WebInitial Authorization Criteria ALL of the following are met: • Age 18 years or older • Diagnosis of chronic migraine headache as defined by 15 days or more per month with headache lasting four hours a day or longer • Documentation of ONE of the following: o Failure following a minimum 8 week trial of TWO migraine Webof the following (A and B): A. Euflexxa (1% sodium hyaluronate) [may require prior authorization] B. Durolane (hyaluronic acid) OR. Gelsyn-3 (high molecular weight hyaluronan) [may require prior authorization] 2. Individual meets both of the following (A and B): A. The request is for product that requires more than one inj ection to

Cigna Medical Coverage Policies – Sleep Disorders Diagnosis …

WebTo better serve our providers, business partners, and patients, to Cigna Coverage Examine Province is transitioning from PromptPA, fax, and phone coverage revue (also called before authorizations) toward Electronic Prior Authorizations (ePAs). ePAs save time and help patients receive their therapies speedier. Webradiation therapy (IMRT) Prior Authorization Required G6015 G6016 77385 77386 Proton Beam TherapyPrior Authorization Required 77520 77522 77523 77525 Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) Prior Authorization Required 77371 77372 77373 G0173 G0251 G0339 G0340 2024 WellMed Medical … chr seal

Prior Authorizations & Precertifications Cigna

WebRadiation Therapy (Oncology) The terms of an individual's particular coverage plan document [Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD), or similar plan document] may differ significantly from the standard coverage plans upon which these guidelines are based. WebFor information on how to submit a preauthorization for frequently requested services/procedures for your patients with Humana commercial or Medicare coverage, please use the drop-down function below. For all other services, please reference the inpatient and outpatient requests to complete your request online or call 800-523-0023. WebYou asked for an exception to our plan's utilization management tools—such as dosage limits, batch set, past authorization requirements, or step therapy requirements. Asking for an exception to a utilization admin tool is a type of formulary extra. NON-FORMULARY EXCEPTION MAKE; You ask for a non-preferred drug at the favored cost-sharing floor. chrs emmaus bacalan