Effective Immediately – Additional Changes to Prior Authorization Requirements
| Date: | February 22, 2018 |
| To: | Health Plan of San Joaquin (HPSJ) Practitioners and Providers |
| From: | HPSJ Medical Management Department |
| Subject: | Effective Immediately – Additional Changes to Prior Authorization Requirements |
| Business: | Medi-Cal |
Effective immediately
As we continue to seek ways to streamline processes, HPSJ has simplified prior authorization requirements for your busy office.
A prior authorization is no longer required for the following:
- Cardiac Stress Test (CPT 93015-93018)
- Holter Monitor (CPT 93224-93227)
- Myocardial Perfusion Imaging (CPT 78451-78454)
- Cystoscopy (CPT 52000,52001,52005,52007,52204)
- Scanning Laser Polarimetry (CPT code 92132 to 92134)
- Fundus photography (CPT 92250)
- Fluorescein angiography (CPT 92230,92235,92242)
- Ophthalmoscopy (CPT 92225 and 92226)
- Avastin (Bevacizumab) 10mg/unit (CPT J9035) when billed with Injection (CPT 67028) NOTE – CORRECTED CPT CODE
| Reminder: Please consult the HPSJ (DRE) provider portal for services requiring authorization. |
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Our HPSJ network providers are important partners in delivering care to our members. We hope this change will be helpful for you and your practice. If you have questions, please contact our Customer Services Department at 209-942-6320.