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- 2022 Prior Authorization List for Florida
2022 Prior Authorization List for Florida
Providers: For the quickest turnaround on prior authorizations, use Availity. You can find the login link and instructions in the "Using Availity" section of our Providers page.
Members: Your provider usually handles prior authorizations for you. If you need any help, call us at 1-800-338-6833, TTY 711.
The services and items listed below require prior authorization.
Behavioral Health
Contact our behavioral health partner, Magellan Healthcare (1-800-776-8684), about prior authorizations for:
- Electroconvulsive therapy (ECT)
- Transcranial magnetic stimulation (TMS)
Cardiac Devices
- Defibrillators (implantable)
- Left atrial appendage closure (LAAC) device, such as The Watchman
- Loop recorders
- Ventricular assist devices
- Wearable cardiac devices, such as Lifevest
Cardiac Diagnostic Testing
- Electrophysiology study (EPS)
- EPS with 3D mapping
- Myocardial perfusion imaging SPECT
- Nuclear stress test
- Transesophageal echocardiogram (TEE)
Cardiac Procedures and Surgeries
- Cardiac ablation
- Cardiac catheterizations (elective)
- Cardiac resynchronization therapy
- Outpatient coronary angioplasty/stent
- Transcatheter valve surgeries (TAVR)
Cosmetic and Plastic Surgery
- Abdominoplasty
- Blepharoplasty
- Breast procedures (except for mastectomy, reconstruction after mastectomy, and any cancer-related breast procedures)
- Gynecomastia surgery
- Panniculectomy and redundant skin tightening
- Rhinoplasty
Dental
In general, you don't need a prior authorization for dental care. We suggest that you always ask for a cost estimate before you receive dental services.
Diagnostic Imaging
- MRA
- MRI
- PET Scan
- SPECT
Durable Medical Equipment (DME)
Contact our DME partner, Integrated Home Care Services (1-844-215-4264), about prior authorizations for:
- Any DME that is not listed below and where the single purchase price or a rental over 13 months is more than $750
- Bariatric equipment (greater than 300 pounds)
- Bone growth stimulator
- Custom or specialized wheelchairs and scooters
- Neuromuscular stimulator
- Portable oxygen concentrator
- Prosthetic devices
- Specialty beds
- Ventilators covered by Medicare
- Wound vac
Home Healthcare
Contact our home healthcare partner, Integrated Home Care Services (1-844-215-4265), about prior authorizations for:
- Home healthcare
- Home infusion
Inpatient Admissions
- Acute hospital
- Acute rehab facility
- Long-term acute care (LTAC)
- Skilled nursing facility (SNF)
Please contact our behavioral health partner, Magellan Healthcare (1-800-776-8684), about prior authorizations for:
- Mental health/Substance abuse
- Partial hospitalization (PHP)
Medicare Part B Drugs
Prior authorization list for Medicare Part B drugs
Observation
No prior authorization needed, but make sure to let us know about it.
Oncology
- Chemotherapy, supportive drugs, and symptom management drugs
- Radiation therapy
Other Surgery
- Cochlear and auditory brainstem implants
- Gender dysphoria surgery
- Obesity surgery, such as gastric bypass
- Oral, orthognathic, temporomandibular joint surgeries
- Orthopedic (hip, knee, shoulder arthroscopy)
- Surgery for obstructive sleep apnea
- Transplant surgeries
- Varicose veins: surgical treatment and sclerotherapy
Outpatient Diagnostic Testing
- Facility-based sleep studies (PSG)
- Infertility testing and treatment
- Molecular diagnostic and genetic testing
Outpatient Therapy
- Hyperbaric therapy
Spine
- Epidural injections (outpatient)
- Facet injections
- Kyphoplasty
- Neurostimulators
- Spinal cord stimulator
- Spinal decompression surgery
- Spinal fusion
- Vertebroplasty
Vision care
- Ophthalmologic services
Wound Therapy
- Negative pressure wound therapy (NPWT)
Other Services
- Experimental procedures, services, or devices
- Non-emergency ambulance services
- Out-of-network services and care (In most cases, members need to see in-network providers. But for special cases, they can request a prior authorization to see if we'll cover out-of-network care.)
No prior authorization needed for the following services, but make sure to let us know about them:
- Clinical trials
- Out-of-area dialysis at a Medicare-certified facility