CurrentUnitedHealthcarePolicy N/A

Prior authorization requirements for Arizona Developmental Disabilities

Lists prior authorization requirements and related instructions for health care professionals participating with the UnitedHealthcare Community Plan of Arizona Developmental Disabilities; governs submission methods, covered benefit eligibility, and numerous service- and code-specific prior authorization rules affecting participating providers and members in Arizona.

Policy Summary

PayerUnitedHealthcare

PolicyPrior authorization requirements for Arizona Developmental Disabilities

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2025

Next Review DateN/A

Key ActionSubmit prior authorization requests using the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal or call 800-445-1638.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

800+Codes listed (approx.)

AZState applicability

Online & PhoneSubmission methods

15OT/PT visit limit

PA requiredOut-of-network

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria and Authorization Rules

Extracted coverage criteria (partial)

Coverage and prior authorization criteria summaries present in this document part include general eligibility, age-based rules, service exclusions, and code-specific prior authorization requirements.

Services must be covered under AHCCCS to be eligible for prior authorization; experimental/investigational services are not covered and all providers must be registered with AHCCCS.

Services provided by non-network or out-of-state providers require prior authorization and supporting documentation; second-level division review applies to out-of-state requests.

For members younger than 21: allergy immunotherapy and allergy testing are covered under EPSDT when medically necessary (prior authorization required when testing meets specified severe-reaction criteria).

For members 21 and older: certain allergy immunotherapy administrations are not a covered benefit (prior authorization rules differ by administration/route).

Injectable chemotherapy drugs (J9000-J9999 range and specified J/Q codes, miscellaneous HCPCS for unassigned drugs) administered outpatient for a cancer diagnosis require prior authorization; submit requests via the Provider Portal Prior Authorization and Notification tool or by phone as instructed.

Colony-stimulating factor and bone-modifying agent drugs administered outpatient for cancer (listed J/Q codes) require prior authorization.

DME prior authorization conditions

Certain DME require prior authorization only when retail purchase or cumulative rental cost exceeds $500.
Specific DME items (listed E-series and others) require prior authorization regardless of dollar amount.

Cochlear and auditory implant services and related codes require prior authorization per the listed rules (age- and supply-type distinctions apply for members under 21 versus 21 and older).

Services furnished solely for cosmetic purposes are excluded from AHCCCS coverage; prior authorization is required for the listed cosmetic/reconstructive codes where indicated.

Vision coverage and prior authorization by age

Vision benefits and prior authorization rules vary by age:

Members younger than 21: routine vision benefits include one routine eye exam every 12 months, covered lenses and frames up to specified retail value, and one replacement pair when lost/stolen/damaged; member may elect an upgraded frame by signing a vendor waiver.

Members 21 and older: prior authorization is required when services are medically necessary to diagnose or treat diseases and conditions of the eye.

Enteral/parenteral nutrition coverage

Enteral/parenteral nutrition (including TPN, lipids, oral supplements):

Services and supplies (enteral, gastrostomy tube feeding, total parenteral nutrition, lipids, oral supplements) require prior authorization via Preferred Homecare (800-636-2123).

Clinical documentation and, when applicable, an oral supplement certificate of medical necessity must accompany the request to establish medical necessity.

In-home infusion/injectable medications and DME coverage

In-home infusion, injectable medications and listed DME/items:

Prior authorization is required for in-home infusion services and injectable medications not covered by Optum Infusion; providers must call Optum Infusion at 800-985-3059 to request services or medications.

Numerous injectable chemotherapy drugs and DME items are listed with specific CPT/HCPCS and E/K-series codes that require prior authorization per the document listings.

Incontinence supplies are a benefit only when provided through Preferred Homecare; providers must request these supplies by contacting Preferred as instructed.

Coverage requirements (partial)

Prior authorization is required for infusion in-home services and injectable medications not covered by Optum Infusion; call Optum Infusion 800-985-3059 to request services/medications.

Inpatient admissions require notification; prior authorization and notification of admission date are required for acute care hospitals and specified post-acute services.

Incontinence supplies are a covered benefit only when provided through Preferred Homecare; requests must be directed to Preferred per the document instructions.

