3/30/2022
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Posted by Provider Relations
The following sections of the Fidelis Care authorization grids have been updated effective May 1, 2022.
The Medicaid, Essential Plan, Medicare, & Metal Level Plan grids have been updated as follows:
- Outpatient and DME Services: The following services require prior authorization:
- Effective 10/1/2021, Outpatient Therapy, including services rendered in the home: Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST): Please note, CPT codes 92610 and 92611, do not require prior authorization.
Pharmacy:
- The following code has been added to the Medicaid authorization grid and requires prior authorization:
J9202 goserelin (Zoladex)~
~ authorization is required for NYM/HARP members; it is not required for CHP members
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.