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Fidelis Care Authorization Grids Effective August 1, 2021
7/1/2021 • Posted by Provider Relations

The following sections of the Fidelis Care authorization grids have been updated effective August 1, 2021.

Authorization for Therapeutic Services has been amended on the Medicaid, Medicare, Essential Plan, and Metal Level Plan authorization grids as follows:

  • Therapeutic Services requiring prior authorization:
    • Phototherapy - Added 96921, 96922
    • Pain Management Codes – Removed 62310-62311, 62318-62319

The following has been removed from the Medicaid, Medicare, Essential Plan, and Metal Level Plan authorization grids:

  • Telehealth

       Authorization is required for G2010 and G2012.

 

Visit:  Authorization Grids

 

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.

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

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