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Fidelis Care Authorization Grids Effective June 1, 2019
4/29/2019 • Posted by Fidelis Care

The following sections of the Fidelis Care authorization grids have been updated 
effective June 1, 2019.

The following services apply to all lines of business and require prior authorization:

IV. or V.   Outpatient and DME Services:    
                  E.  Imaging Studies*: 
                        Five or more ultrasounds for a normal pregnancy:  diagnosis code Z32.01 (added)
                        (*refer to the online authorization grid for the full description on E. Imaging Studies)

VIII. or IX.  Pharmacy:
                  •    These injectable codes require prior authorization: J2787, Q4081 (excludes Medicare) (added)
                  •    These injectable codes do not require authorization: 
                        C9035, C9037, J2358, J2426, J2794 (removed)    
Visit:  Authorization Grids

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