Additional services to require a medical necessity review

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Apple Health (Medicaid) Provider Alert

Effective for claims with dates of service on and after April 15, 2018, the Health Care Authority (HCA) requires the following services to undergo a medical necessity review by Qualis Health:

  • Injections of OnabotulinumtoxinA to treat chronic migraines and tension headaches
  • Hysterectomies, except hysterectomies that result from cancer or trauma and meet expedited prior authorization criteria
  • Varicose vein treatment

These changes will appear in an April 15 publication of the Physician-Related Services/Health Care Professional Services Billing Guide.

HCA will send a reminder once the guide is published.

For more information, contact Jodi Kunkel at