September 2025 Provider News
Date: 09/30/25
In this issue:
- General Updates - 2025 Joint MCO Live Training Sessions for Apple Health (Medicaid) Providers, Evolent updates, Apple Health COVID-19 Vaccine Policy, Syphilis screening in pregnancy, COVID 19 vaccine updates
- Quality - Medicaid - Fluoride, Cervical Cancer Screenings, Mammograms, Imaging Studies for Low Back Pain, Asthma and 90 Day Medication Refills. Medicare - AWV
- Clinical & Payment Policies and Prior Authorization Updates - Policy updates
- Wellcare - Medicare Prior Authorization Updates
- Apple Health Core Connections - Comprehensive Sexual Healthcare for Youth in Foster Care
- Training/Education - Supporting LGBTQIA+ Youth in Foster Care, Suicide Prevention, Cultural Care & Connections, Apple Health/Coordinated Care Overview, ACES, Trauma Informed Care & Discipline
- Pharmacy Updates - Labeler Termination Notice - Effective 10/01/2025
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General Updates
2025 Joint MCO Live Training Sessions for Apple Health (Medicaid) Providers
Washington’s Managed Care Organizations (MCOs) request your participation in 2025 joint Apple Health (Medicaid) & Medicare Advantage Provider Training. You will hear from Community Health Plan of Washington, Coordinated Care of Washington, Inc., Molina Healthcare of Washington, UnitedHealthcare Community Plan of Washington, and Wellpoint Washington about this training.
Joining one of the training sessions will satisfy your annual attendance requirement under 42 CFR 38.608(a)(1) iv.
Who: Providers servicing Medicaid and Medicare Advantage enrollees.
What is Covered:
- Enrollee Rights & Responsibilities
- Advanced Directives
- Fraud, Waste and Abuse
- False Claims Act
- Cultural Awareness
Where: Webinar. To register, please use the date specific links below.
When: Please register for one of the training sessions below.
Date | Session | Session | Time | Registration Link |
October 27, 2025 | Session 1 | Session 1 | 12:00 PM | Register |
October 29, 2025 | Session 2 | Session 2 | 5:00 PM | Register |
October 30, 2025 | Session 3 | Session 3 | 1:00 PM | Register |
November 5, 2025 | Session 4 | Session 4 | 8:00 AM | |
November 6, 2025 | Session 5 | Session 5 | 8:00 AM | |
November 7, 2025 | Session 6 | Session 6 | 1:00 PM |
After the training, you will be asked to complete a short survey, which confirms your participation and provides an opportunity to submit feedback.
If you have questions regarding this training requirement, please contact: valerie_martinolich@uhc.com
We appreciate your partnership in serving our patients and look forward to your attendance!
Evolent Program changes effective January 1, 2026
Coordinated Care has partnered with Evolent to implement a new prior authorization program. This interventional cardiovascular program is intended to help providers effectively deliver quality patient care using clinical criteria based on nationally recognized guidelines to promote evidence-based practices.
Effective January 1, 2026, select interventional cardiovascular services will require prior authorization through Evolent prior to being rendered in an outpatient or inpatient* (*professional component of elective services only) setting
What does this mean for you?
The Evolent interventional cardiovascular program will apply to all provider specialties for the following non-emergent procedures for Coordinated Care Medicaid and Exchange members aged 21 years and older:
- Cardiac catheterization and intervention
- Electrophysiology
- Vascular radiology and intervention
- Cardiac surgery
- Vascular surgery
Prior authorization requests for these services can be submitted to Evolent:
- Via the Evolent portal, select RadMD.
- Via telephone (Monday - Friday from 5:00 a.m. to 5:00 p.m. PST):
- Exchange: 1.800.424.4918
- Medicaid: 1.800.727.8627
Update on syphilis screening and treatment in Washington State
The Health Care Authority (HCA,) the Department of Health (DOH), and the American College of OB/GYN recently signed a joint letter updating recommendations for screening and treating syphilis, especially for pregnant individuals.
The recommendations include:
- Conducting universal syphilis screening three times for each pregnancy during the first and third trimesters and at delivery.
- Screen pregnant individuals with limited, no, or unknown prenatal care for syphilis whenever they seek medical care, including in emergency departments, urgent care, drug treatment programs, syringe service programs, and in correctional facilities. If they screen positive for syphilis or have symptoms of primary or secondary syphilis, treat them without delay.
- Also, screen all pregnant individuals for HIV, Hepatitis B, and Hepatitis C infections that can occur with syphilis to prevent perinatal transmission.
More information
- Find contacts for your local health jurisdiction.
- Information on syphilis from Public Health—Seattle & King County.
- Current evidence-based prevention, diagnostic, and treatment recommendations for clinical guidance. Health care providers should always assess patients based on their clinical circumstances and local context.
- A free clinical consultation service provided by expert faculty at regional STD Prevention Training Centers, as part of the National Network of STD Clinical Prevention Training Centers. The STD clinical consultation service is only available to licensed healthcare professionals and STD program staff.
- The most recent ACOG guidelines recommend universal syphilis screening at three time points in pregnancy.
- HCA Bicillin L-A® national shortage prioritization guidance for syphilis treatment
- DOH syphilis web page
Training Sessions Starting Soon
To help you prepare, we’ll be hosting live, virtual training sessions beginning in December. Registration will open soon for the following:
Practice Training Sessions
Instructional sessions on how to use the Evolent provider portals to submit prior authorization requests:
Dates to be announced
Apple Health COVID-19 vaccine Policy
Despite recent federal-level changes related to vaccines, the Washington State Health Care Authority(HCA) continues to ensure our vaccine policies are grounded in the best available science, in close partnership with the Washington State Department of Health (DOH)
The Apple Health (Medicaid) COVID-19 vaccine policy has not changed and remains:
- Covered without cost sharing
- At clinics, hospitals, and pharmacies
- For all children over 6 months old, adults, and pregnant individuals.
The COVID-19 vaccine remains one of our most effective tools for preventing severe illness from COVID-19.
HCA welcomes announcements about the West Coast Health Alliances' efforts to ensure that public health recommendations are guided by science. HCA will continue to work closely with the Office of the Governor and the DOH to track, monitor, and implement the recommendations of the Alliance when applicable.
