Nov. 23, 2021

Currently, Medicare Advantage requires prior authorization for durable medical equipment, all inpatient admissions, dialysis treatment, non-emergent transportation, and behavioral health services.

Beginning Jan. 1, 2022, the following services will be included in the prior authorization requirements:

• Medications covered under Medicare Part B – including, but not limited to visco-supplementation for knee osteoarthritis (hyaluronan), monoclonal antibody treatments and other biologicals for multiple sclerosis, rheumatoid arthritis, psoriasis, inflammatory bowel disease, or chronic migraines.

• Continuous glucose monitors – including, but not limited to the Dexcom and Freestyle Libre systems.

• Powered mobility – including, but not limited to electric wheelchairs and scooters.

• Durable medical equipment (DME) – including, but not limited to prosthetics, orthotics, braces, and walkers in the amount of $250 or more.

• Facility-based polysomnography (sleep study) – unsupervised home studies are preferred unless there are specific complicating factors requiring sleep lab monitoring.

• Bariatric surgery

• Life Vest – external cardiac defibrillators

• Inpatient level of care for non-emergent surgery

Methods for Requesting Prior Authorization

Medical Services

• My Insurance Manager℠
• Phone: 855-843-2325
• Fax: 803-264-6552

Behavioral Health Services

• Online: www.CompanionBenefitAlternatives.com
• Phone: 800-868-1032

If you have any questions, please contact Provider Education using the Provider Education Contact Form located on www.SouthCarolinaBlues.com.