2022 Medicare Prior Authorization Grid

2022 Medicare Prior Authorization Grid Please Note: not reflected on this Authorization grid do not require services must be medically necessary, subject to CMS is based on benefits in effect at the time of service, member eligibility and SNP members require a Prior Authorization for ALL out-of-network Plans do NOT require a Prior Authorization for out-of-network requests (services already rendered) need to be submitted as a Authorization is not required for emergent inpatient admission; however, Authorization ofan inpatient or observation stay is required Prior to claim payment. Please submit a notificationto allow for Authorization entry and concurrent may not be categorized in an area that you are familiar, please search the first table is a high-level listing of PA s required. Codes by Category can be found on thefollowing pages, listed in alphabetical order by is required for the following services/procedures Inpatient Hospital Services Inpatient Hospital / Inpatient Rehabilitation / Psychiatric Inpatient Hospital / Planned Inpatient Surgeries Inpatient and Observation Stays Skilled Nursing Facility Services All SNF Services Home Health Services All Home Health Services Occupational Therapy Services Occupational Therapy requires Prior Authorization after the first 20 visit

78710 Kidney imaging (3d) 78725 Kidney function study 78730 Urinary bladder retention 78740 Ureteral reflux study 78761 Testicular imaging w/flow 78799 Genitourinary nuclear exam 78800 Tumor imaging limited area 78801 Tumor imaging multiple areas 78802 Tumor imaging whole body 78803 Tumor imaging (3d) 78804 Tumor imaging whole body

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