CurrentUnitedHealthcarePolicy N/A

Prior authorization requirements for Virginia Cardinal Care

Lists prior authorization requirements for participating UnitedHealthcare Community Plan of Virginia/Virginia Cardinal Care providers and explains how to submit requests; affects participating and out-of-network providers in Virginia.

Policy Summary

PayerUnitedHealthcare

PolicyPrior authorization requirements for Virginia Cardinal Care

Policy CodePolicy N/A

Change TypeNo material change noted

Effective DateEffective Jan. 1, 2025

Next Review Date

Key ActionSubmit prior authorization requests online via the UnitedHealthcare Provider Portal Prior Authorization and Notification tool or by phone at 844-284-0146.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Online, Phonesubmission methods provided

Not requiredemergency or urgent care

Prior authinjectable chemo (outpatient)

866-889-8054portal phone (radiation)

E2402, 33927+VAD/wound VAC codes listed

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.

Services Requiring Prior Authorization

Prior authorization criteria examples

Prior authorization is required for many listed inpatient and outpatient services; specific codes and service types are enumerated in the list.

ALL of the following

CPT codes: 43644, 43645, 43659, 43770.

ALL of the following

CPT codes: 20975, 20979.

ALL of the following

CPT codes: 19316, 19318, 19325, 19328, 19330, 19340, 19342.

ALL of the following

Example codes include: J1442, J1447, J2506, Q5101, Q5108, Q5110 (and related Q-codes listed in the cancer supportive care section).

Partial prior authorization criteria

Extracted coverage/prior authorization criteria from partial document:

ALL of the following

CPT/HCPCS codes: 95700, 95711-95716, 95718, 95720, 95722, 95724, 95726 (as listed for inpatient video EEG).

ALL of the following

Chemotherapy injectable drugs include J9000-J9999 range and specified agents (e.g., leucovorin J0640, levoleucovorin J0641/J0642); submit requests via UnitedHealthcare Provider Portal or call 888-397-8129.

ALL of the following

Examples and DME HCPCS codes appear in the DME/orthotics sections (e.g., various L-codes listed).

Device / Procedure examples

Injectable medications prior authorization

Prior authorization is required for named injectable medications and providers should submit requests via the UnitedHealthcare Provider Portal or by phone.

Injectable medications require prior authorization; providers should submit requests online via the UnitedHealthcare Provider Portal (UHCprovider.com) or call 888-397-8129.

ALL of the following

Examples within the injectable medications list include Actemra (J3262), Acthar (J0801), Adakveo (J0791), Avsola (Q5121) and many others listed in the injectable medications section.

Pre-determination is highly recommended for drugs on the Review at Launch Medication List and newly FDA-approved drugs.

Enteral and genetic testing

Prior authorization is required for enteral services and for genetic/molecular testing.

ALL of the following

Example HCPCS/E-codes referenced in the enteral section (see enteral services entries).

ALL of the following

Example CPT codes listed for genetic/molecular testing include 81162, 81163, 81164, 81228 and many additional molecular test CPT/HCPCS codes referenced in the genetic testing entries.

Home health and hysterectomy

Prior authorization is required for home health care in outpatient settings and for hysterectomy procedures.

ALL of the following

Example HCPCS codes referenced for home health: G0299, G0495, G0300, G0496, G0493, S9474, G0494.

ALL of the following

Example CPT codes listed for hysterectomy include: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58542, 58552.

Prior authorization criteria and submission instructions

Prior authorization requirements and submission instructions for listed injectables and services

A broad list of injectable medications (by name and J-/HCPCS codes) requires prior authorization; see the Review at Launch Medication List for newly approved drugs and consider pre-determination.

Effective Oct. 1, 2024: specific white blood cell colony-stimulating factor codes (for example J1442, J1447, J1448, J2506, Q5101, Q5108, Q5110, Q5111, Q5120, Q5122) require prior authorization for both oncology and non-oncology diagnoses; oncology diagnoses are addressed in the Cancer supportive care section.

For non-oncology diagnoses and many requests, submit prior authorization requests online using the UnitedHealthcare Provider Portal (UHCprovider.com) or connect via the Contact Us page; therapeutic radiopharmaceuticals requests may be submitted via the portal or by calling 888-397-8129.

