24-1234 Prior Authorization Requirement Change for Medicare

Date: 11/15/24

Prosthetic code requires prior authorization effective January 1, 2025

Wellcare By Health Net (Health Net) is making a change to the Medicare Advantage HMO/PPO prior authorization (PA) requirements as outlined in the table below.

This change applies to Direct Network physicians, hospitals, ancillary providers, and non-delegated fee-for-service participating physician groups.

Change effective January 1, 2025

The following code now requires PA – Addition:

Code	Description	Category
L8702	Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated	Prosthetics

 

Additional information

If you have questions regarding the information contained in this update, contact the Provider Services Center by email, by telephone at 800-929-9224 or through the provider portal.
 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary Providers.