Massachusetts Precertification · Request Form. Commercial HMO and POS). K1014, L5856, L5857, L5858: Prior authorization is required; in effect. Commercial. PPO/ ...

For some services listed in our medical policies, we require prior authorization. When prior authorization is required, you can contact us to make this request.

Prior approval is required for sleep studies performed in a location other than the home. Fax prior authorization requests to us at 1-888-282-1315. •.

1 нояб. 2024 г. · PA Criteria. Prior Authorization Group. ABIRATERONE. Drug Names. ABIRATERONE ACETATE. PA Indication Indicator. All FDA-approved Indications, ...

8 окт. 2024 г. · This procedure outlines the codes that fall under the Medicare Advantage Part B Drug prior authorizations.

For a list of codes that require prior authorization as part of this program, refer to: Carelon Genetic Testing Management Program CPT and HCPCS Codes medical ...

The following services require Prior Authorization or notification: · J3490, · J3590, · J8999, · J9999 and · C9399 are unlisted and do not require PA for all drugs ...

6 нояб. 2023 г. · The health plan recently removed prior authorization requirements for other conditions including continuous glucose monitoring devices and ...

The procedures or services on the below lists may require prior authorization or prenotification by BCBSTX Medical Management, eviCore Healthcare® or Magellan ...

EFFECTIVE DATE OF PRIOR. AUTHORIZATION REQUIREMENT. 1/1/21. 1/1/21. HERZUMA. HUMATE-P. 1/1/21. 1/1/21. HYALGAN. 1/1/21. HYMOVIS. 1/1/21. IDELVION.