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Federal Employee Program (FEP) Pre-authorization List
Effective January 1, 2011
This list does not pertain to Group or Individual products, Medicare products or Uniform Medical Plan members. Please contact your provider relations representative for copies of previous lists.
Important pre-authorization reminders
- Before requesting pre-authorization, please verify eligibility and benefits via the Provider Center or contact FEP Provider Customer Service directly: (877) 668-4654.
- Verify that you are an in-network provider for each member to help reduce his or her out-of-pocket expense.
- Contract exclusions will not be pre-authorized. Denials may be appealed through FEP Provider Customer Service.
- Pre-authorizations obtained within 30 business days prior to service are valid except in the case of misrepresentation.
- Urgent/Emergent services do not require pre-authorization.
- Pre-authorization decisions will be communicated both in writing and by phone.
Behavioral Health Services
Phone: 1 (866) 873-9743 or Fax: 1 (888) 496-1540 |
Regence uses Milliman Care Guideline as the basis for determining medical necessity for Mental Health and Substance Abuse services. Visit Milliman’s website for information on purchasing their criteria, or contact Regence at the phone number(s) above and we will be happy to provide you with a copy of guidelines for specific services.
- Detox/Inpatient/Partial admissions: Notification and review required within 2 business days of admission.
- Chemical dependency and mental health Residential: No longer considered a covered provider category according to the 2011 FEP Service Benefit Plan booklet. For additional information or clinical assistance, contact FEP Behavioral Health Services.
- Chemical dependency and mental health intensive outpatient: Concurrent review will occur after 8 weeks.
- Outpatient mental health and chemical dependency: Concurrent review will occur after 20 visits.
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Hospice Services:
Phone: (503) 220-4795, toll-free: 1 (800) 824-8563 or Fax: (800) 453-4341 |
S0255, S9125, S9126, Q5001, Q5002, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, and Q5009 |
Inpatient Medical Admissions:
Phone: (503) 220-4795, toll-free: 1 (800) 824-8563 or Fax: (800) 453-4341 |
All hospital admissions require notification |
Concurrent review will occur after 7 days. |
Long Term Acute Care Facility (LTAC) |
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Rehabilitation |
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Skilled Nursing Facility (SNF) |
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Transplants, ventricular assist devices and total artificial hearts
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| Blood or marrow stem cell transplant procedures |
38241, 38240 |
| Autologous pancreas islet cell transplant |
0141T, 01412 |
| Heart |
33945 |
| Heart-lung |
33935 |
| Intestinal transplants (small intestine without other organs) |
44135, 44136 |
| Liver |
44135, 44136 |
| Lung (singer, double or lobar) |
38251, 38252, 38253, 3825 |
| Pancreas |
48554 |
| Pancreas after kidney transplant |
48554 |
| Simultaneous liver-kidney |
44799 |
| Small intestine and Liver |
47135 - 47136 and 44135 - 44136 |
| Simultaneous pancreas-kidney |
50360 and 48554 |
| Ventricular Assist Devices (VADS) |
33975, 33976, 33979, 0048T, 0049T, 0051T, 0052T, 0053T |
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Other Services:
Phone: (503) 220-4795, toll-free: 1 (800) 824-8563 or Fax: (800) 453-4341 |
| Congenital abnormalities |
33813 through 33814, 40700 through 40761, 42200 through 42225, 50070, 50135, 50405, 61680 through 61692, 61710, 63250 through 63252 |
Obesity surgery |
43644, 43645, 43770, 43771, 43773, 43842, 43843, 43845, 43846, 43847, 43848, 43888, S2083 |
| Oral/Maxillofacial |
20605, 21010, 21026, 21030, 21030, 21031, 21032, 21032, 21034, 21037, 21040, 21044 through 21047, 21048, 21049, 21050, 21060, 21070, 21073, 21116, 21240, 21243, 21480 through 21485, 21490, 29800, 29804, 40490, 40500, 40510, 40520, 40525, 40527, 40530, 40650, 40808, 40800, 40801, 40804 through 40806, 40810, 40812, 40814, 40816, 40819, 40820, 40840, 40842 through 40845, 40860 through 40831, 41000, 41005 through 41010, 41015 through 41018, 41100, 41105, 41108, 41110, 41112 through 41116, 41120, 41130, 41150, 41250 through 41252, 41520, 42000, 42100, 42104, 42106, 42107, 42120, 42140, 42145, 42160, 42300 through 42320, 42330, 42335, 42340 |
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