Medicaid Prior Authorization Codes - Update
Date: 04/15/22
Magnolia is committed to ongoing quality assurance and ensuring that the information we provide is accurate. During Magnolia’s annual audit of the PA Tool response versus claim configuration, it was noted that 162 codes were not accurate. These codes indicate on the PA Tool that no authorization is required but the configuration for claims actually requires an authorization. Magnolia’s plan to correct this issue includes updating the PA Tool response to indicate that an auth is required in order to align with claims configuration and provide advanced notice to our providers of this change. Also, Claims will be monitoring these codes and ensure claims payment based on the PA Tool response prior to 6/1/2022 as Magnolia wants to ensure we honor the information currently provided to our providers. The PA Tool will be updated to indicate that these codes require authorization for all providers on 6/1/2022. The impacted codes are listed below:
Code | Description |
570 | HH AIDE |
571 | HH AIDE-VISIT |
572 | HH AIDE-HOUR |
579 | HH AIDE-OTHER |
580 | HH-OTH VIS |
581 | HH-OTH VIS/VISIT |
582 | HH-OTH VIS/HOUR |
583 | HH-OTH VIS/ASSESS |
589 | HH-OTH VIS/OTHER |
590 | HH-SVCS/UNIT |
600 | O2/HOME HEALTH |
657 | HOSPICE/PHYSICIAN |
659 | HOSPICE/OTHER |
21159 | LEFORT III W/FHDW/O LEFORT I |
21433 | TREAT CRANIOFACIAL FRACTURE |
81254 | GJB6 GENE COM VARIANTS |
99500 | HOME VISIT PRENATAL |
99501 | HOME VISIT POSTNATAL |
99502 | HOME VISIT NB CARE |
99503 | HOME VISIT RESP THERAPY |
99504 | HOME VISIT MECH VENTILATOR |
99505 | HOME VISIT STOMA CARE |
99506 | HOME VISIT IM INJECTION |
99507 | HOME VISIT CATH MAINTAIN |
99509 | HOME VISIT DAY LIFE ACTIVITY |
99510 | HOME VISIT SING/M/FAM COUNS |
99511 | HOME VISIT FECAL/ENEMA MGMT |
99600 | HOME VISIT NOS |
99602 | HOME INFUSION EACH ADDTL HR |
A9542 | IN-111 IBRITUMAB TIUXTN DX TO 5 MCI |
C9259 | INJECTION, PRALATREXATE, 1 MG |
C9260 | INJECTION, OFATUMUMAB, 10 MG |
C9265 | INJECTION, ROMIDEPSIN, 1 MG |
C9284 | INJECTION, IPILIMUMAB |
C9287 | INJ, BRENTUXIMAB VEDOTIN |
C9289 | INJ ERWINIA CHRYSANTHEMI |
E0575 | NEBULIZER ULTRASONIC LARGE VOLUME |
E0668 | SEG PNEUMAT APPLINC COMPRS FULL ARM |
G0068 | PROF SRVC ADM ANTI-INFEC PM ADM CD IND HM E 15 M |
G0069 | PROF SRVC ADM SUBQ IMT ADM CAL DA IND HM EA 15 M |
G0070 | PROF SRVC ADM CHEMO ADM CAL DA IND HOME EA 15 M |
H1004 | PRENATAL @RISK ENHNCD SRVC F/U HOM |
J9001 | DOXORUBICIN HCL LIPOSOME INJ |
