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G0302

Emergency Medical Outpatient Services
Labs, X-Rays and Other Tests
Preventive Dental Care for Children
Maternity Services
Medical Care Outpatient Visits
Mental Health and Substance Use Treatment - Biologically Based Mental Conditions
Mental Health and Substance Use Treatment - Non-Biologically Based Mental Conditions
Mental Health and Substance Use Treatment - Alcoholism Treatment
Routine Vision Care
Short-Term Rehabilitation Therapy
TMJ Disorder Treatment
PRE-OP SERVICE LVRS COMPLETE
PRE-OP SERVICE LVRS COMPLETE

G0303

Emergency Medical Outpatient Services
Labs, X-Rays and Other Tests
Preventive Dental Care for Children
Maternity Services
Medical Care Outpatient Visits
Mental Health and Substance Use Treatment - Biologically Based Mental Conditions
Mental Health and Substance Use Treatment - Non-Biologically Based Mental Conditions
Mental Health and Substance Use Treatment - Alcoholism Treatment
Routine Vision Care
Short-Term Rehabilitation Therapy
TMJ Disorder Treatment
PRE-OP SERVICE LVRS 10-15DOS
PRE-OP SERVICE LVRS 10-15DOS

G0378

Emergency Medical Outpatient Services
Inpatient Medical and Surgical Care in a General Hospital
Labs, X-Rays and Other Tests
Preventive Dental Care for Children
Maternity Services
Medical Care Outpatient Visits
Mental Health and Substance Use Treatment - Biologically Based Mental Conditions
Mental Health and Substance Use Treatment - Non-Biologically Based Mental Conditions
Mental Health and Substance Use Treatment - Alcoholism Treatment
TMJ Disorder Treatment
HOSPITAL OBSERVATION PER HR
HOSPITAL OBSERVATION PER HR

G0379

Emergency Medical Outpatient Services
Inpatient Medical and Surgical Care in a General Hospital
Labs, X-Rays and Other Tests
Preventive Dental Care for Children
Maternity Services
Medical Care Outpatient Visits
Mental Health and Substance Use Treatment - Biologically Based Mental Conditions
Mental Health and Substance Use Treatment - Non-Biologically Based Mental Conditions
Mental Health and Substance Use Treatment - Alcoholism Treatment
TMJ Disorder Treatment
DIRECT REFER HOSPITAL OBSERV
DIRECT REFER HOSPITAL OBSERV