TO:                         HOSPITALS, AMBULATORY SURGICAL CENTERS, PHYSICIANS AND PHYSICIAN ASSISTANTS

FROM:                   RANDY W. MAY, Deputy Administrator

                                Division of Medicaid 

Effective June 1, 2001, Cholecystectomy and Coronary Bypass surgeries will no longer require prior authorization from either the Department or PRO-West. Refer to the attached Select Pre-Authorization List for the specific ICD-9 and CPT codes.

Effective June 1, 2001, the following ICD-9 codes will be added to the Select Pre-Authorization List for review by PRO-West: Arthrodesis (Spinal Fusion) 78.59, Laminectomy/Diskectomy 03.1,and 03.6.

Effective June 1, 2001, prior authorization requests for surgeries for Abdominoplasty and Panniculectomy, will no longer be reviewed by PRO-West, but will instead be reviewed by the Department’s Medical Consultant. Refer to the attached Select Pre-Authorization List for the specific ICD-9 and CPT codes.

All requests for pre-approval from the Department should include the following:

·         Requesting and performing provider name, Medicaid provider number and phone number

·         Client name and Medicaid ID number

·         CPT codes and description of procedure requested

·         Expected date of surgery and location (inpatient, outpatient and facility name)

·         Justification and supporting documentation for medical necessity of the surgery

Send or FAX requests to:

Division of Medicaid

                                Attention: Medical Consultant Review

                                PO Box 83720

                                Boise, ID 83720-0036

                                                FAX 208 364-1846

V-Codes That May be Used for Principal Diagnoses

Following is an updated list of approved V-Codes, which can be used, if appropriate, as the principal diagnosis code for preauthorizaton and concurrent review purposes.

Questions regarding requests for Department authorizations may be directed to Bonnie Rhoades at 208 364-1839.  Questions regarding PRO-West authorization or contract issues contact Arlee Coppinger at 208 334-5754.