WSR 12-11-003

INTERPRETIVE OR POLICY STATEMENT

HEALTH CARE AUTHORITY


[ Filed May 2, 2012, 4:41 p.m. ]


Notice of Interpretive or Policy Statement


In accordance with RCW 34.05.230(12), following is a list of policy and interpretive statements issued by the health care authority (HCA).

HCA

Legal and Administrative Servcies [Services]



Document Title: Provider Notice #12-24.

Subject: Physician-related services/healthcare professional services.

Effective Date: April 1, 2012.

Retroactive to dates of service on and after April 1, 2012, the medicaid program of the HCA has published a revised physician-related services/healthcare professional services medicaid provider guide with updates and new information as follows:


Submitting authorization requests through Qualis Health for selected surgical procedures and spinal injections;
Surgical codes that require prior authorization (PA) through the HCA;
New information regarding surgeries of the uterus;
Updates to the expedited prior authorization (EPA) criteria coding list with added codes for hysterectomies;
New information regarding surgical assistant and cosurgeons;
Updated criteria for computed tomography angiography (CTA) and medical necessity;
Forms available to submit authorization requests for Prolia (Denosumab inj.); and
New information regarding electronic submission of photos and X-rays.

For additional information, contact Amber Dassow, HCA, P.O. Box 45504, phone (360) 725-1349, TDD/TTY 1-800-848-5429, fax (360) 586-9727, e-mail dassoal@hca.wa.gov, web site http://www.hca.wa.gov/.

Washington State Code Reviser's Office