12/21/2018
Healthfirst (MCR)-Required Authorization for 20600 and 20550
All of a sudden Healthfirst is requiring auth for Medicare for 20600 and 20550 - it is NOT in their provider manual on the site- what's this new headache?
Health First has not published any documentation or sent any bulletins to participating providers regarding the new prior authorization for these injection codes. In order to confirm if one of these services need authorization per the patient’s Medicare Advantage Plan, a search must be done through the Health First provider portal:
When benefits are verified for a patient, a search can be done for whether or not a specific procedure code needs to be pre-certified. If the website is not used, customer service can also be contacted to confirm authorization requirements with a patient’s Managed Care Plan. Without verifying benefits through one of these two ways, a service can potentially be denied by the insurance since the information is not posted publicly.