12/13/2021
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Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective January 1, 2022.
The Medicaid, Medicare, Essential Plan, & Metal Level Plan grids have been updated as follows:
Outpatient surgery: The following services require prior authorization:
- Eyelid and Ocular Procedures: new codes 66989, 66991, & 68841 added.
- Speech Processor Implant Procedures (new category): 69716, 69719, 69726, & 69727.
- “Esophageal sphincter augmentation” has been updated to “Esophageal procedures”: added 43497.
Outpatient and DME Services: The following services require prior authorization:
- Diagnostic testing - Wireless Motility capsule: added 91113.
- Imaging Studies - TBS Scans: 77089, 77090, 77091, & 77092 added.
- Therapeutic Services - Pain Management Codes: 64582, 64583, 64628, & 64629 added.
- Therapeutic Services – “Other” Category: 61736, 61737 added.
The following changes apply to the Medicaid line of business only:
“DME and pharmaceutical treatment for Erectile Dysfunction” has been updated to be “DME, Services, and Pharmaceutical treatment for erectile dysfunction”; codes 54408,54410,54411,54416,54417,& 55870 added.
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.