Prior Authorization List - WelbeHealth

From: WelbeHealth
To: Health Plan Providers
Type: Informational
Subject: Prior Authorization List
Business: PACE
State(s): PACE – California

Our Prior Authorization List has been updated to reflect changes that are effective October 1, 2025.

Codes Being Added

• 15275 – High-cost wound care code
  Rationale: Added to ensure appropriate utilization of advanced wound care procedures.
• 43239, 45380, 45385, 45388 – Colonoscopy codes
  Rationale: Added to promote accurate procedure review and improve alignment with clinical guidelines.
• 99999 – Unlisted procedure code
  Rationale: Added to ensure unlisted services undergo prior review to determine clinical appropriateness.

Codes Being Removed

• 99199 – Unlisted special service
  Rationale: This code does not require prior authorization under our current configuration and has been removed to align the PA list with system settings.
• 45378 – Diagnostic colonoscopy
  Rationale: Due to broad approval criteria, this code will always be approved and does not require prior authorization.

For the most current version of the PA list, please visit https://welbehealth.com/partners/. Requests for prior authorization can be submitted via:
Our provider portal (for contracted providers): https://welbehealth.quickcap.net/ Or complete our Prior Auth Form and send via Fax: (209) 729-5854.

Thank you for your continued partnership in delivering high-quality care to our participants.

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If you have any questions, please contact your Provider Partnership Representative, or email the Provider Partnership team at providers@welbehealth.com. You may also visit welbehealth.com/partners. for online access to this document and all other WelbeHealth Provider Alerts