Provider UR Data Belies Rosy Insurer Claims

August 22, 2023 47 min read

By: the daisyNews Team

Provider UR Data Belies Rosy Insurer Claims

At a recent California Division of Workers’ Compensation (DWC) meeting, a representative from the California Workers’ Compensation Institute (CWCI) — an insurers’ organization dedicated to insurers’ interests — reportedly claimed a 95% approval rate for treatments requested by doctors to heal injured workers.

daisyBill challenged this estimate by publishing data revealing the overall treatment approval rate for the providers in our system is closer to 70%.

Today, we look closer at our Utilization Review (UR) data.

Below we unpack UR data for two significant claims administrators: Athens Administrators and Intercare Holdings Insurances Services, Inc. These data include the precise treatments these Third-Party Administrators (TPAs) denied on behalf of workers’ comp insurers and self-insured employers.

Data from these particular TPAs are instructive; of the ten largest claims administrators in our system by volume, Athens has the highest denial rate at 41%, while Intercare has the lowest denial rate at 9%.

Contrast these specific, verifiable data with uncorroborated insurer-reported statistics from the CWCI. When confronting the challenges that face workers’ comp, stakeholders should insist on seeing the underlying numbers behind any entity’s assertions and scrutinize potentially self-serving claims.

We encourage all employers to peruse our data and ponder why Athens’ denial rate is over four times higher than Intercare’s. Denial of recommended care may mean delayed recovery, increased costs, and higher insurance premiums or fees — to say nothing of undue employee suffering.

Data On the Ground: UR Statistics for Athens, Intercare

Requests for Authorization (RFAs) submitted by a physician often list multiple treatment requests. For that reason, daisyBill software tracks each treatment a doctor requests on an RFA individually, along with the UR decisions issued for each treatment.

Athens returned 1,822 UR decisions either approving or denying the treatments requested in RFAs submitted by providers from January 1, 2023, to July 31, 2023. Intercare returned 2,711 approval and denial decisions in the same period. Overall, Athens denied 41% of providers’ requested treatments, while Intercare denied only 9% of the requested treatments.

Is it plausible that doctors requested inappropriate, unnecessary treatment four times more often when submitting RFAs to Athens, as opposed to Intercare? In all likelihood, no; the disparity suggests that Athens UR is much quicker to deny treatment — a chilling notion for injured workers covered by Athens (as well as for their employers).

The Real Costs of High Denial Rates

These data should raise questions regarding whether injured workers are being denied medically necessary care.

Under what circumstances are things like Tylenol, wheelchairs, and pre-operative clearance considered medically inappropriate or unnecessary? While we do not expect 100% approval rates, we find it extremely difficult to believe that doctors requested unnecessary, inappropriate treatment 41% of the time — when asking Athens for approval.

Based on its touting of a 95% approval claim, the CWCI seems to agree with daisyBill that in an ideal world, claims administrators would honor doctors’ decisions about what’s best for injured workers. But daisyBill data strongly suggest that the CWCI 95% claim does not reflect reality.

Are treatment decisions guided by doctors’ informed opinions of the injuries in front of them or by the cost-cutting goals of payer UR organizations? Only verifiable data can begin to offer an answer.

Employers, take a look at the numbers below. Ask yourselves two critical, essential questions. When payers like Athens maintain such high rates of denial of treatments, does it:

Save employers money by eliminating “unnecessary” medical costs? Or,
Does it cost employers more because injured workers do not return to work quickly?

Putting the moral implications aside, when an injured worker is denied necessary care, is the employer better off? Or can the cost of high denial rates ultimately outweigh the savings?

Denial Rates by Treatment Type: Athens vs. Intercare

Below is a summary of treatments submitted to Athens and Intercare by clients between 1/1/2023 and 7/31/2023 where daisyBill has a Utilization Review decision either approving or denying the requested treatment.

For data analysis purposes, daisyBill assigned each requested treatment a category describing the type requested. The summary below calculates the denial rates for Intercare and Athens for each treatment category.

This summary does not include the instances when the entity refused to perform a Utilization Review of the requested treatment because of deferred liability, an assertion that the RFA was incomplete, or the entity modified the requested treatment.

Further, below, we publish the precise treatments Athens and Intercare denied as medically unnecessary.

Service / Good Requested Category	Intercare Approve Count	Intercare Deny Count	Intercare % Denial	Athens Approve Count	Athens Deny Count	Athens % Denial
Physical Therapy and Rehabilitation	544	36	6%	130	116	47%
Specialist Referral	482	5	1%	172	13	7%
Medical Imaging and Diagnostic Tests	408	27	6%	192	124	39%
Surgery and Invasive Procedures	330	41	11%	123	108	47%
Medications and Pharmacotherapy	291	40	12%	212	175	45%
DMEPOS	96	29	23%	82	80	49%
Alternative and Complementary Therapies	89	4	4%	38	26	41%
Dentistry	58	28	33%	0	0	0%
Psychotherapy and Counseling	53	1	2%	49	14	22%
Pre-Op Medical Clearance	42	11	21%	38	45	54%
Acupuncture	39	1	3%	19	29	60%
Chiropractic Care	31	2	6%	15	10	40%
Home Health Assistance	15	8	35%	3	7	70%
Transportation	0	0	0%	1	1	50%
Grand Total	2,478	233	9%	1,074	748	41%

