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Effective September 1, 2021: Prior Authorization Changes for Multiple Subcutaneous Internal Cardiac Defibrillator Procedures

Date: 07/29/21

Effective September 1, 2021, certain Subcutaneous Internal Cardiac Defibrillator (S-ICD) Procedures will become a benefit for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members.

Prior Authorization Required

Below are the associated Current Procedural Terminology (CPT) codes included in this change to benefits which will require prior authorization. TurningPoint Healthcare Solutions, LLC will process prior authorization requests for medical necessity for these services listed. Physicians will be able to submit requests to TurningPoint for prior authorization beginning on August 23, 2021 for dates of service on or after September 1, 2021.

CPT Codes

Description

33270

Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed.

33271

Insertion of subcutaneous implantable defibrillator electrode.

33274

Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (e.g., fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (e.g., interrogation or programming), when performed.


For questions regarding this notification, utilization management or prior authorization, and to submit prior authorization requests, please contact TurningPoint at: 


Prior Authorization Removal

Below are the associated Current Procedural Terminology (CPT) codes included in this change to benefits which will no longer require prior authorization.

CPT Codes

Description

33273

Repositioning of previously implanted subcutaneous implantable defibrillator electrode.

93287

Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure or test with physician analysis, review and report.

93290

Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health-care professional; includes connection, recording and disconnection per patient encounter; implantable cardiovascular physiologic monitor system, including analysis of one or more recorded physiologic cardiovascular data elements from all internal and external sensors.


To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.

For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.