SHPBN-2016-068 Important Prior Authorization Updates

Date: 09/26/16

Updates Regarding Prior Authorization Requirements for OB Ultrasounds and Bone Marrow Biopsies

Prior Authorization for OB Ultrasounds:

Sunflower Health Plan no longer requires prior authorization for obstetric ultrasounds. Effective November 1, 2016, reimbursement of OB ultrasounds will be based on the type of ultrasound (CPT code) and diagnosis (ICD-10) submitted on the ultrasound claim. Specific details on the type of ultrasounds covered and how often each is covered can be found in the "Ultrasound in Pregnancy" policy located on our policies page.

Prior Authorization for Bone Marrow Biopsies:

Effective November 1, 2016, Sunflower no longer requires prior authorization for Bone Marrow Biopsy when using CPT codes 38220 (Bone Marrow, Aspiration Only) and 38221 (Bone Marrow; Biopsy Needle/Trocar).

Questions about prior authorizations? Please see the prior authorization checker on the Sunflower website at https://www.sunflowerhealthplan.com/providers/preauth-check/medicaid-pre-auth.html.

 

If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.