Prior Auth Required

34187 - JO15493 -200-1906

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceJO15493 -200-1906
Procedure / Service Description

WPS Health Insurance Arise Health Plan Aspirus Arise - Last Updated: 06/2019 Page 2 of 2 ©2019 Wisconsin Physicians Service Insurance Corpozration, WPS Health Plan, Inc., and Aspirus Arise Health Plan of Wisconsin, Inc. All rights reserved. JO15493 34187-200-1906 Children’s Community Health Plan (CCHP)

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.