Resources
For more information, see:
- Provider billing guides and fee schedules | Washington State Health Care Authority
- COVID-19 Vaccine Information | Washington State Department of Health
- West Coast Health Alliance Announcement
- Washington State COVID-19 Vaccine Standing Order (PDF)
DOH confirms COVID-19 vaccine position with new Standing Order
Standing Order improves vaccine access for everyone 6 months and older
OLYMPIA – The Washington State Department of Health (DOH) issued a Standing Order for the COVID-19 vaccine, making it easier for Washington residents to get vaccinated. The order comes as DOH reaffirms its guidance that everyone 6 months and older, including pregnant people, should stay up to date on COVID-19 vaccinations to protect against severe illness, hospitalization, and death. This recommendation aligns with guidance from the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians.
Standing Order improves vaccine access. The new Standing Order allows most residents to go directly to a Washington pharmacy or clinic and receive the COVID-19 vaccine without an individual prescription. The vaccine remains covered by most private insurers, Apple Health, and Washington’s Adult Vaccine and Childhood Vaccine Programs, removing barriers and helping people stay healthy. Learn more about the Standing Order and find answers to frequently asked questions here (PDF).
West Coast states unite in vaccine, public health guidance. The Standing Order follows Washington’s Sept. 3 announcement joining Oregon and California to form the West Coast Health Alliance, with Hawaii joining the partnership on Sept. 4. The Alliance is committed to using the best available science to guide public health decisions. It was created in response to recent federal actions that undermined the independence of the CDC and raised concerns about the politicization of science. Together, the three states will help ensure public health policies are informed by trusted scientists, clinicians, and other public health leaders. See link.
Protect yourself and your community. While some health care providers have already received the 2025-26 COVID-19 vaccine, other providers are still waiting to receive supplies of the updated vaccine, which may limit appointments. Supply through the Childhood and Adult Vaccine programs are not available yet, and may not be available until late September or October. DOH urges everyone to remain patient but vigilant in staying up to date on vaccinations. Ask your provider or local pharmacy when they expect to start offering COVID-19 vaccines for the season and prioritize making vaccination appointments for yourself and your family.For more information about the COVID-19 vaccine visits the DOH's website.
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Quality
Medicaid Quality
Fluoride
Health Professionals Fluoride and Healthful Diets Fluoride fact sheet
Oral Health Training for Healthcare Professionals Smiles for Life is a comprehensive oral health curriculum for healthcare professionals and health educators.
This American Dental Association endorsed curriculum is designed to enhance the role of primary care clinicians in the promotion of oral health for all age groups. This curriculum includes oral health training for all ages and offers free CME to healthcare providers.
Cervical Cancer Screening
The goal for CCS is to assess the following for your patients:
* Women 21 - 64 years of age who have had cervical cytology performed within last 3 yrs.
* Women 30 - 64 years of age who had cervical high risk human papillomavirus testing performed within the last 5 yrs.
* Women 30 - 64 years of age who had cervical/high risk human papillomavirus cotesting within the last 5 yrs.
Cervical Cancer Screening (CCS-E) - NCQA
Mammograms (HEDIS Measure)
The HEDIS measure assesses women ages 50-74 who had at least one mammogram to screen for breast cancer in the past 2 years.
Does your patient have any of these risk factors? They may need to be assessed for early onset Breast Cancer:
* Reproductive history- menstrual history of starting periods before age 12 and menopause after 55
* Having dense breasts
* Breast/ ovarian cancer personal/family history or personal/family history of genetic mutations
Breast Cancer Screening (BCS) - NCQA
Use of Imaging Studies for Low Back Pain (LBP)
Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation in collaboration with more than 70 specialty society partners, promotes a “national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures” by publishing recommendations from the specialty societies to, “facilitate wise decisions about the most appropriate care based on a patient’s individual situation.” Nine specialty societies have published recommendations regarding the use of imaging for patients with low back pain4, indicating the topic’s importance to health care providers.
Use of Imaging Studies for Low Back Pain (LBP) - NCQA
Appropriate Treatment for Upper Respiratory Infection (URI)
The common cold (or URI) is a frequent reason for patients visiting the doctor’s office. Though existing clinical guidelines do not support the use of antibiotics for the common cold, physicians often prescribe them for this ailment1.
Appropriate Treatment for Upper Respiratory Infection (URI) - NCQA
Upper Respiratory Infection (URI)
Preventing transmission of viral respiratory pathogens in healthcare settings.
To prevent the transmission (spread) of all viral respiratory infections in healthcare settings, including influenza virus and SARS-CoV-2 infection, the following infection control measures should be implemented into standard procedures.
Asthma and 90 Day Medication Refills
Moving members with asthma prescriptions to 90-day medication refills may increase their maintenance medication adherence.
Wellcare Quality
Annual Wellness Visits: Annual Preventative Wellness Visits (APV) are an opportunity to close clinical HEDIS measure gaps, establish or strengthen your Provider/Patient rapport and most importantly provide quality health care including early detection to save lives. The AWV helps develop or update a Personalized Prevention Plan (PPP) and perform a Health Risk Assessment (HRA). Resources for Annual Wellness Visits: helpful resource tools for the AWV can be found here. CMS website Medicare Learning Network documents 12 defined components of the First Annual Wellness Visit and subsequent Annual Wellness Visits having 11 components. Preparing eligible Patients for the AWV can include encouraging them to bring to their appointment at a minimum: Medical records, including immunization records. Detailed family health history Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take Full list of current providers and suppliers involved in their care, including community-based providers (for example, personal care, adult day care, and home-delivered meals), and behavioral health specialists.
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Clinical & Payment Policies and Prior Authorization Updates
Clinical Policy Updates
With the start of the new Evolent Cardiovascular program, the following policies will be effective on January 1, 2026. You will find the policies on Evolent’s public facing website now, or on the Evolent landing page found at the link on our Prior Authorization page after 1/1/26. Please note, this program does not apply to children under the age of 18.
