Prior Authorization Codes for Leg Stents and Related Services

WellCare of North Carolina is adding the following codes for leg stents and related services to prior authorization, effective 1/1/2024, for our North Carolina Medicaid and Medicare Advantage health plans. These services will be reviewed based on nationally recognized, evidence-based clinical practice guidelines.

To facilitate efficient prior authorization, please provide complete supporting clinical records, including clinical notes, for prior authorization requests for the following vascular codes, which will require a medical necessity review.

Information on submitting prior authorizations to WellCare may be found at https://provider.wellcare.com/, in our WellCare of North Carolina Provider Manual at Provider Manual, and in our WellCare of North Carolina Quick Reference Guide at Quick Reference Guide.

We are here to help. Please contact your Provider Relations Representative at ncproviderrelations@wellcare.com for questions regarding this program.