Prior authorization is required for orthotics and prosthetics for the listed L-codes; many orthotics/prosthetics codes throughout the document require prior authorization.

Authorization and coverage rules (orthotics/prosthetics and therapy)

Coverage and authorization rules extracted from document section.

Orthotics and prosthetics: listed L-codes require prior authorization; documentation must be provided to establish need for component replacement, repair or new device as indicated.

Prior authorization is required for all out-of-network services.

Out-of-state services are approved only when emergent or the service is unavailable in Arizona.

Outpatient therapy rules

Outpatient speech therapy is not a covered benefit.
Outpatient occupational and physical therapy are covered but limited to 15 visits per benefit year for restoration/maintenance and 15 visits per benefit year for acquiring/maintaining a new skill (Oct 1 - Sept 30).

Coverage criteria and prior authorization rules (excerpt)

Coverage and prior authorization requirements for therapies and beneficiaries in this excerpt:

Members 21 and older: prior authorization is not required (where specifically stated for outpatient therapy and related services).

Outpatient speech therapy: not a covered benefit.

Outpatient occupational and physical therapy: covered inpatient or outpatient but limited to 15 visits per benefit year to restore/maintain function and 15 visits per benefit year to acquire and maintain a new skill (Oct 1 - Sept 30).

Qualified Medicare beneficiaries: therapy visits are covered for unlimited visits when medically necessary (per document context).

Operational and medication rules

Certain advanced imaging and specified procedures require prior authorization; providers must use the Provider Portal Prior Authorization and Notification tool or specified contact methods to submit requests.

Prior authorization and documentation requirements (partial)

Coverage-related operational notes and requirements present in this section:

Categories requiring prior authorization

Spinal surgery codes listed require prior authorization.
Transplant services, CAR T-cell and marrow collection related codes require prior authorization and must be submitted with clinical documentation to establish medical necessity.
Implantable stimulators and neurostimulator device codes require prior authorization.
Sleep apnea procedures and surgeries listed require prior authorization.

Transplant authorization requests must include clinical documentation to establish medical necessity and providers should contact the UnitedHealthcare Community and State Transplant Management Team at 800-418-4994 or use the notification number on the member's ID card.

Prior authorization criteria (section)

Prior authorization requirements and instructions for selected services and codes in this section.

Transportation (nonemergent taxi and stretcher van) requires prior authorization; to schedule transportation call Medical Transportation Management at 888-700-6822.

Wound vacuum therapy (E2402 and related codes) requires prior authorization.

Ventricular assist devices require prior authorization/notification: call the notification number on the back of the member's health plan ID card and fax the form provided by the nurse to the Optum VAD Case Management team as instructed.

CPT code 38232: prior authorization is required only for an oncology diagnosis (conditional prior authorization rule).

Code Lists and Coding Rules

Covered HCPCS (colony-stimulating & bone-modifying agents)HCPCSCovered

J1442	Filgrastim (Neupogen)
Q5110	Filgrastim-aafi (Nivestym)
Q5125	Filgrastim-ayow (Releuko)
Q5101	Filgrastim-sndz (Zarxio)
J2506	Pegfilgrastim (Neulasta)
Q5122	Pegfilgrastim-apgf (Nyvepria)
Q5120	Pegfilgrastim-bmez (Ziextenzo)
Q5111	Pegfilgrastim-cbqv (UDENYCA)
Q5108	Pegfilgrastim-jmdb (Fulphila)
J2820	Sargramostim (Leukine)

1–10 of 13

1/2

Covered HCPCS/CPT (Augmentative & Alternative Communication)mixedCovered

92607	Augmentative and alternative communication assessment
E2500	Speech generating device component
E2508	Speech generating device component
92608	AAC device assessment
E2502	Speech generating device component
E2510	Speech generating device component
A9901	Temporary communication device/home use
E2506	Communication device accessory
E2512	Communication device accessory

Covered CPT (Bariatric surgery)CPTCovered

43644	Laparoscopy, gastric restrictive procedure
43775	Laparoscopy, gastric bypass
43659	Adjunct procedures for bariatric
43845	Gastric restrictive procedure
43770	Revision of gastric bypass

