Fidelis Care Authorization Grids Effective September 1, 2025
7/30/2025
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Posted by Provider Relations
The following section of the Fidelis Care authorization grids have been updated effective September 1, 2025.
The following code has been updated on the Essential Plan and Metal-Level Products Authorization Grids:
- Durable Medical Equipment/Supplies:
1. These DME codes do not require an authorization: A7046
The following codes have been updated on the Medicare Authorization Grid:
A. Durable Medical Equipment/Supplies:
1. These DME codes do not require an authorization: A4557, A5500, A6530, A7046, E0443, E0730, E0849, E0951, E0955, E0956, E0961, E0971, E0973, E0990, E1392, E2210, E2365, E2601, E2607, E2624, K0001, K0019, K0040, K0195, K0738, L5685
2. The following orthotic codes do not require an authorization: L2820, L3908
F. Therapeutic Services:
2. Pain Management Codes (i.e. injections, TENS, therapeutic services): Removed codes 20550 and 20551
I. Outpatient and DME Services:
A. Diagnostic Testing:
1. Sleep Studies, including Home Sleep Studies
** 95806 does not require authorization
Visit: Authorization Grids