Providers for BCG Employees - Services Requiring Prior Authorization

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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 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
Obstetrical Care (Global Authorization) All Sonograms, Pre-natal Procedures and Delivery
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
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