Good news: Your Devoted benefits are not affected by the government shutdown. If you have a Food & Home Card, your November funds are on your card just like usual.

Navigated to 2026 Prior Authorization List page

2026 Prior Authorization List

Members: Your provider usually handles prior authorizations for you. If you need any help, call us at 1-800-338-6833, TTY 711.

Note: If you have an HMO plan and an Advocate Physician Partners (APP) primary care provider, APP will manage your prior authorizations.

The services and items listed below require prior authorization on all Devoted Health plans. If needed, you can review our coverage criteria here:

Internal coverage criteria for medical services

Internal coverage criteria for Part B drugs

For services managed by our partners, see the list below for links to coverage criteria.

Behavioral Health

  • Transcranial magnetic stimulation

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 Procedures and Surgeries

  • Cardiac ablation
  • Cardiac catheterizations (elective)
  • Outpatient coronary angioplasty/stent
  • Transcatheter valve surgeries (TAVR)
  • Cardiac Resynchronization Therapy

Cosmetic and Plastic Surgery

  • Abdominoplasty
  • Blepharoplasty
  • Breast augmentation procedures (except for mastectomy, reconstruction after mastectomy, and any cancer-related breast procedures)
  • Gynecomastia surgery
  • Panniculectomy and redundant skin tightening
  • Rhinoplasty

Dental

If your plan offers dental coverage through the Liberty Dental or Devoted Dental network, you may need prior authorization for certain services related to:

  • Crowns
  • Root canals
  • Gum surgery
  • Deep cleanings
  • Dentures
  • Bridges
  • Extractions and oral surgery
  • Nitrous oxide (laughing gas)
  • Nightguards

See a detailed list of dental codes that require prior authorization

If your plan has a dental benefit card or dental allowance, you do not need prior authorization.

Even when prior authorization isn’t required, we always recommend that you ask for a cost estimate before you get any dental care.

Diagnostic Imaging

  • MRA
  • MRI
  • PET Scan
  • SPECT

Diagnostic Testing

  • Electrophysiology study (EPS)
  • EPS with 3D mapping
  • Myocardial perfusion imaging SPECT
  • Nuclear stress test
  • Transesophageal echocardiogram (TEE)

Durable Medical Equipment (DME)

To get prior authorization on the items below for members in Arizona, Colorado, Florida, Georgia, North Carolina, Ohio, Oregon, South Carolina, Tennessee, and Washington, call Integrated Home Care Services at 1-844-215-4264. Note that when reviewing prior authorization requests, Integrated Home Care Services uses National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and other Medicare guidelines.

For members in all other states, call us directly at 1-800-338-6833 (TTY 711).

  • Any DME (not listed below) that costs more than $750 based on Medicare allowable amount
  • Bariatric equipment (greater than 300 pounds)
  • Bone growth stimulator
  • Custom or specialized wheelchairs and scooters
  • Diabetes testing supplies
  • Portable oxygen concentrator
  • Prosthetics *please call Devoted for prior authorization
  • Specialty beds
  • Ventilators covered by Medicare
  • Wound vac

Home Healthcare

To get prior authorization on the services below for members in Arizona, Colorado, Florida, Georgia, North Carolina, Ohio, Oregon, South Carolina, Tennessee, and Washington, call Integrated Home Care Services at 1-844-215-4264, , fax: 1-844-215-4265.

For members in all other states, call us directly at 1-800-338-6833 (TTY 711).

  • Home health care
  • Home infusion

Inpatient Admissions

  • Acute hospital
  • Acute rehab facility
  • Long-term acute care (LTAC)
  • Mental health/Substance abuse
  • Partial hospitalization (PHP)
  • Skilled nursing facility (SNF)

Medicare Part B Drugs

2026 prior authorization list for Medicare Part B drugs

You can also review our internal coverage criteria for part B drugs.

Observation

No prior authorization needed, but make sure to let us know about it.

Oncology

For all members, call OncoHealth at 1-888-916-2616, extension 806. Learn about OncoHealth's internal coverage criteria.

  • Chemotherapy, supportive drugs, and symptom management drugs
  • Radiation therapy

Other Surgery

  • Cochlear and auditory brain stem 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

Outpatient Therapy

  • Hyperbaric therapy

Spine

  • Epidural injections (outpatient)
  • Facet injections
  • Kyphoplasty
  • Neurostimulators
  • Spinal cord stimulator
  • Spinal decompression surgery
  • Spinal fusion
  • Vertebroplasty

Wound Therapy

  • Negative pressure wound therapy (NPWT)

Other Services

Prior authorization required
The following services require prior authorization:

  • Non-emergency ambulance services
  • Non-emergency medical transportation, like rides to the doctor (this benefit is not available on all plans)
  • Vision care (some ophthalmologic services only)
  • Experimental procedures (category III CPTs)

Update requested
The following services don't require prior authorization but make sure to let us know about them:

  • Clinical trials
  • Out-of-area dialysis at a Medicare-certified facility