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Welcome  » May 20, 2024 12:33 AM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Dental
05/20/2024  

Prior Authorization : Services Requiring Prior Authorization

Topic #20398

Oral Devices/Appliances

ForwardHealth covers oral devices/appliances for members 20 years of age and younger with PA.

Prior Authorization Criteria

All of the following criteria must be met in order for a PA request for an oral device/appliance to be approved:

  • The member received a referral for mild or moderate obstructive sleep apnea.
  • The member completed a sleep study/polysomnogram.
  • Documentation shows that other modalities failed.
 
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