West Virginia Bureau For Medical Services (Department Of Human Services) Prior Authorization Lookup
- West Virginia Bureau For Medical Services (Department Of Human Services) timely filing
- West Virginia Bureau For Medical Services (Department Of Human Services) coverage criteria
- All West Virginia Bureau For Medical Services (Department Of Human Services) policy updates
Latest West Virginia Bureau For Medical Services (Department Of Human Services) prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-07-01CHAPTER 518 — Pharmacy Services (Outpatient Pharmacy Coverage, Prior Authorization, IHPT, and Related Requirements)Defines West Virginia Medicaid coverage, limits, prior authorization, and provider/member requirements for outpatient pharmacy services including OTCs, diabetic supplies, home infusion, and in-home parenteral therapy. Applies to providers and Medicaid members served by the West Virginia Bureau for Medical Services.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-04-01WV BMS Dental Fee Schedule — Part 1 (effective 4/1/2026–3/31/2027)Lists West Virginia Medicaid dental procedure (ADA/D) codes with fees, code effective dates and notes; some codes require prior authorization for pricing.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2026-03-01Chapter 504 — Substance Use Disorder Services (Coverage Criteria)Governance of Medicaid-covered substance use disorder services in West Virginia, including provider enrollment, clinical and administrative requirements, medical necessity, prior authorization, and program structure affecting enrolled providers and Medicaid members.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-25Prior Authorization Criteria — Rhapsido (remibrutinib) for Chronic Spontaneous UrticariaThis document defines prior authorization requirements for Rhapsido (remibrutinib) for treatment of adult patients with chronic spontaneous urticaria (CSU) within the West Virginia Bureau for Medical Services pharmacy program.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-01-01Billing Instructions for Cell and Gene Therapy (CGT) Access ModelGuidance on billing and reimbursement for CMS CGT Access Model drugs (Casgevy and Lyfgenia) for West Virginia Medicaid, including prior authorization, POS billing, and reimbursement methodology effective January 1, 2026.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Prior Authorization Criteria — Agamree (vamorolone) for Duchenne Muscular DystrophyThis document establishes prior authorization requirements for Agamree (vamorolone) for treatment of Duchenne muscular dystrophy (DMD) in patients aged two years and older for members of the West Virginia Bureau for Medical Services.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Prior Authorization Criteria — Wegovy (semaglutide)Prior authorization criteria for coverage of Wegovy (semaglutide) under the West Virginia Bureau for Medical Services, limited to secondary prevention of major adverse cardiovascular events and treatment of noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH). Affects prescribers requesting PA for WV BMS beneficiaries.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2025-11-19Prior Authorization Criteria — DUPIXENT (dupilumab)This document defines prior authorization requirements and clinical criteria for coverage of Dupixent (dupilumab) across its FDA-indicated uses for West Virginia Bureau for Medical Services members. It applies to prescribers requesting PA for Dupixent under the payer's pharmacy prior authorization process.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2025-11-19Prior Authorization Criteria — Ebglyss (lebrikizumab-lbkz) for Moderate-to-Severe Atopic DermatitisPrior authorization criteria for coverage of Ebglyss (lebrikizumab-lbkz) for patients with moderate-to-severe atopic dermatitis, specifying prescriber qualifications, diagnostic documentation, prior topical therapy trials, age/weight eligibility, and approval durations.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2025-11-19Prior Authorization Criteria: Cibinqo (abrocitinib) for Atopic DermatitisPrior authorization criteria and approval rules for Cibinqo (abrocitinib) to treat adults with moderate-to-severe atopic dermatitis for West Virginia Bureau for Medical Services members.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2025-10-23Prior Authorization Criteria — Voxzogo (vosoritide)Prior authorization criteria and approval rules for Voxzogo (vosoritide) for pediatric patients with achondroplasia as administered by the West Virginia Bureau for Medical Services. Applies to providers seeking PA for this drug under the WV Medicaid program.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2025-05-21Nemluvio (nemolizumab-ilto) — Prior Authorization Criteria for Atopic Dermatitis and Prurigo NodularisDefines prior authorization criteria and reauthorization requirements for Nemluvio (nemolizumab-ilto) for treatment of moderate-to-severe atopic dermatitis in patients ≥12 years and prurigo nodularis in adults ≥18 years under West Virginia Bureau for Medical Services.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2025-02-26Alyftrek (deutivacaftor/tezacaftor/vanzacaftor) prior authorizationDefines prior authorization criteria, approval duration, and reauthorization requirements for Alyftrek for treatment of cystic fibrosis in patients aged 6 years and older, as used by West Virginia Bureau for Medical Services.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2025-02-26Criteria for Approval: Casgevy (exagamglogene autotemcel) Prior AuthorizationDefines prior authorization requirements and medical necessity criteria for one-time administration of Casgevy (autologous genome-edited HSC gene therapy) for patients with sickle cell disease (SCD) with recurrent vaso-occlusive crises and transfusion-dependent β-thalassemia (TDT), affecting providers and members seeking coverage under West Virginia Bureau for Medical Services.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2025-02-26Prior Authorization Criteria — Zurzuvae (zuranolone) for Postpartum DepressionPrior authorization criteria governing coverage of Zurzuvae (zuranolone) for treatment of postpartum depression in adults under the West Virginia Bureau for Medical Services; affects prescribers and prior authorization reviewers.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2024-12-01Continuous Glucose Monitors (Freestyle Libre & Dexcom) — Prior Authorization CriteriaPrior authorization criteria for coverage of specified continuous glucose monitors (CGMs) under West Virginia Medicaid, detailing initial approval, reauthorization, and special pediatric provisions. Applies to providers requesting CGM coverage for WV Medicaid members.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2024-11-13Prior Authorization Criteria — PCSK9 Inhibitors (REPATHA, PRALUENT)Prior authorization criteria and approval requirements for the PCSK9 inhibitor drugs REPATHA (evolocumab) and PRALUENT (alirocumab) for West Virginia Bureau for Medical Services members.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2024-11-13Prior authorization criteria for Opzelura (ruxolitinib) topicalDefines prior authorization requirements and clinical criteria for coverage of topical ruxolitinib (Opzelura) for mild to moderate atopic dermatitis in patients meeting FDA age indications, for West Virginia Bureau for Medical Services members.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthReimbursement/Payment PolicyEff. 2024-10-01CHAPTER 503 AND LICENSED BEHAVIORAL HEALTH CENTERS (LBHCS) — Appendix 503I.2 Service CodesThis chapter (503) governs service codes, billing forms, prior authorization notes, and cost-report inclusion for Certified Community Behavioral Health Clinics and Licensed Behavioral Health Centers under the West Virginia Bureau for Medical Services; it affects providers billing Medicaid for CCBHC/LBHC services.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-25Prior Authorization Criteria — Veozah (fezolinetant)Prior authorization criteria for Veozah (fezolinetant) for treatment of moderate to severe vasomotor symptoms due to menopause for members of West Virginia Bureau for Medical Services.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-25Prior Authorization Criteria — Winrevair (sotatercept-csrk)This document sets prior authorization criteria for Winrevair (sotatercept-csrk) for adults with WHO Group 1 pulmonary arterial hypertension (PAH) under West Virginia Bureau for Medical Services. It defines initial and continuation approval requirements and prescriber qualifications.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-25Prior Authorization Criteria — Xolair (omalizumab)Defines clinical prior authorization requirements, step therapy, and continuation criteria for Xolair (omalizumab) for WV Bureau for Medical Services members across indicated conditions (asthma, chronic idiopathic urticaria, nasal polyps, IgE-mediated food allergy). Affects prescribers requesting PA for Xolair.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-01Bone Density Testing (DXA and related modalities) — Coverage CriteriaDefines coverage, limitations, and non-covered bone density testing services for West Virginia Medicaid members, and outlines prior authorization and documentation requirements for providers.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2024-09-01CHAPTER 515: Occupational Therapy and Physical Therapy (Policy 515.1)Defines Medicaid coverage, limitations, provider qualifications, prior authorization, and settings for occupational and physical therapy services under West Virginia Medicaid.All West Virginia Bureau for Medical Services (Department of Human Services) updates
- Prior AuthClinical/Medical PolicyEff. 2024-07-01CHAPTER 505 ORAL HEALTH SERVICES — Covered Services (505.1)Defines West Virginia Medicaid coverage, provider requirements, prior authorization, documentation, and limits for oral health services for members, including special rules for those under and over age 21.All West Virginia Bureau for Medical Services (Department of Human Services) updates
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Tool Description
Search West Virginia Bureau For Medical Services (Department Of Human Services)prior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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