Covered (Injectable chemotherapy and related)mixedCovered

J9000-J9999	Chemotherapy injectable drugs range (prior auth required)
J0640	Leucovorin
J0641	Levoleucovorin
J0642	Levoleucovorin
J1950	Lupron Depot
C9301	Therapeutic radiopharmaceuticals (example)
C9399	Therapeutic radiopharmaceuticals (misc)
J3490	Unclassified drugs (misc HCPCS)
J3590	Unclassified drugs (misc HCPCS)

Covered HCPCS/CPT (Cochlear & auditory implants)mixedCovered

69710	Cochlear implant procedure
L8619	Cochlear implant internal device
69714	Cochlear implant procedure
L8690	Auditory implant component
69930	Cochlear implant removal/revision
L8691	Auditory implant component
L8614	Auditory implant component
L8692	Auditory implant component

Covered HCPCS (DME examples)HCPCSCovered

E0194	Patient lift - example
E0265	Hospital bed accessory - example
E0266	Hospital bed accessory - example
E0270	Seat lift - example
E0300	Hospital bed - example
E0445	Incontinence supply - example
E0457	Oxygen accessory - example
E0465	Oxygen equipment - example
E0466	Oxygen equipment - example

Covered HCPCS (Example E-series)HCPCSCovered

E0693	Diabetic supply - example
E0694	Diabetic supply - example
E0700	Diabetic supply - example

Covered DME K-series (examples)HCPCSCovered

K0005	Manual wheelchair - example
K0008	Manual wheelchair - example
K0013	Wheelchair component - example

Neutral CPT (Example surgical)CPT

27130	Total hip arthroplasty - example
27134	Revision hip arthroplasty - example

Neutral CPT (Hysterectomy)CPT

58180	Laparoscopic hysterectomy - example
58200	Abdominal hysterectomy - example
58210	Vaginal hysterectomy - example
58240	Hysterectomy with repair - example
58260	Hysterectomy with salpingo-oophorectomy - example
58262	Hysterectomy - example
58263	Hysterectomy - example
58267	Hysterectomy - example
58270	Hysterectomy - example

Neutral (Select injectable medication HCPCS/J-codes)HCPCS

J1566	Example injectable drug
J1575	Example injectable drug
J2782	Izervay™
J0175	Kisunla
J0879	Korsuva™
J2507	Krystexxa®
J0217	Lamzede®
J1932	Lanreotide
J0202	Lemtrada™
J0174	Leqembi™

Neutral HCPCS (Orthotics/Prosthetics L-codes partial)HCPCS

L0112	Misc orthotic component
L0170	Orthotic component
L0456	Knee orthosis
L0462	Ankle-foot orthosis
L0464	Foot orthosis
L0480	Spinal orthosis
L0482	Spinal orthosis

Covered HCPCS (Selected orthotics/prosthetics)HCPCSCovered

L0632	Knee orthosis - covered example
L0634	Knee orthosis - covered example
L0636	Orthotic component
L0637	Orthotic component

Covered CPT (Outpatient therapy)CPTCovered

92507	Speech-language therapy (Note: outpatient speech is not covered in policy text)
92508	Speech-language therapy

Neutral CPT (Example single)CPT

92521

Evaluation of speech fluency - example

Neutral HCPCS/NDC (Medication coding requirement)mixed

J-codes + NDC

Service requests must include J codes and NDC codes for the medication requested

Neutral CPT (Orthopedic/shoulder examples)CPT

23470	Open treatment of clavicle fracture - example
23472	Revision shoulder procedure - example
23474	Shoulder reconstruction - example
23743	Shoulder procedure - example

Neutral CPT/HCPCS (Neurostimulator/stimulator)mixed

E0747	Neurostimulator device
E0748	Neurostimulator device
E0749	Neurostimulator device
L8680	Neurostimulator implantable generator

Neutral CPT/HCPCS (Surgical & injection examples)mixed

43648	Bariatric-related procedure - example
43882	Bariatric-related procedure - example
61863	Neurosurgical procedure - example
61864	Neurosurgical procedure - example
61867	Neurosurgical procedure - example
61868	Neurosurgical procedure - example
61885	Neurosurgical procedure - example
61886	Neurosurgical procedure - example
63650	Spinal neurostimulator implantation - example
63655	Spinal neurostimulator - example

