Medicare will require Prior Authorization of Non-Emergent (HBO) Therapy in 2015

-By Roque Wicker

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CMS has just announced that starting March 2015 three states (Illinois, Michigan, and New Jersey) will be required to get “Pre-authorizations” for the next three years for non-emergent hyperbaric treatments for the following indications:
1. Chronic refractory osteomyelitis
2. Diabetic lower extremity wounds (Wagner 3 and above).
3. Osteoradionecrosis.
4. Preparation and preservation of compromised skin grafts and flaps.
5. Soft tissue radionecrosis.
6. Actinomycrosis.
The decision was made due to “high incidences of improper payments for these services”.

Authorization times will vary from 10-20 business days and as little as 2 days for “imminent” treatment for a life or limb threatening indication.

According to the memo A provisional affirmative prior authorization decision, justified by the beneficiary’s condition, may affirm up to 36 treatments in a 12-month period.

To read more about this please click the links below:
Insurance news HBO article

CMS prior auth process

CMS prior auth (PA) HBO presntation

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