Orthotics and prosthetics require prior authorization only when the retail purchase or cumulative rental cost exceeds $500.

Prior authorization requirements (fragment)

Services requiring prior authorization as listed in this document fragment.

ALL of the following

Example HCPCS L-codes listed: L0112, L0170, L0456, L0462, L0464, L0486 (and additional L-codes in the orthotics/prosthetics section).

ALL of the following

Example HCPCS codes: T1000, T1002, T1003.

ALL of the following

Example codes: 77014, 77387, G6001, G6002.

ALL of the following

Prior authorization criteria and instructions

Prior authorization requirements and how to obtain authorization for listed services

Standard radiation therapy (2D/3D): prior authorization is required only when billed with diagnoses in specified code ranges (for example C34.00-C34.92, C50.011-C50.929, C61, etc.); submit requests via the UnitedHealthcare Provider Portal or call 866-889-8054.

Advanced outpatient imaging (certain CT, MRI, MRA, PET, nuclear medicine and nuclear cardiology procedures): prior authorization required; the ordering clinician is responsible for notification prior to scheduling; submit via the Provider Portal or call 866-889-8054.

Transplant and CAR T-cell therapy services require prior authorization; contact Optum Health Transplant Resource Services at 888-805-1802 or use the notification number on the member's ID card.

ALL of the following

Example VAD procedure codes listed include: 33927, 33928, 33929, 33975, 33976, 33979, 33981, 33982, 33983; related Q-codes: Q0507, Q0508, Q0509.

Authorization and coding notes

Authorization and coding notes extracted from document segment.

ALL of the following

Provider action: 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.

ALL of the following

Example HCPCS code: E2402 (wound vac).

Additional coding notes

Removal and ablation of saphenous veins / varicose veins referenced with CPT/HCPCS and prior authorization notes (details present in this segment).
Unclassified J/C codes (e.g., J3490, J3590, C9399) have special handling notes elsewhere in the document (effective dates and exceptions referenced).

Codes and Coding Notes

Examples of CPT/HCPCS codes requiring prior authorizationmixedCovered

43644	Bariatric surgery procedure code
43645	Bariatric surgery procedure code
43659	Bariatric surgery procedure code
43770	Bariatric surgery procedure code
20975	Bone growth stimulator (electronic stimulation)
20979	Bone growth stimulator (ultrasound)
19316	Breast reconstruction code
J1442	Filgrastim (Neupogen) J-code
Q5101	Biosimilar (Zarxio) Q-code

ICD-10 diagnosis codes (partial)ICD-10

M86.562	Osteomyelitis code referenced
M86.571	Osteomyelitis code referenced
I96	Gangrene code referenced
L03.115	Cellulitis code referenced

Durable medical equipment codes (partial)HCPCS

A9279	DME HCPCS code listed
A9280	DME HCPCS code listed
A9900	DME HCPCS code listed
E0277	DME HCPCS code listed

Sample DME/HCPCS codesHCPCSCovered

E0471	Durable medical equipment code listed requiring prior authorization
E0483	Durable medical equipment code listed requiring prior authorization
E0486	Durable medical equipment code listed requiring prior authorization
E0636	DME prior authorization code

Sample injectable medication codesHCPCSCovered

J1439	Injectafer - injectable iron requiring prior authorization
J1551	Cutaquig - injectable immunoglobulin requiring prior authorization
J0638	Ilaris - injectable medication listed

Sample injectable medication HCPCS/J-codes from listHCPCS

J1439	Injectafer (example listed)
J0223	Example injectable drug code listed
J1303	Ultomiris (example listed)

Sample procedure and orthotic/prosthetic codesmixed

27130	Total hip/knee code (example listed)
27486	Knee procedure code (example listed)
L0112	Orthotic/prosthetic code (example listed)

Maxillofacial/jaw proceduresCPTCovered

21143	Treatment of maxillofacial/jaw functional impairment (code listed in fragment)
21145	Treatment of maxillofacial/jaw functional impairment
21146	Treatment of maxillofacial/jaw functional impairment

Orthotics/Prosthetics HCPCS codes (sample)HCPCSCovered

L0637	Orthotics/prosthetics HCPCS code listed
L1000	Orthotics/prosthetics HCPCS code listed
L1310	Orthotics/prosthetics HCPCS code listed

Private duty nursingHCPCSCovered

T1000

Private duty nursing

Radiation therapy codesmixedCovered

77014	IGRT
77385	IMRT planning/complex treatment
77520	Proton beam delivery

Intensity-modulated radiation therapy (IMRT)CPTCovered

77385	IMRT planning/related
77386	IMRT continuing
G6015	IMRT related G-code
G6016	IMRT related G-code

Proton beam therapyCPTCovered

77520	Proton beam therapy code
77522	Proton beam therapy code
77523	Proton beam therapy code
77525	Proton beam therapy code

Stereotactic radiosurgery / SBRTCPTCovered

77371	SRS/SBRT planning or delivery
77372	SRS/SBRT related
77373	SRS/SBRT related
G0340	SRS/SBRT HCPCS

Transplant / VAD related codesCPTCovered

38232	Stem cell harvest — requires PA only for oncology diagnosis (note in text)
33927	VAD related code
33928	VAD related code
33929	VAD related code

CAR T-cell therapy codesHCPCSCovered

Q2041	CAR T-cell therapy code
Q2042	CAR T-cell therapy code
Q2053	CAR T-cell therapy code
Q2056	CAR T-cell therapy code

Unclassified drug codesHCPCS

J3490	Unclassified drug (note: effective July 1, 2024 special handling)
J3590	Unclassified drug (note: effective July 1, 2024 special handling)
C9399	Unclassified drug/biologic (note: effective July 1, 2024 special handling)

VAD and wound VAC codesCPT | HCPCS

33927	VAD procedure code listed in document
33928	VAD procedure code listed in document
33929	VAD procedure code listed in document
33975	VAD procedure code listed in document
33976	VAD procedure code listed in document
33979	VAD procedure code listed in document
33981	VAD procedure code listed in document
33982	VAD procedure code listed in document
33983	VAD procedure code listed in document
Q0507	VAD blood flow HCPCS Q-code listed

1–10 of 13

1/2

DME prior authorization cost threshold

ThresholdRetail purchase or cumulative rental cost greater than $500 requires prior authorization for DME items

ScopeApplies to durable medical equipment listed with HCPCS codes (e.g., E0265, E0277, E0445) where the retail or cumulative rental cost exceeds $500

Action for providersSubmit prior authorization via the UnitedHealthcare Provider Portal or follow instructions on listed HCPCS entries

How Providers Submit Requests & Notification Steps

Prior Authorization

How to submit prior authorization requests

Submit prior authorization requests online via the UnitedHealthcare Provider Portal Prior Authorization and Notification tool (UHCprovider.com). If you don't have a One Healthcare ID, visit UHCprovider.com/access. Phone assistance: 844-284-0146. Prior authorization is not required for emergency or urgent care. Out-of-network providers must request prior authorization for all procedures and services.

Prior Authorization

Bariatric surgery

Bariatric surgery (inpatient and outpatient) requires prior authorization. Examples of CPT codes that require prior authorization include 43644, 43645, 43659 and 43770. Submit requests via the UnitedHealthcare Provider Portal or call the number on the member's ID card/portal phone line.

Prior authorization required for inpatient and outpatient bariatric surgery.
Affected CPT codes: 43644, 43645, 43659, 43770.

Prior Authorization

Key Terms and Scope

Emergency/urgent care

PolicyPrior authorization is not required for emergency or urgent care

ScopeApplies to participating UnitedHealthcare Community Plan of Virginia/Virginia Cardinal Care providers

Provider noteOut-of-network providers must still request prior authorization for all other procedures and services

Out-of-network provider requirement

RequirementOut-of-network physicians, facilities and other providers must request prior authorization for all procedures and services

How to submitUse the UnitedHealthcare Provider Portal or call the phone number listed in policy for prior authorization requests

Policy Summary

PayerUnitedHealthcare

PolicyPrior authorization requirements for Virginia Cardinal Care

Policy CodePolicy N/A

Change TypeNo material change noted

Effective DateEffective Jan. 1, 2025

Next Review Date

Key ActionSubmit prior authorization requests online via the UnitedHealthcare Provider Portal Prior Authorization and Notification tool or by phone at 844-284-0146.

SourceLink

On This Page

Cochlear implants and other auditory implants listed with prior authorization.

Continuous glucose monitors and selected device codes are listed with prior authorization notes.

Joint replacement, musculoskeletal surgeries and many specified CPT codes require prior authorization as listed in the document.

Example codes: 77385, 77386, G6015, G6016.

ALL of the following

Example codes: 77520, 77522, 77523, 77525.

Orthotic/prosthetic prior authorization threshold

ThresholdOrthotic and prosthetic items with a retail purchase or cumulative rental cost of more than $500 require prior authorization

Examples of affected codesSample HCPCS: L0112, L0170, L0456, L0462, L0464, L0486

NotePrior authorization is required only for orthotics/prosthetics that meet the cost threshold

Orthotics/prosthetics prior authorization threshold

Threshold (restated)Retail purchase or cumulative rental cost more than $500 triggers prior authorization for orthotics/prosthetics

Representative codesExamples in document include L0486, L0637, L1310 (orthotics/prosthetics HCPCS samples)

Provider instructionFollow prior authorization submission process for items meeting the threshold

Radiation therapy prior authorization by diagnosis

ConditionPrior authorization for standard radiation therapy (2D/3D) is required only when billed with specified diagnosis code ranges

Example diagnosis rangesC34.00-C34.92; C50.011-C50.929; C61; C79.51-C79.52; C84.7A; D05.00-D05.92

SubmissionSubmit requests online via the UnitedHealthcare Provider Portal or call 866-889-8054

Selected procedure prior authorizations

Selected procedures and devices require prior authorization. Examples include bone growth stimulators, selected breast reconstruction codes, and other listed procedures — confirm specific CPT/HCPCS codes and submit via the Provider Portal.

Bone growth stimulators (e.g., CPT/HCPCS: 20975, 20979) require prior authorization.
Breast reconstruction and reconstruction of the breast (selected CPT codes: 19316, 19318, 19325, 19328, 19330, 19340, 19342) require prior authorization.
For other selected procedures (examples include FAI, FESS, orthognathic surgery, joint replacement, hysterectomy, prostate procedures), see the specific code lists and submit requests via the Provider Portal.

Prior Authorization

Cancer supportive care medications & injectable chemotherapy (outpatient)

For cancer supportive care medications and certain injectable chemotherapy agents administered in outpatient settings, prior authorization is required. Submit requests online via the UnitedHealthcare Provider Portal or call the applicable phone number listed for injectable medications.

Prior authorization required for injectable colony-stimulating factor drugs and bone-modifying agents for oncology diagnoses (examples: J1442, J1447, J2506, Q5101, Q5108, Q5110, Q5111, Q5120, Q5122, Q5125).
Injectable chemotherapy drugs administered outpatient (J9000-J9999 and other specified J-/Q- codes, plus miscellaneous HCPCS billed agents) require prior authorization. Submit via the Provider Portal or call 888-397-8129.
Some drugs (e.g., Cimzia, Synagis) require prior notification through Optum Rx at 800-310-6826.

Prior Authorization

Behavioral health prior authorization path

Behavioral health services follow plan-specific authorization paths. For specific behavioral health and substance use/abuse codes requiring prior authorization, call the number on the member's health plan ID card. Applied behavior analysis (ABA) therapy has a separate submission path (fax or Provider Express as directed by the plan).

For mental health and substance use referrals and code-specific prior authorization requirements, call the phone number on the member's health plan ID card.
ABA therapy: submit via fax or Provider Express per plan instructions.

Prior Authorization

Cardiology prior authorization

Cardiology procedures performed in outpatient and office settings (diagnostic catheterizations, echocardiograms, electrophysiology implants, stress echoes) require prior authorization. Submit requests online using the UnitedHealthcare Provider Portal or call 866-889-8054 for assistance and the full list of CPT codes requiring authorization.

Prior authorization required for participating physicians for outpatient and office-based diagnostic catheterizations, echocardiograms, electrophysiology implants and stress echoes.
Submit via UHCprovider.com or call 866-889-8054. See the Cardiology Prior Authorization and Notification resource for code details.

Prior Authorization

Inpatient video EEG prior authorization

Cerebral seizure monitoring — inpatient video EEG services require prior authorization; outpatient EEG services do not require authorization. Affected CPT codes for inpatient video EEG monitoring include 95700–95718 and 95720–95726 as applicable. Submit inpatient authorization requests via the UnitedHealthcare Provider Portal.

Prior authorization required for inpatient video EEG (cerebral seizure monitoring).
Affected CPT codes include 95700, 95711–95718 and 95720, 95722, 95724, 95726 (submit inpatient requests via the Provider Portal).
Outpatient hospital or ambulatory surgical center EEG/video monitoring does not require prior authorization.

Prior Authorization

Device/DME and procedure prior authorization indications

Device, DME and other procedure prior authorizations: Various implantable devices, cochlear implants, continuous glucose monitors, orthotics/prosthetics (above cost thresholds), ventricular assist devices (VAD), and other specified devices require prior authorization. Follow the specific device code guidance and submission instructions — some devices require calling the notification number on the member's health plan ID card and faxing provided forms.

Cochlear and other auditory implants: examples include CPT/HCPCS 69710 (L8619), 69714 (L8690), 69930 (L8691), L8614/L8692 — prior authorization required.
Continuous glucose monitors: prior authorization required for type 2 diabetes diagnosis; example HCPCS codes include A4226, A4239, A9276, A9277, A9278, E0787.
Orthotics and prosthetics: prior authorization required only when retail purchase or cumulative rental cost exceeds $500 (example HCPCS: L0112, L0170, L0456, L0462, L0486, L0624, L0629, L0636, L0634, L0640, L0700, L0830, L8046, L8047, L8499, L8609, L8610, L8612, L8631, L8659).
Ventricular assist devices (VAD): prior authorization required — 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.
Some devices and supplies may be listed with specific HCPCS codes (e.g., K0886, K0890, K0891, S1030, S1031, S2102, K-codes, V-codes); verify code-specific rules and submit via the Provider Portal or the phone numbers provided.

Prior Authorization

Procedures and genetic testing

Procedures and genetic/molecular testing require prior authorization as noted. Examples include femoroacetabular impingement (FAI) surgery (CPT 29914–29916), functional endoscopic sinus surgery (FESS) (CPT 31240, 31253–31259, 31267), orthognathic surgery (CPT 21121, 21123, 21125, 21127), joint replacement and total hip/knee procedures (selected CPTs listed in the policy), hysterectomy (CPTs 58150, 58152, 58180, 58260, 58262–58270, 58290–58292, 58542, 58552), and a broad list of genetic and molecular tests (examples CPT 81162–81164, 81228–81229, 81400–81412, 0272U–0282U). Submit prior authorization requests via the UnitedHealthcare Provider Portal.

Musculoskeletal procedures (e.g., FAI: 29914–29916) and sinus surgeries (FESS: 31240, 31253–31259, 31267) require prior authorization.
Orthognathic surgery and maxillofacial functional impairment procedures require prior authorization (examples: 21121, 21123, 21125, 21127, 21141, 21142).
Joint replacement and total hip/knee procedures require prior authorization (see code lists in policy).
Hysterectomy procedures require prior authorization (examples: 58150, 58152, 58180, 58260, 58262–58270, 58290–58292, 58542, 58552).
Genetic and molecular testing requires prior authorization (examples: CPT codes 81162–81164, 81228–81229, 81400–81412, 0272U–0282U and many others); use the Provider Portal for submission.

Prior Authorization

How to obtain prior authorization (radiation therapy, imaging, transplant, VAD)

How to submit prior authorization requests for radiation therapy and imaging: Please submit requests online using the UnitedHealthcare Provider Portal (UHCprovider.com) or call 866-889-8054. For transplant and CAR T-cell therapy, contact Optum Health Transplant Resource Services at 888-805-1802. For VADs, call the notification number on the member's health plan ID card and fax the provided form.

Radiation therapy (IGRT, IMRT, proton beam, and standard RT when applicable) requires prior authorization — submit via UHCprovider.com or call 866-889-8054.
Transplant and CAR T-cell therapy services: call Optum Health Transplant Resource Services at 888-805-1802.
Ventricular assist devices: call the notification number on the back of the member's health plan ID card and follow fax instructions provided by the nurse.

ContextThis requirement applies even though emergency/urgent care does not require prior authorization

Cochlear implant

DefinitionCochlear implant: a medical device with an internal component within the inner ear and an external portion that helps persons with profound sensorineural deafness achieve conversational speech

Codes (examples)Associated procedure/device codes listed include 69710, L8619; 69714, L8690; 69930, L8691

AuthorizationCochlear implants are listed as prior authorization required

Injectable chemotherapy drugs

DefinitionInjectable chemotherapy drugs: includes the J9000–J9999 range and named agents such as leucovorin (J0640), levoleucovorin (J0641, J0642), Lupron Depot (J1950), leuprolide acetate (J1954), lanreotide (J1932)

Coding noteAlso includes chemotherapy injectable drugs with Q-codes and miscellaneous HCPCS-billed agents (unassigned codes)

SubmissionSubmit prior authorization requests online via the UnitedHealthcare Provider Portal or call 888-397-8129

DME

DefinitionDurable medical equipment (DME): equipment items billed with HCPCS codes (document lists multiple E- and other HCPCS codes)

ClarificationProsthetics are not classified as DME; see orthotics and prosthetics section for those items

ExamplesDocument references DME codes such as E0471, E0483, E0486, E0636

Enteral services

DefinitionEnteral services (in-home nutritional therapy) provided either enterally or via gastrostomy tube

RequirementEnteral services require prior authorization

CodingDocument lists enteral-related HCPCS/CPT entries alongside the prior authorization note

Pre-determination recommendation

RecommendationPre-determination is highly recommended for drugs on the Review at Launch Medication List and for newly FDA-approved drugs

RationaleThese drugs are included on the Review at Launch Medication List and may require special handling or notification

Provider actionCheck the Review at Launch policy and obtain pre-determination when applicable

Optum Rx prior notification vendor

VendorOptum Rx prior notification services (phone: 800-310-6826) for prior notification of specific drugs such as Cimzia and Synagis

When to useObtain prior notification via Optum Rx for the drugs specifically noted in the document (e.g., Cimzia, Synagis)

Related guidanceOther drug prior authorization requests are submitted via the UnitedHealthcare Provider Portal or phone numbers provided in policy

Proton beam

DefinitionProton beam therapy: focused radiation therapy that uses beams of protons (tiny particles with a positive charge)

CodesExamples listed: 77520, 77522, 77523, 77525

AuthorizationProton beam therapy requires prior authorization

IGRT

DefinitionImage-guided radiation therapy (IGRT): radiation therapy delivered with image guidance (document lists associated CPT/HCPCS codes)

CodesExamples listed: 77014, 77387, G6001, G6002

AuthorizationIGRT requires prior authorization

IMRT

DefinitionIntensity-modulated radiation therapy (IMRT): an advanced form of radiation therapy planning and delivery

CodesExamples listed: 77385, 77386, G6015, G6016

AuthorizationIMRT requires prior authorization

Proton beam (duplicate)

DefinitionProton beam therapy: focused radiation therapy that uses beams of protons (tiny particles with a positive charge)

CodesDocument lists CPT codes 77520, 77522, 77523, 77525 as examples

AuthorizationPrior authorization required for proton beam therapy

Transplant / CAR T prior authorization

RequirementTransplant and CAR T-cell therapy services require prior authorization via Optum Health Transplant Resource Services

ContactCall Optum Health Transplant Resource Services at 888-805-1802 or use the notification number on the member's ID card

ExamplesCAR T products named include Abecma, Breyanzi, Carvykti, Kymriah, Tecartus, Yescarta

Ventricular assist device (VAD)

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

AuthorizationPrior authorization is required for VAD procedures and related services

Provider processCall 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

Wound vac

DefinitionWound vac: a negative pressure wound therapy device (document lists HCPCS/CPT entries)

AuthorizationPrior authorization is required for wound vac services (example code: E2402)

Provider instructionFollow prior authorization contact instructions as listed in the policy for device-related requests