1–10 of 14

1/2

Neutral (Drug & CAR T-cell related)mixed

38232	Autologous blood-derived product (prior auth only for oncology diagnosis)
J3391	Example therapeutic drug
J3392	Example therapeutic drug (listed in source)
J3394	Example therapeutic drug
J3402	Example therapeutic drug
J9999	Miscellaneous injectable (CAR T-cell related)
Q2041	CAR T-cell related
Q2042	CAR T-cell related
Q2053	CAR T-cell related
Q2054	CAR T-cell related

Neutral HCPCS (Vein & misc procedures)CPT

36473	Endovenous ablation of incompetent vein
36475	Endovenous ablation, other
36478	Endovenous ablation, multiple veins
37700	Thrombectomy

Neutral (Ventricular assist device & related)mixed

33927	Ventricular assist device implantation
33928	Ventricular assist device procedure
33929	Ventricular assist device procedure
33975	Ventricular assist device revision
33976	Ventricular assist device procedure
33979	Ventricular assist device procedure
33981	Ventricular assist device procedure
33982	Ventricular assist device procedure
33983	Ventricular assist device procedure
Q0507	VAD related HCPCS

1–10 of 12

1/2

Neutral HCPCS (Wound vac)HCPCS

E2402

Wound VAC canister or related

How Providers Request Authorization and Operational Contacts

Prior Authorization

How to request prior authorization

To request prior authorization, submit requests using the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal (UHCprovider.com — Sign In with One Healthcare ID). Providers may also call the numbers listed below for specific service lines.

Online: Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal (UHCprovider.com).
By phone: 800-445-1638 (general)

Prior Authorization

General prior authorization eligibility and exclusions

Prior authorization is only applicable when the service is a covered benefit under AHCCCS and is medically necessary, cost-effective, and provided by an AHCCCS-eligible rendering provider. Services by non-network or out-of-state providers require prior authorization and supporting documentation; experimental or investigational services are not covered. For out-of-state requests, a division-level second‑level review is required. Prior authorization is required for all out-of-network services. Services delivered inside designated CRS multidisciplinary clinics do not require prior authorization.

Definitions and Reference Terms

Services that are medically necessary, cost-effective, and reimbursable under AHCCCS

DefinitionCovered benefits = services that are medically necessary, cost-effective, and reimbursable under AHCCCS

Eligibility noteServices must be covered under AHCCCS to be eligible for prior authorization

ExclusionsExperimental and investigational services are not covered benefits

Online submission tool on the UnitedHealthcare Provider Portal

Tool namePrior Authorization and Notification tool on the UnitedHealthcare Provider Portal (UHCprovider.com)

Online accessSign in at UHCprovider.com using One Healthcare ID and password to submit requests

Policy Summary

PayerUnitedHealthcare

PolicyPrior authorization requirements for Arizona Developmental Disabilities

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2025

Next Review DateN/A

Key ActionSubmit prior authorization requests using the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal or call 800-445-1638.

SourceLink

On This Page

For members 21 and older: prior authorization for outpatient therapy is not required; for members younger than 21 prior authorization is required (EPSDT applies).

Medication prior authorization requests must include J-codes and NDCs; specific hemophilia factor/biotech drugs are listed on the prior authorization list.

Code 38232 requires prior authorization only when billed for an oncology diagnosis (conditional rule).

Members requesting sterilization must sign appropriate consent forms as referenced in AMPM Chapter 400 resources; sterilization procedure codes listed require prior authorization.

Eligibility: Services must be AHCCCS-covered benefits and medically necessary.

Out-of-network/out-of-state: Prior authorization required; out-of-state only approved when emergent or unavailable in Arizona.

Experimental/investigational services: Not covered.

Second-level review: Required for out-of-state service requests.

Prior Authorization

Service-specific prior authorization requirements (chemotherapy, behavioral health, inpatient/outpatient)

Certain services have specific prior authorization workflows and operational contacts. Injectable chemotherapy, behavioral health services, inpatient admissions and many specialty services require prior authorization per the program rules below. Submit injectable chemotherapy requests via the Provider Portal or call the chemotherapy contact. Behavioral health prior authorization lists are maintained on ProviderExpress. Inpatient admissions and post‑acute services require notification/prior authorization for acute care hospitals and other specified facilities.

