Changes to Prior Authorization Requirements – REMINDER
| Date: | June 1, 2017 |
| To: | Health Plan of San Joaquin (HPSJ) Providers |
| From: | Medical Management Department |
| Subject: | Changes to Prior Authorization Requirements – REMINDER |
| Business: | Medi-Cal, MCAP (Medi-Cal Access Program, previously known as AIM) |
Our HPSJ network providers are important partners in delivering care to our members. As we continue to seek ways to streamline processes, HPSJ has simplified prior authorization requirements for your busy office.
As of September 24, 2016, prior authorization is no longer needed for the following:
| Service/ Procedure | Code(s) |
| Compression Stockings with Medi-Cal limitations | A6549 |
| Tympanometry Impediment Test | 92570 |
| Fibroscopic Laryngoscopy | 31575, 78227 |
| Fetal Biopsy | 76818, 76819 |
| DuplexScan/Hemodialysis Access | 93990 |
| Placement & Exchange of Nephrostomy Tube | 50432, 50435 |
| Cream, Washes and Tape (adults) | A4335, A6250 |
In addition, for FQHC facilities:
- No prior authorization is required for incision + drainage performed in physician offices
- No prior authorization is required for physical therapy (PT) in FQHC facilities
We hope this will prove useful for the operations of your practice. Please direct any questions to our Provider Services Department at 209-942-6340.