TN0732 PITUITARY ACROMEGALY
PREAUTH		CLAIMS
MIN. CLINICAL SYMPTOMS	MIN. REQUIRED	CRITERIA	DETAILS	% breakup amount - claims	POINTS AWARDED	SPECIAL MENTION
BODY PAIN, HEADACHE, VISUAL DISTURBANCE JOINT PAINS,	CLINICAL PHOTO, BLOOD HORMONE LEVELS - GH LEVELS OR IGF-1 LEVEL	TOTAL BED DAYS		20
		INVESTIGATIONS	GENERAL WORK UP	30
			MRI BRAIN		mandatory
			CHEST CT
			IGF-1, IGF BINDING PROTEIN 3 MEASUREMENT		mandatory
		TREATMENT	STOMATOSTAIN AND DOPAMINE ANALOGUE OR	50	mandatory
			GH RECEPTOR ANTAGONIST - PEGVISOMANT
			RADIATION THERAPY