Outpatient Authorization Changes

Effective January 19, 2009, the following services do not require prior authorization:

Services Codes
Dialysis 90918-90925, 90935-90940, 90945-90999
Diagnostic Testing – Cardiac  
Exercise Treadmill Test (ETT) 93015, 93016, 93017, 93018
Cardiography (ECG) 93000-93278
Transesophageal Echocardiogrphy (TEE) 93312-93318
Doppler Echocardography 93320-93325
Angioplasty (PTCA) 92982-92998
Intracardiac Electrophysiological Procedures (Arrythmia Inductions, Mapping and Ablation) 93600-93662
Pacemaker Studies 93724-93744
Vascular Diagnostic Studies (non-invasive) of extremities 93922-93971; 93990
Diagnostic Testing- Pulmonary  
Spriometry and Other Pulmonary Function testing 94010-94621
Diagnostic Testing- Neurology  
EEG 95812-95830
Monitoring for identification and lateralization of seizure disorders 95950-95953; 95956
Procedures- Endoscopic  
Proctosigmoidoscopy/Sigmoidoscopy 45300-45345
Colonoscopy 45355-45387;45391;45392
EDG 43200-43259
ERCP 43260-43272
Misc. Endoscopy (small intestine, stomal, anus, biliary tract) 44360-44397; 46600-46615; 47550-47556
Bronchoscopy 31622-31656
Sinus Endoscopy 31231-31294
Laryngoscopy 31505-31579
Fetal non-stress test 76818, 76819, 59025
Dermatologist 10060,10061, 10140, 11055-11057, 11100, 11101,11300-11313, 11400-11404, 11420-11424, 11440-11444, 11755, 17000-17004, 17110, 17111, 17260-17264, 17270-17274, 17280-17284, 40490, 46916, 46924, 54056, 54065, 56501, 56515, 67810, 69100, 87101, 872220, 90782, 96902, J3301, Q0111, Q0112
Durable Medical Equipment Limit $270 PA limit
Maternity/Obstetrics

No PA for normal Maternity delivery and well newborn inpatient stay with discharge within the 2 days (vaginal) and 4 days (C-section-type delivery).

Mercy Care will conduct retrospective reviews and recoup any payments exceeding the 2- or 4-day requirements, unless prior authorized.

4350 E. Cotton Center Blvd.,
Bldg D, Phoenix,
Arizona 85040
Member Services
7 a.m. to 6 p.m. Monday-Friday
602-263-3000,
Toll-free 1-800-624-3879
(TTY/TDD)
Toll-free: 1-866-602-1982

If you or a family member has a medical emergency, dial 911.