Humana Healthy Horizons SC Prior Authorization and Notification List (PAL)
Defines services, procedures, devices and medications that require prior authorization or provider notification for Humana Healthy Horizons members in South Carolina; applies to providers serving South Carolina Medicaid recipients under this product.
No material clinical or coverage changes in this revision.
Services Requiring Prior Authorization or Notification
Services Requiring Prior Authorization or Notification
Prior authorization or notification is required for the following service subcategories and codes. When a subcategory lists "All" admissions or procedures, prior authorization/notification is required for all applicable services within that subcategory. For obstetrical admissions: notification is required when stays exceed 48 hours for vaginal deliveries and 96 hours for cesarean sections for concurrent review, care coordination and discharge planning. Specialty drugs administered in physician office, clinic, outpatient or home settings require prior authorization (see pharmacy/specialty drug process).
ALL of the following
- Ablation (cardiac electrophysiology and ablation for bone, liver, kidney, prostate cancers)
Codes require prior authorization
- Codes: 20982, 20983, 47370, 47371, 47380, 47381, 47382, 47383, 50250, 50541, 50542, 50592, 50593, 53850, 53854, 55873, 93650, 93653, 93654, 93656
ALL of the following
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