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Fidelis Care Authorization Grids Effective February 1, 2021
1/4/2021 • Posted by Provider Relations

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 February 1, 2021

Authorization for podiatric services has been amended on the Medicaid, Essential Plan, and Metal Level Plan authorization grids in Outpatient and DME Services as follows:

G. Podiatry Services

Authorization is no longer required for podiatric services however, authorization requirements will apply to individual services that are indicated on this grid and rendered by podiatrists.

The following services apply to Medicaid, Essential Plan, and Metal Level Plans and require prior authorization:

VIII. Pharmacy


S0013  esketamine nasal spray


Visit:  Authorization Grids

Authorization Resources

To submit prior authorization request types, use the Fidelis Care provider portal.

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