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     Home → Welfare→ SPD → 6.5.1 WHAT SERVICES AND PROCEDURES REQUIRE PRECERTIFICATION OR PRE-SU

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6.5.1 WHAT SERVICES AND PROCEDURES REQUIRE PRECERTIFICATION OR PRE-SURGICAL REVIEW

  • Precertification Review is required for all non-Emergency inpatient Hospital admissions

  • Pre-surgical Review is required for the following surgical procedures:

Knee surgery
Rhinoplasty (nose bone surgery)
Bunionectomy and/or hammertoe (multiple)
Septoplasty (nose cartilage surgery)
Jaw surgery
Varicose vein surgery


  • Precertification Review is required for Home Health Services.

  • Precertification Review IS REQUIRED for Emergency inpatient hospitalization. If an Emergency requires admittance into the Hospital, the Utilization Management Organization must be contacted within 72 hours. Your Physician, a family member or friend can make that phone call. This will enable the Utilization Management Organization to advise you on the Medical Necessity of health services.

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