|
Service |
Preauthorization Requirements |
|
Inpatient Hospital Admissions |
YES |
|
Ambulance Services |
YES - Air Ambulance only |
|
Bone Mass Measurement |
NO |
|
Chiropractic Services |
NO |
|
Colorectal Screening Exams |
NO |
|
Diabetes Self Monitoring Training and Supplies |
NO |
|
Doctor Office Visits (PCP or Specialist) |
NO |
|
Durable Medical Equipment |
YES > $2500 |
|
Emergency Care |
NO |
|
Home Health Care/Home Infusion Therapy (HIT) |
YES |
|
Hospice Care |
YES |
|
Immunizations (Flu, Hepatitis B for At Risk and Pneumonia) |
NO |
|
Laboratory Services (Outpatient) |
NO |
|
Mammograms (Annual Screening 40+) |
NO |
|
Mental Health Care (Inpatient & Outpatient) |
YES - All levels of care |
|
Out-of-Network Services |
YES - If In-Network Benefit Level is Requested |
|
Outpatient Services (Outpatient Facility Based Services not included on this list) |
NO |
|
Pap Smears and Pelvic Exams |
NO |
|
Podiatry Sevices |
NO |
|
Prostate Cancer Screening Exams |
NO |
|
Prosthetic Devices |
YES > $2500 |
|
Radiology Services (Outpatient) |
YES - High Tech Imaging Services only |
|
Rehabilitation (Outpatient) |
YES - Home Setting Only |
|
Skilled Nursing (In a Medicare Certified Nursing Facility) |
YES |
|
Substance Abuse Care (Inpatient & Outpatient) |
YES - All levels of care |
For preauthorization, call Utilization Management at 1-800-325-8334.
For preauthorization of high tech imaging services, call American Imaging Management (AIM) at 1-866-745-1789.
NOTE: Whether the services are Medically Necessary must be determined before an authorization number will be issued. Claims received that do not have a preauthorization number will be denied. Blue Medicare PPO Physicians/Professional Providers may not seek payment from the Member when a claim is denied for lack of a preauthorization number.
For additional information, please refer to the Blue Medicare PPO Section.
