Wellcare is reinforcing the prior authorization review for Leg Stent Coding with an effective date as of May 2, 2022.
Summary of Policy:
Wellcare is reminding providers to provide complete supporting clinical records, including clinical notes, for prior authorization requests for the following vascular codes, which require a medical necessity review.
ILIAC REVASC W/ STENT
FEM/POPL REVAS W/TLA
FEM/POPL REVAS W/ATHER
FEM/POPL REVASC W/STENT
FEM/POPL REVASC STNT & ATHER
TIB/PER REVASC W/TLA
TIB/PER REVASC W/ATHER
TIB/PER REVASC W/STENT
TIB/PER REVASC STENT & ATHER
Providers are currently required to submit all pertinent clinical records when submitting a prior authorization request for these 10 codes.
Providers can review posted payment policies at: Wellcare.com/Texas/Providers/Medicare/Claims/Payment-Policy.
We are here to help. Please contact your Network Representative for general inquiries regarding this program.