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Culinary Health Fund prior authorization rules by place of service

For Prior Authorization, contact Nevada Health Solutions (NHS)

PLEASE BE ADVISED THAT THE CULINARY HEALTH FUND DOES NOT HAVE OUT OF AREA/NETWORK BENEFITS AND REQUIRES ALL PROVIDERS TO REFER TO IN-NETWORK PROVIDERS. FOR A CURRENT LIST OF PROVIDERS PLEASE GO TO: www.CulinaryHealthFund.org OR CALL CUSTOMER SERVICE AT 702-733-9938.

Please get prior authorization for the following services:

IN OFFICE (PLACE OF SERVICE 11)
CUSTOM COMPRESSION STOCKINGS* AUTHORIZATION REQUIRED
*LIMITED TO FUND CONTRACTED PROVIDERS
CYBERKNIFE NO AUTHORIZATION REQUIRED WHEN PERFORMED BY COHEN, CURTIS, FARZIN, MEOZ AND SCHWARTZ (TIN: 27223260)
DME* Durable medical equipment items that are over $500 require authorization (whether it is a rental or purchase, to include oxygen equipment over $500, i.e. oxygen concentrators)
*LIMITED TO FUND CONTRACTED PROVIDERS
HOME EEG MONITORING AUTHORIZATION REQUIRED
HEMATOLOGY/​ONCOLOGY SERVICES ALL HEMATOLOGY/​ONCOLOGY NOT PROVIDED BY COMPREHENSIVE CANCER CENTERS OF NEVADA REQUIRES PRIOR AUTHORIZATION.
HYPERBARIC TREATMENT AUTHORIZATION REQUIRED
LABORATORY SERVICES CLINICAL PATHOLOGY LABORATORIES IS THE CULINARY HEALTH FUND’S EXCLUSIVE LABORATORY PROVIDER AND MUST BE USED FOR ALL OUTPATIENT LABORATORY SERVICES
LABORATORY – ALL GENETIC TESTING* AUTHORIZATION REQUIRED
*LIMITED TO FUND CONTRACTED PROVIDERS
OFFICE ADMINISTERED DRUGS DRUGS INDICATED REQUIRE AUTHORIZATION:
Biologics and Implantable Hormone Replacement Therapy
PLEASE CALL HEALTHCARE SERVICES AT 702-892-7313 IF YOU HAVE QUESTIONS REGARDING COVERAGE OF A SPECIFIC DRUG.
ORTHOTIC & PROSTHETIC APPLIANCES* Orthotic & Prosthetic Appliances that are over $500 require authorization
*LIMITED TO FUND CONTRACTED PROVIDERS
RADIOLOGY SERVICES Services performed by DESERT RADIOLOGISTS or STEINBERG DIAGNOSTIC do not require prior authorization
For Radiology Services NOT performed by Desert Radiology or Steinberg Diagnostic authorization is required for: CT/CTA, Discography, Some Obstetrical Ultrasounds, Fetal Biophysical Profiles, MRI/MRA, PET Scans
SLEEP STUDIES NOCTURNA IS THE CULINARY HEALTH FUND’S EXCLUSIVE SLEEP STUDY PROVIDER. Requires authorization and must be ordered by a Cardiologist, ENT, Neurologist, Pulmonologist or Culinary Health Center – Primary Care
SURGERY AUTHORIZATION REQUIRED FOR CERTAIN PROCEDURES.
VARICOSE VEINS AUTHORIZATION REQUIRED – LIMITED TO SELECT SPECIALTIES
TMJ PROCEDURES AUTHORIZATION REQUIRED
HOME HEALTH AND HOME INFUSION SERVICES (PLACE OF SERVICE 12)
AUTHORIZATION REQUIRED
INPATIENT (PLACE OF SERVICE 21, 31, 61)
ALL INPATIENT ADMISSIONS REQUIRE AUTHORIZATION, INCLUDING ELECTIVE ADMISSIONS AND THOSE RESULTING FROM ER OR OBSERVATION STAY
OBSERVATION (PLACE OF SERVICE 22)
ALL OBSERVATION ADMISSIONS REQUIRE AUTHORIZATION
OUTPATIENT HOSPITAL (PLACE OF SERVICE 22)
HYPERBARIC & WOUND CARE TREATMENT AUTHORIZATION REQUIRED
RADIOLOGY SERVICES Services performed by DESERT RADIOLOGISTS or STEINBERG DIAGNOSTIC do not require prior authorization
For Radiology Services NOT performed by Desert Radiology or Steinberg Diagnostic authorization is required for: CT/CTA, Discography, Some Obstetrical Ultrasounds, Fetal Biophysical Profiles, MRI/MRA, PET Scans
SLEEP STUDIES NOCTURNA IS THE CULINARY HEALTH FUND’S EXCLUSIVE SLEEP STUDY PROVIDER. Requires authorization and must be ordered by a Cardiologist, ENT, Neurologist, Pulmonologist or Culinary Health Center – Primary Care
SURGERY & INVASIVE DIAGNOSTIC PROCEDURES AUTHORIZATION REQUIRED (Exception: Colonoscopy and EGD procedures do not require prior authorization)
AMBULATORY SURGERY CENTER (PLACE OF SERVICE 24)
AUTHORIZATION REQUIRED (Exception: Colonoscopy and EGD procedures do NOT require prior authorization.)
DIALYSIS CENTER (PLACE OF SERVICE 65)
AUTHORIZATION NOT REQUIRED FOR CONTRACTED FACILITIES
INDEPENDENT LABORATORY (PLACE OF SERVICE 81)
CLINICAL PATHOLOGY LABORATORIES IS THE CULINARY HEALTH FUND’S EXCLUSIVE LABORATORY PROVIDER AND MUST BE USED FOR ALL OUTPATIENT LABORATORY SERVICES
ALL GENETIC TESTING AUTHORIZATION REQUIRED
BEHAVIORAL HEALTH SERVICES (PLACE OF SERVICE 51, 52, 53, 54, 55, 56, 57)
INPATIENT & OUTPATIENT BEHAVIORAL HEALTH SERVICES All behavioral health services require authorization through Harmony Healthcare 702-251-8000
TRANSPLANT SERVICES
AUTHORIZATION IS REQUIRED FOR ALL TRANSPLANT SERVICES INCLUDING CONSULTS

