Prior Authorization Changes Coming

Attention: All TCHP ProvidersSubject: TCHP Prior Authorizations TCHP will be updating the services requiring a prior authorization effective April 1, 2017. Please note there are some key changes to make providers aware of.

• Physical Therapy, Occupational Therapy and Speech Therapy re-evaluations will no longer need to be prior authorized. The CPT codes for these services are: 97164, 97168, S9152
• Spinraza(Nusinersen) has been added as a Medical Benefit by TMHP. Spinraza(Nusinersen) will require a prior authorization. TCHP will follow TMHP coding guidance located at http://www.tmhp.com/News_Items/2017/03-Mar/03-03-%2017%20Billing%20Process%20Reminder%20for%20Spinraza%20nusinersen.pdf

A new TCHP prior authorization list will soon be posted at http://www.tchp.us/forproviders/ provider-resources Please contact TCHP Provider Relations at 800-731-8527 for any questions.