What services require prior authorization?

Prior authorization is required for:

• All inpatient Hospital and Skilled Nursing Facility stays (except inpatient Hospital stays for the delivery of a Child, Mental or Nervous Disorders and Substance Abuse, or mastectomy surgery, including the length of Hospital stays associated with mastectomy).
• Home health visits.
• All Organ and tissue transplants and peripheral stem replacement and similar procedures and Coronary Artery Bypass Surgery.
• All infusion therapy and related service in any setting
• The following diagnostic procedures wherever performed:
  • Magnetic Resonance Imaging (M.R.I.) of the spine only.
  • Computerized Axial Tomography (CAT Scan) of the spine only.
  • Positron Emission Tomography (PET Scan)
• The following specified surgical procedures wherever performed:
  • Septoplasty
  • Knee arthroscopy