The spending authority for surgery/surgeries for the life of the case is $10,000.

When an individual surgery or a combination of surgeries is projected to cost $10,001 or more, prior approval is required. Each RS Program Administrator will establish a procedure for routing such exception requests through the RS Managers, RS Program Administrator or both. Use of the Exceptions Request Form (see Section 8 / Part 54) is required. These costs include hospital and primary doctor fees. These costs do not include radiology, anesthesia or other related expenses.

When including surgery as an IPE service, regardless of the projected costs, the counselor must analyze and document the following factors:

Appropriate CPT and service codes are required.

Special procedures for dental surgery:

Effective Date: April 10, 2006