Please refer to the following service-specific checklists when preparing your documentation in response to an Additional Development Request (ADR).

• Ambulance
• Cardiology Diagnostics (EKG/Holter)
• Drugs and Biologicals
• Federally Qualified Health Center Services
• Hemodialysis
• Inpatient Psychiatric Services
• Inpatient Rehabilitation Services
• Inpatient Skilled Nursing Facility Services
• Laboratory and Pathology Diagnostics
• Modifier 25
• Operative/Surgical Services (Including Cosmetic/OCE Questionable Procedures)
• Outpatient Psychological/Psychiatric Services
• Partial Hospitalization Programs
• Physical/Occupational Therapies and Speech-Language Pathology Services (Outpatient)—Including Aquatics
• Pulmonary Rehabilitation
• Radiation Oncology
• Radiology Diagnostics
• 56900 Denial (Reopening)