SOM - State of Michigan
Lines 01 through 07 are available for lenses, frames, and/or special characteristics (e.g., prisms, high adds) or other services (e.g., contact lens, orthoptics), if applicable. Item 18 (Procedure Code) must reflect the appropriate CPT/HCPCS procedure code. Item 19 (Modifier) must reflect a valid modifier applicable for the listed procedure code. ................
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