Injectable chemotherapy: Prior authorization required for outpatient administration (intravenous, intravesical, intrathecal) for a cancer diagnosis. Submit via Provider Portal or call 888-397-8129.
Behavioral health: Follow Behavioral Health prior authorization requirements on providerexpress.com (Behavioral Health Prior Authorization Code List by State).
Inpatient admissions/post-acute: Notification and prior authorization required for admissions to acute care hospitals and specified facilities; notification is required for admissions.

Prior Authorization

Prior authorization required — codes listed / medication documentation

The policy lists numerous CPT/HCPCS and J/Q codes that require prior authorization. Medication requests must include J-codes and NDC codes. Hemophilia factors and many specialty/biotech drugs are on the prior authorization list; Review-at-Launch and other drug-specific policies may require predetermination.

Medication requests: Include J‑codes and NDC codes on service requests.
Hemophilia factor/biotech drugs included (examples): Soliris®, Spinraza™, Xolair®, Zolgensma®, and others listed in the program.
Review at Launch: New-to-market medications may require predetermination; see UHCprovider.com/policies for the Review at Launch for New to Market Medications policy.

Prior Authorization

Eye care prior authorization/contact

For member eye care services, prior authorization and scheduling assistance are coordinated through Nationwide Vision.

Eye care prior authorization/contact: Call Nationwide Vision at 480-961-1702 for member eye care services.

Prior Authorization

Outpatient therapy prior authorization by age

Outpatient therapy prior authorization varies by member age. For members under 21, prior authorization is required for specified outpatient therapy CPT codes; for members 21 and older, prior authorization is not required. Note: outpatient speech therapy is not a covered benefit; occupational and physical therapy have visit limits per benefit year.

Members under 21: Prior authorization required for listed outpatient therapy CPT codes (examples include 92507–92526, 97012–97039, 97110–97116, 97112–97113).
Members 21 and older: Prior authorization is not required for outpatient therapy.
Coverage limits: Outpatient OT/PT limited to 15 visits per benefit year for skill restoration or acquisition; outpatient speech therapy is not covered.

Prior Authorization

Stimulators / neurostimulator implants

Implantable stimulators and neurostimulator devices require prior authorization. This includes bone growth stimulators and implantable neurostimulator systems; the applicable HCPCS/CPT and device codes listed in the program must be authorized prior to implantation.

Bone growth stimulator codes (examples): 20975, E0760.
Implantable neurostimulator and related device codes requiring prior authorization: E0747, E0748, E0749 and the CPT implantation codes listed (for example 61863–61868, 61885–61886, 63650, 63655).

Prior Authorization

CAR T-cell therapy / specialty drug codes

CAR T‑cell therapy and other specified specialty cellular therapies require prior authorization through the Transplant/CAR T management workflow. Many CAR T and related drug codes (J‑ and Q‑codes) and miscellaneous codes require prior authorization; code 38232 requires prior authorization only for oncology diagnoses. For CAR T and other listed cellular therapies, contact the UnitedHealthcare Community and State Transplant Management Team.

CAR T and cellular therapies (examples listed): J9999, Q2041–Q2057 and specific product names such as Kymriah, Yescarta, Abecma, Breyanzi, Tecartus, Carvykti — prior authorization required.
Code 38232: Prior authorization required only when billed for an oncology diagnosis.
Contact for transplant / CAR T: UnitedHealthcare Community and State Transplant Case Management Team at 800-418-4994 (or the notification number on the back of the member's ID card).

Prior Authorization

Ventricular assist device prior authorization

Ventricular assist devices (VADs) require prior authorization and a coordinated notification workflow. Providers should call the notification number on the back of the member's health plan ID card and follow the nurse-provided instructions; the required form must then be faxed to the Optum VAD Case Management team. Specific CPT and Q-codes for VAD procedures and components (for example 33927–33929, 33975, 33976, 33979–33983, Q0507–Q0509) are listed and require prior authorization.

