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Pharmacy Manual Archive

Below are the previous versions of the Pharmacy Manual.

Version Manual Document Change Notes

2021 - 7

Archived October 29, 2021

Fee Schedule (XLS 118KB)

 

2021 - 6

Archived September 30, 2021

Fee Schedule (XLS 118KB)

 

2021 - 5

Archived September 21, 2021

Fee Schedule (XLS 118KB)

 

2021 - 4

Archived September 17, 2021

Fee Schedule (XLS 118KB)

 

2021 - 3

Archived August 26, 2021

Fee Schedule (XLS 118KB)

 

2021 - 1

2021 - 2

Archived July 1, 2021

Procedure Codes (PDF 936KB)

Fee Schedule (XLS 118KB)

 

2021 - 3

Archived June 24, 2021

Policy Guidelines (PDF 544KB)

 

2021 - 2

Archived April 29, 2021

Policy Guidelines (PDF 1,111KB)

 

2020 - 2

2021 - 1

Archived April 27, 2021

Procedure Codes (PDF 929KB)

Fee Schedule (XLS 120KB)

 

2019 - 1

Archived February 12, 2021

Policy Guidelines (PDF 1,039KB)

 

2020 - 2

Archived January 4, 2021

Fee Schedule (XLS 120KB)

 

2013 - 1

Archived December 4, 2020

Billing Guidelines (PDF 1,681KB)

 

2020 - 1

2020 - 1

Archived September 4, 2020

Procedure Codes (PDF 795KB)

Fee Schedule (XLS 120KB)

 

2019 - 2

2019 - 4

Archived August 17, 2020

Procedure Codes (PDF 789KB)

Fee Schedule (XLS 120KB)

 

2019 - 3

Archived April 30, 2020

Fee Schedule (PDF 120KB)

 

2015 - 1

Archived October 23, 2019

Policy Guidelines (PDF 1,141KB)

 

2019 - 1

2019 - 2

Archived July 31, 2019

Procedure Codes (PDF 686KB)

Fee Schedule (XLS 115KB)

 

2018 - 1

2019 - 1

Archived May 13, 2019

Procedure Codes (PDF 569KB)

Fee Schedule (XLS 119KB)

 

2015 - 1

Archived February 11, 2019

Policy Guidelines (PDF 795KB)  

2018 - 2 (04/01/18)

Archived December 27, 2018

Fee Schedule (XLS 119KB)  

2017 - 2

2018 - 1

Archived March 27, 2018

Procedure Codes (PDF 218KB)

Fee Schedule (XLS 119KB)
 

2017 - 4 (05/01/17)

Archived December 27, 2017

Fee Schedule (XLS 112KB)  

2017 - 3 (05/01/17)

Archived May 17, 2017

Fee Schedule (XLS 112KB)  

2017 - 2 (04/03/17)

Archived May 4, 2017

Fee Schedule (XLS 111KB)  

2017 - 1 (01/01/17)

Archived March 24, 2017

Fee Schedule (XLS 145KB)  

2017 - 1 (01/01/17)

Archived March 23, 2017

Procedure Codes (PDF 223KB)  

2016 - 1 (04/01/16)

Archived December 29, 2016

Procedure Codes (PDF 226KB)  

2016 - 1 (01/01/16)

Archived December 29, 2016

Fee Schedule (XLS 140KB)  

2015 - 1 (04/01/15)

Archived March 30, 2016

Procedure Codes (PDF 228KB)  

2015 - 3 (06/15)

Archived December 29, 2015

Fee Schedule (XLS 146KB)  

2013 - 1 (09/13)

Archived November 20, 2015

Policy Guidelines (PDF 328KB)  

2015 - 2 (04/01/15)

Archived May 5, 2015

Fee Schedule (XLS 140KB)  

2014 - 1 (4/01/14)

2015 - 1 (1/01/15)


Archived March 31, 2015

Procedure Codes (PDF 263KB)

Fee Schedule (XLS 147KB)

 

2014 - 1 (04/01/14)

