Services that require prior authorization include:
- Some Behavioral Health Services
- Out of Network
- Inpatient Facility
- Behavioral Health Residential Facility
- Psychological and Neuropsychological Testing
- Electroconvulsive Therapy (ECT)
- Inpatient hospital services
- Planned, non-emergency admissions
- Non-emergency Out of Network admissions
- Surgeries, pre-scheduled
- Some medical equipment and supplies
- DME/electric equipment
- Prosthetics and orthotics
- Special lab work
- Some scans and Imaging
- MRI, MRA
- PET Scans
- Some Medications
- Dialysis
- Some Outpatient procedures and surgeries
- Non-emergency out of network services and treatments
If you have any questions about these services or if you would like to discuss options to address your needs, please call our Customer Care Center so we can discuss your options. Contact your PCP to check if a service or medication needs a prior authorization.
Please review your Evidence of Coverage for services requiring prior approval.
Criteria that decisions are based on are available upon request.
Important Information Related to RSV and Synagis
Banner Medicare Advantage is pausing prior authorization requirements this season for Synagis® (palivizumab). Effective November 15, 2022, prior authorization for Syangis is not required. This is effective for the remainder of the 2022-23 RSV season.