Intercare - Treatment Denied on RFAs submitted 1/1/2023 - 7/31/2023

Service/Good Category	Service/Good Requested
Acupuncture	six sessions of acupuncture for the lumbar spine
Alternative and Complementary Therapies	12 visits Massage Therapy.
Alternative and Complementary Therapies	ADDITIONAL MASSAGE THERAPY
Alternative and Complementary Therapies	ADDITIONAL MASSAGE THERAPY. PATIENT HAS BENEFITTED FROM PREVIOUS MASSAGE SESSIONS.
Alternative and Complementary Therapies	Intraoperative monitor
Chiropractic Care	8 sessions of chiropractic care for the back
Chiropractic Care	CHIROPRACTIC
Dentistry	24 sessions of in house laser
Dentistry	24 sessions of in house tens unit
Dentistry	crown # 9
Dentistry	Crowns on teeth #6,7,8,9,10,11
Dentistry	Crowns teeth #5, 8 and #9
Dentistry	Ct scan implant planning
Dentistry	Day time and Night time Orthotics
Dentistry	Day time and Night time Orthotics
Dentistry	Day Time Upper Orthotic
Dentistry	In house tense sessions
Dentistry	In house tense sessions
Dentistry	Laser Therapy
Dentistry	MLS In house Laser treatment
Dentistry	MLS Laser
Dentistry	MLS LASER IN HOUSE
Dentistry	PRP
Dentistry	Sleep Study (Embleta Take Home Kit)
Dentistry	Sleep Study In house
Dentistry	SLEEP STUDY( EMBLETTA)
Dentistry	Surgical Guide
Dentistry	Teeth # 23,24,25,26 Incisal composite fillings
Dentistry	TENSE IN HOUSE SESSIONS
Dentistry	Tooth #30 Bone Graft
Dentistry	Tooth #30 custom abutment
Dentistry	Tooth #30 extraction
Dentistry	Tooth #30 Implant
Dentistry	Tooth #30 implant crown
Dentistry	Tooth #30 Membrane
DMEPOS	Cold Compression Therapy System VENDOR: [REDACTED]
DMEPOS	IN-FRARED HEATING PAD
DMEPOS	LUMBAR BRACE
DMEPOS	LUMBAR EXERCISE KIT
DMEPOS	POST-OP DME
DMEPOS	POST-OP DME
DMEPOS	POST-OP DME
DMEPOS	POSTOP DME
DMEPOS	POSTOP DME
DMEPOS	POSTOP DME
DMEPOS	POSTOP DME
DMEPOS	POSTOP DME
DMEPOS	POSTOP DME
DMEPOS	Pull-up style Station Boots for work
DMEPOS	Purchase IF-4 unit for home use for pain relief
DMEPOS	radiofrequency ablation
DMEPOS	RFA FOR MOTORIZED SCOOTER, RATIONALE, PATIENT HAS ADVANCED OA BOTH KNEES PRIMARILY ON THE RIGHT.
DMEPOS	DME: Cold compression therapy system rental X30 Vendor: [redacted] E 1399
DMEPOS	ELECTRIC SCOOTER
DMEPOS	FAR INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	H-WAVE E-STIM UNIT FOR AT HOME USE
Home Health Assistance	HOME HEALTH AIDE ASSIT D/T WORSENING LBP INTO LES
Home Health Assistance	Home Health Aid
Home Health Assistance	HOME HEALTH EVALUATION
Home Health Assistance	IN HOME CARE PERSON TO TAKE CARE OF PATIENT
Home Health Assistance	RN In Home Evaluation for wound Check
Home Health Assistance	POSTOP IN-HOME THERAPY
Home Health Assistance	POSTOP IN-HOME THERAPY
Home Health Assistance	POSTOP IN-HOME THERAPY
Medical Imaging and Diagnostic Tests	2ND REQUEST MRA RIGHT HIP
Medical Imaging and Diagnostic Tests	2ND REQUEST MRI BILATERAL KNEES
Medical Imaging and Diagnostic Tests	CBC, CMP, UA, TSH, EKG, CXR
Medical Imaging and Diagnostic Tests	EKG,CBC,BMP
Medical Imaging and Diagnostic Tests	FLOUROSCOPY
Medical Imaging and Diagnostic Tests	Fluoroscopy
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	MRI
Medical Imaging and Diagnostic Tests	MRI C. spine
Medical Imaging and Diagnostic Tests	MRI Left hip.
Medical Imaging and Diagnostic Tests	MRI OF THE LEFT ANKLE/FOOT
Medical Imaging and Diagnostic Tests	MRI OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	MRI OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	MRI of the lumbar spine to rule out discopathy
Medical Imaging and Diagnostic Tests	SARS COVID 2 nasopharyngeal swab test.
Medical Imaging and Diagnostic Tests	SARS COVID 2 nasopharyngeal swab test.
Medical Imaging and Diagnostic Tests	SARS COVID 2 nasopharyngeal swab test.
Medical Imaging and Diagnostic Tests	SARS-COV-2 NASAL SWAB TEST
Medical Imaging and Diagnostic Tests	I am requesting MRI of right shoulder. I will see him back after the MRI so we can go over the results and formulate appropriate treatment plan.
Medications and Pharmacotherapy	Ambien
Medications and Pharmacotherapy	Ambien
Medications and Pharmacotherapy	Amitriptyline 25 mg 2 PO QHS
Medications and Pharmacotherapy	Amitriptyline 25 mg 2 PO QHS
Medications and Pharmacotherapy	Cyclobenzaprine 10mg 1 tab PO Q8H PRN Spasms #30, 0 refills
Medications and Pharmacotherapy	Duexis 800-26.6MG#90 and Lidoderm 5% External Patch #30 to take as needed for pain management
Medications and Pharmacotherapy	FLEXERIL 10MG #60
Medications and Pharmacotherapy	Hydrocodone/APAP, 10/325, #60, 1 PO q6h prn
Medications and Pharmacotherapy	Hydroxyzine 10 mg PO QHS
Medications and Pharmacotherapy	Ibuprofen 800mg PO Q6hrs #30
Medications and Pharmacotherapy	Ibuprofen 800MG#90 and Tizanidine HCl 4MG#60 to take as needed and Medrol 4MG 1 packet to take as directed for pain management.
Medications and Pharmacotherapy	Naproxen 500 mg PO BID
Medications and Pharmacotherapy	Naproxen 500 mg PO BID
Medications and Pharmacotherapy	NORCO 5-325MG #60
Medications and Pharmacotherapy	Norco 5-325mg#60 and Movantik 25mg#30 to be taken as needed for pain management.
Medications and Pharmacotherapy	Norco 5/325mg PO Q6hrs #20
Medications and Pharmacotherapy	PERCOCET 10/325MG #105
Medications and Pharmacotherapy	Percocet 5-325MG#60 and SOMA 350MG #60
Medications and Pharmacotherapy	POST-OP MEDICATION
Medications and Pharmacotherapy	POST-OP MEDICATION
Medications and Pharmacotherapy	POST-OP MEDICATION
Medications and Pharmacotherapy	POSTOP MEDICATION
Medications and Pharmacotherapy	POSTOP MEDICATION
Medications and Pharmacotherapy	POSTOP MEDICATION
Medications and Pharmacotherapy	POSTOP RX
Medications and Pharmacotherapy	POSTOP RX
Medications and Pharmacotherapy	POSTOP RX
Medications and Pharmacotherapy	Prevacid 15 mg PO QD
Medications and Pharmacotherapy	Prevacid 15 mg PO QD
Medications and Pharmacotherapy	Prevacid 15 mg PO QD
Medications and Pharmacotherapy	Robaxin 500 mg po qhs #60 for low back muscle spasms
Medications and Pharmacotherapy	ROBAXIN 750MG #90
Medications and Pharmacotherapy	Skelaxin 800 mg PO QHS
Medications and Pharmacotherapy	tramadol 50 mg every 6-8 hours as needed for pain
Medications and Pharmacotherapy	TRAMADOL 50MG #60 X1 REFILL
Medications and Pharmacotherapy	TYLENOL #3 #90 X3 REFILLS
Medications and Pharmacotherapy	Tylenol #3 1 #90
Medications and Pharmacotherapy	VOLTAREN GEL 1% #300G
Medications and Pharmacotherapy	VOLTAREN GEL 1% #350G X 3 REFILLS
Medications and Pharmacotherapy	Xanax 1 mg one at bedtime as needed
Physical Therapy and Rehabilitation	POST INJECTION CERVICAL THERAPY EVALUATION
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJJECTION THERAPY
Physical Therapy and Rehabilitation	12 sessions of physical therapy for C. spine
Physical Therapy and Rehabilitation	6 sessions of physical therapy to left shoulder
Physical Therapy and Rehabilitation	Additional PT - 6 Additional
Physical Therapy and Rehabilitation	Addtl PT 3x2 - C-Spine, L/S Spine, Bilateral Upper Extremity
Physical Therapy and Rehabilitation	Initial PT - 3x4
Physical Therapy and Rehabilitation	Physical therapy 3 times a week for 4 weeks
Physical Therapy and Rehabilitation	PHYSICAL THERAPY LEFT KNEE
Physical Therapy and Rehabilitation	PHYSICAL THERAPY RIGHT QUADRICEPS
Physical Therapy and Rehabilitation	POST INJECTION CERVICAL PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST INJECTION PHYSICAL THERAPY 2X4 C/S
Physical Therapy and Rehabilitation	POST OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST-OP PHYSICAL THERAPY LEFT ANKLE
Physical Therapy and Rehabilitation	POST-OP PHYSICAL THERAPY LEFT ANKLE
Physical Therapy and Rehabilitation	POST-OP PHYSICAL THERAPY RIGHT FOOT
Physical Therapy and Rehabilitation	Post-Op PT 3xwk for 4wks
Physical Therapy and Rehabilitation	Post-Op PT: 2xwk/4wks After 1wk
Physical Therapy and Rehabilitation	POSTOP P.T.
Physical Therapy and Rehabilitation	POSTOP P.T.
Physical Therapy and Rehabilitation	POSTOP P.T.
Physical Therapy and Rehabilitation	POSTOP P.T.
Physical Therapy and Rehabilitation	POSTOP P.T.
Physical Therapy and Rehabilitation	POSTOP P.T.
Physical Therapy and Rehabilitation	TWELVE SESSIONS OF PHYSICAL THERAPY FOR THE LUMBAR SPINE
Pre-Op Medical Clearance	Medical Clearance
Pre-Op Medical Clearance	Medical Clearance
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE
Pre-Op Medical Clearance	PREOP
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE PLEASE LIST DR. [REDACTED] TO PREVENT DELAY IN SCHEDULING
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE PLEASE LIST DR. [REDACTED] TO PREVENT DELAY IN SCHEDULING
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE PLEASE LIST DR. [REDACTED] TO PREVENT DELAY IN SCHEDULING
Psychotherapy and Counseling	Cognitive behavioral therapy 6 sessions
Specialist Referral	FCE
Specialist Referral	Follow Up Evaluation
Specialist Referral	Follow Up Evaluation with Primary Treating Physician
Specialist Referral	EVALUATION AND TREATMENT OF HER LEFT HIP PAIN
Specialist Referral	I kindly request you to authorize a one time Podiatry Consultation for Left Foot and Ankle with Podiatrist [Redacted], DPM and to have his name on the approval letter in order for patient to be seen. Thank you.
Surgery and Invasive Procedures	A bilateral L4-5 TFESI for pain relief.
Surgery and Invasive Procedures	BIL L3-4 and L4-5 MBB
Surgery and Invasive Procedures	BIL T10-T11 and T11-T12 MBB
Surgery and Invasive Procedures	Bil T10-T11 and T11-T12 RFA
Surgery and Invasive Procedures	BILATERAL C5-6 MEDIAL BRANCH BLOCK
Surgery and Invasive Procedures	Bilateral Facet Blocks L1-3
Surgery and Invasive Procedures	Cervical Epidural Steroid Injection
Surgery and Invasive Procedures	CERVICAL EPIDURAL STEROID INJECTION AT C6-C7
Surgery and Invasive Procedures	CERVICAL EPIDURAL STEROID INJECTION AT C6-C7
Surgery and Invasive Procedures	CERVICAL FACET BLOCKS C5-C7
Surgery and Invasive Procedures	Destruction of precancerous lesions w/ liquid nitrogen
Surgery and Invasive Procedures	Left greater trochanter bursa injection.
Surgery and Invasive Procedures	left hand ring and small finger digital nerve lacerations with possible repair vs neurolysis
Surgery and Invasive Procedures	Left L3-4, L4-5 PRP
Surgery and Invasive Procedures	Lidocaine ointment 5% locally
Surgery and Invasive Procedures	LUMBAR EPIDURAL STEROID INJECTION AT L4-L5
Surgery and Invasive Procedures	Lumbar epidural steroid injection L5- S1
Surgery and Invasive Procedures	NEURO SURGICAL CONSULTATION TO THE LUMBAR SPINE
Surgery and Invasive Procedures	One level translaminar C6-C7 cervical epidural steroid injection.
Surgery and Invasive Procedures	PRP INJECTION RIGHT KNEE
Surgery and Invasive Procedures	revision C5-6 anterior cervical discectomy and fusion
Surgery and Invasive Procedures	Right C8 root, right C7/T1 facet, fluoroscopic guidance, local anesthesia
Surgery and Invasive Procedures	RIGHT L3-4 and L4-5 TRANSFORAMINAL EPIDURAL STEROID INJECTION
Surgery and Invasive Procedures	RIGHT LUMBAR EPIDURAL STEROID INJECTION AT L4-L5
Surgery and Invasive Procedures	SURGERY
Surgery and Invasive Procedures	SURGERY
Surgery and Invasive Procedures	SURGERY
Surgery and Invasive Procedures	SURGERY LEFT ANKLE
Surgery and Invasive Procedures	SURGERY PLEASE ADD THE FACILITY TO PREVENT DELAY IN SCHEDULING
Surgery and Invasive Procedures	SURGERY PLEASE ADD THE FACILITY TO PREVENT DELAY IN SCHEDULING
Surgery and Invasive Procedures	SURGERY PLEASE ADD THE FACILITY TO PREVENT DELAY IN SCHEDULING
Surgery and Invasive Procedures	SURGERY RIGHT FOOT
Surgery and Invasive Procedures	SURGICAL IMPLANTS
Surgery and Invasive Procedures	SURGICAL IMPLANTS
Surgery and Invasive Procedures	SURGICAL IMPLANTS
Surgery and Invasive Procedures	THORACIC EPIDURAL STEROID INJECTION AT T8-T9
Surgery and Invasive Procedures	APPEALING SURGERY DENIAL SURGERY LEFT ANKLE. PLEASE SEE ATTACHED NEW CLINICAL NOTES D.O.S. 7/18/23 WITH RECENT X-RAYS.
Surgery and Invasive Procedures	Bilateral Facet Blocks L1-3- We have exhausted all conservative care, including physical therapy, home exercise programs, and medications, and will now proceed with an injection. Patient has completed physical therapy, 16 sessions of acupuncture, 20 sessions of massage therapy, and 24 sessions of chiropractic care for his low back. He complains of back pain to be 8/10 in severity. Notes that he has tightness in his back. On exam, he has tenderness to palpation in his mid and low back, pain with extension, pain with axial loading, and good strength in his lower extremities. On imaging, patient has degenerative disc disease, Schmorl's nodes, facet arthropathy, and facet fluid, as well as a grade 1 isthmic spondylolisthesis at L5-S1. Patient is not having radicular pain but rather localized back pain. I believe he would benefit from having facet blocks done at L1-3, where the facet arthropathy and fluid is worse. I would like him to have a diagnostic and therapeutic injection done given that he has tried and failed extensive conservative care and his pain is worsening.
Surgery and Invasive Procedures	Kindly authorize left shoulder PRP injection.
Surgery and Invasive Procedures	RIGHT SHOULDER ARTHROSCOPY WITH DECOMPRESSION, DISTAL CLAVICLE EXCISION AND POSSIBLE BICEPS TENODESIS DUE TO WORSENING SYMPTOMS, POSITIVE EXAMINATION AND POSITIVE MRI SCAN, AND THE PATIENT HAS TRIED AND FAILED PHYSICAL THERAPY X 4 MONTHS, REST, NSAIDS AND A CORTISONE INJECTION GAVE RELIEF FOR JUST 4 DAYS. THE PATIENT HAS CHRONIC AND CONSTANT SYMPTOMS
Surgery and Invasive Procedures	total disc replacement at C5-C7, assistant surgeon, 1-3 day in patient stay, pre op labs (CMP, PT, PTT, CBC, UA), A1C glucose test, EKG, chest X-rays, pre op clearance by Dr. [redacted] in-house, 3 post op hospital visits, Pneumatic Compression System, DME cervical hard collar and soft collar – to be dispensed in house, post op in home physical therapy two times a week for four weeks, post op outpatient patient physical therapy two times a week for four weeks, RN evaluation for wound check with possible home health aide services 4 hours a day 2-3 times a week for four weeks. Surgery will be performed at [redacted].

