Services Requiring Pre-authorization

Lawrence Memorial Hospital Services Members, please see services that require pre-authorization for your plan.

Search or browse by service type to see services requiring pre-authorization.

Please also check the QualChoice Coverage Policies if you do not find a specific procedure listed here.

These services require Pre-Authorization.Click to View Medical Policy
Abortions
Botox
Cancer Prevention Surgery
Cartilage Transplants, Lower Extremities
Dental Anesthesia
Dorsal Column Stimulator
Eyelid Surgery
Hip Resurfacing Arthroplasty
Intervertebral Disk Prosthesis
Liver Neoplasms Treatment
Neurostimulator - Implantable Electrodes
Penetrating Keratoplasty other than Corneal Transplant.
Penile Implants
Percutaneous Kyphoplasty
Percutaneous Transluminal Sep0tal Myocardial Ablation
Percutaneous Vertebroplasty
Peripheral Atherectomy
Prophylactic or Preventive Surgery
Proton Beam Radiotherapy
Radiofrequency Ablation of Lesions
Reconstruction of the intact breast after contralateral mastectomy for cancer.
Reconstructive surgery and all potentially cosmetic surgery.
Stereotactic Radiosurgery (eg: Gamma Knife)
Strabismus Surgery over 6 years of age.
TMJ, services for the diagnosis or treatment.
Total Disk Arthroplasty--Cervical or Lumbar
Transcatheter Pulmonary Valve Implantation (TPVI)
Urinary incontinence treatment with devices and artificial sphincter.
Varicose Vein Surgery

QualChoice Network Medical Providers: You will receive verbal approval when requesting pre-authorization. Please inform your patient at that time that the request has been approved. Thank you.

Pre-authorization is the decision to cover a planned medical procedure, prescription drug or medical device. Pre-authorization is not a promise of payment for care or services.

Items with an asterisk (*) may be reviewed after the service has been performed. All others must be approved before services are performed. The member must get pre-authorization for any services outside the network noted on their ID card.

Payment for care or services is based on eligibility, medical necessity and available benefits at time of service and is subject to all contractual exclusions and limitations, including pre-existing conditions if applicable.

Future eligibility cannot be guaranteed and should be rechecked at time of service. Verify benefits by signing into My Account or calling Customer Service at 800.235.7111 or 501.228.7111.

QualChoice follows care guidelines published by MCG Health.