The table is only a general guideline to Culinary Health Fund’s prior authorization requirements. This list may be updated from time to time. It is the provider’s responsibility to check for updates. If the procedure billed is not the procedure approved, there may be no payment and the patient is not liable. The presence or absence of a procedure code and/or service on this list does not determine benefits or coverage for your patient. Verification of benefits and eligibility should be obtained by calling Customer Service at 702-733-9938

CULINARY HEALTH FUND EXCLUSIVE PROVIDERS
DURABLE MEDICAL EQUIPMENT Adapt Health: 702-382-4940
Apria Healthcare: 702-736-4466
Aveanna Healthcare: 866-883-1188
Byrum Healthcare: 800-552-2633
Dia-Foot: 702-970-7166
Everything Medical: 702-366-1111
Gabel Distributors: 702-489-2288
Preferred Homecare: 702-951-6900
LABORATORY SERVICES Clinical Pathology Laboratories: 702-795-4900
LABORATORY SERVICES – GENETIC TESTING Ambry Genetics: 866-262-7943 (BRCA and other select tests)
Sequenom Laboratories: 877-821-7266 (MaterniT 21 Plus & HerediT)
PROSTHETIC AND ORTHOTIC APPLIANCES Brace-It Orthotics & Prosthetics: 702-478-5848
Prosthetic Centers of Excellence: 702-384-1410
RADIOLOGY SERVICES Desert Radiologists: 702-387-6900
Steinberg Diagnostic Medical Imaging (SDMI): 702-732-6000
SLEEP STUDIES Nocturna: 702-896-7378