Plumbers, Pipefitters, and Service Technicians, Local 525 prior authorization rules

Prior authorization rules by place of service

For Prior Authorization, please contact NEVADA HEALTH SOLUTIONS:
Telephone: 702-216-1653
Toll Free: 855-487-0353
Fax: 866-201-5601
https://www.nevadahealthsolutions.org

Prior authorization is required for:

In Office or Freestanding Facility

All hematology/​oncology services
Hyperbaric treatment
Orthotic & prosthetic appliances over $500
Radiology services: CT/CTA, Discography, MRI/MRA, PET Scans
Varicose veins
TMJ procedures orthognathic surgery
All biologic injections/​infusions
Botox injections
Rhinoplasties
Any spinal injections or procedures

Home health and home infusion services

All skilled services in a home setting

Inpatient

All inpatient admissions (except 2-day Vaginal Deliveries and 4-day Cesarean Sections)
All admissions to skilled nursing, acute rehabilitation, and long-term acute care facilities

Outpatient hospital

Hyperbaric treatment
Radiology services: CT/CTA, Discography, MRI/MRA, PET Scans
Hematology/oncology services
Physical, speech, and occupational therapies
Sleep studies
All surgery & invasive diagnostic procedures performed in surgery area (except colonoscopy/​sigmoidoscopy)

Ambulatory surgery center

All outpatient surgery or procedures (except colonoscopy/​sigmoidoscopy)

Additional services

All transplant services (including consults)
All genetic testing
All air ambulance transports
Sleep Studies
Autism Treatment, including Applied Behavioral Analysis (ABA) Therapy [EPO only]
Durable Medical Equipment items over $500 (whether rented or purchased)
All clinical trials
Enteral list formulas/food (but note that only the EPO plan covers these services)
Neuromonitoring

This table is only a general guideline to Plumbers & Pipefitters Service Technicians Local 525 Plan prior authorization requirements. This list may be updated from time to time. It is the provider’s responsibility to check for updates. If the procedure billed is not the procedure approved, there may be no payment and the patient is not liable. The presence or absence of a procedure code and/or service on this list does not determine benefits or coverage for your patient. Verification of benefits and eligibility should be obtained by calling BeneSys at 844-763-3228.