(CT Scans, MRIs/MRAs, PET Scans, Nuclear Medicine)
|Authorization, certification, or notification not required; however, VPCR is available. |
||Prior approval required if participating in the PADP. Refer to ICORE at www.icorehealthcare.com. |
||No authorization, certification or notification required.|
||No authorization, certification or notification required. |
Prior authorization is required and is managed by our specialty pharmacy, Express Scripts
(Acute, Psych, Substance and LTAC)
Preadmission certification is required for acute care, LTAC, psychiatric and substance hospitals, including change from observation to inpatient status .
- Penalty is 20 percent of the allowed amount, not to exceed $500.
- Exceptions are:
- When Medicare A is primary
- VA hospitals
- Out of country hospitals
Quest Diagnostics and Ameripath are Florida Blue's preferred laboratory and anatomical pathology provider. The preferred lab for dermatopathology services is Dermpath Diagnostics.
Services referred to non-participating laboratories may result in higher out-of-pocket cost for the member.
||Authorization, certification, or notification is not required. |
VPCR is available
Potentially cosmetic, plastic, or reconstructive surgery is subject to medical necessity review.
(excluding office visit)
|Prior benefit determination must be obtained for all transplants, except for kidney or cornea. Contact the State Employees' PPO Plan customer service to determine if benefit applies. |