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Services Requiring Preauthorization

Services Requiring Preauthorization

  • Advanced imaging scans (e.g. MRI, CT scans) of the neck and spine provided on an outpatient basis. Such scans provided while you are inpatient or provided as part of emergency care are not subject to preauthorization. * 
  • Arthroscopic Procedures (Knees, Hips and Shoulders)
  • Autologous Chondrocyte Implantations
  • Behavioral Health Care:
    • Partial hospitalization
    • Intensive outpatient
    • Residential services
  • PET Scans 
  • MRA Scans 
  • Back surgeries for pain
  • Invasive Back Procedures 
  • Certain high-cost durable medical equipment, prosthetics, orthotics and oxygen-related equipment and services 
    • CPAP, BiPAP, and VPAP machines
    • Apnea monitors and oral appliances for the treatment of apnea
    • Ventilators and supplies
    • Oxygen concentrators
    • Stimulators – bone, brain
    • Home infusion
    • Hyperbaric Oxygen Therapy
    • Enteral Nutrition
    • Home infusion/ambulatory infusion pumps
    • Specialty beds and accessories
    • Defibrillator vest
    • Power wheelchairs and accessories
    • Power operated vehicles (i.e. scooters)
    • Artificial limbs
    • Custom back braces
    • Lower extremity braces
    • Chest Compression System 
  • Cochlear Implants
  • Continuous Glucose Monitors
  • ​Dialysis - Outpatient and Home Dialysis
  • Elective and/or planned inpatient stays prior to admission
  • Electroconvulsive Therapy 
  • Gastric Neurostimulators
  • Genetic testing
  • Home Health Services – Including Wound Care 
  • Impression and Custom Preparation; Speech Aid Prosthesis
  • Inpatient and outpatient facility usage associated with any dental services
  • Insulin Pumps
  • Knee Scooters (Effective 3/1/17)
  • LINX
  • Minimally Invasive Direct Coronary Bypass Grafts (9/1/2017)
  • Nonsegmental pneumatic appliance
  • Nuclear Medicine – Cardiology (Myocardial Perfusion Imaging, Tomographic/Planar) 
  • Orthognathic Procedures   **these are still not covered for WEA Trust members in the State Health plan.
  • Osteochondral Autograft Knee, Open
  • Physical, speech, and occupational therapy services (excluding evaluations)
  • Pneumatic Compressor
  • Psychological and neuropsychological testing
    [Use this form when requesting authorization]
  • Reconstructive or plastic surgery such as, but not limited to,
    • Abdominoplasty
    • Blepharoplasty and ptosis repair
    • Brachioplasty
    • Breast augmentation, lift, or other breast reconstructive surgery
    • Panniculectomy
    • Thighplasty
    • Treatment of varicose veins
  • Segmental pneumatic appliance
  • Skilled nursing facility care 
  • Skilled rehabilitation services
  • Sleep Studies
  • Surgical Sleep Disorder Treatment 
  • Specialty drugs and high-cost drugs with unique monitoring or delivery needs
  • Tens Units
  • Total Joint Replacement  
  • Transmagnetic Stimulation
  • Transplant evaluations, services and procedures 
  • Treatment of temporomandibular disorders (TMD)
  • UAS Therapy (Effective 10/1/17)
  • Whole Body Imaging

* All advanced imaging scans require preauthorization for State Health Plan members.

Third-party Preauthorization

Magellan logo

For physical, speech, and occupational therapy services (excluding evaluations) please obtain preauthorization through Magellan Healthcare (formerly HSM). All Chiropractic claims should also be submitted to Magellan, but there is no preauthorization for chiropractic care. 

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