Policy No. | Policy Name |
ECG_7252 | Evolent - Ambulatory Rhythm Monitoring |
ECG_7254 | Evolent - Coronary Artery Bypass Graft |
ECG_7255 | Evolent - Aortic Valve Replacement |
ECG_7258 | Evolent - Device Interrogation and Programming |
ECG_7261 | Evolent - Device (AICD, CRT and/or Pacemaker) Battery Replacement |
ECG_7262 | Evolent - Diagnostic Electrophysiologic Testing |
ECG_7263 | Evolent - Cardiac Resynchronization Therapy |
ECG_7264 | Evolent - Renal Angiography and Intervention |
ECG_7266 | Evolent - Carotid Artery Stenting |
ECG_7268 | Evolent - Carotid Endarterectomy |
ECG_7269 | Evolent - Catheter Based Carotid & Brachiocephalic Arteriography, Venography & Intervention |
ECG_7282 | Evolent - Atrial Fibrillation Ablation |
ECG_7283 | Evolent - Abdominal Aortography w Bilateral Iliofemoral Lower Extremity Runoff |
ECG_7284 | Evolent - Catheter Ablation of Reentrant or Focal Tachydysrhythmias |
ECG_7286 | Evolent - Endomyocardial Biopsy |
ECG_7287 | Evolent - Endovascular Femoropopliteal Interventions |
ECG_7288 | Evolent - Endovascular Aortoiliac Interventions |
ECG_7289 | Evolent - Endovascular Infrapopliteal (Tibioperoneal) Interventions |
ECG_7290 | Evolent - Treatment of Varicose Veins |
ECG_7292 | Evolent - Infra-inguinal Open Arterial Vascular Surgery |
ECG_7295 | Evolent - Hearth Catheterization |
ECG_7299 | Evolent - Hemodialysis Access Creation |
ECG_7301 | Evolent - Implantable Cardioverter Defibrillator |
ECG_7302 | Evolent - Percutaneous Coronary Interventions |
ECG_7303 | Evolent - Interventions for Adults with Congenital Heart Defects |
ECG_7305 | Evolent - Introduction of Inferior Vena Cava Filter Device |
ECG_7310 | Evolent - Mitral Valve Surgery |
ECG_7315 | Evolent - Pacemaker Insertion |
ECG_7319 | Evolent - Percutaneous Iliocaval Interventions |
ECG_7320 | Evolent - Percutaneous Left Atrial Appendage Closure |
ECG_7327 | Evolent - Standalone Right Heart Catheterization |
ECG_7334 | Evolent - Transcatheter Aortic Valve Replacement (TAVR) |
ECG_7335 | Evolent - Transcatheter Edge to Edge Repair (TEER) of Mitral Valve |
ECG_7338 | Evolent - Tricuspid Valve Surgery |
ECG_7339 | Evolent - Ultrasound-Guided Vascular Access |
ECG_7341 | Evolent - Venogram Invasive Vein Mapping |
ECG_7345 | Evolent - Wireless Pulmonary Artery Pressure Device Placement and Monitoring |
The following policies were updated as part of our regular monthly review in August. The policy changes are effective October 1, 2025. You will find the policies, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
WA.CP.MP.69 | Intensity Modulated Radiation Therapy | Apple Health & Ambetter |
WA.CP.MP.95 | Gender Affirming Procedures | Ambetter |
WA.CP.MP.507 | Enteral Nutrition | Apple Health |
WA.CP.BH.528 | Intensive Behavioral Supportive Services | Apple Health |
CP.MP.133 | Posterior Nerve Stimulation for Voiding Dysfunction | Ambetter |
CP.MP.167 | Intradiscal Steroid Injections | Apple Health & Ambetter |
CP.MP.169 | Trigger Point Injections for Pain Management | Apple Health & Ambetter |
CP.MP.203 | Diaphragmatic Phrenic Nerve Stimulation | Apple Health & Ambetter |
CP.MP.247 | Transplant Service Documentation Requirement | Apple Health & Ambetter |
CP.MP.250 | Lantidra (donisclecel) Allogeneic Pancreatic Islet Cellular Therapy | Apple Health & Ambetter |
WA.CP.MP.501 | Continuous Glucose Monitoring | Apple Health |
WA.CP.MP.219 | CG Exome Genome Genetic Sequencing for Diagnosis of Genetic Disorders | Apple Health |
WA.CP.MP.230 | CG Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay | Apple Health |
WA.CP.MP.232 | CG Pharmacogenetics (Version A) | Apple Health |
WA.CP.MP.237 | CG Oncology Algorithmic Testing | Apple Health |
WA.CP.MP.12 | Vagal Nerve Stimulation | Apple Health |
WA.CP.MP.194 | Osteogenic Stimulation | Apple Health |
The following policies were updated as part of our regular monthly review in August. The policy changes are effective January 1, 2026. You will find the policies, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
CP.MP.93 | Bone-anchored hearing aid | Apple Health & Ambetter |
CG.CP.MP.01 | Infection Disease: Respiratory Lab Testing | Apple Health & Ambetter |
CG.CP.MP.02 | Infectious Disease: Multisystems Lab Testing | Apple Health & Ambetter |
CG.CP.MP.03 | Infectious Dz Dermatologic Lab Testing | Apple Health & Ambetter |
CG.CP.MP.04 | Infectious Dz Gastroenterologic Lab Testing | Apple Health & Ambetter |
CG.CP.MP.05 | ID Primary Care Preventive Lab Testing | Apple Health & Ambetter |
CG.CP.MP.06 | ID Vector-Borne and Tropical Dz Lab Testing | Apple Health & Ambetter |
CG.CP.MP.07 | Infectious Dz Genitourinary Lab Testing | Apple Health & Ambetter |
CG.PP.551A | Concert Genetic and Molecular Testing Payment Policy | Apple Health & Ambetter |
CG.CC.PP.01 | Concert Lab Payment Policy | Apple Health & Ambetter |
The following policies are new effective October 1, 2025. You will find the policies posted on the policy Web site.
Policy Number | Policy Title | Line of Business |
WA.HIM.CP.MP.27 | Hyperbaric Oxygen Therapy | Ambetter |
WA.CP.MP.501 | Continuous Glucose Monitoring | Ambetter |
WA.CP.MP.219 | CG Exome Genome Genetic Sequencing for Diagnosis of Genetic Disorders | Ambetter |
WA.CP.MP.230 | CG Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay | Ambetter |
WA.CP.MP.237 | CG Oncology Algorithmic Testing | Ambetter |
WA.CP.MP.12 | Vagal Nerve Stimulation | Ambetter |
WA.CP.MP.194 | Osteogenic Stimulation | Ambetter |
The following policies will be archived effective September 30, 2025. These policies are being replaced with a state-specific version noted above effective 10/1/25.
