As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Wellcare wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.
Code change details can be found below. These changes may include:
- Removing PA requirements based on criticality of review and clinical need.
- Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.
If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.
| Service Category | PA Rule | Services | Procedure Codes |
|---|---|---|---|
| DME Services |
No PA Required for PAR providers |
Beds | E0185 |
| Orthotic & Prosthetic | L1951 | ||
|
Supplies and Devices |
E0486 | ||
| Drug Codes | No PA Required for PAR providers | Medications | J1096 |
| Genetic Analysis | No PA Required for PAR providers | Genetic Testing | 81240, 81256 |
| Physician Services | No PA Required for PAR providers | Other Services | G3002 |
| Skin Procedures | PA Required | Muscle Flap Procedures | 15734, 15736, 15738 |
| Surgery Procedures | No PA Required for PAR providers | Surgery-Nervous System | 64718, 64719 |
| Vision Services | No PA Required for PAR providers | Vision Evaluation | 92004 |
