To the extent the following services are covered benefits, precertification or notification is required for all services billed with the following REVENUE codes:
- All Inpatient and Behavioral Health Accommodations
- 0023 – Home Health Prospective Payment System
- 0240 through 0249 – All Inclusive Ancillary Psychiatric
- 0570 through 0572, 0579 – Home Health Aide
- 0632 – Pharmacy Multiple Sources
- 0762 – Observation (Behavioral Health only)
- 0901, 0905 through 0907, 0913, 0917 – Behavioral health Treatment Services
- 0944 through 0945 – Other Therapeutic Services
- 0961 – Psychiatric Professional Fees
- 3101 through 3109 – Adult Day Care and Foster Care
For information on drug coverage please check the Preferred Drug List.
All elective services provided by or arranged at a non-participating facility require precertification.
The precertification rules listed here apply to Amerigroup Medicaid and Medicare products. For information on precertification for Behavioral Health, please call 800-454-3730.
Precertification/Prior Authorization for Long Term Support Services:
All Long Term Services and Support, including Texas STAR+PLUS require authorization, the Amerigroup Pre-certification look up tool is used for Acute care services only.
||Call 1-512-382-4970, Option 3 or fax to 1-877-744-2334|
||Fax to 1-561-750-6293|
||Fax to 1-866-249-1294|
||Fax to 1-866-920-8356|
||Call 1-212-563-5570 ext. 66713, or fax 1-866-574-6721|
||Call 1-210-737-5700, Option 3 or fax to 1-877-820-9014|