Policy Number | Policy Title | Line of Business |
V1.2025 | CG Exome Genome Genetic Sequencing for Diagnosis of Genetic Disorders | Ambetter |
V1.2025 | CG Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay | Ambetter |
V1.2025 | CG Oncology Algorithmic Testing | Ambetter |
CP.MP.12 | Vagus Nerve Stimulation | Ambetter |
CP.MP.194 | Osteogenic Stimulation | Ambetter |
The following policies will be archived effective December 31, 2025.
Policy Number | Policy Title | Line of Business |
WA.HIM.CP.MP.92 | Acupuncture | Ambetter |
CC.PP.018 | Inpatient Only Procedures | Medicaid |
MP.PP.018 | Inpatient Only Procedures | Ambetter |
The following policies were previously announced as revised effective on the date noted. You will find the policies posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
CP.MP.132 | Heart-Lung Transplant | 10/1/25 | Apple Health & Ambetter |
CP.MP.58 | Intestinal and Multivisceral Transplant | 10/1/25 | Apple Health & Ambetter |
CP.MP.87 | Therapeutic Utilization of Inhaled Nitric Oxide | 10/1/25 | Apple Health & Ambetter |
CP.BH.200 | Transcranial Magnetic Stimulation (TMS) for TRMD | 10/1/25 | Ambetter |
CP.MP.249 | Allogeneic Hematopoietic Progenitor Cell Therapy | 11/1/25 | Apple Health & Ambetter |
CP.MP.137 | Fecal Incontinence Treatments | 11/1/25 | Apple Health & Ambetter |
CP.MP.51 | Reduction Mammoplasty and Gynecomastia Surgery | 11/1/25 | Apple Health & Ambetter |
CP.MP.127 | Total Artificial Heart | 11/1/25 | Apple Health & Ambetter |
WA.CP.MP.54 | Hospice Services | 12/1/25 | Apple Health |
CP.MP.49 | Physical, Occupational and Speech Therapy Services | 12/1/25 | Apple Health & Ambetter |
WA.CP.MP.185 | Skin and Soft Tissue Substitutes | 12/1/25 | Apple Health |
CP.MP.185 | Skin and Soft Tissue Substitutes for Chronic Wounds | 12/1/25 | Ambetter |
The following new policies were previously announced as being effective on the dates noted. You will find the policies posted on the policy site.
Policy Number | Policy Title | Effective Date | Line of Business |
WA.CP.MP.522 | Varicose Vein Treatment | 10/1/25 | Ambetter |
The following policies were previously announced as being archived on the dates noted.
Policy Number | Policy Title | Effective Date | Line of Business |
CP.MP.146 | Sclerotherapy for Varicose Veins | 9/30/25 | Ambetter |
Prior Authorization Updates
The following services will require prior authorization effective January 1, 2026:
Line of Business | Code | Description |
Apple Health | 69714 | Implantation, osseo-integrated implant, skull; with percutaneous attachment to external speech processor |
Apple Health | 69729 | Implantation, osseo-integrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex |
With the implementation of the Evolent Interventional Cardiology program for both Ambetter and Apple Health on January 1, 2026, the following services will require prior authorization from Evolent as of January 1:
Evolent Interventional Cardiology Program Prior Authorization Requirements | |
Code | Description |
33202 | Insertion of epicardial electrode(s); open incision (eg, thoracotomy, median sternotomy, subxiphoid approach) |
33203 | Insertion of epicardial electrode(s); endoscopic approach (eg, thoracoscopy, pericardioscopy) |
33206 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial |
33207 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular |
33208 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular |
33210 | Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure) |
33211 | Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure) |
33212 | Insertion of pacemaker pulse generator only; with existing single lead |
33213 | Insertion of pacemaker pulse generator only; with existing dual leads |
33214 | Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) |
33215 | Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode |
33216 | Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator |
33217 | Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator |
33218 | Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator |
33220 | Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator |
33221 | Insertion of pacemaker pulse generator only; with existing multiple leads |
33222 | Relocation of skin pocket for pacemaker |
33223 | Relocation of skin pocket for implantable defibrillator |
33224 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) |
33225 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure) |
33226 | Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) |
33227 | Removal of Permanent Pacemaker Pulse Generator with Replacement of Pacemaker Pulse Generator; single Lead System |
33228 | Removal of Permanent Pacemaker Pulse Generator with Replacement of Pacemaker Pulse Generator; Dual Lead System |
33229 | Removal of Permanent Pacemaker Pulse Generator with Replacement of Pacemaker Pulse Generator; Multiple Lead System |
33230 | Insertion of implantable defibrillator pulse generator only; with existing dual leads |
33231 | Insertion of implantable defibrillator pulse generator only; with existing multiple leads |
33233 | Removal of permanent pacemaker pulse generator only |
33234 | Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular |
33235 | Removal of transvenous pacemaker electrode(s); dual lead system |
33236 | Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or ventricular |
33237 | Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system |
33240 | Insertion of implantable defibrillator pulse generator only; with existing single lead |
33241 | Removal of implantable defibrillator pulse generator only |
33243 | Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy |
33244 | Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction |
33249 | Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber |
33262 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system |
33263 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system |
33264 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system |
33270 | Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed |
33271 | Insertion of subcutaneous implantable defibrillator electrode |
33272 | Removal of subcutaneous implantable defibrillator electrode |
33273 | Repositioning of previously implanted subcutaneous implantable defibrillator electrode |
33274 | Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed |
33275 | Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed |
33285 | Insertion, subcutaneous cardiac rhythm monitor, including programming |
33286 | Removal, subcutaneous cardiac rhythm monitor |
33289 | Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed |
33340 | Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation |
33361 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach |
33362 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach |
33363 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach |
33364 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach |
33365 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) |
33366 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy) |
33367 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (eg, femoral vessels) (List separately in addition to code for primary procedure) |
33368 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (List separately in addition to code for primary procedure) |
33369 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (List separately in addition to code for primary procedure) |
33405 | Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve |
33406 | Replacement, aortic valve, open, with cardiopulmonary bypass; with allograft valve (freehand) |
33410 | Replacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve |
33411 | Replacement, aortic valve; with aortic annulus enlargement, noncoronary sinus |
33412 | Replacement, aortic valve; with transventricular aortic annulus enlargement (Konno procedure) |
33413 | Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross procedure) |
33418 | Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis |
33419 | Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure) |
33425 | Valvuloplasty, mitral valve, with cardiopulmonary bypass; |
33426 | Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring |
33427 | Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring |
33430 | Replacement, mitral valve, with cardiopulmonary bypass |
33440 | Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve (Ross-Konno procedure) |
33465 | Replacement, Tricuspid Valve, with Cardiopulmonary Bypass |
33475 | Replacement, Pulmonary Valve |
33477 | Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed |
33510 | Coronary artery bypass, vein only; single coronary venous graft |
33511 | Coronary artery bypass, vein only; 2 coronary venous grafts |
33512 | Coronary artery bypass, vein only; 3 coronary venous grafts |
33513 | Coronary artery bypass, vein only; 4 coronary venous grafts |
33514 | Coronary artery bypass, vein only; 5 coronary venous grafts |
33516 | Coronary artery bypass, vein only; 6 or more coronary venous grafts |
33517 | Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure) |
33518 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure) |
33519 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (List separately in addition to code for primary procedure) |
33521 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (List separately in addition to code for primary procedure) |
33522 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (List separately in addition to code for primary procedure) |
33523 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 6 or more venous grafts (List separately in addition to code for primary procedure) |
33530 | Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (List separately in addition to code for primary procedure) |
33533 | Coronary artery bypass, using arterial graft(s); single arterial graft |
33534 | Coronary artery bypass, using arterial graft(s); 2 coronary arterial grafts |
33535 | Coronary artery bypass, using arterial graft(s); 3 coronary arterial grafts |
33536 | Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts |
33572 | Coronary endarterectomy, open, any method, of left anterior descending, circumflex, or right coronary artery performed in conjunction with coronary artery bypass graft procedure, each vessel (List separately in addition to primary procedure) |
33641 | Repair atrial septal defect, secundum, with cardiopulmonary bypass, with or without patch |
33768 | Anastomosis, cavopulmonary, second superior vena cava (List separately in addition to primary procedure) |
33820 | Repair of patent ductus arteriosus; by ligation |
33840 | Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with direct anastomosis |
33900 | Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, unilateral |
33901 | Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, bilateral |
33902 | Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, unilateral |
33903 | Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, bilateral |
33904 | Percutaneous pulmonary artery revascularization by stent placement, each additional vessel or separate lesion, normal or abnormal connections (List separately in addition to code for primary procedure) |
33917 | Repair of pulmonary artery stenosis by reconstruction with patch or graft |
33924 | Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (List separately in addition to code for primary procedure) |
35001 | Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, carotid, subclavian artery, by neck incision |
35011 | Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, axillary-brachial artery, by arm incision |
35141 | Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, common femoral artery (profunda femoris, superficial femoral) |
35151 | Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, popliteal artery |
35301 | Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision |
35302 | Thromboendarterectomy, including patch graft, if performed; superficial femoral artery |
35303 | Thromboendarterectomy, including patch graft, if performed; popliteal artery |
35304 | Thromboendarterectomy, including patch graft, if performed; tibioperoneal trunk artery |
35305 | Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery, initial vessel |
35306 | Thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery (List separately in addition to code for primary procedure) |
35351 | Thromboendarterectomy, including patch graft, if performed; iliac |
35355 | Thromboendarterectomy, including patch graft, if performed; iliofemoral |
35371 | Thromboendarterectomy, including patch graft, if performed; common femoral |
35372 | Thromboendarterectomy, including patch graft, if performed; deep (profunda) femoral |
35390 | Reoperation, carotid, thromboendarterectomy, more than 1 month after original operation (List separately in addition to code for primary procedure) |
35400 | Angioscopy (noncoronary vessels or grafts) during therapeutic intervention (List separately in addition to code for primary procedure) |
35500 | Harvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (List separately in addition to code for primary procedure) |
35556 | Bypass graft, with vein; femoral-popliteal |
35558 | Bypass graft, with vein; femoral-femoral |
35566 | Bypass graft, with vein; femoral-anterior tibial, posterior tibial, peroneal artery or other distal vessels |
35571 | Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels |
35572 | Harvest of femoropopliteal vein, 1 segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (List separately in addition to code for primary procedure) |
35583 | In-situ vein bypass; femoral-popliteal |
35585 | In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery |
35587 | In-situ vein bypass; popliteal-tibial, peroneal |
35600 | Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, open |
35621 | Bypass graft, with other than vein; axillary-femoral |
35646 | Bypass graft, with other than vein; aortobifemoral |
35654 | Bypass graft, with other than vein; axillary-femoral-femoral |
35656 | Bypass graft, with other than vein; femoral-popliteal |
35661 | Bypass graft, with other than vein; femoral-femoral |
35665 | Bypass graft, with other than vein; Iliofemoral |
35666 | Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or peroneal artery |
35671 | Bypass graft, with other than vein; popliteal-tibial or -peroneal artery |
35700 | Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal vessels, more than 1 month after original operation (List separately in addition to code for primary procedure) |
35881 | Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition |
35883 | Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, Dacron, ePTFE, bovine pericardium) |
35884 | Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with autogenous vein patch graft |
36005 | Injection procedure for extremity venography (including introduction of needle or intracatheter) |
36140 | Introduction of needle or intracatheter, upper or lower extremity artery |
36200 | Introduction of catheter, aorta |
36215 | Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family |
36216 | Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family |
36217 | Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family |
36218 | Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate) |
36221 | Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed |
36245 | Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family |
36246 | Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family |
36247 | Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family |
36251 | Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral |
36252 | Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral |
36253 | Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral |
36254 | Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral |
36465 | Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) |
36466 | Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg |
36473 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated |
36474 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) |
36475 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated |
36476 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) |
36478 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated |
36479 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) |
36482 | Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated |
36483 | Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) |
36836 | Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation |
36837 | Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation |
37215 | Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection |
37220 | Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty |
37221 | Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed |
37224 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty |
37225 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed |
37226 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed |
37227 | Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed |
37228 | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty |
37229 | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed |
37230 | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed |
37231 | Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed |
37232 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) |
37233 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) |
37234 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) |
37235 | Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed (List separately in addition to code for primary procedure) |
37236 | Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery |
37237 | Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional artery (List separately in addition to code for primary procedure) |
37238 | Transcatheter Placement of An Intravascular Stent(S), Open or Percutaneous, including Radiological Supervision and Interpretation and including Angioplasty within the Same Vessel, when Performed; initial Vein |
