4.5 Specialty Team or Center Services

In addition to requiring prior authorization, the following services require that physicians and facilities be enrolled as specialty team or center providers:

•	For stem cell transplant services, the facility must be enrolled as a specialty center.

•	For cleft/craniofacial surgical procedures, the surgeon must be a member of a comprehensive cleft/craniofacial team.

If the specialty team or center requirements are not met, all services related to the procedure are denied.

Note: Anesthesiologists and assistant surgeons are not required to be enrolled as a specialty team or specialty center. An anesthesiologist may be paid if all enrollment and filing deadlines are met. However, when a procedure or admission is denied by the CSHCN Services Program because the primary surgeon or hospital is not appropriately specialty team- or center-enrolled, the assistant surgeon’s claims also are denied.

Refer to:

Section 2.1.7, “Transplant Specialty Centers,” on page 2‑8 for more information about transplant specialty centers enrollment.