Most prior authorizations for surgeries for Medicaid participants are provided through Qualis Health. Please see the ICD-9 list of procedures and diagnoses requiring prior authorization from Qualis Health or the ICD-10 list of procedures and diagnoses requiring prior authorization from Qualis Health to determine if you should request a prior authorization from them.
The Medical Care Unit reviews and provides prior authorization for a small number of surgeries and other procedures. Please see the list of surgeries requiring prior authorization from Medicaid’s Medical Care Unit to see the most common surgeries Medicaid prior authorizes. For a full list of surgeries see the Medicaid fee schedule.
To determine whether or not a surgery or procedure requires a Prior Authorization, please see the current Medicaid Fee Schedule. Providers are asked to submit a request to either Qualis Health or Medicaid’s Medical Care Unit, but not both. For more information on how to check the Fee Schedule, please see the FAQ document in the right hand column of this page.
Frequently Asked Questions
Many questions can be answered by checking the FAQ document in the right hand column of this page. This document also will provide you with the information on how to submit prior authorization request forms to Qualis Health or Medicaid’s Medical Care Unit.