37239 | Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code for primary procedure) |
37246 | Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery |
37247 | Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) |
37248 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein |
37249 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) |
37765 | Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions |
37766 | Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions |
4110F | Internal mammary artery graft performed for primary, isolated coronary artery bypass graft procedure (CABG) |
75580 | Noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified health care professional |
75625 | Aortography, abdominal, by serialography, radiological supervision and interpretation |
75630 | Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation |
75710 | Angiography, extremity, unilateral, radiological supervision and interpretation |
75716 | Angiography, extremity, bilateral, radiological supervision and interpretation |
75726 | Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation |
75736 | Angiography, pelvic, selective or supraselective, radiological supervision and interpretation |
76937 | Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure) |
76984 | Ultrasound, intraoperative thoracic aorta (eg, epiaortic), diagnostic |
76987 | Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; including placement and manipulation of transducer, image acquisition, interpretation and report |
76988 | Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; placement, manipulation of transducer, and image acquisition only |
76989 | Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; interpretation and report only |
92920 | Percutaneous transluminal coronary angioplasty; single major coronary artery or branch |
92921 | Percutaneous transluminal coronary angioplasty; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) |
92924 | Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch |
92925 | Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) |
92928 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch |
92929 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) |
92933 | Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch |
92934 | Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (List separately in addition to code for primary procedure) |
92937 | Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel |
92938 | Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure) |
92943 | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel |
92944 | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or bypass graft (List separately in addition to code for primary procedure) |
92960 | Cardioversion, elective, electrical conversion of arrhythmia; external |
92961 | Cardioversion, elective, electrical conversion of arrhythmia; internal (separate procedure) |
92972 | Percutaneous transluminal coronary lithotripsy (List separately in addition to code for primary procedure) |
92973 | Percutaneous transluminal coronary thrombectomy mechanical (List separately in addition to code for primary procedure) |
92974 | Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (List separately in addition to code for primary procedure) |
92978 | Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (List separately in addition to code for primary procedure) |
92979 | Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (List separately in addition to code for primary procedure) |
92986 | Percutaneous balloon valvuloplasty; aortic valve |
92987 | Percutaneous balloon valvuloplasty; mitral valve |
92997 | Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel |
92998 | Percutaneous transluminal pulmonary artery balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure) |
93292 | Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator system |
93451 | Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed |
93452 | Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed |
93453 | Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed |
93454 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; |
93455 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography |
93456 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization |
93457 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization |
93458 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed |
93459 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography |
93460 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed |
93461 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography |
93462 | Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure) |
93463 | Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed (List separately in addition to code for primary procedure) |
93464 | Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (List separately in addition to code for primary procedure) |
93505 | Endomyocardial Biopsy |
93563 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective coronary angiography during congenital heart catheterization (List separately in addition to code for primary procedure) |
93564 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary arteries and in situ arterial conduits (eg, internal mammary), whether native or used for bypass to one or more coronary arteries during congenital heart catheterization, when performed (List separately in addition to code for primary procedure) |
93565 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective left ventricular or left atrial angiography (List separately in addition to code for primary procedure) |
93566 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography (List separately in addition to code for primary procedure) |
93567 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography (List separately in addition to code for primary procedure) |
93568 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for pulmonary angiography (List separately in addition to code for primary procedure) |
93569 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure) |
93571 | Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel (List separately in addition to code for primary procedure) |
93572 | Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure) |
93573 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure) |
93574 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure) |
93575 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (List separately in addition to code for primary procedure) |
93580 | Percutaneous transcatheter closure of congenital interatrial communication (ie, Fontan fenestration, atrial septal defect) with implant |
93581 | Percutaneous transcatheter closure of a congenital ventricular septal defect with implant |
93582 | Percutaneous transcatheter closure of patent ductus arteriosus |
93583 | Percutaneous Transcatheter Septal Reduction therapy (Eg, Alcohol Septal Ablation) including Temporary Pacemaker Insertion when Performed |
93590 | Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve |
93591 | Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve |
93592 | Percutaneous transcatheter closure of paravalvular leak; each additional occlusion device (List separately in addition to code for primary procedure) |
93609 | Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure) |
93613 | Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure) |
93619 | Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia |
93620 | Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording |
93621 | Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure) |
93622 | Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure) |
93623 | Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure) |
93650 | Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement |
93653 | Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry |
93654 | Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; with treatment of ventricular tachycardia or focus of ventricular ectopy including left ventricular pacing and recording, when performed |
93655 | Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure) |
93656 | Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, and intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography with imaging supervision and interpretation, right ventricular pacing/recording, and His bundle recording, when performed |
93657 | Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure) |
93662 | Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure) |
93745 | Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events |
C1721 | Cardioverter-defibrillator, dual chamber |
C1722 | Cardioverter-defibrillator, single chamber |
C1730 | Catheter, electrophysiology, diagnostic, other than 3D mapping, 19 or fewer electrodes |
C1731 | Catheter, electrophysiology, diagnostic, other than 3D mapping, 20 or more electrodes |
C1732 | Catheter, electrophysiology, diagnostic/ablation, 3D or vector mapping |
