Please Note: Prior to submitting our Provider Relief Emergency Temporary Practitioner Application, please verify if they are already contracted and a participating provider.
To confirm that your provider is considered participating, we have three convenient options for you to choose from.
You can find our online provider directory at PacificSource.com. Select the Find a Provider link from our top menu bar. On the right hand side of your screen, find the Quick Links menu and click on PacificSource Provider Directory.
If you have any questions, please feel free to contact us at the numbers listed above.
Currently diagnostic mammogram 77066 and screening mammogram 77067 do not require a Prior Authorization (PA), however 77067 does have an age requirement (PA required for ages < 40 years old). Effective April 15, 2019 the age requirement will change for screening mammogram 77067. No PA will be required for ages 35 and older.
In addition, the PA requirement for G0279 Diagnostic digital breast tomosynthesis is changing. It will no longer require a PA effective April 15, 2019. It continues to not be a covered service for Medicaid per Diagnostic Guideline D6 and Guideline Note 173 of the OHP Prioritized List of Health Services.
Please call PacificSource with any questions regarding this notice.