February 1, 2017
New for 2017, prior approval (also known as prior authorization) must be obtained for the following services for members with Federal Employee Program (FEP) Standard or Basic Option:
- Outpatient sleep studies performed outside the home
- Applied behavior analysis (ABA
- Gender reassignment surgery
These services continue to require prior approval:
- Inpatient hospital admission or inpatient residential treatment center admission
- Certain prescription drugs and supplies
- BRCA testing
- Surgery for morbid obesity
- Outpatient surgical correction of congenital anomalies
- Outpatient surgery needed to correct accidental injuries to jaws, cheeks, lips, tongue, roof, and floor of mouth
- Outpatient intensity-modulated radiation therapy (IMRT), except IMRT related to the treatment of head, neck, breast, anal, or prostate cancer.
- Hospice care
- Organ/tissue transplants
- Blood or marrow stem cell transplants
- Clinical trials for certain blood or marrow stem cell transplants
Find more information prior approvals for FEP members, look on our FEP web page, where you'll find forms, where to submit a prior approval request with related billing codes, and FEP medical policies.