The Fidelis Care Blog

The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2022.

The Essential Plan, Medicaid, Medicare and Metal-Level Products grids have been updated as follows:

V.         Outpatient and DME Services: The following services require prior authorization:                                      

A.    Diagnostic testing:                                                                                                          

2.   Breast Cancer testing (BRCA) and other Genetic Testing (Note: Authorization is not required for CPT 81220, 81329, 81336 and 81420.  CPT 81220 has a lifetime limit of 1. CPT 81329 and 81336 have a combined limit of 1 per lifetime.)                                                                                                                     

The following codes have been updated on the Essential Plan, Medicaid, Medicare and Metal-Level Products grids and require prior authorization:

C9142 bevacizumab-maly (Alymsys)

J1302  sutimlimab-jome (Enjaymo)

J1932  lanreotide

J2777  faricimab-svoa (Vabysmo)

J9274  tebentafusp-tebn (Kimmtrak)

J9298  nivolumab and relatlim a b-rmbw (Opduakag)

Q2056 ciltacabtagene autoleuce (Carvykti)

Q5125 filgrastim-ayow, biosimilar, (Releuko)

The following codes have been added to the Medicaid DME authorization grid and require prior authorization:

The following sections of the Fidelis Care authorization grids have been updated effective October 1, 2022.

The Essential Plan, Medicaid, Medicare and Metal-Level Products grids have been updated as follows:

V.         Outpatient and DME Services: The following services require prior authorization:                                      

A.    Diagnostic testing:                                                                                                          

2.   Breast Cancer testing (BRCA) and other Genetic Testing (Note: Authorization is not required for CPT 81220, 81329, 81336 and 81420.  CPT 81220 has a lifetime limit of 1. CPT 81329 and 81336 have a combined limit of 1 per lifetime.)                                                                                                                     

The following codes have been updated on the Essential Plan, Medicaid, Medicare and Metal-Level Products grids and require prior authorization:

C9142 bevacizumab-maly (Alymsys)

J1302  sutimlimab-jome (Enjaymo)

J1932  lanreotide

J2777  faricimab-svoa (Vabysmo)

J9274  tebentafusp-tebn (Kimmtrak)

J9298  nivolumab and relatlim a b-rmbw (Opduakag)

Q2056 ciltacabtagene autoleuce (Carvykti)

Q5125 filgrastim-ayow, biosimilar, (Releuko)

The following codes have been added to the Medicaid DME authorization grid and require prior authorization: