Applies to:
All plans
Definition
The surgical removal of all or part of the prostate gland.
Prostatectomy authorizations
Patients must meet InterQual criteria for the service to be covered.
Priority Health requires prior authorization for radical prostatectomies.
Participating providers: Use the Auth Request tool to request through GuidingCare
Non-participating providers: Use the Medical Authorization Request form (PDF)
After the service is authorized, pre-service education is recommended for:
- Group and individual HMO, EPO, POS and PPO plan members
- Medicare plan members
- Medicaid and Healthy Michigan Plan members