Pharmacy Manual Archive

Below are the previous versions of the Pharmacy Manual.

Version	Manual Document	Change Notes
2025 - 2 Archived October 8, 2025	Policy Guidelines (PDF 1629KB)
2022 - 1 Archived July 23, 2025	Pharmacy Billing Guidelines (PDF 1.77MB)
2025 - 1 Archived July 15, 2025	Policy Guidelines (PDF 597KB)
2024 - 3 Archived April 4, 2025	Policy Guidelines (PDF 1586KB)
2024 - 2 Archived October 2, 2024	Policy Guidelines (PDF 1770KB)
2024 - 2 2024 - 2 Archived September 3, 2024	DMEPOS Fee Schedule (XLS 312KB) Medical Supplies Procedure Codes & Coverage Guidelines (PDF 1348KB)
2024 - 1 Archived June 6, 2024	Policy Guidelines (PDF 1560KB)
2023 - 6 Archived May 13, 2024	Policy Guidelines (PDF 1490KB)
2024 - 1 2024 - 1 Archived March 14, 2024	Medical Supply Codes (PDF 89KB) Medical Supply Fee Schedule (XLS 224KB)
2023 - 3 Archived February 14, 2024	Medical Supply Codes (PDF 1297KB)
2023 - 11 Archived January 3, 2024	Fee Schedule (XLS 223KB)
2023 - 5 Archived December 29, 2023	Policy Guidelines (PDF 1382KB)
2023 - 10 Archived October 13, 2023	Fee Schedule (XLS 227KB)
2023 - 9 Archived October 2, 2023	Fee Schedule (XLS 217KB)
2023 - 4 Archived August 14, 2023	Policy Guidelines (PDF 1514KB)
2023 - 8 Archived July 31, 2023	Fee Schedule (XLS 217KB)
2023 - 7 Archived July 13, 2023	Fee Schedule (XLS 220KB)
2023 - 3 Archived May 22, 2023	Policy Guidelines (PDF 1358KB)
2023 - 6 Archived May 15, 2023	Fee Schedule (XLS 220KB)
2023 - 5 Archived May 4, 2023	Fee Schedule (XLS 227KB)
2023 - 4 Archived May 2, 2023	Fee Schedule (XLS 190KB)
2023 - 2 Archived April 21, 2023	Medical Supply Codes (PDF 1024KB)
2023 - 1 Archived April 7, 2023	Medical Supply Codes (PDF 994KB)
2023 - 2 Archived April 3, 2023	Policy Guidelines (PDF 1079KB)
2023 - 1 Archived March 27, 2023	Policy Guidelines (PDF 1359KB)
2022 - 3 Archived March 14, 2023	Procedure Codes (PDF 1.16MB)
2023 - 3 Archived February 10, 2023	Fee Schedule (XLS 190KB)
2023 - 2 Archived January 30, 2023	Fee Schedule (XLS 196KB)
2023 - 1 Archived January 24, 2023	Fee Schedule (XLS 196KB)
2022 - 2 Archived January 11, 2023	Policy Guidelines (PDF 1668KB)
2022 - 2 2022 - 9 Archived November 23, 2022	Procedure Codes (PDF 400KB) Fee Schedule (XLS 196KB)
2022 - 8 Archived November 4, 2022	Fee Schedule (XLS 196KB)
2022 - 1 Archived October 26, 2022	Policy Guidelines (PDF 1094KB)
2022 - 7 Archived October 19, 2022	Fee Schedule (XLS 196KB)
2022 - 6 Archived October 5, 2022	Fee Schedule (XLS 195KB)
2022 - 5 Archived September 7, 2022	Fee Schedule (XLS 196KB)
2013 - 1 (6/28/13) Archived August 16, 2022	Billing Guidelines (PDF 1.8MB)
2022 - 4 Archived August 2, 2022	Fee Schedule (XLS 195KB)
2022 - 3 Archived June 30, 2022	Fee Schedule (XLS 195KB)
2022 - 1 2022 - 2 Archived June 3, 2022	Procedure Codes (PDF 956KB) Fee Schedule (XLS 183KB)
2021 - 5 Archived May 3, 2022	Policy Guidelines (PDF 1094KB)
2021 - 2 2022 - 1 Archived April 19, 2022	Procedure Codes (PDF 939KB) Fee Schedule (XLS 183KB)
2021 - 8 Archived March 11, 2022	Fee Schedule (XLS 118KB)
2021 - 4 Archived December 22, 2021	Policy Guidelines (PDF 1104KB)
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)