On this page is a compilation of the obsolete pages as they correspond to the revision date. Click on a date to see the manual chapter page(s) prior to the revision.

Page replaced from 03/31/2025 revision – Section 46.1 – Covered Services

Page replaced from 01/02/2025 revision – Table of Contents

Page replaced from 01/02/2025 revision – Section 46.0 – Overview

Page replaced from 01/02/2025 revision – Section 46.1 – Covered Services

Page replaced from 01/02/2025 revision – Section 46.2 – Recipient Requirements

Page replaced from 01/02/2025 revision – Section 46.3 – Provider Requirements

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Page replaced from 01/02/2025 revision – Appendix D – Contact/Referral Information

Page replaced from 12/12/2024 revision – Appendix C – Claims Filing

Page replaced from 05/21/2024 revision – Title Page

Page replaced from 05/21/2024 revision – Section 46.1 – Covered Services

Page replaced from 11/01/2022 revision – Section 46.1 – Covered Services

Page replaced from 09/08/2022 revision – Section 46.0 – Overview

Page replaced from 09/08/2022 revision – Section 46.1 – Covered Services

Page replaced from 09/08/2022 revision – Section 46.2 – Beneficiary Requirements

Page replaced from 09/08/2022 revision – Section 46.4 – Prior Authorization

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Page replaced from 09/08/2022 revision – Appendix A – Fee Schedule

Page replaced from 09/08/2022 revision – Appendix B – Prior Authorization Form

Page replaced from 09/08/2022 revision – Appendix C – Claims Filing

Page replaced from 08/06/2021 revision – Table of Contents

Page replaced from 08/06/2021 revision – Section 46.0 – Overview

Page replaced from 08/06/2021 revision – Section 46.1 – Covered Services

Page replaced from 08/06/2021 revision – Section 46.2 – Recipient Requirements

Page replaced from 08/06/2021 revision – Section 46.3 – Provider Requirements

Page replaced from 08/06/2021 revision – Section 46.4 – Prior Authorization

Page replaced from 08/06/2021 revision – Section 46.5 – Reimbursement

Page replaced from 08/06/2021 revision – Section 46.6 – Record Keeping

Page replaced from 08/06/2021 revision – Appendix C – Claims Filing

Page replaced from 08/06/2021 revision – Appendix D – Contact/Referral Information

Page replaced from 01/20/2020 revision – Title Page

Pages replaced from 01/20/2020 revision – Appendix C – Claims Filing

Pages replaced from 01/20/2020 revision – Appendix D – Contact/Referral Information

Pages replaced from 06/19/2018 revision – Title Page

Pages replaced from 06/19/2018 revision – Section 46.1 – Covered Services

Pages replaced from 06/19/2018 revision – Section 46.2 – Recipient Requirements

Pages replaced from 06/19/2018 revision – Section 46.4 – Prior Authorization

Pages replaced from 06/19/2018 revision – Section 46.5 – Reimbursement

Pages replaced from 06/19/2018 revision – Section 46.6 – Record Keeping

Pages replaced from 06/19/2018 revision – Appendix A – Fee Schedule

Pages replaced from 06/19/2018 revision – Appendix C – Claims Filing

Pages replaced from 06/19/2018 revision – Appendix D – Contact/Referral Information

Pages replaced from 12/22/2017 revision – Section 46.1 – Covered Services Filing

Pages replaced from 09/29/2015 revision – Title Page

Pages replaced from 09/29/2015 revision – Appendix C – Claims Filing

Pages replaced from 10/14/2014 revision – Appendix D – Contact/Referral Information

Pages replaced from 05/12/2014 revision – Section 46.5 – Reimbursement

Pages replaced from 05/12/2014 revision – Section 46 – Appendix C – Claims Filing

Pages replaced from 04/21/11 revision – Table of Contents

Pages replaced from 04/21/11 revision – Section 46.2 - Recipient Requirements

Pages replaced from 04/21/11 revision – Appendix A

Pages replaced from 04/21/11 revision – Appendix B

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