The following services require precertification as soon as possible in advance of providing the 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

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

No precertification is needed for services for emergency medical conditions.

To request precertification, please call 1-800-574-8556 or 910-715-8100
From the prompt, select Option 1, at the next prompt select Option 2, wait for the next prompt and then select Option 1 OR fax a completed precertification request form to 1-866-896-1941.

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