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Authorization Lookup

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The information contained in this listing pertains to WellCare of Georgia Medicaid authorization requirements only. The codes contained on this list are limited to Current Procedural Terminology (CPT codes) and does not include most HCPCS codes. Separate authorization requirements may apply for HCPCS codes.

 

 

Authorization is required for the following services:

  • Services rendered by non-participating providers and facilities.
  • Inpatient confinements including: Elective Inpatient, Acute Inpatient, Skilled Nursing Facility, Behavioral Health, Rehabilitation and Long-term/Sub-acute care services.
  • Advanced Radiological, Diagnostic Cardiac, Musculoskeletal (Pain Management), Diagnostic Sleep Services, certain Molecular and Genetic Laboratory Tests - managed by CareCore National
  • Select Behavioral Health Services.
  • Cosmetic Procedures.
  • Select Durable Medical Equipment (DME) items.
  • Home Health Care.
  • Preplanned Observation services are subject to Outpatient (Place of Service 22) Authorization requirements.
  • Select Pharmaceuticals.
  • Skilled Therapy Services: Please refer to your Quick Reference Guide for vendor contact information.
  • Transplant services.

We encourage you to verify member eligibility and confirm benefits prior to rendering services. Reimbursement for these services will be in accordance with the terms and conditions of your agreement.

 

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