C1733 | Catheter, electrophysiology, diagnostic/ablation, other than 3D or vector mapping other than cool-tip |
C1753 | Catheter, intravascular ultrasound |
C1759 | Catheter, intracardiac echocardiography |
C1760 | Closure device, vascular |
C1764 | Event recorder, cardiac |
C1768 | Graft, vascular |
C1777 | Lead, cardioverter-defibrillator, endocardial single coil |
C1779 | Lead, pacemaker, transvenous VDD single pass |
C1785 | Pacemaker, dual chamber, rate-responsive |
C1786 | Pacemaker, single chamber, rate-responsive |
C1876 | Stent, noncoated/noncovered, with delivery system |
C1877 | Stent, noncoated/noncovered, without delivery system |
C1882 | Cardioverter-defibrillator, other than single or dual chamber |
C1895 | Lead, cardioverter-defibrillator, endocardial dual coil |
C1896 | Lead, cardioverter-defibrillator, other than endocardial dual coil |
C1898 | Lead, pacemaker, other than transvenous VDD single pass |
C1899 | Lead, pacemaker/cardioverter-defibrillator combination |
C1900 | Lead, left ventricular coronary venous system |
C2617 | Stent, noncoronary, temporary, without delivery system |
C2619 | Pacemaker, dual chamber, nonrate-responsive |
C2620 | Pacemaker, single chamber, nonrate-responsive |
C2621 | Pacemaker, other than single or dual chamber |
C2623 | Catheter, transluminal angioplasty, drug-coated, nonlaser |
C2624 | Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components |
C2630 | Catheter, electrophysiology, diagnostic/ablation, other than 3D or vector mapping, cool-tip |
C9600 | Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch |
C9601 | Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery |
C9602 | Percutaneous transluminal coronary atherectomy with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch |
C9603 | Percutaneous transluminal coronary atherectomy with drug eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery |
C9604 | Percutaneous transluminal revascularization of or through coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel |
C9605 | Percutaneous transluminal revascularization of or through coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft |
C9606 | Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, single vessel |
C9607 | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, single vessel |
C9608 | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including aspiration thrombectomy when performed, each additional coronary artery, coronary artery branch, or bypass graft |
E0616 | Implantable cardiac event recorder with memory, activator, and programmer |
G0278 | Iliac and/or femoral artery angiography, nonselective, bilateral or ipsilateral to catheter insertion, performed at the same time as cardiac catheterization and/or coronary angiography |
G0448 | Insertion or replacement of a permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber with insertion of pacing electrode, cardiac venous system, for left ventricular pacing |
K0606 | Automatic external defibrillator, with integrated electrocardiogram analysis, garment type |
K0607 | Replacement battery for automated external defibrillator, garment type only, each |
K0608 | Replacement garment for use with automated external defibrillator, each |
K0609 | Replacement electrodes for use with automated external defibrillator, garment type only, each |
S2205 | Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using arterial graft(s), single coronary arterial graft |
S2206 | Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using arterial graft(s), two coronary arterial grafts |
S2207 | Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using venous graft only, single coronary venous graft |
S2208 | Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using single arterial and venous graft(s), single venous graft |
S2209 | Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using two arterial grafts and single venous graft |
Payment Policy Updates
The below policy was updated as part of our regular monthly review in August. The policy change is effective January 1, 2026. You will find the policy, including a description of the revisions, posted on the policy site.
Policy Number | Policy Title | Line of Business |
CC.PP.145 | Malnutrition | Apple Health & Ambetter |
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Wellcare
Medicare Prior Authorization Updates:
Effective October 1, 2025
Wellcare is notifying all participating Medicare providers that prior authorization will no longer be required for a series of computed tomography (CT) and transthoracic echocardiogram procedure codes.
A comprehensive list of procedure codes affected by this notification are provided in the following table.
Procedure Codes No Longer Requiring Prior Authorization Effective 10/01/2025 | |
Procedure | Procedure Codes |
Chest CT | 71250, 71260, 71270, 0722T |
CT for Low Dose Lung Cancer Screening | 71271 |
CT of the Pelvis and Abdomen | 74176, 74177, 74178, 0722T |
Transthoracic Echocardiogram | 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93356 |
Please Note:
Non-participating providers require authorization for all HMO services, except where indicated. A complete CPT/HCPCS code list can be viewed online.
It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.
Please verify eligibility and benefits for all members prior to rendering services. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered.
For additional assistance, please contact your Provider Services team.
Effective October 15, 2025
As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Wellcare wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.
A full list of code changes for Wellcare, including Medicare (Wellcare), can be found on our website here. These changes may include:
- Removing PA requirements based on criticality of review and clinical need.
- Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.
If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.
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Apple Health Core Connections
Refer members to our new Comprehensive Sexual Healthcare webpage for more information about birth control, STI testing, pregnancy testing and abortion, pregnancy support, privacy rights, healthy relationships, LGBTQIA+ support and other resources. Coordinated Care worked with Passion 2 Action, the youth advisory group to Washington State’s Department of Children, Youth and Families, to develop content for this webpage to empower youth and young adults who have experienced child welfare with education about, and access to, comprehensive sexual health resources.
Members who are pregnant can receive support through Coordinated Care’s Start Smart for Your Baby Program. Services include finding a provider, mental health, preparing for the baby, breastfeeding support, education about baby development, recovery after delivery, birth control, and more. Benefits also include a free breast pump and a choice of a stroller, car seat or pack ‘n play at no cost.
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Training/Education
Supporting LGBTQIA+ Youth in Foster Care This curriculum was developed through Amara with input from Coordinated Care and guidance from many community organizations. This training is for caregivers and professionals who work in the child welfare setting. Tuesday Oct 7 10a – 11:30a Register.
Suicide Prevention Provides an overview of the topic of suicide, signs and symptoms, and how caregivers should respond in times of crisis. The training will dive into the rates of youth suicide, risk factors, and proactive steps to take for prevention. Wednesday Oct 8 12p – 1:30p Register.
Cultural Care & Connections This training explains the importance of cultural differences when caring for a child of a different race or culture. It provides insight on how the caregiver can recognize different values, beliefs, behaviors, communication variations and potential barriers, including personal care. Additionally, this training addresses the need to keep children connected to their culture of origin. Wednesday Oct 8 2p – 3:30p Register.
Apple Health/Coordinated Care Overview: Coordinated Care's Apple Health Foster Care Overview includes program information, insurance coverage and special benefits for youth in foster care, adoption support, alumni of foster care and reunified families that choose Coordinated Care. Professionals supporting foster parents should take this informative and surprising presentation! Thursday Oct. 2, 11:00am - 12:30pm Register.
ACE's (Adverse Childhood Experiences): This training explains the Adverse Childhood Experiences (ACEs) study and identifies all 10 ACEs. All childhood experiences, especially traumatic events, have an impact on people as they mature. This training explores the long term effects that adverse childhood experiences have on physical and mental health. Preventative measures, resiliency, and how to address the needs of children with a high ACEs score are all discussed. Personal ACE's test provided. Wednesday Oct 8, 2025 05:30 - 07:05pm Register.
