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Medicare Prior Authorization List Effective January 1, 2021

Medicare Prior Authorization List Effective January 1, 2021

www.superiorhealthplan.com

Breast Reduction Capsule Endoscopy Chondrocyte Implants Cochlear Implant Facial Osteotomy Hysterectomy Joint Replacements Mastectomy for Gynecomastia . Medicare Prior Authorization List . Effective January 1, 2021 . ... J7326 GEL-ONE J7327 MONOVISC INJ PER DOSE J7328 HYAL/DERIV GELSYN-3 IA INJ 0.1 MG ...

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