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Authorization required list for Healthcare services



Following are list of services that required Authorization, again it will differ from insurance to insurance, below are the most common list. So please refer your insurance documentation for particular requirement.

Inpatient and Observation Admissions, as noted above
Admission to any rehabilitation and skilled nursing facility
All surgical procedures, inpatient or outpatient
The following have special reporting requirements (refer to Forms Section):
 Abortions
 Hysterectomies
 Sterilization procedures
Cosmetic or Reconstructive Surgery, including but not limited to:
 Breast reconstruction or reduction
 Blepharoplasty
 Venous procedures
 Sclerotherapy
Services and items:
 Allergy (immunotherapy), exept for those services identified on the QAF
 Ambulance transportation (non emergent)
 Amniocentesis
 Cardiac and pulmonary rehabilitation programs
 Circumcisions after 12 weeks of age
 Court-ordered services
 Chemotherapy
 Dialysis
 DME, including apnea monitors and bili-blankets
 Upper endoscopies at colonoscopies at hospitals
 Genetic testing
 Gamma Knife, Cyberknife
 Hearing aids
 Home Health Services
 Hospice care
 Hyperbaric Oxygen Therapy (HBO)
 Investigational and experimental procedures and treatments
 IV Infusions
 Laboratory services in POS 22 and 24
 Lithotripsy
 Mental Health (See Mental Health Section)
 Nutritional counseling
 MRI’s, MRA’s
 Oral Surgery
 Oxygen therapy and equipment
 Out-of-Network Services
 Pain Management and or Pain Injections
 PET Scans
 Prenatal care
 Orthotics and Prosthetics, including Cranial Orthotics
 Physical, Occupational and Speech Therapy
 Radiation therapy
 SPECT scans
 Transplants and pre and post transplant evaluations
 Wound Care and wound vacuums
 Drugs that require pre-authorization
 Any services or procedures not listed on the Quick Authorization Form (QAF)

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