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
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All hematology/oncology services
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Hyperbaric treatment
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Orthotic & prosthetic appliances over $500
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Radiology services: CT/CTA, Discography, MRI/MRA, PET Scans
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Varicose veins
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TMJ procedures orthognathic surgery
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All biologic injections/infusions
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Botox injections
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Rhinoplasties
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Any spinal injections or procedures
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Home health and home infusion services
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All skilled services in a home setting
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Inpatient
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All inpatient admissions (except 2-day Vaginal Deliveries and 4-day Cesarean Sections)
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All admissions to skilled nursing, acute rehabilitation, and long-term acute care facilities
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Outpatient hospital
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Hyperbaric treatment
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Radiology services: CT/CTA, Discography, MRI/MRA, PET Scans
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Hematology/oncology services
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Physical, speech, and occupational therapies
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Sleep studies
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All surgery & invasive diagnostic procedures performed in surgery area (except colonoscopy/sigmoidoscopy)
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Ambulatory surgery center
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All outpatient surgery or procedures (except colonoscopy/sigmoidoscopy)
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Additional services
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All transplant services (including consults)
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All genetic testing
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All air ambulance transports
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Sleep Studies
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Autism Treatment, including Applied Behavioral Analysis (ABA) Therapy [EPO only]
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Durable Medical Equipment items over $500 (whether rented or purchased)
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All clinical trials
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Enteral list formulas/food (but note that only the EPO plan covers these services)
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Neuromonitoring
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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.
