Prior Auth Required

11136 - o Personal Care Addendum (Form F- ) when applicable

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / Serviceo Personal Care Addendum (Form F- ) when applicable
Procedure / Service Description

• All PA requests for personal care worker (PCW) services must include - o Personal care screening tool (PCST) (Form F-11133) completed per instructions; o Personal Care Addendum (Form F-11136) when applicable; o Registered Nurse (RN)-developed plan of care (POC) reflecting orders, task, and service frequencies;

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.