AZ Complete Health CMS Final Rule 0057-F Prior Authorization Requirements: 102 (PDF)
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This part lists procedure and service groupings with associated CPT/HCPCS/T-Codes that may require prior authorization under Arizona Complete Health. It notes the ordering/prescribing provider is responsible for determining which specific codes require prior authorization.
No material clinical or coverage changes reported in this Part 2 listing.
Policy summary & scope
This document is Part 2 of a multi-part prior authorization requirements list from Arizona Complete Health (CMS Final Rule 0057-F). It enumerates procedure and service groupings with associated CPT/HCPCS/T-Codes that may require prior authorization, including services across surgical specialties, major joint reconstruction and arthroscopy, spine surgery, therapy (PT/OT/Speech and chiropractic), respiratory diagnostics, hearing services and devices, telehealth, therapeutic injections and vaccines/immune globulin, transportation, and urological/kidney procedures.
Ordering/prescribing providers are operationally responsible for determining which specific codes on these lists require prior authorization; the lists are illustrative groupings of procedure codes that may require PA under Arizona Complete Health.
Prior authorization applicability & provider responsibilities
Provider Responsibility Statement
Operational responsibility for identifying PA-required codes:
Verify eligibility and benefits prior to rendering services; see Online Prior Authorization Tool for complete code listing.
Service / Procedure Code Groupings
Listed procedure codes are grouped by service; presence in the list indicates potential prior authorization requirement:
Provider responsibility to identify PA-required codes
Ordering/prescribing providers must determine which specific procedure codes require prior authorization; the lists are illustrative groupings. Failure to obtain required prior authorization may result in claim denial.
- Ordering/prescribing provider is responsible for identifying PA-required codes.
- The procedure code groupings in the document are illustrative; verify specific codes via the online prior authorization tool or payer guidance.
- Failure to obtain required prior authorization may result in claim denial.
Procedure codes (grouped)
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What providers must do
Provider responsibility to identify PA-required codes
Ordering/prescribing providers must determine which specific procedure codes require prior authorization; the lists are illustrative groupings. Failure to obtain required prior authorization may result in claim denial.
- Ordering/provider responsibility to identify which codes need prior authorization.
- Procedure code lists in the document are illustrative groupings — verify specific codes before ordering.
- Claims may be denied if required prior authorization is not obtained.
Providers should obtain prior authorization before rendering services when a code may require PA, verify member eligibility and benefits, and confirm plan-specific code requirements.
Ordering/prescribing providers must determine whether a specific procedure code requires prior authorization (the lists are grouped and illustrative); failure to obtain a required PA may result in claim denial.
For detailed, code-specific PA requirements and to submit or check authorizations, consult the payer’s online Prior Authorization Tool/portal.
Definitions & terms
Document changes
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