J9015 | INJ ALDESLEUKIN PER SINGLE USE VIAL |
J9032 | INJECTION BELINOSTAT 10 MG |
J9039 | INJECTION BLINATUMOMAB 1 MICROGRAM |
J9041 | INJECTION BORTEZOMIB 0.1 MG |
J9043 | INJECTION CABAZITAXEL 1 MG |
J9055 | INJECTION CETUXIMAB 10 MG |
J9062 | CISPLATIN 50 MG |
J9090 | CYCLOPHOSPHAMIDE 500 MG |
J9091 | CYCLOPHOSPHAMIDE 1 G |
J9092 | CYCLOPHOSPHAMIDE 2 G |
J9110 | CYTARABINE HCL 500 MG INJ |
J9140 | DACARBAZINE 200 MG |
J9228 | INJECTION IPILIMUMAB 1 MG |
J9264 | INJ PACLITAXEL PROTBND PARTICL 1 MG |
J9290 | MITOMYCIN 20 MG |
J9291 | MITOMYCIN 40 MG |
J9301 | OBINUTUZUMAB INJ |
J9302 | INJECTION OFATUMUMAB 10 MG |
J9303 | INJECTION PANITUMUMAB 10 MG |
J9305 | INJECTION PEMETREXED NOS10 MG |
J9308 | INJECTION RAMUCIRUMAB 5 MG |
J9330 | INJECTION TEMSIROLIMUS 1 MG |
J9350 | TOPOTECAN INJECTION |
J9375 | VINCRISTINE SULFATE 2 MG |
J9380 | VINCRISTINE SULFATE 5 MG |
L3916 | WH ORTHOS 1/> NONTORSN JOINT PREFAB |
L5631 | ADD LW EXT ABVE KNEE/DISARTC ACRYLC |
L5650 | ADD LW EXTRM TOT CONTACT AK/DISARTC |
L5652 | ADD LW EXTRM SUCTN SUSP AK/DISARTC |
L5679 | ADD LW EXT BK/AK CSTM FAB XST MOLD |
L5920 | ADD ENDOSKEL AK/HIP DISRTC ALIGNBL |
S5035 | HOME INFUS TX ROUTINE INFUS DEVC |
S5036 | HOME INFUS TX REPAIR INFUS DEVICE |
S5108 | HOM CARE TRN HOM CARE CLIENT 15 MIN |
S5109 | HOME CARE TRN HOME CARE CLIENT SESS |
S5110 | HOME CARE TRAINING FAM PER 15 MIN |
S5111 | HOME CARE TRAINING FAM PER SESSION |
S5115 | HOME CARE TRN NON-FAM PER 15 MIN |
S5116 | HOME CARE TRN NON-FAM PER SESSION |
S5165 | HOME MODIFICATIONS PER SERVICE |
S5181 | HOME HEALTH RESP TX NOS PER DIEM |
S5497 | HOME INFUS TX CATH CARE NOC DIEM |
S5498 | HOME INFUS TX CATH CARE/MAINT SIMPLE PER DIEM |
S5501 | HOME INFUS TX CATH CARE COMPLX DIEM |
S5502 | HIT CATH CARE IMPL ACSS DEVC PD |
S5517 | HIT SPL RESTOR CATH PATENCY/DECLOT |
S5518 | HIT ALL SPL NECES FOR CATH REPAIR |
S5520 | HIT ALL SPL NECES PICC LINE INSERT |
S5521 | HIT SPL NECES MIDLINE CATH INSERT |
S5522 | HIT INSRT PICC NURSE SRVC ONLY |
S5523 | HIT INSRT ML VEN CATH NRS SRVC ONLY |
S9061 | HOME ADMIN AEROSOLIZED DRUG TX DIEM |
S9098 | HOME VISIT PHOTOTHERAPY SRVC DIEM |
S9127 | SOCIAL WORK VISIT THE HOME PER DIEM |
S9208 | HOME MGMT PRETERM LABOR PER DIEM |
S9209 | HOME MANGEMENT PPROM DIEM |
S9211 | HOME MGMT GESTATIONAL HTN DIEM |
S9212 | HOME MANAGEMENT POSTPARTUM HTN DIEM |
S9213 | HOME MANAGEMENT PREECLAMPSIA DIEM |
S9214 | HOME MGMT GESTATIONAL DIABETES DIEM |
S9325 | HIT PAIN MANAGEMENT INFUS PER DIEM |
