Effective July 15, 2021 through December 31, 2021: Temporary Relaxation of Prior Authorization Requirements for DME, Orthotic, and Enteral/Parenteral Nutrition and Medical Supplies
Superior HealthPlan is temporarily relaxing prior authorization requirements for Durable Medical Equipment (DME), Prosthetics, Orthotics, and Supplies for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members. The temporary relaxation in prior authorization requirements for the group of health-care service categories listed below will be effective for prior authorization requests received from July 15, 2021 through December 31, 2021.
The existing authorization requirements for applicable service categories will be reinstated effective on January 1, 2022. The temporary relaxation of current prior authorization requirements include the following, effective for prior authorization requests received as of July 15, 2021:
- Increase of the threshold for individual DME items greater than $2,000/ DME item.
- Adoption of a threshold of $2,000/item for the following services:
- Enteral Nutrition Supplies
- Incontinence Supplies
- Medical Supplies
- Total Parenteral Nutrition (TPN) Supplies
For the specific Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes for which the relaxation of current prior authorization requirements will be applied between July 15 through December 31, please review the listing impacted codes:
No modification to clinical criteria for the applicable service categories are associated with the relaxation of the dollar threshold for prior authorization of the applicable service categories.
For questions or additional information, contact the Utilization Review department at 1-800-218-7508.