## Provider Alert! Prior authorization Updates

Date: July 23, 2021

Attention: All Providers

**Effective Dates: August 1, 2021 and November 1, 2021**

*Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.*

Call to action: Services no longer requiring a prior authorization effective August 1, 2021 include the following:

- Biofeedback Codes 90901, 90912, and 90913
- Durable Medical Equipment (DME) repair over 35 units

Services requiring a prior authorization for dates of service on or after August 1, 2021 include the following:

- Mobility Aides Code E1035 Transfer system
- Breast reduction Code 19318
- Vein procedure Code 36473

Services requiring a prior authorization for dates of service on or after November 1, 2021 include the following:

- Durable Medical Equipment (DME) when billed amount exceeds $500- Miscellaneous Code T199
- Prosthetics Code L8610 Ocular Implant
- Cerebral Seizure Monitoring – Inpatient EEG for Codes:

o 95726

o 95700

o 95718

o 95720

o 95722

o 95724

• Clinician Administered Drug Code Q2026 Dermal filler

• Functional Endoscopic Sinus Surgery inpatient/outpatient for Codes:

o 31240

o 31253

o 31254

o 31255

o 31256

o 31257

o 31259

o 31267

o 31276

o 31287

o 31288

• Gait Trainer/Standers for Code E0641

• Joint Replacement inpatient/outpatient for Codes:

o 23470

o 23472

o 23473

o 23474

o 24360

o 24361

o 24362

o 24363

o 24370

o 24371

o 27120

o 27122

o 27125

o 27130

o 27132

o 27134

o 27137

o 27138

o 27412

o 27446

o 27447

o 27486

o 27487

o 29866

o 29867

o 29868

• Spinal Surgery for Members age 21 and older, STAR only for Codes:

o 22100

o 22101

o 22102

o 22110

o 22112

o 22114

o 22206

o 22207

o 22210

o 22212

o 22214

o 22220

o 22224

o 22532

o 22533

o 22548

o 22551

o 22554

o 22556

o 22558

o 22586

o 22590

o 22600

o 22610

o 22630

o 22633

o 22800

o 22802

o 22804

o 22808

o 22810

o 22812

o 22818

o 22819

o 22830

o 22849

o 22850

o 22852

o 22855

o 22865

o 22899

o 63001

o 63003

o 63005

o 63011

o 63012

o 63015

o 63016

o 63017

o 63020

o 63030

o 63040

o 63042

o 63045

o 63046

o 63047

o 63050

o 63055

o 63056

o 63064

o 63075

o 63077

o 63081

o 63085

o 63087

o 63090

o 63101

o 63102

o 63170

o 63172

o 63173

o 63185

o 63190

o 63191

o 63194

o 63195

o 63196

o 63198

o 63199

o 63200

o 63250

o 63251

o 63252

o 63265

o 63267

o 63268

o 63300

o 63301

o 63302

o 63303

o 63304

o 63305

o 63306

o 63307

o 63308

Next steps for providers: Providers should share these prior authorization requirements with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:

www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

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