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December 2016 Texas Medicaid Provider Procedures Manual

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook : 5 Gynecological Health Services : 5.8 Ovarian Wedge Resection : 5.8.1 Prior Authorization for Ovarian Wedge Resection

5.8.1
Prior Authorization is required for ovarian wedge resection.
The prior authorization request must include documentation of polycystic ovarian syndrome (PCOS).
Note:

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.