Athens - Treatment Denied on RFAs submitted 1/1/2023 - 7/31/2023

Service/Good Category	Service/Good Requested
Acupuncture	10 sessions of acupuncture for the lumbar spine
Acupuncture	10 sessions of acupuncture for the neck
Acupuncture	12 visits Acupuncture Therapy for right foot.
Acupuncture	6 sessions of acupuncture
Acupuncture	8 sessions of acupuncture for the back
Acupuncture	8 sessions of acupuncture for the low back
Acupuncture	8 sessions of acupuncture for the lumbar spine
Acupuncture	8 sessions of acupuncture for the neck
Acupuncture	8 sessions of acupuncture for the neck
Acupuncture	8 sessions of acupuncture for the neck
Acupuncture	8 sessions of acupuncture for the thoracic spine
Acupuncture	ACUPUNCTURE
Acupuncture	ACUPUNCTURE 2X4
Acupuncture	ACUPUNCTURE 2X4 FOR HA AND NECK PAIN
Acupuncture	ACUPUNCTURE 2X4 FOR PAIN IN BOTH KNEES
Acupuncture	Acupuncture 2x4 LBP
Acupuncture	ACUPUNCTURE 2X6 WEEKS FOR BILATERAL SHOULDERS
Acupuncture	ACUPUNCTURE 2X6 WEEKS FOR RIGHT SHOULDERAS AB ADJUNCT MODALITY FOR PAIN MANAGEMENT
Acupuncture	ACUPUNCTURE 2X6 WEEKS FOR THE CERVICAL SPINE AND BILATERAL SHOULDERS
Acupuncture	Acupuncture treatment
Acupuncture	Acupuncture treatment directed to the cervical spine and lumbar spine
Acupuncture	Acupuncture treatment directed to the cervical, thoracic and lumbar spain and right knee
Acupuncture	Acupuncture x6 sessions
Acupuncture	Acupuncture, 1 time a week for 6 weeks, as an adjunct modality for the patient's pain management.
Acupuncture	CONSULTATION AND A TRIAL OF ACUPUNCTURE TO THE RIGHT SHOULDER, RIGHT HIP, LEFT HAND, AND RIGHT LOWER BACK
Acupuncture	eight sessions of acupuncture for the lumbar spine
Acupuncture	Request 8 sessions of acupuncture for the back
Acupuncture	SIX SESSIONS OF ACUPUNCTURE
Acupuncture	TRIAL ACUPUNCTURE
Alternative and Complementary Therapies	12 sessions MT for L. spine
Alternative and Complementary Therapies	12 sessions of massage therapy for C. spine
Alternative and Complementary Therapies	12 sessions of Massage Therapy for L. spine.
Alternative and Complementary Therapies	12 sessions of Massage Therapy for right upper extremity and right trapezius region
Alternative and Complementary Therapies	6 SESSIONS OF OUTSIDE MASSAGE THERAPY TO THE RIGHT ANKLE / RIGHT FOOT
Alternative and Complementary Therapies	8 sessions of aqua therapy for the neck and back
Alternative and Complementary Therapies	8 sessions of aquatic therapy for the Lumbar spine
Alternative and Complementary Therapies	8 sessions of massage therapy for her low back and neck
Alternative and Complementary Therapies	8 sessions of massage therapy for neck
Alternative and Complementary Therapies	8 sessions of massage therapy for the back
Alternative and Complementary Therapies	8 sessions of massage therapy for the low back
Alternative and Complementary Therapies	8 sessions of massage therapy for the lumbar spine
Alternative and Complementary Therapies	EIGHT SESSIONS OF AQUATIC THERAPY FOR THE LUMBAR SPINE
Alternative and Complementary Therapies	Foot/Ankle Therapy Wrap/Pad
Alternative and Complementary Therapies	Massage Therapy Sessions x6
Alternative and Complementary Therapies	Massage Therapy x 12 ( myofacial release)
Alternative and Complementary Therapies	Myofacial release therapy / Massage therapy x 10
Alternative and Complementary Therapies	Pool Therapy x24 sessions
Alternative and Complementary Therapies	POSTOP AQUATIC P.T.
Alternative and Complementary Therapies	TRIAL MASSAGE
Alternative and Complementary Therapies	IF-4
Alternative and Complementary Therapies	8 sessions of massage therapy for the neck
Alternative and Complementary Therapies	APPLICATION OF SHORT ARM SPLINT
Alternative and Complementary Therapies	Aqua Therapy 2x3
Alternative and Complementary Therapies	Aquatic therapy
Alternative and Complementary Therapies	Aquatic therapy
Chiropractic Care	8 sessions of chiropractic care for the thoracic and lumbar spine
Chiropractic Care	Chiropractic 2TIMES X 3WKS
Chiropractic Care	Chiropractic treatment
Chiropractic Care	Chiropractic treatment directed to the cervical spine and lumbar spine
Chiropractic Care	Chiropractic treatment directed to the cervical spine and lumbar spine
Chiropractic Care	eight sessions of chiropractic care for lumbar spine
Chiropractic Care	SIX SESSIONS OF CHIROPRACTIC
Chiropractic Care	SIX SESSIONS OF CHIROPRACTIC CARE FOR THE LUMBAR SPINE
Chiropractic Care	8 sessions of chiropractice treatment for her low back and neck
Chiropractic Care	Thus we have proof that it is helping. At this time, I am requesting authorization for the chiropractic sessions to continue once a week for the next six weeks and I will see her back in six weeks intervals. We will make her permanent and stationary status after she completes all her chiro sessions. Dr. [redacted] and his PA, [redacted] also requested for more chiro sessions.
DMEPOS	Motorized scooter for mobility
DMEPOS	TENS unit trial for 30 days
DMEPOS	TENS unit trial for 30 days.
DMEPOS	TWO PAIR 1) EXTRA WIDE/EXTRA DEPTH SUPPORTIVE ATHLETIC SHOEGEAR AND 2) DRESS SHOES FOR WORK
DMEPOS	BILATERAL CASTING MATERIAL
DMEPOS	BILATERAL CASTING MATERIAL
DMEPOS	Breg VPULSE Cold Compression Therapy Unit
DMEPOS	CERVICAL BRACE
DMEPOS	CERVICAL EXERCISE KIT
DMEPOS	dynasplint for ELBOW EXTN
DMEPOS	HEEL LIFT FOR LEFT FOOT
DMEPOS	Left Knee Hinged Brace
DMEPOS	LUMBAR BRACE
DMEPOS	Lumbar corset brace. (L0627)
DMEPOS	LUMBAR EXERCISE KIT
DMEPOS	LUMBAR EXERCISE KIT
DMEPOS	ORTHOPLAST SPLINT
DMEPOS	OUTSIDE DME UPRIGHT WALKER WITH SEAT
DMEPOS	RETROSPECTIVE R KNEE IMMOBILIZER
DMEPOS	RFA FOR FRONT WHEELED WALKER
DMEPOS	SHOULDER EXERCISE KIT
DMEPOS	I am also requesting authorization for far infrared heating pad therapy through [redacted] to help control pain, inflammation, improve mobility, decrease spasm, minimize need for pain medication, studies have shown it to be an effective modality.
DMEPOS	I am requesting authorization for a scooter
DMEPOS	I am requesting for therapy to continue two times a week for four weeks additional eight sessions.
DMEPOS	I AM REQUESTING INFRARXFAR INFRARED HEAT PAD.
DMEPOS	I AM REQUESTING INFRARXFAR INFRARED HEAT PAD.
DMEPOS	POST OP DME: LSO BRACE, BONE GROWTH STIMULATOR
DMEPOS	POST OP DME: SOFT C-COLLAR BRACE
DMEPOS	POST OP DME: WALKER (E0143), CANE (E0100), COMMODE (E0163)
DMEPOS	POST OP DME: WALKER, LSO BRACE
DMEPOS	POST OP DME: WALKER, LSO BRACE
DMEPOS	POST-OP DME
DMEPOS	POST-OP DME
DMEPOS	POST-OP DME
DMEPOS	POSTOP DME
DMEPOS	POSTOP DME
DMEPOS	Requesting authorization for a FAR infrared heating pad therapy through [redacted] to help control pain, inflammation, improve mobility, decrease spasm, minimize need for pain medication. Studies have shown this to be effective modality at this point time.
DMEPOS	RFA donut chair for her car.
DMEPOS	2 PAIRS TOTAL TO INCLUDE: ONE PAIR OF EXTRA WIDE/EXTRA DEPTH SUPPORTIVE ATHLETIC SHOEGEAR AND ONE PAIR OF WORK BOOTS (TO BE CHOSEN BY PATIENT/EMPLOYER)
DMEPOS	30-Day TENS unit trial
DMEPOS	a cold compression therapy system.
DMEPOS	a Far-Infrared Heating Pad for at home use.
DMEPOS	BILATERAL CUSTOM FOOT ORTHOTICS X2 PAIRS FOR ATHLETIC SHOES AND DRESS SHOES FOR COURT APPEARENCES/WORK EVENTS
DMEPOS	Cold Compression Therapy System
DMEPOS	COLD COMPRESSION THERAPY SYSTEM
DMEPOS	Cold Therapy 14 day use
DMEPOS	Cold therapy-7 day use
DMEPOS	Continue IF - 4 unit for home use for temporary pain relief
DMEPOS	Cubital Tunnel Splint (L3762)
DMEPOS	DME
DMEPOS	DME
DMEPOS	DME
DMEPOS	DME
DMEPOS	DME
DMEPOS	DME
DMEPOS	DME: Cane
DMEPOS	DME: Cold Compression Therapy System rental X30
DMEPOS	DME: Cold compression therapy system rental X30
DMEPOS	DME: Cold Compression Therapy System rental X30
DMEPOS	DME: Cold Compression Therapy System rental X30
DMEPOS	DME: Cold Compression Therapy System rental X30
DMEPOS	DME: DVT Portable Pneumatic Compression System rental X30 E0676
DMEPOS	DME: DVT Portable Pneumatic Compression System rental X30 E0676
DMEPOS	DME: Grabber Sock Donner
DMEPOS	DME: Home commode & shower chair
DMEPOS	ELECTRIC WHEELCHAIR
DMEPOS	Far-Infrared Heating Pad
DMEPOS	Far-Infrared Heating Pad
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	FAR-INFRARED HEATING PAD
DMEPOS	I am also re-requesting authorization for far infrared heating pad therapy through [redacted] to help control pain and inflammation, improved mobility, decreased spasm, minimize need for pain medications, studies have shown it to be effective modality. I am appealing denial on this and Dr. [redacted] and his PA, [redacted] have also requested this. I think she can benefit from this.
DMEPOS	I am also requesting authorization for a far infrared heating pad therapy through [redacted] o help control pain and inflammation, improve mobility, decrease spasm, minimize need for pain medication.
DMEPOS	WE ALSO NEED AUTHORIZATION FOR POST-OP DME: WALKER, 3 IN 1 COMMODE, COLD THERAPY UNIT, CRUTCHES AND A CANE. PATIENT NEEDS THESE DEVICES FOR MOBILITY AFTER SURGERY. SHE CAN NOT PROCEED WITH SURGERY WITHOUT THESE ITEMS
DMEPOS	Wrap around ice pack such as the SMI Cold Therapy Knee wrap for relief of his right knee effusion and pain prior to surgery.
Home Health Assistance	POST OP IN-HOME HEALTH THERAPY NEEDED FOR AFTER SURGERY
Home Health Assistance	PHYSICAL IN HOME HEALTH CARE, 3X2
Home Health Assistance	POST OP EXECUTIVE HOME HEALTH
Home Health Assistance	POST OP IN-HOME HEALTH THERAPY
