| SERIAL NUMBER | Procedure | 1st Qtr | Per Qtr (for next 3 Qtrs) | Requirements while submitting for follow-up Preauth | Requirements while submitting for follow-up Claims |
|---|---|---|---|---|---|
| 99 | FP0099 : Interstitial lung disease | 4,000 | 2,000 | Previous Discharge Summary | (Clinical Evaluation-Mandatory), PFT,HRCT |
| 100 | FP0100 : Pneumoconiosis | 4,000 | 2,000 | Previous Discharge Summary | (Clinical Evaluation, PFT, Chest X-Ray-Mandatory) |
