Effective September 1, 2017, Mercy Care Plan and Mercy Maricopa will change the way unlisted and non-specific CPT and HCPCS codes are reviewed and paid.
With a few exceptions listed below, these codes will no longer be managed through the prior authorization process. They will be managed
at the time of claim submission. That is, records supporting the use of these codes must be submitted with the claim. These claims will pend to our AMA Edit Team who will review for:
- Experimental/Investigational status per relevant Clinical Policy Bulletins; and
- Medical necessity applying relevant criteria; and
- Assignment of a more appropriate specific code if one exists; or
- Approval to pay as submitted.
Codes not included in the process change are:
- 41899 - General Anesthesia for dental procedures - Prior Authorization Required
- E1399 and K0108 - wheelchair components and services -Prior Authorization Required
- 90999 - unlisted dialysis procedure - Prior Authorization Required
- Unlisted J codes - Prior Authorization Required
Thanks for all you do!