Initial call: Call the notification number on the back of the member's health plan ID card to initiate the VAD prior authorization workflow.
Documentation: Fax the VAD form provided by the nurse to the Optum VAD Case Management team as instructed.
Codes requiring authorization (examples): 33927, 33928, 33929, 33975, 33976, 33979, 33981, 33982, 33983, Q0507, Q0508, Q0509.

Phone alternativeRequests may also be submitted by phone at 800-445-1638 (per document)

Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

Definition (EPSDT)Early and Periodic Screening, Diagnostic and Treatment (EPSDT) — covers medically necessary services for members younger than 21

ExampleAllergy immunotherapy and allergy testing for members <21 covered under EPSDT when medically necessary

Age distinctionCoverage rules may differ for members 21 and older (certain services not covered)

Documentation requirement for enteral/parenteral nutrition

Documentation requiredClinical documentation and oral supplement certificate of medical necessity must accompany enteral/parenteral nutrition service requests

How to requestTo request enteral/parenteral (including TPN, lipids, oral supplements) services and supplies, call Preferred Homecare at 800-636-2123

ScopeApplies to in-home enteral/parenteral nutritional therapy delivered enterally or via gastrostomy and to TPN and lipids

In-home infusion prior authorization scope

Prior authorization requiredPrior authorization is required for in-home infusion services and injectable medications not covered by Optum Infusion

How to requestTo request in-home infusion services or injectable medications not covered by Optum Infusion, call Optum Infusion at 800-985-3059

ExceptionServices covered by Optum Infusion follow Optum processes; only items not covered by Optum require separate prior auth

Optum Infusion

DefinitionOptum Infusion — referenced vendor/service for infusion and injectable medication management (contact Optum Infusion at 800-985-3059)

RoleOptum Infusion processes requests for in-home infusion services and many injectable medications; items not covered by Optum require prior authorization via provider instructions

ContactOptum Infusion phone: 800-985-3059 (document reference)

Review at Launch for New to Market Medications

Policy referenceReview at Launch for New to Market Medications policy available at UHCprovider.com/policies > For Community Plans > Medical & Drug Policies and Coverage Determination Guidelines

RecommendationPredetermination is highly recommended for drugs on the Review at Launch Medication List

ContextApplies to inpatient admission and post-acute services and newly approved drugs included on the Review at Launch list

Out-of-network

DefinitionOut-of-network = services provided by non-network health care professionals (prior authorization required)

RequirementPrior authorization is required for all out-of-network services

DocumentationOut-of-state or out-of-network requests must include supporting documentation for the out-of-network request

Out-of-state services

Approval conditionOut-of-state services are approved only when emergent or the service is unavailable in Arizona

Second-level reviewSecond-level review by the division is required for out-of-state service requests (see document)

ImplicationProviders must document emergent need or lack of in-state availability to support out-of-state requests

Site of service (SOS) - outpatient hospital

DefinitionSite of service (SOS) - outpatient hospital: prior authorization is required only when requesting service in an outpatient hospital setting

ExceptionPrior authorization is not required when the same service is performed at a participating ambulatory surgery center

Action for providersConfirm site of service when submitting prior authorization requests to determine if authorization is needed

UnitedHealthcare Community and State Transplant Management Team

TeamUnitedHealthcare Community and State Transplant Management Team (contact for transplant and CAR T-Cell services)

ContactCall the Transplant Management Team at 800-418-4994 or use the notification number on the back of the member's health plan ID card

DocumentationClinical documentation to support transplant requests must accompany and establish medical necessity

Sterilization consent form

RequirementAny member requesting sterilization must sign an appropriate consent to sterilization form

ReferenceSee AMPM Chapter 400 Section 420 Family Planning Section E Sterilization for the consent form and details (azahcccs.gov)

Prior authorizationSterilization and related procedure codes require prior authorization per the document

Ventricular assist device

DefinitionVentricular assist device (VAD) = a mechanical pump that takes over the function of the damaged ventricle and restores normal heart function

Prior authorizationPrior authorization is required for VAD codes listed in the document

How to requestCall the notification number on the back of the member's health plan ID card, then fax the nurse-provided form to the Optum VAD Case Management team