Reminder: Fidelis Care Authorization Grids Effective October 1, 2020
10/13/2020
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Posted by Provider Relations
COVID-19 UPDATE:
Please refer to this link: Important Updates Regarding Coronavirus COVID-19, for authorization and coding guidelines related to the COVID-19 Pandemic.
The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2020.
Outpatient surgery code 30462 requires prior authorization across all lines of business:
Facial cosmetic, septoplasty, rhinoplasty: 30462
Prior Authorization is required for the following Outpatient and DME Services across all lines of business:
- Diagnostic testing: Wireless Motility capsule (91112).
- Therapeutic Services:
- Pain Management Codes (i.e. injections, TENS, therapeutic services): 63622 and 63688 do not require authorization for requests from orthopedic specialties.
- Radiofrequency Ablation of Uterine Fibroids – 58674
- Bronchial Thermoplasty – 31660, 31661
The following note accompanies outpatient surgery code 20610 for the Essential Plan Line of Business:
III. Outpatient surgery: The following services require prior authorization:
E. Note: CPT code 20610 is non-covered when billed with one of the following diagnosis codes: M17.0, M17.10-M17.12, M17.2, M17.20-M17.32, M17.4, M17.5, M17.9
Visit: Authorization Grids