Prior Authorization Update

Fecha: 02/04/25

Effective July 1, 2025, the following codes will require prior authorization to be submitted to Ambetter from WellCare of Kentucky.

•  31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed
• J1439 Injection, ferric carboxymaltose, 1 mg
• 31295 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa
• 31296 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium

The following codes will no longer require prior authorization:

• 81257 HBA1/HBA2 (alpha globin 1 and alpha globin 2)
  (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant Spring)

If you have questions, please contact Provider Services.