Laser Interstitial Thermal Therapy to Require Prior Authorization

Date: April 6, 2022  Attention: Radiologists Effective date: July 5, 2022Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business days to complete. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete. Providers should direct questions to their assigned Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org. Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after July 5, 2022, a prior authorization will be required for laser interstitial thermal therapy (LITT) procedure codes 61736 and 61737. Click here for the Texas Standard Authorization Form. How this impacts providers: LITT, an intraoperative magnetic resonance imaging (MRI) procedure, will be considered for prior authorization when the following medical necessity criteria have been met:

• The client has one of the following documented diagnoses:
  • Relapsed brain metastasis
  • Acute cerebrovascular insufficiency
  • Radiation necrosis
  • Secondary malignant neoplasm of the brain

• The client is not a surgical candidate.

Next steps for providers: Providers should share this communication with their staff. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers