Spinal injections performed by neurosurgeons and orthopedic surgeons do not require prior authorization. Medical necessity criteria added for lumbar and thoracic surgeries. Defined conservative management and criteria for waiver of conservative management. Any disagreement with official reports of advanced imaging studies (CT, MRI and myelograms) require documentation by the surgeon in the medical records. Updated CPT code listing to include parent codes.
For urgent questions about QualChoice Medical Coverage Policies, please fax a completed Predetermination Request Form for each patient to 844.501.2830.