Home Health Assistance	POST-OP EXECUTIVE HOME HEALTH
Home Health Assistance	POST-OP EXECUTIVE HOME HEALTH
Home Health Assistance	POST-OP EXECUTIVE HOME HEALTH
Medical Imaging and Diagnostic Tests	Fluoroscopy
Medical Imaging and Diagnostic Tests	Fluoroscopy
Medical Imaging and Diagnostic Tests	2 view cervical spine xray ap/lat
Medical Imaging and Diagnostic Tests	3.0 Tesla MRI ARTHROGRAM LEFT HIP ***MUST BE DONE WITH INTRA-ARTICULAR CORTISONE INJECTION
Medical Imaging and Diagnostic Tests	4 View Cervical Spine Xray AP/LAT/ Flexion & Extension
Medical Imaging and Diagnostic Tests	AN UPDATED MRI OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	Cardio-Pulmonary Exercise Study
Medical Imaging and Diagnostic Tests	CBC, BMP, EKG, HgbA1c
Medical Imaging and Diagnostic Tests	CBC, CMP, UA, CXR, EKG
Medical Imaging and Diagnostic Tests	Cervical C7-T1 interlaminar epidural steroid injection
Medical Imaging and Diagnostic Tests	CLOSED 3.0 TESLA MRI OF RIGHT WRIST W/O CONTRAST
Medical Imaging and Diagnostic Tests	CLOSED 3T MR RT SHOULDER W/ARTHROGRAM
Medical Imaging and Diagnostic Tests	CLOSED MRI L/S
Medical Imaging and Diagnostic Tests	CLOSED MRI LT SHOULDER
Medical Imaging and Diagnostic Tests	CLOSED MRI OF LEFT SHOULDER WITH ARTHROGRAM
Medical Imaging and Diagnostic Tests	CLOSED MRI RT WRIST
Medical Imaging and Diagnostic Tests	CLOSED MRI T/S
Medical Imaging and Diagnostic Tests	COMP METABOLIC W/EGFR (NA, K, CI, CO2, GLU, BUN, CR, CA, TP, ALB, TBILL, AP, AST, ALT)
Medical Imaging and Diagnostic Tests	CT SCAN FACE 2º TO tmj TENDERNESS
Medical Imaging and Diagnostic Tests	CT SCAN L/S
Medical Imaging and Diagnostic Tests	CT scan of the left hand with fine cuts and 3D recon
Medical Imaging and Diagnostic Tests	CT SCAN OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	CT scan of the thoracic spine without contrast
Medical Imaging and Diagnostic Tests	ECHOCARDIOGRAM
Medical Imaging and Diagnostic Tests	EKG,CBC,TSH,BMP
Medical Imaging and Diagnostic Tests	EMG/NCS (BILATERAL)
Medical Imaging and Diagnostic Tests	EMG/NCS BL UE
Medical Imaging and Diagnostic Tests	EMG/NCS of the Bilateral Upper Extremities (From the C-spine down to the bilateral upper extremities to all finger tips.)
Medical Imaging and Diagnostic Tests	EMG/NCV study of lower extremities.
Medical Imaging and Diagnostic Tests	Evaluation by a cardiologist
Medical Imaging and Diagnostic Tests	fluoroscopy
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	FLUROSCOPY
Medical Imaging and Diagnostic Tests	High Resolution CT Scan of the Chest w/o Contrast
Medical Imaging and Diagnostic Tests	HIGH RESOLUTION MRI CERVICAL, LUMBAR AND THORACIC SPINE W/O CONTRAST
Medical Imaging and Diagnostic Tests	Human Resources ergonomic evaluation/implementation of New Work site
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	LABS
Medical Imaging and Diagnostic Tests	Labs: CBC, CMP, UA
Medical Imaging and Diagnostic Tests	LABS: COVID 19 TEST
Medical Imaging and Diagnostic Tests	LABS: COVID 19 TEST
Medical Imaging and Diagnostic Tests	LABS: COVID 19 TEST
Medical Imaging and Diagnostic Tests	LEFT CARPOMETACARPAL JOINT DENERVATION FLUOROSCOPY
Medical Imaging and Diagnostic Tests	Left shoulder and cervical spine MRI to make sure there is no further damage.
Medical Imaging and Diagnostic Tests	LT BREAST ULTRASOUND AND MAMMOGRAM
Medical Imaging and Diagnostic Tests	Lumbar Spine MRI without contrast
Medical Imaging and Diagnostic Tests	Lumbar Spine MRI without contrast
Medical Imaging and Diagnostic Tests	Lumbar Spine MRI without contrast
Medical Imaging and Diagnostic Tests	MR ARTHROGRAM OF THE RIGHT SHOULDER
Medical Imaging and Diagnostic Tests	MRI BRAIN W/O CONTRAST
Medical Imaging and Diagnostic Tests	MRI C/S
Medical Imaging and Diagnostic Tests	MRI L/S
Medical Imaging and Diagnostic Tests	MRI L/S WITHOUT CONTRAST
Medical Imaging and Diagnostic Tests	MRI LT HIP WITHOUT CONTRAST
Medical Imaging and Diagnostic Tests	MRI LUMBAR SPINE WITHOUT CONTRAST
Medical Imaging and Diagnostic Tests	MRI LUMBAR SPINE WO CONTRAST
Medical Imaging and Diagnostic Tests	MRI OF LEFT SHOULDER W/ ARTHROGRAM
Medical Imaging and Diagnostic Tests	MRI OF LUMBAR SPINE W/O CONTRAST
Medical Imaging and Diagnostic Tests	MRI OF THE CERVICAL SPINE
Medical Imaging and Diagnostic Tests	MRI OF THE CERVICAL SPINE
Medical Imaging and Diagnostic Tests	MRI OF THE CERVICAL SPINE
Medical Imaging and Diagnostic Tests	MRI of the cervical spine
Medical Imaging and Diagnostic Tests	MRI of the cervical spine.
Medical Imaging and Diagnostic Tests	MRI OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	MRI OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	MRI OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	MRI of the lumbar spine
Medical Imaging and Diagnostic Tests	MRI OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	MRI OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	MRI of the lumbar spine
Medical Imaging and Diagnostic Tests	MRI OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	MRI OF THE LUMBAR SPINE
Medical Imaging and Diagnostic Tests	MRI of the lumbar spine without contrast
Medical Imaging and Diagnostic Tests	MRI of the patient’s lumbar spine.
Medical Imaging and Diagnostic Tests	MRI OF THE RIGHT ANKLE / FOOT
Medical Imaging and Diagnostic Tests	MRI OF THE RIGHT ANKLE/FOOT
Medical Imaging and Diagnostic Tests	MRI OF THE THORACIC SPINE
Medical Imaging and Diagnostic Tests	MRI of the thoracic spine without contrast
Medical Imaging and Diagnostic Tests	MRI RT MIDDLE FINGER
Medical Imaging and Diagnostic Tests	MRI RT SHOULDER W/ARTHROGRAM
Medical Imaging and Diagnostic Tests	Needle EMG/NCV upper extremities to be performed by Dr. [redacted]
Medical Imaging and Diagnostic Tests	ORTHOVISC X4 LEFT KNEE
Medical Imaging and Diagnostic Tests	OUTSIDE XRAYS WITH RADIOLOGIST INTERPRETATION OF THE THORACIC SPINE AND LUMBAR SPINE
Medical Imaging and Diagnostic Tests	Radiologic examination, knee; 3 views
Medical Imaging and Diagnostic Tests	RANDOM URINE DRUG SCREEN
Medical Imaging and Diagnostic Tests	Repeat Medical Clearance (H&P)
Medical Imaging and Diagnostic Tests	RETROSPECTIVE XRAY R KNEE
Medical Imaging and Diagnostic Tests	RETROSPECTIVE XRAY T AND L SPINE
Medical Imaging and Diagnostic Tests	Right UE EMG/NCV
Medical Imaging and Diagnostic Tests	SARS COVID 2 nasopharyngeal swab test.
Medical Imaging and Diagnostic Tests	SARS COVID 2 nasopharyngeal swab test.
Medical Imaging and Diagnostic Tests	SARS COVID 2 nasopharyngeal swab test.
Medical Imaging and Diagnostic Tests	SARS COVID 2 nasopharyngeal swab test.
Medical Imaging and Diagnostic Tests	SARS COVID 2 nasopharyngeal swab test.
Medical Imaging and Diagnostic Tests	SARS COVID 2 nasopharyngeal swab test.
Medical Imaging and Diagnostic Tests	SLEEP STUDY
Medical Imaging and Diagnostic Tests	UTox
Medical Imaging and Diagnostic Tests	COVID 19 SCREENING BEFORE INJECTION
Medical Imaging and Diagnostic Tests	I AM ALSO REQUESTING FOR A CT SCAN WITH ARTHREX VIP PROTOCOL FOR CUSTOM INSTRUMENTATION THAT IS DONE AT [REDACTED]
Medical Imaging and Diagnostic Tests	I AM ALSO REQUESTING FOR A CT SCAN WITH ARTHREX VIP PROTOCOL FOR CUSTOM INSTRUMENTATION THAT IS DONE AT [REDACTED]
Medical Imaging and Diagnostic Tests	re-requesting random urine drug screen
Medical Imaging and Diagnostic Tests	Thus, I am requesting authorization for MRI C-spine and left shoulder to be done with anesthesia or IV sedation.
Medications and Pharmacotherapy	Medication: Citalopram; Unit Dosage: 10 mg
Medications and Pharmacotherapy	Ativan 0.5mg 1 tab PO 60 min prior to procedure, then 1 tab PO 30 min prior to procedure #2, 0 refills for his claustrophobia
Medications and Pharmacotherapy	Flexeril 10mg 1 tab PO BID PRN Spasms #60, 0 refills
Medications and Pharmacotherapy	ALPRAZolam 1 mg oral tablet, 1 (one) Tablet PO 1 hour prior to procedure, then 1 tab PO 30 min before procedure, #2, 01/23/2023, No Refill.
Medications and Pharmacotherapy	CELEBREX 200 MG # 60
Medications and Pharmacotherapy	Celebrex 200 mg #30 with refills for pain management.
Medications and Pharmacotherapy	Celebrex 200mg 1 tab PO QDAY with food PRN Pain #30, 1 refill
Medications and Pharmacotherapy	Celebrex 200mg 1 tab PO QDAY with food PRN Pain #30, 1 refill
Medications and Pharmacotherapy	celecoxib 200 mg capsule, 1 (one) Capsule PO QDAY with food PRN Pain, #30, 04/27/2023, Ref. x1.
Medications and Pharmacotherapy	Cervical Xray with Flexion and Extension
Medications and Pharmacotherapy	Changed gabapentin 300 mg capsule, 1 (one) Capsule PO QHS for nerve pain, #30, Ref. x1
Medications and Pharmacotherapy	Continued gabapentin 300 mg capsule, 1 (one) Capsule PO QHS for nerve pain, #30, 04/27/2023, Ref. x1.
Medications and Pharmacotherapy	CYCLOBENZAPRINE 10MG #25 X3 REFILLS
Medications and Pharmacotherapy	Cyclobenzaprine 10mg 1 tab PO Q8H PRN Spasms #30, 0 refills
Medications and Pharmacotherapy	Cyclobenzaprine 10mg 1 tab PO Q8H PRN Spasms #30, 0 refills
Medications and Pharmacotherapy	Cyclobenzaprine 10mg 1 tab PO Q8H PRN Spasms #30, 0 refills
Medications and Pharmacotherapy	Cyclobenzaprine 10MG#90 to be taken as needed for pain management.
Medications and Pharmacotherapy	CYCLOBENZAPRINE 5MG #14
Medications and Pharmacotherapy	Cymbalta 20mg 1 cap PO QHS for nerve pain #30, 1 refill
Medications and Pharmacotherapy	Cymbalta 20mg 1 cap PO QHS for nerve pain #30, 1 refill