Archived March 10, 2015

Fee Schedule (XLS 140KB)  

2013 - 1 (04/01/13)

Archived April 4, 2014

Fee Schedule (XLS 109KB)  

2013 - 2 (06/01/13)

Archived April 4, 2014

Procedure Codes (PDF 299KB)  

2011 - 1 (09/06/11)

Archived December 2, 2013

Policy Guidelines (PDF 248KB)  

2011 - 1 (06/01/11)

Archived July 1, 2013

Billing Guidelines (PDF 1.32MB)  

2013 - 1 (04/01/13)

Archived June 19, 2013

Procedure Codes (PDF 251KB)  

2012 - 1 (04/01/12)

Archived April 9, 2013

Procedure Codes (PDF 280KB)  

2012 - 1 (04/01/12)

Archived April 9, 2013

Fee Schedule (XLS 106KB)  

2011 - 1 (05/01/11)

Archived April 3, 2012

Procedure Codes (PDF 251KB)  

2011 - 1 (04/01/11)

Archived April 3, 2012

Fee Schedule (XLS 82KB)  

2010 - 2 (12/15/10)

Archived September 13, 2011

Policy Guidelines (PDF 322KB)  

2010 - 1 (09/21/10)

Archived June 20, 2011

Billing Guidelines (PDF 1.23MB)  

2010 - 1 (04/01/10)

Archived May 5, 2011

Procedure Codes (PDF 329KB)  

2010 - 1 (01/01/11)

Archived April 1, 2011

Fee Schedule (XLS 83KB)

 

2010 - 1 (4/01/10)

Archived January 5, 2011

Fee Schedule (XLS 74KB)  

2010 - 1 (10/01/10)

Archived December 20, 2010

Policy Guidelines (PDF 610KB)  

2009 - 1 (10/01/09)

Archived November 17, 2010

Billing Guidelines (PDF 778KB)  

2009 - 1 (7/01/09)

Archived October 26, 2010

Policy Guidelines (PDF 518KB)  

2009 - 1 (6/1/09)

Archived April 1, 2010

Fee Schedule (XLS 261KB)  

2009 - 2 (6/01/09)

Archived April 1, 2010

Procedure Codes (PDF 280KB)  

2008 - 3 (11/11/08)

Archived October 29, 2009

Billing Guidelines (PDF 433KB)  

2008 - 1 (10/01/08)

Archived July 16, 2009

Policy Guidelines (PDF 325KB)  

2009 - 1 (4/01/09)

Archived June 11, 2009

Procedure Codes (PDF 91KB)  

2008 - 1 (4/01/08)

Archived April 1, 2009

Procedure Codes (PDF 91KB)  

2008 - 1 (3/08)

Archived April 1, 2009

Fee Schedule (XLS 87KB)  

2008 - 2 (7/07/08)

Archived December 4, 2008

Billing Guidelines (PDF 285KB)  

2007 - 1 (4/11/07)

Archived October 23, 2008

Policy Guidelines (PDF 320KB)  

2008 - 1 (1/16/08)

Archived July 24, 2008

Billing Guidelines (PDF 284KB)  

2007 - 1 (4/07)

Archived April 11, 2008

Procedure Codes (PDF 93KB)  

2007 - 1 (4/07)

Archived April 11, 2008

Fee Schedule (PDF 76KB)  

2007 - 1 (5/07)

Archived January 23, 2008

Billing Guidelines (PDF 295KB)  

2005 - 1 (4/01/05)

Archived July 18, 2007

Billing Guidelines (PDF 370KB)  

2006 - 1 (8/06)

Archived May 2, 2007

Policy Guidelines (PDF 473KB)  

2006 - 1 (4/06)

Archived April 13, 2007

Procedure Codes & Fee Schedule (PDF 585KB)  
2005 - 4 Procedure Codes & Fee Schedule (PDF 749KB)  

2004 - 1 (4/04)

Archived August 14, 2008

Pharmacy Provider Manual (PDF 27MB)