The following changes to Priority Health's prior authorization requirements are effective September 1, 2008. Note that coverage of specific procedures varies by plan. Claims will adjudicate as described in the applicable medical policy.
Go to the medical policies.
| Service |
Decision |
Applies to HMO, EPO, POS, PPO |
Applies to Medicaid |
Applies to Medicare |
| Breast implant removal |
PA requirement removed
(effective 8/20/2008) |
X |
X |
X |
| Carotid & intercranial artery stenting |
PA requirement removed |
X |
X |
X |
Surgical correction of obstructive sleep apnea
(UPPP and uvulectomy)
|
PA requirement removed |
X |
X |
X |
| Pulse oximetry for home use |
Requires prior auth after
3 months rather than initially
|
X |
X |
X |
Last modified
09/03/08
