Updates to prior authorization requirements

• 01/31/2025

Hennepin Health made updates to prior authorization (PA) requirements starting January 1, 2025. Read below for a summary of these updates.

1. Psychiatric Residential Treatment Facility: PA required after the initial 90 days. Providers should fax the inpatient admission notification form at the time of admission.
2. Wheelchairs require PA if the total purchase price when purchase amount equals or exceeds $3,000* per item or line item is greater than $3,000.
3. Scalp Hair Protheses (wigs) require PA. This is a covered benefit for diagnoses of cancer and alopecia.  Scalp hair prostheses must be purchased, not rented.
4. SNBC change for Skilled Nursing: PA required after 9 visits. This is a change from the previous PA requirement which occurred after the first visit. This is now aligned with PMAP member authorization requirements. 
5. Injection/Drugs Administered in a Physician Office/Clinic or Outpatient Setting: Added Taltz J3590 and C9399.
6. Eyeglasses and Frames: Hennepin Health added detail related to repairs and replacements.

The most up-to-date 2025 prior authorization list can be found on the Hennepin Health prior authorization webpage.