Prior Auth Required

96161 - same CPT® code and will be reimbursed at $225. You can complete the ePAFs electronically in the Quality Care Rewards

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / Servicesame CPT® code and will be reimbursed at $225. You can complete the ePAFs electronically in the Quality Care Rewards
Procedure / Service Description

A full medical necessity review and collaborative discharge planning activities will be conducted to best support our members. - Nonstandard Provider Assessment Forms Discontinued in 2024 Beginning in 2024, only Electronic Provider Assessment Forms (ePAFs) will be accepted. These forms can be billed with the same CPT® code 96161 and will be reimbursed at $225. You can complete the ePAFs electronically in the Quality Care Rewards tool (QCR) or complete them by hand and upload them to the QCR. You can also fax them to 877-922-2963.

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.