Prior Auth Required

10146 - (Form CMS- ) which will include the denial reason and appeal rights

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Service(Form CMS- ) which will include the denial reason and appeal rights
Procedure / Service Description

D drug is denied, the provider will receive a Notice of Denial of Medicare Part D Prescription Drug Coverage - Coverage Determinations, Redeterminations, and Reconsiderations. If a Coverage Determination for a Part D drug is denied, the provider will receive a Notice of Denial of Medicare Part D Prescription Drug Coverage (Form CMS-10146) which will include the denial reason and appeal rights. H9869_PHP Provider Manual_2025 | 169

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.