S9326 | HIT CONT PAIN MGMT INFUS PER DIEM |
S9327 | HIT INTERMIT PAIN MGMT INFUS DIEM |
S9328 | HIT IMPLANTED PUMP PAIN MGMT DIEM |
S9335 | HOM TX HD ADMIN SPL AND EQP PER DIEM |
S9336 | HIT CONT ANTICOAGULNT INFUS TX DIEM |
S9338 | HOME INFUS TX IMMUOTHAPY PER DIEM |
S9339 | HOME TX PERITONL DIALYSIS PER DIEM |
S9340 | HOME TX ENTERAL NUTRITION DIEM |
S9341 | HT ENTERL NUTRIT VIA GRAVITY DIEM |
S9345 | HIT ANTI-HEMOPHILIC AGENT PER DIEM |
S9346 | HIT ALPHA-1-PROTENAS INHIBITR DIEM |
S9347 | HIT UNINTRPED LNG-TERM IV/SUBQ DIEM |
S9348 | HIT SYMPATHOMIMETIC/INOTROPIC DIEM |
S9349 | HOME INFUS TX TOCOLYTIC PER DIEM |
S9351 | HIT CONT ANTI-EMETIC PER DIEM |
S9353 | HOME INFUS TX CONT INSULIN DIEM |
S9355 | HOME INFUS TX CHELATION PER DIEM |
S9357 | HIT ENZYME REPL IV TX PER DIEM |
S9359 | HIT ANTI-TUMR NECROS FACTOR IV TX |
S9361 | HIT DIURETIC IV TX PER DIEM |
S9363 | HIT ANTI-SPASMOTIC TX PER DIEM |
S9366 | HIT TPN >1 L BUT NOT > 2 L-DA-DIEM |
S9367 | HIT TPN >2 L BUT NOT >3 L-DAY-DIEM |
S9368 | HOM INFUS TX TPN > 3 L-DAY-DIEM |
S9370 | HT INTERMITTENT ANTI-EMETIC INJ TX |
S9372 | HT INTERMIT ANTICOAGULANT INJ TX |
S9373 | HIT HYDRATION TX PER DIEM |
S9374 | HIT HYDRATION TX 1 LITER DAY |
S9375 | HIT HYDRAT >1 LITR NO>2 LITR DAY |
S9376 | HIT HYDRAT >2 LITR NO>3 LITR DAY |
S9377 | HIT HYDRATION TX >3 LITERS DAY |
S9460 | DIABETIC MGMT PROGM NURSE VISIT |
S9474 | ENTRSTML TX RN CERT ENTRSTML TX DAY |
S9490 | HIT CORTICOSTEROID INFUS ADMN SRVC |
S9494 | HIT ANTIBIOTIC/ANTIFUNGAL DIEM |
S9497 | HIT ANTIBIOTIC/ANTIFUNGAL Q3 HRS |
S9500 | HIT ANTIBIOTIC/ANTIFUNGAL Q24 HRS |
S9502 | HIT ABX ANTIVIRL/ANTIFUNGAL Q8 HRS |
S9503 | HIT ABX ANTIVIRL/ANTIFUNGAL Q6 HRS |
S9504 | HIT ABX ANTIVIRL/ANTIFUNGAL Q4 HRS |
S9538 | HOME TRANSFUSION BLOOD PROD DIEM |
S9542 | HOME INJECTABLE THERAPY NOC-DIEM |
S9558 | HOME INFUS TX GROWTH HORMONE-DIEM |
S9559 | HOME INFUS TX INTERFERON PER DIEM |
S9560 | HOME INJ TX HORMONAL THERAPY DIEM |
S9562 | HOM INJ TX PALIVIZUMAB-PER DIEM |
S9590 | HOM TX IRRIG TX W/ADMN-PER DIEM |
S9810 | HOME THERAPY NOC PER HOUR |
T1000 | PRIV DUTY/INDEPENDENT NRS TO 15 MIN |
T1002 | RN SERVICES UP TO 15 MINUTES |
T1003 | LPN/LVN SERVICES UP TO 15 MINUTES |
T1004 | SRVC QUALIFIED NRS AIDE TO 15 MIN |
T1028 | ASSESS HOME PHYSICAL AND FAMILY ENVIR |
T1029 | COMP ENVIR LEAD INVESTIGAT-DWELL |
T1031 | NURSING CARE THE HOME LPN PER DIEM |
T1502 | ADMN ORL IMAND/SUBQ MED HLTH PROF |
T1503 | ADMN MED NOT ORALAND/INJ AGENCY/PROF |
T2035 | UTILITY SERVICES MED EQP WAIVER |