The following services require precertification as soon as possible in advance of providing the services. Members should call 1-800-574-8556 to verify pre-certification information for the following services:

• Inpatient admissions (except maternity and emergency admissions)
• Skilled nursing facility admissions
• Inpatient rehabilitation admissions
• Outpatient surgery
• Surgery of the jaw, face or head
• Reconstructive surgery
• Gastric surgery
• Anesthesia and facility services related to dental services
• Covered clinical trials
• Injectable drugs received in an outpatient setting
• Physical therapy
• Occupational therapy
• Speech therapy
• Chiropractic care
• Cardiac rehabilitation (outpatient)
• Pain clinic
• Cardiac catheterization
• MRI/MRA
• CT scans
• Colonoscopy
• Upper endoscopies
• Endoscopic retrograde cholangiopancreatography (ERCP)
• PET scans
• Spect scans
• Muga scans
• Myelogram
• Sleep studies
• Allergy testing
• Invasive radiologic services
• Durable medical equipment with purchase price $250.00 or greater
• Durable medical equipment rentals
• Orthotics and prosthetics with purchase price greater than $250.00
• Home health services
• Behavioral health services for all places of service (includes mental/nervous disorders and chemical dependency).

Note: This list may be amended by FirstCarolinaCare from time to time.

No precertification is needed for services for emergency medical conditions.

To request precertification, please call 1-800-574-8556 (from the prompt select Option 2, at the next prompt select Option 2, then select Option 1).

All precertification requests must be made prior to starting the services listed above so that FCC’s utilization review staff will have time to make a decision or get more information as required.