Prior authorization update for prosthetics

Point32Health is pleased to share that we have reevaluated our utilization management criteria related to upper and lower limb prosthetic devices, and will now only require prior authorization for microprocessor/complex components of prosthetics. 

Prior authorization is no longer required for the standard prosthetic build codes indicated on this document. 

We’ve updated the following Medical Necessity Guidelines to reflect this change: 

• Lower Limb Prostheses Medical Necessity Guidelines (Commercial and Public Plans)
• Upper Limb Prostheses Medical Necessity Guidelines (Commercial and Public Plans)
• Tufts Medicare Preferred (HMO and PPO) Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines
• Tufts Health Senior Care Options Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines