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Federal Employee Program Medical Pre-authorization List
Effective January 1, 2013
Important pre-authorization reminders
Effective July 1, 2013:
Failure to secure approval for services subject to pre-authorization will result in claim non-payment and provider liability. Regence members may not be balance billed. View the notification regarding these requirements.
- Before requesting pre-authorization, please verify eligibility and benefits via Provider Center.
- Verify that you are an in-network provider for each member to help reduce his or her out-of-pocket expense.
- Contract exclusions will not be pre-authorized. Denials may be appealed through FEP Provider Customer Service.
- Pre-authorizations obtained within 30 business days prior to service are valid except in the case of misrepresentation.
- Urgent/Emergent services do not require pre-authorization.
- Pre-authorization decisions will be communicated.
| Chemical Dependency and Mental Health |
| Contact Blue Cross of Idaho Medical Management at 1 (877) 908-0972 |
| Inpatient Admissions |
| Contact Blue Cross of Idaho Medical Management at 1 (866) 482-2250 |
| Hospice Services - Inpatient |
Contact Blue Cross of Idaho Medical Management at 1 (866) 482-2250 |
Hospice Services - Outpatient
Phone: (800) 351-2370 or Fax: (800) 453-4341 |
Regence uses Milliman Care Guidelines - End of Life Care PO-006 (Home Care) or End of Life Care PO-006 (Inpatient) as the basis for determining medical necessity for Hospice services.
S9123, S9126, S9214, T2042, T2043, T2044, T2045
For listings of Preferred hospice providers, use the National Doctor & Hospital Finder on the FEP website. |
Other Services
Phone: (800) 351-2370 or Fax: 1 (855) 232-0088 |
| Congenital abnormalities - Outpatient Surgical correction |
26560, 26561, 26562, 26587, 26590, 30460, 30462, 40700, 40701, 40702, 40720, 40761, 42205, 42210, 42215, 42220, 42225, 69300, 69320 |
Obesity surgery (bariatric) |
43644, 43645, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, 43886, 43887, 43888, S2083 |
| Oral/Maxillofacial surgery needed to correct accidental injuries to jaws, cheeks, lips, tongue, roof and floor of mouth. |
40510, 40520, 40525, 40527, 40530, 40650, 40652, 40654, 40804, 40805, 40830, 40831, 41250, 41251, 41252, 41805, 41806 |
| Outpatient intensity-modulated radiation therapy (IMRT) - prior approval is required for all outpatient IMRT services EXCEPT those related to treatment of the head, neck, breast, or prostate cancer. Prior approval is required for IMRT treatment of brain cancer. |
77301, 77338, 77418, 0073T |
| Organ/tissue transplants |
32853, 32854, 33935, 33945, 38205, 38206, 38230, 38232, 38240, 38241, 38242, 44135, 44136, 47135, 47136, 48160, 48554, 32851, 32852, G0341, G0342, G0343, S2053, S2054, S2060, S2065, S2140, S2142, S2150, S2152 |
| Clinical Trials for certain organ/tissue transplants – for blood or marrow stem cell transplants. |
S9988, S9990, S9991 |
| Certain prescription drugs require Prior Authorization |
Contact CVS Caremark at 1 (800) 624-5060 to request prior approval or to obtain a list of the drugs that require prior approval. |
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