2/28/2023
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Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective April 1, 2023.
The Medicaid grid has been updated as follows:
IX. Pharmacy:
A. Enteral Therapy-HCPCS codes B4034-B4162 describe the available enteral formulas or disposable items that require authorization (only applicable to Child Health Plus as of 4/1/2023).
Note: Prescription benefit will transfer to FFS on 4/1/2023 for NYM and HARP line of business.
N. Children’s Home and Community Based Services
The NYS Children’s HCBS Authorization and Care Manager Notification Form should be submitted prior to rendering the service to prevent disruptions in claims processing. HCBS Providers should use a separate field within the notification form to request for individual HCBS services. One field should be used for provision of Planned Respite via 15-minute units. If Providers intend to also deliver per diem Planned Respite, an additional field on the Notification Form should be used.
The following codes have been updated on the Medicaid, Essential Plan, and Metal-Level grids and require prior authorization:
- J1954 leuprolide acetate (Lutrate Depot)
- J9314 pemetrexed injection (Teva)
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.