Please access the Gateway Health Provider Portal via Navinet to determine if a drug/HCPCS code requires authorization and to submit authorization requests. View drug authorization requirements/submit authorization requests here:

Ambulance Services (Ground) (L35162) Medical Policy PA Medicare 09/01/2023
Cardiac Event Detection Monitoring (L34953) Medical Policy PA Medicare 04/01/2024
Electrical Bone Growth Stimulators for the Spine (Osteogenesis Stimulators) Medical Policy PA Medicaid 04/01/2023
Ultrasound Bone Growth Stimulators Medical Policy PA Medicaid 04/01/2023
Spinal Cord Stimulation (Dorsal Column Stimulation) (L35450) Medical Policy PA Medicare 06/01/2024
Glucose Monitors (L33822) Medical Policy PA Medicare 12/01/2022

Highmark Wholecare Policy Disclaimer

  • The Policies neither constitutes nor substitutes for medical advice. Highmark Wholecare’s Policies should not be construed as providing medical advice or treatment or guaranteeing the outcome or results of any medical services/treatments and/or procedures Providers are responsible for providing medical advice and treatment, are independent contractors, and are not employees or agents of Highmark Wholecare. If members have a specific question about their medical condition, they should consult with their provider.
  • In the event of a conflict between the Policy and Member Handbook or Evidence of Coverage, the express terms of the Member Handbook or Evidence of Coverage will govern. The existence of a medical guideline is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the medical guideline.  The Policies are used in making decisions as to medical necessity only and they do not guarantee payment of services. Policies serve as one of the sets of guidelines for coverage decisions.
  • The information on this website may not reflect a recent policy change or all of the applicable medical guidelines.
Last updated on 5/1/2024 4:38:31 PM


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