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PRIOR AUTHORIZATION LIST - Paramount Health Care

PRIOR AUTHORIZATION LIST - Paramount Health Care

www.paramounthealthcare.com

acupuncture services are covered with chronic low back pain. ICD-10 M54.5. Up to 12 visits in 90 days, no prior authorization is required. An additional 8 visits will be covered for those patients demonstrating an improvement, a prior authorization is required, as of 5/1/2020. Total of 20 acupuncture treatments may be administered annually.

  Lists, Authorization, Chronic, Back, Acupuncture, Prior, Prior authorization list, Chronic low back

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