As of July 1, 2008, Priority Health will be removing the requirement for prior authorization on several services.
For more details, consult the
medical policies.
| Service |
Decision |
Applies to
Fully Funded and
Self-funded
|
Applies
to Medicaid
|
Applies
to Medicare
|
Apnea monitor
|
Remove PA requirement
|
Yes |
Yes |
Not applicable
|
Bariatric surgery
|
Remove requirement for psychiatric evaluation
|
Yes |
Yes |
Yes |
| CPM |
Require PA after 21 days rather than initially
|
Yes |
Yes |
Yes (only covered for up to 21 days)
|
Home prothrombin time or INR monitoring
|
Remove PA requirement
|
Yes |
Not covered
|
Yes |
| IDET |
Remove PA requirement |
Yes
(not covered for self-funded products)
|
Yes |
Not covered
|
Lung volume reduction surgery
|
Remove PA requirement
|
Yes |
Yes |
Yes, for certain facilities only
|
Transcatheter closure of septal defects
|
Remove PA requirement
|
Yes |
Yes |
Yes |
| TENS |
Remove PA requirement for 4 diagnoses:
- 722.52 Degeneration of lumbar or lumbosacral intervertebral disc
- 724.2 Lumbago
- 724.5 Backache, unspecified
- 724.6 Disorders of the sacrum
All other diagnoses require prior authorization
|
Yes |
Yes |
Yes |
Last modified
07/01/08
