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.
Please note that buprenorphine implant (J0570) is not covered for any line of business, however Sublocade (Q9991 and Q9992) may be covered for Commercial or Medicare plans with prior authorization. Please see Sublocade page for more information