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When it comes to dosage and frequency, everyone is a little different

An injection can be: Approved when linked to a covered diagnosis with medical records Denied when prescribed solely for weight loss without qualifying conditions Other factors that affect approval include: State Medicaid policy and budget limits Whether the drug appears on the states preferred drug list Prior authorization requirements Proof that other treatments were tried first Because of these variables, it is common for Medicaid recipients to see coverage decisions change even when using the same medication in different states or under different diagnoses

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Document what the provider evaluated beyond preparation for the injection to support the separately identifiable E/M