Medicaid list of services that require pre-approval
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
A
Abdominoplasty/pannieculectomy
Abortion/termination of pregnancy
Adenotonsillectomy, pediatric (applies to members under 18 only)
Ambulance services, air/fixed wing
Ambulance services, non-emergent
Artificial intervertebral discs
Augmentative communications/speech-generating devices
Autism spectrum disorders: Treatment services - including psychiatric, psychological and therapeutic care (i.e., evidence-based speech therapy, physical therapy, occupational therapy and ABA therapy)
Autologous chondrocyte implant/meniscal allograft/osteochondral
AxiaLIFTM lumbar interbody fusion
B
BAHA device or cochlear implant
Behavioral health therapies, outpatient
Behavioral health & substance abuse therapies, inpatient
Blepharoptosis/brow ptosis repair
Bone marrow/stem cell transplantation
Bronchial thermoplasty
C
Cardioverter defibrillators (ICDs)/Biventricular Pacemaker Insertion + ICD
Catheter ablation for cardiac arrhythmias
Chemosensitivity assays (see your policy document for specific prior authorization requirements)
Clinical trials for cancer care
Contnuous passive motion (CPM)
CPAP & other equipment to treat sleep apnea (i.e. ASV, APAP, BiPAP, oral appliances)
Cranial helmets
D
Dental anesthesia
Detoxification
Developmental disorders, pervasive
Dialysis access, permanent
Dialysis for end-stage renal disease
Durable medical equipment (DME) purchases >$1000 and rentals
E
Eating disorders
Enteral nutrition therapy
F
Fetal surgery
G
Gastroparesis teseting and treatment
Genetic counseling, testing & screenings
H
Home health care
Hyperhidrosis
I
Implantable heart failure monitors
Infertility and assisted reproduction
Infusion services & equipment
Inpatient care services: all admissions including behavioral health and substance abuse
Intraoperative radiation therapy
K
Kyphoplasty/vertebroplasty
M
Male gynecomastia
Markers for digestive disorders
Multi-marker tumor panels
N
Non-participating providers
O
Obesity-related services - surgical treatment
Observation
Orthognathic surgery
Orthotics: shoe inserts, orthopedic shoes
Orthotics/support device purchases >$500
P
Parenteral nutrition therapy
Pharmacogenomic testing
Power vehicles
Prophylactic cancer risk-reduction surgery
Prosthetics, purchased for >$1000
Pumps, implantable & external infusion
R
Radical prostatectomy
Radiofrequency ablation for back pain
Radiology: All non-emergent outpatient diagnostic services (MRA, MRI, CT, CTA, PET scans and nuclear cardiology)
Radio surgery, stereotactic, and proton and neutron beam therapies
Reconstructive/cosmetic surgery
Reduction mammoplasty, male or female
S
Septoplasty/rhinoplasty
Sleep studies - in-center only
Stimulation therapy and devices
Surgery, spinal
T
Titanium rib
Tonsillectomy, pediatric
Transcatheter closure of septal defects
Transcatheter heart valves
Transplantation of solid organs
Tumor markers
V
Ventilator, outpatient
Ventricular assist devices (VADs) and artificial hearts
Virtual colonoscopy
Voice synthesizer