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Medicare Prior Authorization Changes Effective 7/1/22

Date: 05/30/22

Our Medicare team recently completed a review of the codes listed on the following pages. These updates are applicable to Medicare Wellcare by Allwell plans (does not apply to Wellcare PPO) and are effective 7/1/22.

Prior Authorization Reminders:

1. It’s the ordering/prescribing provider’s responsibility to determine services that require prior authorization.

2. Please use the Pre-Auth Check Tool on our website to confirm if the code(s) requires prior authorization. Prior authorization  requirements vary based on the line of business so please select the applicable Pre-Auth Check Tool by line of business: https://www.azcompletehealth.com/providers/preauth-check.html.

3. Please verify eligibility and benefits prior to rendering services for members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered.

4. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED

If you have questions regarding the information contained in this update, please contact our Provider Customer Service Center at (866) 796-0542 or your Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us at: AzCHProviderEngagement@azcompletehealth.com 

Service Category

Change

Services

Procedure Codes

Anesthesia

Add PA

Anesthesia for Spine Manipulation or

Closed Proc

00640

Dermatology

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Skin Tag Removal

11200, 11201

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Benign Lesion Excision

11451

Surgical

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Skin Substitutes & Biologicals

15271, 15273, 15274,15275, 15277, 15278, Q4100, Q4101, Q4102, Q4103, Q4104, Q4105, Q4106, Q4110, Q4116, Q4121, Q4122, Q4124, Q4126, Q4128, Q4132, Q4133, Q4137, Q4138, Q4148, Q4151, Q4153, Q4154, Q4155, Q4158, Q4159, Q4160, Q4161, Q4163, Q4169, Q4178, Q4183, Q4186, Q4187, Q4195, Q4196, Q4197

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Breast Reconstruction – No PA when

billed with breast cancer diagnosis

19357, 19380

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Flap Procedures

15600, 15620, 15630, 15650, 15730, 15731, 15733, 15734, 15736, 15738

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Suction Assisted Lipectomy

15877, 15879

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Blepharoplasty (Lower Eyelid)

15820

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Autogenous Rib Cartilage Graft

21230

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Temporomandibular joint treatment

21240, 21242, 21243

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Malar Augmentation

21270

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Unlisted Procedures

21299, 21899, 41899, 60699

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Hernia Repair

49560, 49565, 49652, 49653, 49654, 49656, 49657

Orthopedic

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Procedures of Upper Extremities

23405, 23406, 23430, 23485, 24301, 24305, 24341, 24342, 24343, 24344, 24357, 24359, 25111, 25112, 25115, 25118, 25310, 25320, 26480, 26483, 26485, 26498, 29805, 29806, 29820, 29821, 29822, 29823, 29824, 29825, 29828, 29834, 29837, 29838, 29844, 29846

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Procedures of Lower Extremities

27310, 27380, 27385, 27620, 27696, 27698, 27871, 29891, 29892, 29894, 29895, 29897, 29898

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Procedures of the foot or toes

28008, 28285, 28288, 28289, 28291, 28292, 28295, 28296, 28297, 28298, 28299, 28300, 28306, 28308, 28312

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Endoscopy (Foot, Wrist)

29848, 29893

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Unlisted Procedures

23929, 27599, 28899, 29799

Pulmonology

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Unlisted Pulmonary Service

94799

Service Category

Change

Services

Procedure Codes

Cardiac

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Cardiac Monitor Insertion

33285

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Endovenous Ablation

36473

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Endovascular Revascularization

37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231

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Vascular Embolization and Occlusion

37241, 37242, 37243, 37244

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Unlisted Vascular Surgery

37799

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Intracardiac Catheter Ablation

93653, 93654, 93656

ENT

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Sinus Procedures

30130, 30140, 30560

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Nasal/Sinus Endoscopy

31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288, 31295, 31296, 31298

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Palatopharyngoplasty

42145

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Osseointegrated Implant

69714

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Unlisted ENT Procedure

30999, 31299, 92700

Gastroenterology

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Laparoscopy Procedures

43280, 43281, 43282, 43283

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Unlisted Procedures

43289, 43499, 43659, 44238, 44799, 44979, 45399, 45999, 46999, 47379, 49329, 49659, 49999

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Cholecystectomy

47562, 47563, 47600

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Exploratory Laparotomy

49000

Urology

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Prostrate Procedure

53850, 53854, 53899, 55899

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Penile Prosthesis

54408, 54410, 54416

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Laparoscopy Surgery (Prostrate)

55866

Neurology

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Neurostimulators Procedures

61885, 61886, 64568, 64575, 64999

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Neuroplasty Procedures

64704, 64708, 64716, 64718, 64719, 64721

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Sinusoidal Vertical Axis Rotational Testing

92546

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EEG/VEEG

95700, 95711, 95712, 95713, 95714, 95715, 95716

Ophthalmology

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Corneal Procedures/Transplant

65730, 65750, 65755, 65756, 65757, 65770

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Glaucoma Procedures/Surgery

65855, 66170, 66172, 66183,

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Cataract Procedures

66820, 66821, 66825, 66830, 66840, 66850, 66852, 66940, 66982, 66983, 66984, 66985, 66986, 66987, 66988

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Repair Procedures of Eye

67228, 67255, 67912, 67961, 67966, 68761

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Unlisted Ophthalmological Service/Procedure

67999, 92499

Service Category

Change

Services

Procedure Codes

Diagnostic radiology

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Thyroid/Parathyroid Imaging

78012, 78013, 78014, 78018, 78070, 78071, 78072

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Bone Marrow Imaging

78102

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Liver/Spleen & Gallbladder Imaging

78201, 78202, 78215, 78216, 78226, 78227

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Radiopharmaceutical Localization of Tumor

78800, 78802, 78803, 78830, 78831, 78832

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Unlisted Procedure

78999

Laboratory

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Genetic Analysis Procedures

81245, 81246, 81261, 81263, 81264, 81310, 81315, 81340, 81342

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Engraftment Analysis

81267, 81268

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Chronic HCV assay

81596

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Bone Marrow Culture

88237

Behavioral Health

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Transcranial Magnetic Stimulation

90867

Miscellaneous

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Unlisted Special Service, Procedure, or Report

99199

 

Part B Drugs

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Medical Injectables

C9077, C9081, J2506, J2597, J2794, Q2054, Q2055, Q5123

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Inhalation Solutions

J7605, J7606, J7626

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CAR-T Therapy

0537T, 0539T, 0540T