Trauma Informed Care & Discipline: We all need discipline in our lives to function well in society. For youth especially, boundaries and consistency help provide safety and security. How does a caregiver or professional provide consequences and boundaries with a child who is not attached to the foster family, and has significant trauma in their lives? This training discusses this topic with ideas and tips, as well as an overview of why children with traumatic history can be so challenging! Training content in part developed from National Child Traumatic Stress Network. Wednesday Oct 29, 2025 01:00 – 02:35 PM Register.
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Pharmacy Updates
Labeler Termination Notice - Effective 10/01/2025
Effective October 1, 2025, several manufacturers’ labelers will be terminated with Medicaid Drug Rebate Program. Coordinated Care of Washington, Inc. is required to ensure that drugs that do not have a federal rebate are non-covered.
As a result, the following single-source (Brand) medications—which are not produced by any other manufacturer—will no longer be covered.
Impacted members currently using these medications will receive a notification letter outlining this change. The letter will also include a table of alternative treatment options that can be discussed with you for consideration.
For more information on Labeler Termination, click here.
Manufacturer Patient Assistance Program
Medicaid patients whose plans no longer provide coverage for Xifaxan may be eligible for coverage through manufacturer Bausch Health and Salix’s Patient Assistance Program (PAP).
The details on how to enroll can be found here or by calling 1-833-862-8727.
A prior authorization may be submitted for medical necessity.
Single-Source Medication with Identified Member Impact | Suggested Alternatives |
APLENZIN TABLETS | BUPROPION XL TABLETS BUPROPION HCL SR TABLETS |
CABTREO GEL | ADAPALENE GEL (GRAM) CLINDAMYCIN PHOS-BENZOYL PEROX GEL (GRAM) CLINDAMYCIN PHOSPHATE GEL (GRAM) CLINDAMYCIN-BENZOYL PEROXIDE GEL (GRAM) ERYTHROMYCIN-BENZOYL PEROXIDE GEL (GRAM) RETIN-A GEL (GRAM) TRETINOIN GEL (GRAM) |
DIURIL SUSPENSION 250/5ML | CHLORTHALIDONE TABLET INZIRQO SUSPENSION (PA REQUIRED) SPIRONOLACTONE ORAL SUSPENSION (PA REQUIRED) HYDROCHLOROTHIAZIDE TABLET or CAPSULE INDAPAMIDE TABLET METOLAZONE TABLET |
JUBLIA SOLUTION 10% | CLOTRIMAZOLE SOLUTION TAVABOROLE SOLUTION (PA REQUIRED) CICLOPIROX SOLUTION (PA REQUIRED) ORAL TERBINAFINE TABLET |
PLENVU SOLUTION | CLEARLAX HEALTHYLAX PEG 3350-ELECTROLYTE SOLUTION POLYETHYLENE GLYCOL 3350 GAVILYTE-C |
RELISTOR TABLETS | LUBIPROSTONE CAPSULE (PA REQUIRED) MOVANTIK TABLET (PA REQUIRED) SYMPROIC (PA REQUIRED) |
TRULANCE TABLETS 3MG | LINZESS CAPSULE (PA REQUIRED) LUBIPROSTONE CAPSULE (PA REQUIRED) MOTEGRITY (PA REQUIRED) IBSRELA (for IBS-C) |
XIFAXAN TABLETS | METRONIDAZOLE TABLET CIPROFLOXACIN TABLET NEOMYCIN TABLET For Hepatic Encephalopathy and SIBO: XIFAXAN TABLETS (PA required) IBS-D: LOPERAMIDE, CHOLESTYRAMINE, COLESTIPOL, COLESEVELAM, ALOSETRON, or VIBERZI. Travelers Diarrhea: AZITHROMYCIN |
Full list of all impacted Single-Source Medication Names
|
|
ALTRENO 0.05% LOTION | PEDI-PRE TAPE SPRAY |
AMYTAL SODIUM 0.5 GRAM VIAL | PHENOL EZ SWABS |
APLENZIN ER 174 MG TABLET | PHOSPHOLINE IODIDE 0.125% DROP |
APLENZIN ER 348 MG TABLET | PLENVU POWDER PACKETS |
APLENZIN ER 522 MG TABLET | RELISTOR 12 MG/0.6 ML SYRINGE |
ARAZLO 0.045% LOTION | RELISTOR 12 MG/0.6 ML VIAL |
ATOPICLAIR CREAM | RELISTOR 150 MG TABLET |
BRYHALI 0.01% LOTION | RELISTOR 8 MG/0.4 ML SYRINGE |
CABTREO 1.2%-0.15%-3.15% GEL | RENOVA 0.02% CREAM |
CARAC 0.5% CREAM | RENOVA PUMP 0.02% CREAM |
DIURIL 250 MG/5 ML ORAL SUSP | RETIN-A MICRO PUMP 0.06% GEL |
DUOBRII 0.01%-0.045% LOTION | SILIQ 210 MG/1.5 ML SYRINGE |
ENVIVE 12 BILLION CFU CAPSULE | TIMOPTIC 0.25% OCUDOSE DROP |
FLUORESCEIN-BENOXIN 0.3%-0.4% | TRULANCE 3 MG TABLET |
FOLOTYN 40 MG/2 ML VIAL | UNIFINE PENTIPS PLUS 31GX3/16" |
GLYCERIN 99.5% LIQUID | UNIFINE PENTIPS PLUS 31GX5/16" |
HYLATOPICPLUS CREAM | VIRAZOLE 6 GM VIAL |
INSTA-GLUCOSE GEL | VISUDYNE 15 MG VIAL |
JUBLIA 10% TOPICAL SOLUTION | XERESE 5%-1% CREAM |
LULICONAZOLE 1% CREAM | XIFAXAN 200 MG TABLET |
LUZU 1% CREAM | XIFAXAN 550 MG TABLET |
NAIL SCRUB LOTION | ZELAPAR 1.25 MG ODT TABLET |
NORITATE 1% CREAM | ZYCLARA 2.5% CREAM PUMP |