PA and Policy Updates
Prior Authorizations and Policy Update Notifications Since September 1, 2024
For PA's and Policy notifications delivered prior to September 1 please see Updates page.
Effective February 1, 2025, Buckeye Health Plan will be changing prior authorization requirements for the following codes:
Procedure Code | Procedure Code Description |
New Standard |
Line of Business |
11042 | Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less | Pre-authorization is required after 12 visits for All Providers | Medicaid |
11043 | Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less | Pre-authorization is required after 12 visits for All Providers | Medicaid |
The following clinical pharmacy policy will be used in determining medical necessity criteria for Ferric Carboxymaltose (Injectafer): CP.PHAR.234 Ferric Carboxymaltose (Injectafer).
| Procedure Code | Procedure Code Description | New Standard | Line of Business |
J1439 | NJ FERRIC CARBOXYMALTOS 1MG | Pre-authorization is required for All Providers | Medicaid |
Procedure Code | Procedure Code Description | New Standard | Line of Business |
19303 | MASTECTOMY, SIMPLE, COMPLETE | Pre-authorization is required for All Providers | Medicaid |
New Payment Policy: Leveling of Care: Evaluation and Management Overcoding Effective 12-1-24 (All Products)