News
Ambetter PA Change Notification
Date: 07/28/21
These codes are being added to the Ambetter from MHS prior authorization list as part of standard reviews of our prior authorization (PA) lists to ensure our members are receiving medically necessary, appropriate care.
Procedure Code | Procedure Description |
|---|---|
54401 | Insertion of penile prosthesis; inflatable (self-contained) |
54405 | Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir |
61885 | Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array |
61886 | Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arrays |
64568 | Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator |
69714 | Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy |
77371 | Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based |