SHPBN-2017-015 Removal of Prior Authorization Requirements for Select Codes
Date: 04/17/17
What is Changing
To reduce provider administrative burden and ease member access to services, Sunflower Health Plan is removing or revising the requirement for participating (PAR) providers (providers contracted with Sunflower) to obtain a prior authorization for the specific codes listed below. As always, providers not contracted with Sunflower require prior authorization before providing a service/item to a member.
These changes are effective on May 1, 2017.
Durable Medical Equipment
- A4230 - INFUS SET-EXT INSULIN PMP, NON NEEDLE CANNULA
- A4231 - INFUS SET EXT INSULIN PMP, NEEDLE TYPE
- A4232 - SYR W/NEEDLE-EXT INSULIN PUMP, STER, 3CC
- B4224 - PARENTERAL NUTRITION ADMIN KIT PER DAY
- B9004 - PARENTERAL NUTRITION INFUSION PUMP PORTABLE
- E0202 - PHOTOTHERAPY (BILIRUBIN) LIGHT W/PHOTOMETER
- E0445 - OXIMETER MSR BLD O2 LEVL NON-INVASV
- E0482 - COUGH STIMULATING DEVICE; 20 years of age and under, no PA required
- E0565 - COMPRESSOR AIR POWER SOURCE EQUIPMENT
- E0619 - APNEA MONITOR W/RECORDING FEATURE; 20 years of age and under, no PA required
- E0784 - EXTERNAL AMBULATORY INFUSION PUMP, INSULIN; 20 years of age and under, no PA required
- E2402 - NEG PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE
Hospice Services
- T2046 - HOSPICE LONG TERM CARE, ROOM AND BOARD ONLY, PER DIEM
- T2042 - HOSPICE ROUTINE HOME CARE, PER DIEM
Please note, hospice election using the current process of submission of the election statement within five days of the beneficiary electing hospice is still required.
Sunflower will continue to monitor the utilization of services and make prior authorization requirement adjustments as indicated.
For Questions or Concerns
The prior authorization code checker will be updated accordingly by May 1, 2017, with these changes.
If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.