Pain Management Pre-Authorization Requirements

Pain Management Pre-Authorization Requirements

by abilling, May 1, 2013

Each insurance company has a pre-authorization list for services requiring pre-authorization prior to services being rendered.  We highly suggest you look at these lists for each payer on a regular basis, as they do change.

Generally speaking, anesthesia services do not need to be individually pre-authorized, as the services ‘fly on the coat tail’ of the procedural pre-authorization.  Pain management services, however, are generally the procedure, and therefore are handled differently.  Although, the below insurance companies is not an all-inclusive list of those requiring pre-authorization on pain management, we would like to bring your attention to these:

 Coventry Health Care – Coventry requires all pain management services, excluding trigger points, be pre-authorized.  This is the case with all Coventry Products, including Commercial and Medicare Advantage.

When getting pain management services pre-authorized, Coventry has instructed getting these authorized under the group NPI, rather than by the individual provider.  They stated each individual has been loaded under the group in their system, therefore, need to be authorized accordingly under the group.

 KanCare – With the switch over from Kansas Medicaid, administered by the State of Kansas, to Managed Care, please be aware pain management services are now required to be pre-authorized for Amerigroup and Sunflower Health Plan members (United Healthcare is not requiring pre-authorization at this time for pain management.).  This was not a requirement when the State administered benefits; however, it is now a requirement, at least for two of the Plans.



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Reasonable attempts have been made to be accurate.  However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ.  Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations.  For information specific to your practice, consult a qualified professional.

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