TO:                 HOSPITAL AND PHYSICIAN PROVIDERS

FROM:           PAMELA MASON, Acting Bureau Chief

                        Bureau of Medicaid Programs and Resource Management

Hospitals:       As of July 01, 2001, the following ICD-9 procedure codes will require prior authorization from The Department.

85.53  Unilateral breast implants

85.96  Removal of breast tissue expander

Physicians:    As of July 01, 2001, the following CPT procedure code will require prior authorization from The Department. 

                        11970             Replacement of tissue expander with permanent prosthesis

If you have any questions in regard to this Information Release, please contact Colleen Osborn at (208) 364-1923 or Esther Ussing at (208) 364-1835.

Thank you for your continued participation in the Idaho Medicaid Program.