Medications and Pharmacotherapy	Cymbalta 20mg 1 cap PO QHS for nerve pain #30, 1 refill
Medications and Pharmacotherapy	Cymbalta 20mg 1 cap PO QHS for nerve pain #30, 1 refill
Medications and Pharmacotherapy	Diclofenac 50mg 1 tab PO BID with food PRN Pain #60, 1 refill
Medications and Pharmacotherapy	Diclofenac 50mg 1 tab PO BID with food PRN Pain #60, 1 refill
Medications and Pharmacotherapy	Diclofenac 50mg 1 tab PO BID with food PRN Pain #60, 1 refill
Medications and Pharmacotherapy	DICLOFENAC GEL 1% #350G X3 REFILLS
Medications and Pharmacotherapy	Diclofenac potassium 50 mg po bid prn #60 Ref.x2.
Medications and Pharmacotherapy	Diclofenac potassium 50 mg po bid prn #60, Ref. x2 for pain relief
Medications and Pharmacotherapy	Elavil 25 mg PO QHS
Medications and Pharmacotherapy	Elavil 25 mg PO QHS
Medications and Pharmacotherapy	ELAVIL 50MG #30 X3 REFILLS
Medications and Pharmacotherapy	FLEXERIL 10 MG #21
Medications and Pharmacotherapy	Flexeril 10mg 1 tab PO BID PRN Spasms #60, 0 refills
Medications and Pharmacotherapy	Flexeril 10mg 1 tab PO BID PRN Spasms #60, 0 refills
Medications and Pharmacotherapy	Flovent 220 mcg inhaler - use BID, rinse after use
Medications and Pharmacotherapy	Flovent 220 mcg 2 puffs bid - rinse after use - 3 refills
Medications and Pharmacotherapy	GABAPENTIN 300MG #90 X3 REFILLS
Medications and Pharmacotherapy	Gabapentin 300mg 1 cap PO QHS #30, 1 refill
Medications and Pharmacotherapy	Gabapentin 300mg 1 cap PO QHS #30, 1 refill
Medications and Pharmacotherapy	Gabapentin 300mg 1 cap QAM, 3 capsules PO QHS #120, 1 refill
Medications and Pharmacotherapy	Gabapentin 300mg 1 cap QAM, 3 capsules PO QHS #120, 1 refill
Medications and Pharmacotherapy	Gabapentin 400mg 1 cap PO QHS #30, 2 refill
Medications and Pharmacotherapy	Gabapentin 400mg 1 cap PO QHS #30, 2 refill
Medications and Pharmacotherapy	Gabapentin 400mg 1 tab PO QHS #30, 1 refill
Medications and Pharmacotherapy	HYDROCODONE 5MG-ACETAMINOPHEN 300MG #12
Medications and Pharmacotherapy	Hydrocodone-Acetaminophen 5-325MG#60 and Methocarbamol 750MG#90
Medications and Pharmacotherapy	I AM ALSO REQUESTING FOR TYLENOL NO. 3 WITH CODEINE ONE TO TWO TABS P.O. G. 4-6 H. P.R.N. PAIN #30 WITH NO REFILL TO HELP HER WITH PAIN CONTROL
Medications and Pharmacotherapy	I AM ALSO REQUESTING FOR TYLENOL NO. 3 WITH CODEINE ONE TO TWO TABS P.O. G. 4-6 H. P.R.N. PAIN #30 WITH NO REFILL TO HELP HER WITH PAIN CONTROL
Medications and Pharmacotherapy	I am requesting authorization for; 1. Medrol Dosepak to help control pain and inflammation.
Medications and Pharmacotherapy	I am requesting authorization to give her tramadol 50 mg 1-2 tabs p.o. q. 4-6 p.r.n. pain #40 tablets as needed for pain control as she has not taken this before, but she has taken it under a different insurance and it has been helpful.
Medications and Pharmacotherapy	I am requesting authorization to refill her tramadol and her Flexeril. Infrared heating pad was denied.
Medications and Pharmacotherapy	I am requesting authorization to refill her tramadol and her Flexeril. TRAMADOL 50MG ORAL TABLET, 2(TWO) TAB, EVERY 4-6 HRS PRN PAIN #20 NO REFILL
Medications and Pharmacotherapy	Ibuprofen 800 mg PO Q6hr PRN #30
Medications and Pharmacotherapy	Ibuprofen 800 mg PO Q6hr PRN #30
Medications and Pharmacotherapy	Ibuprofen 800mg 1 tab PO TID with food PRN Pain #60, 1 refill
Medications and Pharmacotherapy	Ibuprofen 800mg 1 tab PO TID with food PRN Pain #60, 1 refill
Medications and Pharmacotherapy	Ibuprofen 800mg 1 tab PO TID with food PRN Pain #60, 1 refill
Medications and Pharmacotherapy	Ibuprofen 800mg 1 tab PO TID with food PRN Pain #60, 1 refill
Medications and Pharmacotherapy	Ibuprofen 800mg PO Q6hrs #30
Medications and Pharmacotherapy	Ibuprofen 800mg PO Q6hrs #30
Medications and Pharmacotherapy	Ibuprofen 800mg PO Q6hrs #30
Medications and Pharmacotherapy	Lansoprazole DR 15 mg PO QD
Medications and Pharmacotherapy	Lansoprazole DR 15 mg PO QD
Medications and Pharmacotherapy	Lansoprazole DR 15 mg PO QD
Medications and Pharmacotherapy	Lidocaine ointment 5% locally
Medications and Pharmacotherapy	Lidocaine ointment 5% TOP QD
Medications and Pharmacotherapy	Lidocaine ointment 5% TOP QD
Medications and Pharmacotherapy	Lidocaine ointment 5% TOP QD
Medications and Pharmacotherapy	Lidocaine ointment 5% TOP QD
Medications and Pharmacotherapy	Lidocaine ointment 5% topical QD
Medications and Pharmacotherapy	Lidocaine patch 5% locally
Medications and Pharmacotherapy	Lidocaine patches loca
Medications and Pharmacotherapy	LIDODERM PATCHES 5% #30 X3 REFILLS
Medications and Pharmacotherapy	MEDICATION
Medications and Pharmacotherapy	MEDICATION
Medications and Pharmacotherapy	MEDICATION
Medications and Pharmacotherapy	MEDICATION
Medications and Pharmacotherapy	MEDICATION CYCLOBENZAPRINE 10MG ORAL TABLET, 1 (ONE) TABLET PO QHS, #30 NO REFILL
Medications and Pharmacotherapy	MEDICATION METHOCARBAMOL 750MG #30 FOR MUSCLE SPASM
Medications and Pharmacotherapy	MEDICATION VOLTAREN GEL 1% 100g TUBE 1-2g TID DO NOT EXCEED 24g IN A DAY
Medications and Pharmacotherapy	Medication: Diclofenac Sodium 3 percent Topical Gel (No Fragrance); Unit Dosage: 4 gram
Medications and Pharmacotherapy	Medication: Diclofenac Sodium 3 percent Topical Gel (No Fragrance); Unit Dosage: 4 gram
Medications and Pharmacotherapy	Medrol Dosepak Use as instructed on package #1, 0 refills
Medications and Pharmacotherapy	MOBIC 15 mg PO QD PRN
Medications and Pharmacotherapy	Naprosyn 500 mg PO BID
Medications and Pharmacotherapy	Naprosyn 500 mg PO BID
Medications and Pharmacotherapy	Naprosyn 500 mg PO BID
Medications and Pharmacotherapy	Naproxen 500 mg PO BID
Medications and Pharmacotherapy	Naproxen 500 mg PO BID
Medications and Pharmacotherapy	NAPROXEN 500MG #60 X3 REFILLS
Medications and Pharmacotherapy	Neurontin 300 mg PO TID
Medications and Pharmacotherapy	Neurontin 300 mg PO TID
Medications and Pharmacotherapy	Neurontin 300 mg PO TID
Medications and Pharmacotherapy	Neurontin 300 mg PO TID
Medications and Pharmacotherapy	Neurontin 300 mg PO TID
Medications and Pharmacotherapy	Neurontin 300 mg PO TID
Medications and Pharmacotherapy	Norco 10/325 mg #60
Medications and Pharmacotherapy	Norco 10/325 PO BID PRN
Medications and Pharmacotherapy	NORCO 10/325MG #120
Medications and Pharmacotherapy	NORCO 10/325MG #120
Medications and Pharmacotherapy	NORCO 10/325MG #125
Medications and Pharmacotherapy	Norco 10/325mg 1 tab PO Q6-8H PRN Pain #30, 0 refills
Medications and Pharmacotherapy	Norco 5/325 mg PO Q6hrs PRN #20
Medications and Pharmacotherapy	Norco 5/325 mg PO Q6hrs PRN #20
Medications and Pharmacotherapy	NORCO 5/325MG #30
Medications and Pharmacotherapy	Norco 5/325mg PO Q6hrs #20
Medications and Pharmacotherapy	Norco 5/325mg PO Q6hrs #20
Medications and Pharmacotherapy	Omeprazole 20mg 1 cap PO QAM before breakfast #30, 1 refill
Medications and Pharmacotherapy	Omeprazole 20mg 1 cap PO QAM before breakfast #30, 1 refill
Medications and Pharmacotherapy	Omeprazole 20mg 1 cap PO QAM before breakfast #30, 1 refill
Medications and Pharmacotherapy	Ondansetron 8m disintegrating tablet 1 tab PO Q8H PRN Nausea #30, 1 refill
Medications and Pharmacotherapy	Pennsaid Solution 2% locally
Medications and Pharmacotherapy	Pennsaid Solution 2% locally
Medications and Pharmacotherapy	Pepcid 20 mg PO BID PRN
Medications and Pharmacotherapy	Percocet 10-325MG#60 to take as needed and Medrol 4MG 1 packet to take as directed for pain management
Medications and Pharmacotherapy	Percocet 10/325mg 1 tab PO Q6-8H PRN Pain #30, 0 refills
Medications and Pharmacotherapy	Plant-based Cannabinoids 750 milligrams
Medications and Pharmacotherapy	PO Medications (generic Norco 10/325mg #30, Naproxen 500mg #60).
Medications and Pharmacotherapy	POST OP MEDICATION: Percocet 5/325 45 tablets,cefadroxil 500 mg bid 7 days, Lyrica 75 mg twice daily for 21 days, celecoxib 200 mg daily for 30 days, Colace 100 mg twice a day for 30 days, 15 tablets of Zofran 4 mg. Aspirin 81 mg twice daily for 30 days.
Medications and Pharmacotherapy	POST OP MEDICATIONS
Medications and Pharmacotherapy	POST OP MEDICATIONS MANDATORY FOR AFTER SURGERY
Medications and Pharmacotherapy	POST-OP MEDICATION
Medications and Pharmacotherapy	POST-OP MEDICATION
Medications and Pharmacotherapy	POST-OP MEDICATION
Medications and Pharmacotherapy	POST-OP MEDICATION
Medications and Pharmacotherapy	POST-OP MEDICATION
Medications and Pharmacotherapy	POST-OP MEDICATION
Medications and Pharmacotherapy	POST-OP MEDICATION
Medications and Pharmacotherapy	POST-OP MEDICATIONS NEEDED FOR PAIN CONTROL, INFLAMMATION, SWELLING AND TO PREVENT BLOOD CLOTS AFTER SURGERY
Medications and Pharmacotherapy	POSTOP MEDICATION
Medications and Pharmacotherapy	POSTOP MEDICATION
Medications and Pharmacotherapy	Postoperative Medication: Norco 10/325 mg oral tablet 1-2 tab every 4-6 hrs prn pain #40
Medications and Pharmacotherapy	Prednisone 10MG#20 to take as directed for pain management.
Medications and Pharmacotherapy	Prevacid 15 mg PO QD
Medications and Pharmacotherapy	Prevacid 15 mg PO QD
Medications and Pharmacotherapy	RETROSPECTIVE CYCLOBENZAPRINE 10MG
Medications and Pharmacotherapy	Robaxin 750MG#90 and Duexis 800-26.6MG#90 to be taken as needed for pain management
Medications and Pharmacotherapy	RX CYCLOBENZAPRINE 5MG
Medications and Pharmacotherapy	Singulair 10 tabs 1 tab po qD #30 - 3 REFILLS
