Culinary Health Fund prior authorization rules by place of service
For Prior Authorization, contact Nevada Health Solutions (NHS)
- Phone: 702-216-1653 or toll free 855-392-0778
- Fax: 702-691-5614
- The NHS authorization portal can be reached through the NHS website
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 (Exception: J0585, J9030, J9155 and J9217 FOR UROLOGY ONLY). 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 a PPO Freestanding Radiology Facility do not require prior authorization |
| For Radiology Services NOT performed at a PPO Freestanding Radiology Facility 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 a PPO Freestanding Radiology Facility do not require prior authorization |
| For Radiology Services NOT performed at a PPO Freestanding Radiology Facility 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 (diabetic shoes/inserts and custom orthotics): 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) | |
| PROSTHETIC AND ORTHOTIC APPLIANCES | Brace-It Orthotics & Prosthetics: 702-478-5848 |
| Prosthetic Centers of Excellence: 702-384-1410 | |
| RADIOLOGY SERVICES | Opensided MRI of Las Vegas (open-sided MRI services only): 702-932-2740 |
| Pueblo Medical Imaging: 702-228-0031 | |
| SimonMed Imaging: 702-433-6934 | |
| Steinberg Diagnostic Medical Imaging (SDMI): 702-732-6000 | |
| SLEEP STUDIES | Nocturna: 702-896-7378 |