22-730 Wound Care With Visit Limits Requires Prior Authorization
Date: 08/30/22
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
Additions to the prior authorization requirements list includes Part B medications
Starting October 1, 2022, wound care will require prior authorization, as well as wound debridement for visits over 12 per calendar year.
Part B medications that require prior authorization immediately
The following Part B medications were updated based on new HCPCS codes issued by the Centers for Medicare & Medicaid Services, effective July 1, 2022.
Additions | |
|---|---|
Code | Description |
C9094 | Injection, sutimlimab-jome, 10 mg |
C9095 | Injection, tebentafusp-tebn, 1 mcg |
C9096 | Injection, filgrastim-ayow, biosimilar, (Releuko), 1 mcg |
C9097 | Injection, faricimab-svoa, 0.1 mg |
C9098 | Ciltacabtagene autoleucel, up to 100 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
J0739 | Injection, cabotegravir, 1 mg |
J1306 | Injection, inclisiran, 1 mg |
J1551 | Injection, immune globulin (Cutaquig), 100 mg |
J2356 | Injection, tezepelumab-ekko, 1 mg |
J2779 | Injection, ranibizumab, via intravitreal implant (Susvimo), 0.1 mg |
J2998 | Injection, plasminogen, human-tvmh, 1 mg |
J3299 | Injection, triamcinolone acetonide (Xipere), 1 mg |
J9331 | Injection, sirolimus protein-bound particles, 1 mg |
J9332 | Injection, efgartigimod alfa-fcab, 2 mg |
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View prior authorization requirements online
It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization. To check if a CPT or HCPCS code requires authorization, go to the Prior Authorization Tool.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net* Provider Services Center within 60 days by emal.