Medications and Pharmacotherapy	TIZANIDINE 4MG # 60
Medications and Pharmacotherapy	TIZANIDINE 4MG #30 X3 REFILLS
Medications and Pharmacotherapy	Topical Lidocaine 5%
Medications and Pharmacotherapy	TRAMADOL 50MG #30 X3 REFILLS
Medications and Pharmacotherapy	Tramadol 50mg 1 tab PO Q8H PRN Pain #30, 0 refills
Medications and Pharmacotherapy	Tramadol 50mg 1 tab PO Q8H PRN Pain #30, 0 refills
Medications and Pharmacotherapy	Tramadol 50mg 1 tab PO Q8H PRN Pain #90, 0 refills
Medications and Pharmacotherapy	Tramadol 50mg 1 tab PO Q8H PRN Pain #90, 0 refills
Medications and Pharmacotherapy	Tylenol # 3 1 # 120
Medications and Pharmacotherapy	TYLENOL #3 #90
Medications and Pharmacotherapy	Tylenol #3 #90
Medications and Pharmacotherapy	TYLENOL #3 #90 X1 REFILL
Medications and Pharmacotherapy	Tylenol #3 PO BID PRN
Medications and Pharmacotherapy	Tylenol #3 PO BID PRN
Medications and Pharmacotherapy	Tylenol #3 PO BID PRN
Medications and Pharmacotherapy	Tylenol #3 PO BID PRN
Medications and Pharmacotherapy	Tylenol #3 PO BID PRN NTE
Medications and Pharmacotherapy	Tylenol #3 PO BID PRN NTE
Medications and Pharmacotherapy	Tylenol #3 PO BID PRN NTE
Medications and Pharmacotherapy	Tylenol #3 PO QD PRN
Medications and Pharmacotherapy	Tylenol #3 PO QD PRN
Medications and Pharmacotherapy	Tylenol #3 PO QD PRN NTE
Medications and Pharmacotherapy	ULTRAM 50MG #30 1 TABLET Q6H PRN FOR PAIN
Medications and Pharmacotherapy	Voltaren 1% External Gel.
Medications and Pharmacotherapy	Voltaren gel 1% for pain relief
Medications and Pharmacotherapy	Voltaren gel 1% topically QD PRN
Medications and Pharmacotherapy	Voltaren gel 1% topically QD PRN
Medications and Pharmacotherapy	Voltaren Gel, Lyrica 75MG#60, Tramadol HCl 50MG#60 to be taken as needed for pain management.
Medications and Pharmacotherapy	Zanaflex 4 mg PO QHS
Medications and Pharmacotherapy	Zanaflex 4 mg PO QHS
Medications and Pharmacotherapy	Zanaflex 4 mg PO QHS
Medications and Pharmacotherapy	Zanaflex 4 mg PO QHS
Medications and Pharmacotherapy	Zanaflex 4 mg PO QHS
Medications and Pharmacotherapy	Zanaflex 4 mg PO QHS
Medications and Pharmacotherapy	Zanaflex 4 mg PO QHS
Medications and Pharmacotherapy	Zanaflex 4 mg PO QHS
Physical Therapy and Rehabilitation	POST-INJECTIONS THERAPY 2X4
Physical Therapy and Rehabilitation	Occupational therapy 2x3
Physical Therapy and Rehabilitation	OT/CHT 2x3 Left hand stiffnes
Physical Therapy and Rehabilitation	POST INJECTION THERAPY C/S
Physical Therapy and Rehabilitation	POST INJECTION THERAPY L/S
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY
Physical Therapy and Rehabilitation	POST INJECTION THERAPY C/S
Physical Therapy and Rehabilitation	POST INJECTION THERAPY L/S
Physical Therapy and Rehabilitation	8 sessions of flexion-based physical therapy of the lumbar spine for muscle strengthening and stabilization.
Physical Therapy and Rehabilitation	12 SESSIONS OF OUTSIDE PHYSICAL THERAPY TO THE LUMBAR SPINE AND THORACIC SPINE
Physical Therapy and Rehabilitation	12 sessions of Physical Therapy for right biceps.
Physical Therapy and Rehabilitation	2 sessions of introductory physical therapy sessions for greater muscle stabilization and strengthening
Physical Therapy and Rehabilitation	6 SESSIONS OF PHYSICAL THERAPY TO THE LEFT HAND
Physical Therapy and Rehabilitation	8 sessions of extension based physical therapy of the cervical spine
Physical Therapy and Rehabilitation	8 sessions of physical therapy for the neck
Physical Therapy and Rehabilitation	8 sessions of physical therapy for the thoracic spine
Physical Therapy and Rehabilitation	8 sessions of physical therapy of the lumbar spine
Physical Therapy and Rehabilitation	ADDITIONAL PHYSICAL THERAPY LEFT ELBOW AND LEFT WRIST
Physical Therapy and Rehabilitation	Additional physical therapy 2x3
Physical Therapy and Rehabilitation	Additional Physical therapy 3xs a week for 2 weeks total of 6 visits
Physical Therapy and Rehabilitation	Additional PT 2 x 6 all affected authorized body parts
Physical Therapy and Rehabilitation	EIGHT SESSIONS OF PHYSICAL THERAPY FOR THE LEFT SHOULDER
Physical Therapy and Rehabilitation	Formal hand therapy with a certified hand specialist, 2 times a week for 4 weeks, for general strengthening and range of motion exercises.
Physical Therapy and Rehabilitation	I am requesting authorization for physical therapy 2 times a week for 6 weeks for 12 sessions
Physical Therapy and Rehabilitation	I am requesting authorization for physical therapy 2 times a week for 6 weeks for 12 sessions
Physical Therapy and Rehabilitation	I AM REQUESTING PHYSICAL THERAPY FOR THE PATIENTS RIGHT SHOULDER AND RIGHT KNEE 2X6 WEEKS
Physical Therapy and Rehabilitation	OUT PATIENT PHYSICAL THERAPY, 2X6
Physical Therapy and Rehabilitation	PHYSICAL THERAPY 3 TIMES PER WEEK FOR 4 WEEKS
Physical Therapy and Rehabilitation	PHYSICAL THERAPY
Physical Therapy and Rehabilitation	PHYSICAL THERAPY
Physical Therapy and Rehabilitation	PHYSICAL THERAPY
Physical Therapy and Rehabilitation	PHYSICAL THERAPY
Physical Therapy and Rehabilitation	PHYSICAL THERAPY
Physical Therapy and Rehabilitation	PHYSICAL THERAPY
Physical Therapy and Rehabilitation	PHYSICAL THERAPY
Physical Therapy and Rehabilitation	PHYSICAL THERAPY 12 SESSIONS
Physical Therapy and Rehabilitation	Physical therapy 2x3
Physical Therapy and Rehabilitation	Physical therapy 2x3
Physical Therapy and Rehabilitation	Physical therapy 2x3 Lt hand/sm finger
Physical Therapy and Rehabilitation	Physical therapy 2x4
Physical Therapy and Rehabilitation	Physical therapy 2x4 for the back
Physical Therapy and Rehabilitation	PHYSICAL THERAPY 2X4 FOR THE LUMBAR SPINE AND LEFT HIP
Physical Therapy and Rehabilitation	Physical therapy 2x4 L/S
Physical Therapy and Rehabilitation	PHYSICAL THERAPY 2x4 WEEKS FOR THE LEFT ELBOW
Physical Therapy and Rehabilitation	PHYSICAL THERAPY 2X6 WEEKS FOR THE CERVICAL SPINE AND BILATERAL SHOULDERS
Physical Therapy and Rehabilitation	Physical therapy 3x3 C SPNE, BOTH SHULDERS, THORACIC SPINE AND LUMBAR SPINES , BOTH WRISTS, BOTH ANKLES
Physical Therapy and Rehabilitation	Physical therapy 3x4
Physical Therapy and Rehabilitation	PHYSICAL THERAPY FOR THE LUMBAR SPINE 2X4 FOR CORE STABILIZATION
Physical Therapy and Rehabilitation	Physical therapy for the lumbar spine, 2x6
Physical Therapy and Rehabilitation	Physical therapy for the patient’s cervical spine 2 times per week for 6 weeks
Physical Therapy and Rehabilitation	Physical therapy for the patient’s cervical spine 2 times per week for 6 weeks.
Physical Therapy and Rehabilitation	PHYSICAL THERAPY LEFT ANKLE TO IMPROVE RANGE OF MOTION AND STRENGTH
Physical Therapy and Rehabilitation	PHYSICAL THERAPY LEFT HIP 2x6 WEEKS TO WORK ON STRENGTH & RANGE OF MOTION
Physical Therapy and Rehabilitation	physical therapy left thumb trigger 2×4
Physical Therapy and Rehabilitation	Physical therapy twice a week for 6 weeks for her lumbar spine.
Physical Therapy and Rehabilitation	PO physical therapy right shoulder 2X6 to start the day after surgery.
Physical Therapy and Rehabilitation	POST INJECTION PHYSICAL THERAPY 2X4 FOR L/S
Physical Therapy and Rehabilitation	POST INJECTION PHYSICAL THERAPY 2X4 FOR L/S
Physical Therapy and Rehabilitation	POST INJECTION PHYSICAL THERAPY 2X4 FOR L/S
Physical Therapy and Rehabilitation	POST OP OUT PATIENT PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	Post op PT 1xwk for 2wks
Physical Therapy and Rehabilitation	post op pt: 1xwk for 2wks
Physical Therapy and Rehabilitation	post op pt: 1xwk for 2wks
Physical Therapy and Rehabilitation	Post- op pt: 2xwk for 4wks
Physical Therapy and Rehabilitation	Post- op pt: 2xwk for 4wks
Physical Therapy and Rehabilitation	Post-Op 2xwk/4wks After 1wk
Physical Therapy and Rehabilitation	Post-Op 2xwk/4wks After 1wk
Physical Therapy and Rehabilitation	POST-OP OUT PATIENT PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST-OP OUT PATIENT PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST-OP OUT PATIENT PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST-OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST-OP PHYSICAL THERAPY
Physical Therapy and Rehabilitation	POST-OP PHYSICAL THERAPY BODY PART: RIGHT SHOULDER
Physical Therapy and Rehabilitation	POST-OP PHYSICAL THERAPY BODY PART: RIGHT SHOULDER
Physical Therapy and Rehabilitation	POST-OP PHYSICAL THERAPY LEFT ANKLE
Physical Therapy and Rehabilitation	Post-Op PT 2xwk for 4wks after 1wk post-op
Physical Therapy and Rehabilitation	POSTOP P.T.
Physical Therapy and Rehabilitation	POSTOP P.T.
Physical Therapy and Rehabilitation	Postoperative therapy : 5 times a week for 2 weeks
Physical Therapy and Rehabilitation	PT 2 x 4 weeks, lumbar spine
Physical Therapy and Rehabilitation	PT 2X4 FOR PAIN C SPINE MUSCLES
Physical Therapy and Rehabilitation	PT 3X4 LOWER BACK
Physical Therapy and Rehabilitation	PT lumbar core stability 2x6
Physical Therapy and Rehabilitation	She goes to [redacted]. At this time, I am requesting authorization for: 1. Physical therapy to continue, two times a week, for six weeks, for additional 12 sessions at the same location.
Physical Therapy and Rehabilitation	TWELVE SESSIONS OF PHYSICAL THERAPY FOR THE LUMBAR SPINE
Physical Therapy and Rehabilitation	We are requesting continued physical therapy for the right knee 2X6 WEEKS
