March 3, 2022

Beginning April 4, 2022, the following services will require prior authorization for our Medicare Advantage plans.

New additions to prior authorization requirement

Testosterone replacement

Pneumatic compression devices

IV iron therapy

Spinal cord stimulators for chronic pain

Left atrial appendage closure devices

Electronic bone growth stimulators

You can the medical policies for these services here.

Medicare Advantage prior authorization

Prior authorization is a process used to determine if a requested service is medically necessary. Currently, Medicare Advantage requires prior authorization for the following services:

• Durable medical equipment (including powered mobility)
• All inpatient admissions
• Dialysis treatment (initial)
• Non-emergent transportation
• 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
• Facility-based polysomnography
• Bariatric surgery
• Inpatient level of care for non-emergency surgery
• Behavioral health services
• Life Vest – external cardiac defibrillators
• Trans-catheter aortic valve replacement

View the list of medications and CPT/HCPCs codes associated with the above-mentioned services here.

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

Behavioral health services are managed by Companion Benefit Alternatives (CBA), a separate company that offers behavioral health benefits on behalf of BlueCross BlueShield of South Carolina. 

If you have any questions, please contact the provider education team using the Provider Education Contact Form.