Fidelis Care Authorization Grids Effective December 1, 2020
10/30/2020
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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 December 1, 2020.
The following language has been removed from Therapeutic Services (pain management) and is now placed in Inpatient Admissions concerning Orthopedic Surgical Procedures and Spinal Surgical Procedures: If a CPT code is delegated to TurningPoint, associated devices (HCPCS codes) will also be reviewed by TurningPoint for medical necessity.
Orthopedic Surgical Procedures and Spinal Surgical Procedures, performed in both inpatient and outpatient settings, require prior authorization for dates of service beginning 10/1/2019. Effective for dates of service rendered on or after 12/23/19, prior authorization has been delegated to TurningPoint Healthcare Solutions, LLC. For a list of codes requiring prior authorization, click here. If a CPT code is delegated to TurningPoint, associated devices (HCPCS codes) will also be reviewed by TurningPoint for medical necessity.
Visit: Authorization Grids