Prior authorization request form Form

Questions? Please call the Alliance Pharmacy Department Monday – Friday, 7:30 am – 5 pm Phone Number: 1.510.747.4541 www.alamedaalliance.org OPUM_PODIATRY AUTH UPDATE 10/2022. FAXED 11/11/2022 Important Update: Podiatry Codes that Require Authorization Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important update we would like to share with you.
Our provider partner satisfaction is a top priority. We are working to improve our Utilization Management and Claims processes to help ensure proper claim payment to our provider partners, and alignment of authorized services. To accomplish this goal, we are reviewing each benefit and we will be sending you updates, as the information is ready to share.
This communication provides an update on podiatry codes that require prior authorization (PA).
This will affect claims with the date(s) of service starting Thursday, December 15, 2022, and onward. Enclosed with this notice is a code-specific list of podiatry codes that shows which codes require PA. The list can also be found on our website at www.alamedaalliance.org/providers/authorizations. Please refer to our website for the most up-to-date information about codes or benefits that require authorization.
In addition to the codes, our claims system will also validate that the claims received match the authorization when an authorization is required. The following items will be validated • Member name • Provider NPI • CPT and HCPC coding • Date(s) of service are within the authorized range • Number of units and/or visits • Place of service matches the site of care submitted on the authorization request form This update has been validated based on current publishable/billable coding for 2022 and was confirmed to be covered by the California Department of Health Care Services (DHCS).
If you have any questions, please call the Alliance Provider Services Department at 1.510.747.4510. Thank you for your continued partnership and for providing high-quality care to our members and the community.

SERVICE CATEGORY PROCEDURE CODE PROCEDURE CODE DESCRIPTION SUBMIT AUTHORIZATION REQUEST TO 28285 REPAIR OF HAMMERTOE Alameda Alliance for Health or Delegate 28286 REPAIR OF HAMMERTOE Alameda Alliance for Health or Delegate 28288 PARTIAL REMOVAL OF FOOT BONE Alameda Alliance for Health or Delegate 28289 CORRJ HALUX RIGDUS W/O IMPLT Alameda Alliance for Health or Delegate 28291 CORRJ HALUX RIGDUS W/IMPLT Alameda Alliance for Health or Delegate 28306 INCISION OF METATARSAL Alameda Alliance for Health or Delegate 28307 INCISION OF METATARSAL Alameda Alliance for Health or Delegate 28308 INCISION OF METATARSAL Alameda Alliance for Health or Delegate 28315 REMOVAL OF SESAMOID BONE Alameda Alliance for Health or Delegate 28360 RECONSTRUCT CLEFT FOOT Alameda Alliance for Health or Delegate 28899 FOOT/TOES SURGERY PROCEDURE Alameda Alliance for Health or Delegate L2006 KAF DVC ANY MATERIAL ADJ CUSTOM FAB Alameda Alliance for Health or Delegate L3000 FT INSRT MOLD UCB TYPE BERKLY SHELL Alameda Alliance for Health or Delegate L3160 FOOT ADJUSTBL SHOE-STYLD PSTN DEVC Alameda Alliance for Health or Delegate ALAMEDA ALLIANCE FOR HEALTH REFERRAL AND PRIOR AUTHORIZATION (PA) PROCEDURE CODES FOR PODIATRY Before services are provided, please check: Member Eligibility ▪ Medical Group ▪ Benefit Coverage ▪ Contracted Provider ▪ Medi-Cal Excluded Code Questions? Please call the Alliance Provider Services Department at 1.510.747.4510 Podiatry Please note: This list does not include all services. Page 1 of 1 PS_PODIATRY PROC CODES REQ PA 10/2022