Authorization and justification flags present

Many line items in the fee schedule include explicit authorization and justification flags on each line. Providers must check these per-code fields when submitting claims and prior authorization requests; absence of a flag in an excerpt does not remove the requirement if defined elsewhere in policy or system rules.

• Per-code flags seen in the source: Requires Medical Justification, Requires Comagine Authorization, Requires Fiscal Agent Authorization, and Requires NDC.
• Examples (non-exhaustive): CPT codes 10060, 11055, 27860, 28002, 28300, 73630, 99202–99205, and many others list these authorization/justification fields.

Authorization indicators present but unspecified

Multiple entries list the authorization flags but the flag values are empty in the excerpt. Providers should not assume authorization is not required; verify in the payer portal, prior authorization tool, or the complete policy text to determine if prior authorization or documentation is required before performing the service.

• Numerous CPT/HCPCS lines show the fields (e.g., Requires Medical Justification = .) with no value populated in this excerpt.
• Operational action: Confirm authorization requirements in the Alaska Medicaid provider portal or contact Comagine (utilization management) and the fiscal agent when unsure.

Imaging authorization flags

Imaging/X‑ray codes explicitly include authorization fields. Prior authorization or documented medical justification may be required for radiographic exams depending on the clinical indication and payer rules.

• X‑ray exam examples with flags: 73630 (X‑ray of foot), 73650 (X‑ray of heel), 73660 (X‑ray of toes) — each lists Requires Medical Justification, Requires Comagine Authorization, and Requires Fiscal Agent Authorization.
• Check modifier and technical/component billing (TC, 26) and follow imaging-specific prior authorization pathways if flags are set.

DME authorization and fee direction

Durable medical equipment (DME) and orthotic HCPCS lines show authorization flags and instruct providers to reference the separate DME fee schedule for pricing. DME often requires supporting documentation and prior authorization through DME workflows.

• DME examples: A5512, A5513 (dental inserts), L2106/L2108/L2112/L2114/L2116 (AFO orthoses), L4360 (pneumatic walking boot) — all show the authorization fields and state "Refer to DME Fee Schedule" for maximum allowable amounts.
• Operational action: For DME requests submit clinical justification, appropriate KX or modifier when applicable, and follow DME-specific prior authorization procedures; price claims per the Alaska Medicaid DME fee schedule.

E/M service authorization flags

Office/outpatient evaluation and management (E/M) services in the schedule include authorization and justification fields. Even when fields are blank in an excerpt, providers must verify whether prior authorization or medical necessity documentation is required for specific services or levels of care.

• E/M examples: 99202–99205 (new patient office), 99211–99215 (established patient office), 99221–99222 (initial hospital care) — each lists Requires Medical Justification, Requires Comagine Authorization, and Requires Fiscal Agent Authorization alongside Maximum Allowable amounts.
• Action: Document the medical necessity in the chart and, where required, obtain prior authorization from Comagine or the fiscal agent before delivering higher-level E/M services.