Provider Notice 2019-45: Medicare Authorization Changes
Date: 12/11/19
Allwell from Louisiana Healthcare Connections has implemented changes to our Prior Authorization requirements which will be applicable to Allwell products.
Prior authorization will be required for the following services:
- 31661 BRONCH THERMOPLSTY 2/> LOBES
- C1813 PROSTHESIS, PENILE, INFLATABLE
- C1822 GENERATOR, NEUROSTIMULATOR (IMPLANTABLE, HIGH FREQUENCY, WITH RECHARGEABLE BATT AND CHARGING SYSTEM)
- C2622 PROSTHESIS, PENILE, NON-INFLATABLE
- J9145 INJECTION DARATUMUMAB 10 MG (WILL BE ADDED UNDER PART B DRUG LIST)
- J9203 INJ GEMTUZUMAB OZOGAMICIN 0.1 MG (WILL BE ADDED UNDER PART B DRUG LIST)
Step Therapy Part B Drug list has several changes. Below is a list of additions:
- J3380 VEDOLIZUMAB
- J0129 ABATACEPT INJECTION
- J7189 FACTOR VIIA
- J7318 DUROLANE 1 MG
- J7320 GENVISC 850, 1MG
- J7321 HYALGAN SUPARTZ VISCO-3 DOSE
- J7322 HYMOVIS INJECTION 1 MG
- J7323 EUFLEXXA INJ PER DOSE
- J7324 ORTHOVISC INJ PER DOSE
- J7325 SYNVISC OR SYNVISC-ONE
- J7326 GEL-ONE
- J7327 MONOVISC INJ PER DOSE
- J7328 GELSYN-3 INJECTION 0.1 MG
- J7329 TRIVISC 1 MG
- J9022 ATEZOLIZUMAB,10 MG
- J9145 INJECTION DARATUMUMAB 10 MG
- J9173 DURVALUMAB, 10 MG
- J9176 ELOTUZUMAB, 1MG
- J9308 RAMUCIRUMAB
- J0604 CINACALCET, ESRD ON DIALYSIS
- J0897 DENOSUMAB INJECTION
- J1300 ECULIZUMAB INJECTION
- J1459 IVIG PRIVIGEN 500 MG
- J1555 CUVITRU, 100 MG
- J1556 IMM GLOB BIVIGAM, 500MG
- J1557 GAMMAPLEX INJECTION
- J1559 HIZENTRA INJECTION
- J1561 GAMUNEX-C/GAMMAKED
- J1566 IMMUNE GLOBULIN, POWDER
- J1568 OCTAGAM INJECTION
- J1569 GAMMAGARD LIQUID INJECTION
- J1572 FLEBOGAMMA INJECTION
- J1575 HYQVIA 100MG IMMUNEGLOBULIN
- J1599 IVIG NON-LYOPHILIZED, NOS
- J1602 GOLIMUMAB FOR IV USE 1MG
- J9355 TRASTUZUMAB INJECTION
- Q2043 SIPULEUCEL-T AUTO CD54+
- J1930 LANREOTIDE INJECTION
- J2353 OCTREOTIDE INJECTION, DEPOT
- J2357 OMALIZUMAB INJECTION
- J3304 TRIAMCINOLONE ACE XR 1MG
- J3357 USTEKINUMAB SUB CU 1 MG
- J0593 LANADELUMAB-FLYO, 1 MG
- J2353 OCTREOTIDE INJECTION, DEPOT
- J2357 OMALIZUMAB INJECTION
- J3304 TRIAMCINOLONE ACE XR 1MG
- J3357 USTEKINUMAB SUB CU 1 MG
- J0593 LANADELUMAB-FLYO, 1 MG
- J3111 ROMOSOZUMAB-AQQG 1 MG
- J7314 YUTIQ, 0.01 MG
- J7331 SYNOJOYNT, 1 MG
- J7332 TRILURON, 1 MG
- J7401 MOMETASONE FUROATE SINUS IMP
- J9118 CALASPARGASE PEGOL-MKNL
- J9203 INJ GEMTUZUMAB OZOGAMICIN 0.1 MG
- Q5112 ONTRUZANT 10 MG
- Q5113 HERZUMA 10 MG
- Q5114 OGIVRI 10 MG
- Q5116 TRAZIMERA 10 MG
- Q5117 KANJINTI 10 MG
- J9356 HERCEPTIN HYLECTA, 10MG
**To review the most up to date Part B Drugs list visit our Prior Authorization Tool on our website.**
Part B Bio-pharmacy procedures/treatments requiring prior authorization. *Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. Non-Par providers & facilities require authorization for all HMO services except where indicated.
Please refer to our prior authorization guidelines (PDF) for additional information on how to obtain prior authorizations.
FREQUENTLY ASKED QUESTIONS:
How do I determine if a specific treatment requires prior authorization?
You may determine which specific codes require prior authorization by visiting our website and clicking on the Pre-Auth Check tab. The Medicare Pre-Auth Check tab will take you to our PreScreen Tool. Enter the CPT code and the PreScreen Tool will advise whether the service requires prior authorization.
How do I request a prior authorization for these services?
You may submit the prior authorization request utilizing our Secure Web Portal at allwell.louisianahealthconnect.com.
- If your request approved, you will receive verification through the Secure Web Portal.
- If you are not currently registered on our Secure Web Portal, you may register through a quick and simple process.
- You may submit the prior authorization request by faxing an authorization to 1-844-522-9881.
- You may call our Medical Management department at MAPD: 1-855-766-1572 or DSNP: 1-833-541-0767 (TTY: 711).
What information will I be required to submit in connection with the prior authorization request?
- CPT code
- Member information
- Diagnosis code
- Rendering facility’s name and information
- Ordering provider information
- Related/pertinent member clinical information
If you have any questions, contact Provider Services at MAPD: 1-855-766-1572 or DSNP: 1-833-541-0767 (TTY: 711) or contact your dedicated Provider Service Consultant.