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| Prior Authorizations
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Updated 11/1/07
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For Springfield, MOObtain precertification for the following services by calling
1-800-330-8305 or 417-820-3182.
All T-codes require prior
authorization. |
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- All observation admits, Medical and Surgical
- All inpatient hospital, skilled nursing, rehabilitation and maternity admissions under the following circumstances:
- Maternity
- Home Health, except for Physical Therapy, Occupational Therapy and
Speech Therapy
- Durable Medical Equipment (DME) over $1000.00 single line item purchase
price. In addition the following items, including but not limited to:
oxygen, CPAP units, TENS units, bone growth or neuromuscular stimulators,
hospital beds, wheelchairs, all custom made items, require prior
authorization.
- Non-emergent ambulance transfers, out of network services, and requests
for benefit exceptions
- Integumentary (skin) System
- Musculoskeletal System
- Respiratory System
- Cardiovascular System
- Digestive System
- Male/Female
- Nervous System
- Eye and Ocular Adnexa
- Radiology
- Medicine
- Cosmetic: Not Covered
- Infertility: Not Covered
- Dental: Not Covered
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