Prior Auth Required

14525 - • Meets eligibility and medical necessity criteria contained in Sections (a), (c), (d) and (e)

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Service• Meets eligibility and medical necessity criteria contained in Sections (a), (c), (d) and (e)
Procedure / Service Description

To qualify for CBAS services, members must be over the age of 18 and meet one of the following specific - Category 1: Nursing Facility-A (NF-A) level of care or above: • Has been determined by DHCS to meet the NF-A level of care or above, and • Meets eligibility and medical necessity criteria contained in Sections 14525(a), (c), (d) and (e); 14526.1(d)(1), (3), (4) and (5); and 14526(e) of the W&I Code (summarized in a. through e. below): o The individual is 18 years of age or older and has one or more chronic or post-acute medical,

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.