATE ANALOG 5/MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME OPIOID &OPIATE ANALOG 5/MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/

15 McKesson Pair Additions Rule Type Rationale Horizon Revised ME OPIOID &OPIATE ANALOG 5/MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME OPIOID &OPIATE ANALOG 5/MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME OPIOID &OPIATE ANALOG 5/MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREENING OXYCODONE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREENING OXYCODONE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREENING OXYCODONE G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREENING OXYCODONE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREENING OXYCODONE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREENING PREGABALIN G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREENING PREGABALIN G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREENING PREGABALIN G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREENING PREGABALIN G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREENING PREGABALIN G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREENING PROPOXYPHENE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREENING PROPOXYPHENE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREENING PROPOXYPHENE G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREENING PROPOXYPHENE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREENING PROPOXYPHENE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME SEDATIVE HYPNOTICS G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME SEDATIVE HYPNOTICS G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME SEDATIVE HYPNOTICS G0482 DRUG TEST DEF CLASSES /1/2017 ME SEDATIVE HYPNOTICS G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME SEDATIVE HYPNOTICS G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME SKELETAL MUSCLE RELAXANT 1/2 G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME SKELETAL MUSCLE RELAXANT 1/2 G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME SKELETAL MUSCLE RELAXANT 1/2 G0482 DRUG TEST DEF CLASSES /1/2017 ME SKELETAL MUSCLE RELAXANT 1/2 G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME SKELETAL MUSCLE RELAXANT 1/2 G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME SKEL MUSC RELAXANT 3 OR MORE G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME SKEL MUSC RELAXANT 3 OR MORE G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME SKEL MUSC RELAXANT 3 OR MORE G0482 DRUG TEST DEF CLASSES /1/2017 ME SKEL MUSC RELAXANT 3 OR MORE G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME SKEL MUSC RELAXANT 3 OR MORE G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME STIMULANTS SYNTHETIC G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME STIMULANTS SYNTHETIC G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME STIMULANTS SYNTHETIC G0482 DRUG TEST DEF CLASSES /1/2017 ME STIMULANTS SYNTHETIC G0483 DRUG TEST DEF 22+ CLASSES /1/

16 McKesson Pair Additions Rule Type Rationale Horizon Revised ME STIMULANTS SYNTHETIC G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREENING TAPENTADOL G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREENING TAPENTADOL G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREENING TAPENTADOL G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREENING TAPENTADOL G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREENING TAPENTADOL G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME DRUG SCREENING TRAMADOL G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME DRUG SCREENING TRAMADOL G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME DRUG SCREENING TRAMADOL G0482 DRUG TEST DEF CLASSES /1/2017 ME DRUG SCREENING TRAMADOL G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME DRUG SCREENING TRAMADOL G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 ME STEREOISOMER ANALYSIS G0480 DRUG TEST DEF 1-7 CLASSES /1/2017 ME STEREOISOMER ANALYSIS G0481 DRUG TEST DEF 8-14 CLASSES /1/2017 ME STEREOISOMER ANALYSIS G0482 DRUG TEST DEF CLASSES /1/2017 ME STEREOISOMER ANALYSIS G0483 DRUG TEST DEF 22+ CLASSES /1/2017 ME STEREOISOMER ANALYSIS G0659 DRUG TEST DEF SIMPLE ALL CL /1/2017 INC URINALYSIS AUTO W/O SCOPE DRUG SCREEN QUANTALCOHOLS /1/2017 INC URINALYSIS AUTO W/O SCOPE ALCOHOLS BIOMARKERS 1OR /1/2017 INC URINALYSIS AUTO W/O SCOPE ALCOHOLS BIOMARKERS 3/MORE /1/2017 INC URINALYSIS AUTO W/O SCOPE DRUG SCREEN AMPHETAMINES 1/ /1/2017 INC URINALYSIS AUTO W/O SCOPE AMPHETAMINES 3OR /1/2017 INC URINALYSIS AUTO W/O SCOPE AMPHETAMINES 5 OR MORE /1/2017 INC URINALYSIS AUTO W/O SCOPE ANABOLIC STEROID 1 OR /1/2017 INC URINALYSIS AUTO W/O SCOPE ANABOLIC STEROID 3 OR MORE /1/2017 INC URINALYSIS AUTO W/O SCOPE ANALGESICS NON-OPIOID 1 OR /1/2017 INC URINALYSIS AUTO W/O SCOPE ANALGESICS NON-OPIOID /1/2017 INC URINALYSIS AUTO W/O SCOPE ANALGESICS NON-OPIOID 6/MORE /1/2017 INC URINALYSIS AUTO W/O SCOPE ANTIDEPRESSANTS CLASS 1 OR /1/2017 INC URINALYSIS AUTO W/O SCOPE ANTIDEPRESSANTS CLASS /1/2017 INC URINALYSIS AUTO W/O SCOPE ANTIDEPRESSANTS CLASS 6/MORE /1/2017 INC URINALYSIS AUTO W/O SCOPE ANTIDEPRESSANT TRICYCLIC 1/ /1/2017 INC URINALYSIS AUTO W/O SCOPE ANTIDEPRESSANT TRICYCLIC /1/2017 INC URINALYSIS AUTO W/O SCOPE TRICYCLIC & CYCLICALS 6/MORE /1/2017 INC URINALYSIS AUTO W/O SCOPE DRUG SCREENING BARBITURATES /1/2017 INC URINALYSIS AUTO W/O SCOPE BENZODIAZEPINES /1/2017 INC URINALYSIS AUTO W/O SCOPE BENZODIAZEPINES 13 OR MORE /1/2017 INC URINALYSIS AUTO W/O SCOPE DRUG SCREENING BUPRENORPHINE /1/