Prior Auth Required

51348 - Comprehensive Perinatal Services Program (CPSP) – Per Title 22, Section , all contracted providers

This procedure appears on the selected insurer prior authorization source.

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Procedure / ServiceComprehensive Perinatal Services Program (CPSP) – Per Title 22, Section , all contracted providers
Procedure / Service Description

services for Alliance members. - consent for sterilization or a hysterectomy. Providers are free to duplicate this form and add their letterhead. For additional information, please see Policy 404-1401 – Sterilization Consent Protocol. Comprehensive Perinatal Services Program (CPSP) – Per Title 22, Section 51348, all contracted providers must perform a comprehensive risk assessment for all pregnant members that is comparable to the American Congress of Obstetricians and Gynecologists (ACOG) and CPSP standards. The Providers can use these forms

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.