No prior authorization required for:
- Emergency room
- Skilled nursing facility
Injectable auth/billing notes:
Medications billed with miscellaneous codes will be reviewed. Explanatory notes must accompany the claim.
Priority Health Medicare applies CMS local coverage determination criteria when available for Part B drugs.
- Treatment of vitreomacular adhesion
- No prior authorization required
- Covered only for diagnoses H43.821-H43.829, vitreomacular adhesion