Search results with tag "Prior authorization list"
Providence Health Plan Combined Prior Authorization List
s3-us-west-2.amazonaws.comThis document establishes 60-day provider notification beginning 7/1/2021 for code changes effective 9/1/2021 *Prior authorization is not a guarantee of payment. Benefits are based on eligibility at the time of service and are subject to applicable contract terms. 06/30/2021 1/302 Combined PA List Code Code Description Prior Authorization
PRIOR AUTHORIZATION LIST - Cigna
www.cigna.comPRIOR AUTHORIZATION LIST Tennessee, Northern Georgia, Eastern Arkansas, Illinois, Indiana For dates of service on or after January 1, 2018 Prior Authorization (PA) Requirements This Cigna-HealthSpring Prior Authorization list supersedes any lists that have been previously
PRIOR AUTHORIZATION LIST - Paramount Health Care
www.paramounthealthcare.comacupuncture 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.
Prior Authorization List 1 10 19 - Paramount Health Care
www.paramounthealthcare.comHOME HEALTH CARE XX X X HPV VACCINES - PRIOR AUTHORIZATION FOR ONLY 27YO OR OLDER X X NON-COVERED X 90649, 90650, 90651 - If the HMO, PPO, Individual Marketplace, or