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2012 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 4. Outpatient Hospital (Medical/Surgical Acute Care Outpatient Facility) : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.11 Fluocinolone Acetonide : 4.2.11.1 Prior Authorization for Fluocinolone Acetonide

4.2.11.1
Procedure code J7311 is only payable with a posterior uveitis diagnosis (36320) of more than six months duration and the condition has been unresponsive to oral or systemic medication treatment. To request prior authorization, providers must submit requests by fax or mail to the SMPA Department at:
Texas Medicaid & Healthcare Partnership
Special Medical Prior Authorization
12357-B Riata Trace Parkway
Austin, TX 78727
Fax: (512) 514-4213
Requests for prior authorization can be submitted online through the TMHP website at www.tmhp.com.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.