Do the procedures recommended by the Medical Treatment Guidelines require pre-authorization if the cost exceeds the $1,000 threshold?
With limited exceptions that are clearly noted in the Guidelines, the testing and treatment that is provided in the Guidelines is pre-authorized. Therefore, the $1,000 pre- authorization threshold does not apply and consent by the insurance carrier will no longer be required. Health care providers are able to treat without pre- authorization, so long as the care is consistent with the Guidelines. A list of procedures specifically identified in the Guidelines, and a repeat of a surgical procedure that has failed or an earlier surgical procedure has had incomplete success requires pre-authorization. The procedures are as follows: Lumbar fusions Artificial disk replacement Vertebroplasty Kyphoplasty Electrical bone growth stimulators Spinal Cord Stimulators Anterior acromioplasty of the shoulder Chrondoplasty Osteochondral autograft Autologus chrondocyte implantation Meniscal allograft transplantation Knee arthroplasty (total or partial knee joint replacement) The repeat performance of a
