Approval of emergency service can be obtained after the fact with appropriate documentation. Unlisted Services a. A special report is required because the procedure is rarely provided, unusual, variable or new. Prior authorization is required for the debridement of mycotic toenails in excess of once every 60 days. Prior authorization is required if trimming corns, warts, callouses or nails is performed for any patient with diabetes, arteriosclerosis, or Buerger's Disease, more frequently than every 60 days.
Services are for treatment of medical disorders or disabilities.
Services are provided for those disorders that are incapacitating for the patient and are reasonable and necessary for treatment of specific medical disorders or disabilities. Services are provided with the expectation that the condition under treatment will improve in a reasonable and generally predictable time. Services are professionally appropriate under the standard in the field, utilizing professionally appropriate methods and materials in a professionally appropriate environment. Services that are requested are justified with sufficient information for approval. All requests for prior approval must be made before the surgery or service is performed, except for recipients made retroactively eligible for Medicaid.