09/11/2017
WellCare Authorization for CPT Codes
As of 8-6, apparently WellCare needs authorization for a lot of codes - am trying to get a list of them since we knew nothing about this until we started getting denials for 11721 and 17110 - and those are only two of them that we know of - would you have any idea of any list available and how do we know the codes we would want to file on a new patient until we see the patient - and not a Medicare rep in the US to be found !!!
Windsor Medicare Extra is a plan that is a subsidiary of WellCare Health Plans. WellCare is the parent company. Windsor Medicare Advantage plans are not offered in New York State (these plans are typically offered in the south [Arkansas, Mississippi, South Carolina, and Georgia]. As of August 1st, 2017, they added several codes to their prior-authorization list. The following codes that are directly affecting podiatry practices are:
Nail Care Codes: 11055, 11056, 11057, 11720, 11721
- Ulcer Debridement Codes: 11042, 11043, 11044, 11045, 11046, 11047
- Excision of Benign Lesions: 11400-11406 and 11420-11426
- Application of a Graft: 15275
- Wart Removal: 17110
- Injection Codes: 20600 and 20605
Below is a link from the WellCare website that will confirm whether or not an authorization is required for a particular CPT code:
https://www.wellcare.com/Authorization-Lookup
This tool will confirm if pre-certification is needed for outpatient or ASC services for all plan types (Medicare, Medicaid, and Exchange plans).