09/28/2021

Fidelis-Injections

Injections with Fidelis are getting denied authorization. Criteria is 6 weeks PT, 3 weeks oral meds and limited activity. Only after this long process will they auth a steroid injection for fasciitis or tendonitis. Please help!!

For injections, Fidelis Care requires an authorization on certain CPT codes, even with the restrictions for podiatry being lifted for most routine services:

• CPT codes 20550-20553 are considered pain management codes, and those will require prior authorization every time they are performed in order to be covered by the Managed Care plan

• CPT codes 20600-20615 only require prior authorization when performed in an ASC- if performed in an office POS, they should be covered by Fidelis Care with our pre-certification

Information is based on the authorization grids from the managed care plans (https://www.fideliscare.org/Provider/Provider-Resources/Authorization-Grids). The rules are the same across the board whether the patient is enrolled in a Medicare advantage plan, Medicaid managed care, or an essential/metal level product.