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Prior Authorization Requirement Changes Effective July 1st, 2025
Date: 05/02/25
Delaware First Health is committed to delivering cost-effective, quality care by verifying the medical necessity of treatments through prior authorization. Effective July 1, 2025, the following services require prior authorization:
- Q4202 – KEROXX (2.5G/CC) 1CC
- Q4164 – HELICOLL PER SQUARE CENTIMETER
Providers must verify member eligibility and benefits before rendering services. Payment depends on member eligibility at the time of service. Non-Par Providers need authorization for all services unless indicated. For a complete list of CPT/HCPCS codes that require authorization, please use the Pre-Auth Check Tool.
If you have any questions, please call Provider Services at 1-877-236-1341. You may also locate your Provider Engagement Administrator Manager to confirm the individual supporting your specialty and region.
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