CommercialPrior AuthMedium impact
Mutual News May 2022 Bulletin
Medical Mutual of Ohio·Pulmonology, Critical Care, Internal Medicine +1 more·Mutual News Bulletin
Effective date
Aug 15, 2022
We identified it
Jun 20, 2026
Summary
Medical Mutual is implementing new prior authorization requirements for home ventilators used with non-invasive interfaces (HCPCS E0466) effective August 15, 2022. Additionally, network fee schedules will be updated with quarterly changes for J-codes and radiological materials, and semi-annual updates for immunization fees.
Action Required
By August 15, 2022: Billing team must update system to require prior authorization for HCPCS code E0466 (home ventilators with non-invasive interface) for Commercial and Medicare Advantage plans. Review MCG Health Care Guideline A-0893 for medical necessity criteria. Update encounter forms to alert providers. Claims without prior auth will be denied.