Medical Review Guidelines

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The following guidelines have been developed as an educational tool to assist providers in understanding when an item or service will be "covered" or "not covered" under the Oklahoma Medicaid program. All references to coding are based on the assumption that the service is medically necessary and properly documented.

Important Note: In order for a service to be covered without prior authorization both the procedure code and the diagnosis code must be present in the following guidelines. If both codes are not present within the guideline, prior authorization must be obtained.