Prior Authorization List for BCG Employees
All mental health and substance abuse services (inpatient or outpatient) require prior authorization from Managed Care Concepts, 800-538-6979.
For an Authorization Request Form, click here
Admission Inpatient |
Elective Surgical Inpatient Admission |
Elective Medical Inpatient Admission |
Inpatient Rehabilitation Admission |
Non-elective (Emergency) Admission |
Skilled Nursing Facility Admission |
Admission Observation |
Admission / Discharge Same Day |
Hospital Observation Services (except for labor checks) |
Home Health |
Skilled Nursing Visits |
Home Respiratory Therapy Visits |
Home Social Worker Visits |
Home Health Aide Visits |
Hospice |
Hospice Outpatient at Home / ALF / SNF |
Hospice Inpatient |
Diagnostic and Lab Testing |
Cardiac Event Monitoring (30 Day) |
CTA and Calcium Scoring |
Genetic Testing (except when related to pregnancy) |
Growth Evaluation & Tx for Hormone Therapy |
PET Scan / SPECT Scan |
Sleep Study |
Durable Medical Equipment |
*Medical and Surgical Supplies do not require Prior Authorization when provided by a participating provider* |
Bone Growth Stimulator |
Clinitron and Electric Beds |
CPAP and BIPAP Machines |
Custom Orthotics and Prosthetics |
Diabetic Shoes |
Electric and manual Wheelchairs / Scooters |
Wheelchair Accessories |
Insulin Pumps and Supplies |
Limb and Torso Prosthetics |
Prosthetic Custom Eye, Surfacing and Fitting |
Enteral Nutrition |
Patient Lifts |
Wound Vac Pumps |
Maternity |
Obstetrical Care (Global Authorization) |
All Sonograms, Pre-natal Procedures and Delivery |
Transportation |
Transportation - Non Emergent |
Transportation - Air |
Invasive Procedures |
Capsule Endoscopy |
Chemodenerve Eccrine Glands |
Denervation |
Epidural Injection for Lysis |
Epidural Injection for Pain |
Hormone Pellet Implant |
Hyperbaric Treatment |
Oral Arthroscopy |
Oral Surgery |
Spider Vein Therapy |
Spider Vein Therapy - Injection / Laser |
Total Disc Arthroplasty |
Virtual CT Colonoscopy |
Plastic / Reconstructive |
Adjacent Tissue Transfer / Rearrangement / Repair |
Canthoplasty |
Correction of Lid Retraction |
Dermatological Procedures |
Eyelid, Excision and Repair |
Foot and Toes Reconstruction |
Hand and Fingers Reconstruction |
Head ( skull, face, TMJ ) Reconstruction |
Humerus and Elbow Reconstruction |
Knee, Arthroplasty, Total |
Keratoprosthesis |
Lip, Repair |
Mastectomy Proc / Repair, Reconstruction |
Mastoid Surgery Revision |
Neck and Thorax Reconstruction |
Nose, Repair |
Ocular Adnexa, Strabismus Surgery |
Palatoplasty for Cleft Palate |
Pelvis and Hip Reconstruction |
Penile Repair |
Skin Flaps and Grafts |
Testicular Prosthesis Insertion |
Transplant |
Any covered transplant evaluation, pre-transplant care, transplant, and post-transplant follow-up services require prior authorization. |
Amniotic Membrane |
Bone- Autograft for Spine Surgery |
Bone Marrow |
Cornea |
Eye |
Heart |
Heart-Lung |
Intestine |
Kidney |
Liver |
Lung |
Ovarian |
Pancreas |
Pancreatic Islet Cells |
Peripheral Stem Cells |
Skin |
Tissue |