Vision Services need to be verified by Opticare.
Dental Services need to be verified by DentaQuest.
Complex imaging, MRA, MRI, PET, and CT scans need to be verified by NIA.
Behavioral Health/Substance Abuse need to be verified by Cenpatico.
Emergency and Urgent Care Services do NOT require prior authorization.
|Type of service||Authorization Required?|
|The information below supersedes responses by the code lookup tool.|
|Anesthesia services for pain management or oral surgery||YES|
|Plastic surgeon services rendered in the office||YES|
|Podiatry services after the third visit||YES|
|Chiropractic services after the 12th visit||YES|
|FQHC, DOH, and RHC||NO|
|Family Planning services billed with a V25 through V25.9 diagnosis||NO|