Medicaid Prior Authorization Updates: Effective July 1, 2025
04/03/2025,
Effective July 1, 2025, the following codes will require prior authorization to be submitted to WellCare of Kentucky:
- 31295: Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa
- 64450: Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch
- 31296: Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium
- L8686: Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension
The following codes will no longer require prior authorization:
- 97606: Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters
- 97605: Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters
If you have questions, please contact Provider Services.