Prior Auth Required

20276 - This policy may also apply in part to Partnership Advantage, the HealthPlan’s Medicare product effective Jan. 1, in

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceThis policy may also apply in part to Partnership Advantage, the HealthPlan’s Medicare product effective Jan. 1, in
Procedure / Service Description

Pharmacotherapy should be individualized to the particular patient. This guideline cannot cover - 1 This policy may also apply in part to Partnership Advantage, the HealthPlan’s Medicare product effective Jan. 1, 20276 in eight counties: Del Norte, Humboldt, Mendocino, Lake, Marin, Sonoma, Napa, and Solano, and may be subject to change based on Centers for Medicare and Medicaid Services (CMS) rules.

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.