Precertification list change notification

The following services will be added to precertification for the effective dates listed below.

To obtain precertification, providers can access Availity Essentials or call the Utilization Management department using the number on the back of the member’s identification card. Service preapproval is based on member’s benefit plan/eligibility at the time the service is reviewed/approved.

Precertification can help avoid unnecessary charges or penalties by helping to ensure that the member's care is medically necessary and administered at an appropriate network facility and by a network provider.

Add to precertification

Criteria	Criteria description	Code	Effective date
SURG.00096	Surgical and Ablative Treatments for Chronic Headaches	64722	October 1, 2024