Physical Therapy and Rehabilitation	At this time, I am requesting authorization for physical therapy to continue on the left shoulder two times a week for four weeks for eight sessions, and I am also requesting authorization for balance therapy two times a week for four weeks as recommended by the neurologist.
Physical Therapy and Rehabilitation	At this time, I am appealing denial, re-requesting authorization for physical therapy two times a week for six weeks for 12 sessions. This is crucial to get to 24 sessions and now it is getting late and she is getting a frozen shoulder. I am very concerned.
Physical Therapy and Rehabilitation	I am requesting authorization for a work conditioning or strengthening program, two times a week, for four weeks, for eight sessions and then we will try to get her back to work the next time I see her, may be in June.
Physical Therapy and Rehabilitation	I did recommend trying to augment the repair given he has a large tear, has a revision situation. He has some atrophy. We should augment his repair with either a CuffMend allograft type material or a Xenograft. This was denied. Thus we will try to do the surgery without the graft, but I did strongly recommend it. Thus I am going to re-request authorization for the graft if possible.
Physical Therapy and Rehabilitation	Eight sessions of active physical therapy of the Thoracic spine for muscle strengthening and stabilization.
Pre-Op Medical Clearance	Medical Clearance
Pre-Op Medical Clearance	Medical Clearance
Pre-Op Medical Clearance	Medical Clearance
Pre-Op Medical Clearance	Medical Clearance
Pre-Op Medical Clearance	Medical Clearance
Pre-Op Medical Clearance	medical clearance
Pre-Op Medical Clearance	Medical clearance: EKG, A1C,CBC, BMP,
Pre-Op Medical Clearance	Medical clearance: EKG, A1C,CBC, BMP,
Pre-Op Medical Clearance	PRE OP CLEARANCE WITH DR. [REDACTED]
Pre-Op Medical Clearance	PRE OP CLEARANCE WITH DR. [REDACTED]
Pre-Op Medical Clearance	PRE OP CLEARANCE WITH [REDACTED]
Pre-Op Medical Clearance	PRE OP CLEARANCE WITH [REDACTED]****MUST BE LISTED ON THE AUTHORIZATION LETTER***
Pre-Op Medical Clearance	PRE OP LABS: CBC, SED RATE, UA/C&S IF INDICATED, MRSA, COVID 19 TEST, CHEST - X RAY, BMP, EKG, PT/PTT/BLEEDING TIME, TYPE & SCREEN
Pre-Op Medical Clearance	PRE OP ORDERS
Pre-Op Medical Clearance	PRE OP ORDERS
Pre-Op Medical Clearance	PRE OP ORDERS
Pre-Op Medical Clearance	PRE OP ORDERS
Pre-Op Medical Clearance	PRE-OP APPOINTMENT
Pre-Op Medical Clearance	PRE-OP APPOINTMENT
Pre-Op Medical Clearance	PRE-OP APPOINTMENT
Pre-Op Medical Clearance	PRE-OP APPOINTMENT
Pre-Op Medical Clearance	PRE-OP APPOINTMENT
Pre-Op Medical Clearance	PRE-OP LABS: CBC AND BMP, UA/C&S IF INDICATED, COVID TESTING MANDATORY FOR ALL SURGERIES
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE BY INTERNAL MEDICINE DOCTOR AT [REDACTED]
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE WITH [REDACTED] ([REDACTED] MUST BE ADDED TO THE DETERMINATION LETTER TO AVOID ANY DELAYS IN SCHEDULING)
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE WITH [REDACTED]
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE WITH [REDACTED] ([REDACTED] MUST BE ADDED TO THE DETERMINATION LETTER TO AVOID ANY DELAYS IN SCHEDULING)
Pre-Op Medical Clearance	PRE-OP MEDICAL CLEARANCE WITH [REDACTED] ([REDACTED] MUST BE ADDED TO THE DETERMINATION LETTER TO AVOID ANY DELAYS IN SCHEDULING)
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE PLEASE LIST DR. [REDACTED] TO PREVENT DELAY IN SCHEDULING
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE PLEASE LIST DR. [REDACTED] TO PREVENT DELAY IN SCHEDULING
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE PLEASE LIST DR. [REDACTED] TO PREVENT DELAY IN SCHEDULING
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE PLEASE LIST DR. [REDACTED] TO PREVENT DELAY IN SCHEDULING
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE PLEASE LIST DR. [REDACTED] TO PREVENT DELAY IN SCHEDULING
Pre-Op Medical Clearance	PREOP MEDICAL CLEARANCE PLEASE LIST DR. [REDACTED] TO PREVENT DELAY IN SCHEDULING. PATIENT IS OVER 50 YEARS OLD AND PREOP IS REQUIRED
Pre-Op Medical Clearance	Preoperative clearance consultation
Pre-Op Medical Clearance	2ND REQUEST POSTOP MEDICATION ZOFRAN 4 MG #20 TO PREVENT NAUSEA OR VOMITING
Pre-Op Medical Clearance	2ND REQUEST PREOP LAB UA, CHEST X-RAY IS REQUIRED BY THE HOSPITAL DUE TO PATIENT BEING OVER 50 YRS OF AGE. SURGERY HAS BEEN AUTHORIZED.
Pre-Op Medical Clearance	2ND REQUEST PREOP WITH DR. [REDACTED] IS REQUIRED DUE TO PATIENT BEING OVER 50 YRS OF AGE. SURGERY HAS BEEN AUTHORIZED.
Pre-Op Medical Clearance	EXTENSION FOR PRE-OP APPOINTMENT
Pre-Op Medical Clearance	EXTENSION FOR PRE-OP APPOINTMENT
Pre-Op Medical Clearance	VOLUNTARY INTERNAL APPEAL FOR PRE-OP APPOINTMENT
Pre-Op Medical Clearance	WE NEED AUTHORIZATION FOR MEDICAL CLEARANCE AT [REDACTED] WITH PRE-OP LABS: CMP, PT, PTT, CBC, UA, EKG & COVID 19 TEST. PATIENT CAN NOT PROCEED WITH SURGERY WITHOUT HAVING A MEDICVAL CLEARANCE
Psychotherapy and Counseling	cognitive behavioral therapy (6 sessions)
Psychotherapy and Counseling	COGNITIVE BEHAVIORAL THERAPY X6
Psychotherapy and Counseling	Full neurocognitive assessment battery
Psychotherapy and Counseling	Full neurocognitive assessment battery
Psychotherapy and Counseling	Full Neurocognitive Assessment Battery- to be completed by [redacted]
Psychotherapy and Counseling	Psychological Progress Report
Psychotherapy and Counseling	Psychological Progress Report
Psychotherapy and Counseling	Psychological Progress Report
Psychotherapy and Counseling	Psychological Progress Report
Psychotherapy and Counseling	Psychological Progress Report
Psychotherapy and Counseling	REFER TO DR [REDACTED] FOR COGNITIVE IMPAIRMENT
Psychotherapy and Counseling	Six sessions of psychotherapy in conjunction to be paid with modifier 59 and modifier 95.
Psychotherapy and Counseling	Six sessions of psychotherapy in conjunction to be paid with modifier 59 and modifier 95.
Psychotherapy and Counseling	Six sessions of psychotherapy in conjunction to be paid with modifier 59 and modifier 95.
Specialist Referral	asap to pain mgt for rec tx options
Specialist Referral	REFER TO SPINE SPECIALIST FOR LUMBAR RADICULOPATHY TO RUE IF ACCEPTED BODY PART
Specialist Referral	Bilateral L3 L4 L5 Radiofrequency Ablation
Specialist Referral	RHEUMATOLOGY CONSULT
Specialist Referral	CONSULTATION AND TREATMENT FOR CARPAL TUNNEL
Specialist Referral	Authorization will now be requested for treatment by Dr. [redacted] as recommended
Specialist Referral	Continued treatment with pain management
Specialist Referral	Neurologist due to concerns of asphasia
Specialist Referral	1. Refer the patient to interval functional capacity evaluation
Specialist Referral	CONSULTATION AND TREATMENT OF THE LEFT HIP
Specialist Referral	AUTH TO TX C/S
Specialist Referral	SPECIALIST REFERRAL PREVIOUSLY AUTHORIZED DR. [REDACTED] HAS BEEN UNABLE TO SCHEDULE PATIENT AND AT THIS TIME WE ARE REQUESTED A CHANGE TO PM SPECIALIST DR. [REDACTED]
Specialist Referral	REFER TO SPECILSIT FOR SYMPATHETIC NERVE BLOCK FOR CRPS IN LUE
Surgery and Invasive Procedures	Diagnostic cervical facet blocks at C5-C7
Surgery and Invasive Procedures	Right total knee arthroplasty revision at [redacted] with spinal anesthesia, spinal adductor block. 1 night hospital observation.
Surgery and Invasive Procedures	**** STAT **** C4-C5 and C5-C6 cervical disc replacement.
Surgery and Invasive Procedures	1 level Translaminar Cervical Epidural Injection
Surgery and Invasive Procedures	ALIF L4-S1
Surgery and Invasive Procedures	APPLICATION OF SHORT ARM SPLINT APPLIED BY DR [REDACTED] DURING SURGERY
Surgery and Invasive Procedures	ARTHREX
Surgery and Invasive Procedures	ARTHREX
Surgery and Invasive Procedures	ASSISTANT SURGEON
Surgery and Invasive Procedures	ASSISTANT SURGEON
Surgery and Invasive Procedures	Assistant Surgeon
Surgery and Invasive Procedures	ASSISTANT SURGEON AND CO- SURGEON
Surgery and Invasive Procedures	ASSISTANT SURGEON: [REDACTED]
Surgery and Invasive Procedures	ASSISTANT SURGEON: [REDACTED]
Surgery and Invasive Procedures	Bialteral L4-5 Facet Joint Injection
Surgery and Invasive Procedures	BILATERAL C5-7 MEDIAL BRANCH BLOCK
Surgery and Invasive Procedures	Bilateral L3, L4, L5 medial branch block
Surgery and Invasive Procedures	BILATERAL L4 AND L5 NERVE ROOT BLOCK UNDER FLUOROSCOPIC GUIDANCE
Surgery and Invasive Procedures	Bilateral L4 transforaminal epidural steroid injections
Surgery and Invasive Procedures	Bilateral L4 transforaminal epidural steroid injections.
Surgery and Invasive Procedures	Bilateral L4-5 TF ESI
Surgery and Invasive Procedures	Bilateral L5-S1 TRANSFORAMINAL EPIDURAL STEROID INJECTION
Surgery and Invasive Procedures	BILATERAL L5-S1 TRANSFORAMINAL EPIDURAL STEROID INJECTION
Surgery and Invasive Procedures	Bilateral Suprascapular Nerve Block
Surgery and Invasive Procedures	CAUDAL EPIDURAL STEROID INJECTION
Surgery and Invasive Procedures	CERVICAL EPIDURAL STEROID INJECTION AT C6-C7
Surgery and Invasive Procedures	CO-SURGEON: DR. [REDACTED]
Surgery and Invasive Procedures	CO-SURGEON: DR. [REDACTED]
Surgery and Invasive Procedures	CORTICOSTEROID INJECTION PLANTAR CALCANEAL BURSA
Surgery and Invasive Procedures	CORTICOSTEROID INJECTION PLANTAR FASCIA
Surgery and Invasive Procedures	FACET JOINT INJECTION AT L4-L5 AND L5-S1
Surgery and Invasive Procedures	I am requesting authorization for manipulation under anesthesia for the right shoulder.
Surgery and Invasive Procedures	I am requesting authorization for a cortisone shot for both the shoulders.
Surgery and Invasive Procedures	IMPLANT: Zimmer components.
Surgery and Invasive Procedures	Intraoperative monitor
Surgery and Invasive Procedures	L4 translaminar epidural steroid injections
Surgery and Invasive Procedures	L4 translaminar epidural steroid injections.
Surgery and Invasive Procedures	L5-S1 anterior lumbar interbody fusion
Surgery and Invasive Procedures	Left Hamstring/Piriformis Injection with Botox 100 units
Surgery and Invasive Procedures	LEFT L5-S1 and S1 TRANSFORAMINAL EPIDURAL STEROID INJECTION
Surgery and Invasive Procedures	Left L5-S1 TRANSFORAMINAL EPIDURAL STEROID INJECTION
Surgery and Invasive Procedures	LEFT L5/S1 TRANSFORAMINAL INJECTION UNDER FLUOROSCOPIC GUIDANCE WITH MONITORED ANESTHESIA CARE (MAC)
Surgery and Invasive Procedures	Left sided C5-6 and C6-7 facet block
Surgery and Invasive Procedures	Left sided C5-6 and C6-7 transforaminal epidural injections.
Surgery and Invasive Procedures	Left sided L4-5, L5-S-1 transforaminal epidural injection
Surgery and Invasive Procedures	LUMBAR EPDIDURAL STEROID INJECTION AT L5-S1
Surgery and Invasive Procedures	LUMBAR EPDIDURAL STEROID INJECTION AT L5-S1
Surgery and Invasive Procedures	LUMBAR EPIDURAL STEROID INJECTION AT L4-5
Surgery and Invasive Procedures	LUMBAR EPIDURAL STEROID INJECTION AT L4-L5
Surgery and Invasive Procedures	LUMBAR EPIDURAL STEROID INJECTION AT L4-L5
Surgery and Invasive Procedures	LUMBAR EPIDURAL STEROID INJECTION AT L4-L5
Surgery and Invasive Procedures	LUMBAR EPIDURAL STEROID INJECTION AT L5-S1
Surgery and Invasive Procedures	Lumbar epidural steroid injection I3-L4 and L5-S1
Surgery and Invasive Procedures	Lumbar epidural steroid injection L3-L4 & L5-S1
Surgery and Invasive Procedures	LUMBAR FACET BLOCKS AT L4-S1
Surgery and Invasive Procedures	LUMBAR FACET BLOCKS AT L5-S1
Surgery and Invasive Procedures	NEURO SURGICAL CONSULTAITON AND TREATMENT OF THE LUMBAR SPINE
Surgery and Invasive Procedures	NEURO-MONITORING DURING SURGERY
Surgery and Invasive Procedures	NEURO-MONITORING DURING SURGERY
Surgery and Invasive Procedures	NEURO-MONITORING DURING SURGERY
Surgery and Invasive Procedures	One level cervical epidural steroid injection between C7-T1.
Surgery and Invasive Procedures	One level translaminar cervical epidural steroid injection
Surgery and Invasive Procedures	One level translaminar Cervical Epidural Steroid Injection.
Surgery and Invasive Procedures	PRP INJECTION LEFT ACHILLES
Surgery and Invasive Procedures	PRP to left ankle with us
Surgery and Invasive Procedures	Request right ulnocarpal 1cc injection
Surgery and Invasive Procedures	Retro-authorization of: corticosteroid injection, x2
Surgery and Invasive Procedures	RFA trigger point injections x3 for cervical paraspinal, trap and rhomboids
Surgery and Invasive Procedures	RIGHT AND LEFT L3 ROOT BLOCK UNDER FLUOROSCOPIC GUIDANCE WITH LOCAL ANESTHESIA
Surgery and Invasive Procedures	RIGHT AND LEFT L4 AND L5 ROOT BLOCK UNDER FLUOROSCOPIC GUIDANCE WITH LOCAL ANESTHESA
Surgery and Invasive Procedures	Right endoscopic vs open carpal tunnel release
Surgery and Invasive Procedures	Right endoscopic vs open carpal tunnel release
Surgery and Invasive Procedures	Right Endoscopic vs Open Carpal Tunnel Release and PRP injection of the Right Lateral Elbow epicondyle
Surgery and Invasive Procedures	Right L4-L5 and L5-S1 traansforaminal epidural steroid injection
Surgery and Invasive Procedures	Right L5 S1 transforaminal epidural steroid injection
Surgery and Invasive Procedures	Right L5 S1 transforaminal epidural steroid injection
Surgery and Invasive Procedures	right lateral epicondylar PRP injection
Surgery and Invasive Procedures	Right shoulder manipulation under anesthesia, arthroscopy with lysis of adhesions. Pre-op labs (CBC, CMP, EKG, Covid).
Surgery and Invasive Procedures	Right ulnar nerve transposition
Surgery and Invasive Procedures	STAT L5-S1 anterior lumbar interbody fusion with percutaneous posterior spinal fusion.
Surgery and Invasive Procedures	SURGERY LEFT ANKLE
Surgery and Invasive Procedures	SURGERY RIGHT ANKLE
Surgery and Invasive Procedures	SURGICAL ASSISTANT
Surgery and Invasive Procedures	SURGICAL IMPLANTS
Surgery and Invasive Procedures	SURGICAL IMPLANTS
Surgery and Invasive Procedures	SURGICAL IMPLANTS
Surgery and Invasive Procedures	SURGICAL IMPLANTS
Surgery and Invasive Procedures	SURGICAL IMPLANTS
Surgery and Invasive Procedures	SURGICAL IMPLANTS
Surgery and Invasive Procedures	TFESI Bil C3-4, C4-5
Surgery and Invasive Procedures	TFESI Bil L4-5, L5-S1
Surgery and Invasive Procedures	TFESI Left L4-5, L5-S1
Surgery and Invasive Procedures	TPI and Piriformis Injection
Surgery and Invasive Procedures	TPI and Piriformis Injection
Surgery and Invasive Procedures	Trigger point injection x 3
Surgery and Invasive Procedures	Trigger point injection x 3
Surgery and Invasive Procedures	TRIGGER POINT INJECTIONS (2)
Surgery and Invasive Procedures	TRIGGER POINT INJECTIONS (2)
Surgery and Invasive Procedures	TRIGGER POINT INJECTIONS (3) TO THE THORACIC SPINE
Surgery and Invasive Procedures	VISCOSUPLEMENT INJECTION X3 FOR THE LEFT KNEE
Surgery and Invasive Procedures	VISCOSUPPLEMENT INJECTION X3 FOR LEFT KNEE
Surgery and Invasive Procedures	* New material information is being submitted. This is NOT an appeal *
Surgery and Invasive Procedures	*APEAL* Right total knee arthroplasty revision at [redacted] with spinal anesthesia, spinal adductor block. 1 night hospital observation.
Surgery and Invasive Procedures	I am now requesting authorization for a PRP injection for the right knee.
Surgery and Invasive Procedures	I am requesting authorization for a Synvisc injection for the right knee.
Surgery and Invasive Procedures	Kindly authorize one level translaminar cervical epidural steroid injection given change in material of facts.
Surgery and Invasive Procedures	She is having lot of pain with the shoulder, cannot lift her arm over her head. Her pain level is 10/10. She has functional limitation and cannot get dressed. She has arthritic change with a deficient rotator cuff based on arthroscopic findings and physical exam findings. She has already failed 40 sessions of physical therapy, cortisone, Medrol-Dosepak, two arthroscopic surgeries, and manipulation under anesthesia. The only treatment option left that could possibly help her will be a reverse shoulder replacement. She meets all criteria. She even meets the BMI cut off. At this time, I am re-requesting authorization for right shoulder reverse shoulder replacement, routine preop work of lab including CBC, BMP, PT, PTT, EKG, medical clearance, postoperative therapy two times a week for six weeks, immobilization in a shoulder immobilizer, cold therapy unit rental for 30 days, Percocet or Norco for pain control. The surgery to be done at [redacted]. She really meets all criteria. So, I am re-requesting authorization for the surgery. Even though the MRI shows she had an intact rotator cuff, it is completely nonfunctional and deficient. Also, requesting authorization for FAR infrared heating pad therapy to help control pain and inflammation, improve mobility, decrease spasm, and minimize need for pain medication including narcotics. I am appealing the denial, re-requesting authorization for reverse shoulder replacement.
Surgery and Invasive Procedures	The patient has a complex problem. She is having a lot of pain with the shoulder, cannot lift her arm. She has pain level, 10/10. She has functional limitation and cannot bathe and cannot get dressed. She has arthritic change with a deficient rotator cuff based on arthroscopic findings and physical exam findings. She has already failed 40 sessions of physical therapy, cortisone, Medrol Dosepak, two arthroscopic surgeries, and manipulation under anesthesia. She meets all criteria for reverse shoulder replacement. Upon reading the denial letter, it states that the patient does not have evidence of functional limitation. I have clearly documented functional limitation. She cannot get dressed, she cannot bathe, she cannot lift her arm very well to do any activity at home. She has difficulty with activity of daily living. I have clearly documented this. Furthermore, it states that the patient does not have a deficient rotator cuff. I have clearly documented evidence of a deficient rotator cuff. She cannot lift her arm. Upon arthroscopy, her rotator cuff was very poor quality. There was attenuation and attrition. She does not have a functioning rotator cuff based on arthroscopic findings which is better than any MRI. She even meets the BMI cut off. Thus again, I am appealing denial, re-requesting authorization for right shoulder reverse shoulder replacement, routine preop work of lab including CBC, BMP, PT, PTT, EKG, medical clearance, postoperative therapy two times a week for six weeks, immobilization in a shoulder immobilizer, cold therapy unit rental for 30 days, Percocet or Norco for pain control, surgery to be done at [redacted] and use of an assistant surgeon.
Transportation	MEDICAL TRANSPORTATION FROM AND TO INJECTION REQUESTED BY THE PATIENT. PLEASE NOTE IT HAS TO BE MEDICAL TRANSPORTATION COMPANY- UBER AND TAXI IS NOT ALLOWED

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