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Federal Employee Program Medical Pre-authorization List
Effective January 1, 2011
This list does not pertain to Group or Individual products, Medicare products or Uniform Medical Plan members. Please contact your Provider Consultant for copies of previous lists.
Important pre-authorization reminders
- Before requesting pre-authorization, please verify eligibility and benefits via Provider Center or contact FEP Provider Customer Service directly: 1 (877) 668-4651.
- Verify that you are an in-network provider for each member to help reduce his or her out-of-pocket expense.
- Contract exclusions will not be pre-authorized. Denials may be appealed through FEP Provider Customer Service.
- Pre-authorizations obtained within 30 business days prior to service are valid except in the case of misrepresentation.
- Urgent/Emergent services do not require pre-authorization.
- Pre-authorization decisions will be communicated both in writing and by phone.
| Behavioral Health Services - Fax: 1 (888) 496-1540 |
Regence uses Milliman Care Guideline as the basis for determining medical necessity for Mental Health and Substance Abuse services. Visit Milliman’s website for information on purchasing their criteria, or contact Regence at the phone number(s) above and we will be happy to provide you with a copy of guidelines for specific services.
- Outpatient mental health and chemical dependency: Concurrent review will occur after 20 visits
- Inpatient, residential, partial hospitalization and intensive outpatient Mental Health: Contact Premera Blue Cross at 1 (800) 622 1379.
- Chemical Dependency Services: Contact Premera Blue Cross at 1 (800) 622 1379.
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| Hospice Services: |
Contact Premera Blue Cross Care Management at 1 (877) 342-5258 option 3. |
Inpatient Medical Admissions: |
Contact Premera Blue Cross Care Management at 1 (877) 342-5258 option 3. |
Other Services:
Phone: (206) 464-3748, toll free: 1 (800) 367-2766 (in state) or 1 (800) 423-6884 (out of state), Fax: 1 (800) 453-4341 |
| Congenital abnormalities |
33813 through 33814, 40700 through 40761, 42200 through 42225, 50070, 50135, 50405, 61680 through 61692, 61710, 63250 through 63252 |
Obesity surgery |
43644, 43645, 43770, 43771, 43773, 43842, 43843, 43845, 43846, 43847, 43848, 43888, S2083 |
| Oral/Maxillofacial |
20605, 21010, 21026, 21030, 21030, 21031, 21032, 21032, 21034, 21037, 21040, 21044 through 21047, 21048, 21049, 21050, 21060, 21070, 21073, 21116, 21240, 21243, 21480 through 21485, 21490, 29800, 29804, 40490, 40500, 40510, 40520, 40525, 40527, 40530, 40650, 40808, 40800, 40801, 40804 through 40806, 40810, 40812, 40814, 40816, 40819, 40820, 40840, 40842 through 40845, 40860 through 40831, 41000, 41005 through 41010, 41015 through 41018, 41100, 41105, 41108, 41110, 41112 through 41116, 41120, 41130, 41150, 41250 through 41252, 41520, 42000, 42100, 42104, 42106, 42107, 42120, 42140, 42145, 42160, 42300 through 42320, 42330, 42335, 42340 |
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