Prior Auth Required

11033 - Evaluation Attachment, F

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceEvaluation Attachment, F
Procedure / Service Description

Health and/or Substance Abuse - by submitting the PA/EA (Mental Health and/or Substance Abuse Evaluation Attachment, F-11033 (07/12)) with the PA request. * The list of ICD-9-CM diagnosis codes for substance abuse day treatment is inclusive. However, not all Medicaid-covered

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.