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List of Services Requiring Prior Authorization

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Clinician Administered Drugs
Service
Biologicals over $500 administered in office or outpatient setting
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Biosimilars over $500 administered in office or outpatient setting
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Chemotherapy over $500 administered in office or outpatientsetting
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Gene Therapy
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Hydroxyprogesterone
(17-P)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Injectable immunoglobulins over $500 administered in office or outpatient setting
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Injectable intravitreal (eye) medications over $500 administered in office or outpatient setting
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Does not need
Prior Authorization
STAR
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Needs Prior
Authorization
Makena over $500 administered in office or outpatient setting
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
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Dental Procedures
Service
Dental Anesthesia (deep sedation or general anesthesia for dental procedures for children six years of age or younger)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
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Durable Medical Equipment (DME)/Supplies
Service
DME greater than
$300/item
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
DME or supplies in excess of benefit limitations (see TMHP Provider Procedures Manual)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
DME rentals longer than two months
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Enteral formulas and nutritional supplies/supplements
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Orthotics
(over $200/item)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Prosthetics
(over $200/item)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
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Home Health Services
*Initial evaluation does not require prior authorization
Service
Private Duty Nursing *
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Skilled Nursing require *
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
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Imaging / Radiology / Diagnostic
Service
CT Scan
CHIP
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Does not need
Prior Authorization
CHIP PERINATE
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Does not need
Prior Authorization
STAR
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Does not need
Prior Authorization
Fetal Echocardiography only the following codes (76825, 76826, 76827, 76828)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
MRI
X Mark Icon
Does not need
Prior Authorization
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Does not need
Prior Authorization
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Does not need
Prior Authorization
PET Scan require a prior authorization
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Sleep Studies require a prior authorization
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
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Outpatient Hospital
Service
Ambulatory Surgical Center Procedures
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Chemotherapy
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Dialysis
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Needs Prior
Authorization
X Mark Icon
NOT COVERED
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Needs Prior
Authorization
Heart Cath procedures
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Intensive Outpatient Hospitalization
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Partial Hospitalization Program
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Prescribed Pediatric Extended Care Center (PPECC)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Heart Cath procedures
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Intensive Outpatient Hospitalization
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
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Inpatient Hospitalization
*Notification of inpatient admission is required within one business day after admission
Service
Deliveries extending beyond 2 days after vaginal/3 days after caesarean section
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Deliveries-Routine do not require a prior authorization
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Does not need
Prior Authorization
X Mark Icon
Does not need
Prior Authorization
X Mark Icon
Does not need
Prior Authorization
Elective/Scheduled procedures *
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Emergent Medical admission do not require a prior authorization *
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Does not need
Prior Authorization
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Does not need
Prior Authorization
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Does not need
Prior Authorization
Emergent Psychiatric admission do not require a prior authorization *
X Mark Icon
Does not need
Prior Authorization
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NOT COVERED
X Mark Icon
Does not need
Prior Authorization
Inpatient hospice *
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Nursery stay in which newborn remains inpatient after mother is discharged
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Rehabilitative *
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Substance Abuse Treatment *
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
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Outpatient Surgical Centers
Service
Elective procedures
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Scheduled procedures
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
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Other Medical Services
Service
Allergy injections when limits are exceeding (see Texas Medicaid Provider Procedures Manual for limitations)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
BRCA screening
(excluding cpt 82105)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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NOT COVERED
STAR
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Needs Prior
Authorization
Emergency Room Care does not require prior authorization
X Mark Icon
Does not need
Prior Authorization
X Mark Icon
Does not need
Prior Authorization
X Mark Icon
Does not need
Prior Authorization
Family Planning does not require prior authorization (contraceptive drugs/devices
are not a benefit for CHIP
X Mark Icon
Does not need
Prior Authorization
X Mark Icon
NOT COVERED
X Mark Icon
Does not need
Prior Authorization
Genetic testing
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Hearing Aids
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Implantable Devices
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Primary Care Physician office visit do not require prior authorization
X Mark Icon
Does not need
Prior Authorization
X Mark Icon
Does not need
Prior Authorization
X Mark Icon
Does not need
Prior Authorization
Specialist-to-Specialist Referral
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Transfers – non-emergent facility to facility outside of El Paso service area
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Venous Procedures (in-office/outpatient)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
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Out-of-Network
Service
All out-of-network medical
and behavioral services
(except emergent) require
a prior authorization
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
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Rehabilitative Services
*Initial evaluation does not require prior authorization
Service
Occupational Therapy (OT) *
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Physical Therapy (PT) *
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Speech Therapy (ST) *
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Re-evaluation for
OT, PT, and ST
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
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Specialist
*Initial evaluation does not require prior authorization
Service
Chiropracter *
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Mental Health Rehabilitation/Targeted Case Management
CHIP
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NOT COVERED
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Podiatry In-Office Surgical (excluding CPT codes 11720, 11721, 11730, 11732, and 11750)
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
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Transplant Services
Service
Evaluation
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
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Needs Prior
Authorization
Needs Prior Authorization
CHIP
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Needs Prior
Authorization
CHIP PERINATE
X Mark Icon
NOT COVERED
STAR
Check Mark Icon
Needs Prior
Authorization
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Transportation
Service
Air Transport
CHIP
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Needs Prior
Authorization
CHIP PERINATE
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Needs Prior
Authorization
STAR
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Needs Prior
Authorization
Non-emergent ambulance
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Needs Prior
Authorization
Check Mark Icon
Needs Prior
Authorization
Check Mark Icon
Needs Prior
Authorization
Emergency Medical Transportation does not require prior authorization
X Mark Icon
Does not need
Prior Authorization
X Mark Icon
Does not need
Prior Authorization
X Mark Icon
Does not need
Prior Authorization
1145 Westmoreland Drive
El Paso, TX 79925-5615

Call us at 915-532-3778 STAR/CHIP
Outside El Paso 1-877-532-3778 STAR/CHIP

Call us at 1-833-742-3127 STAR+PLUS

Hours of Operation
8:00 A.M. – 5:00 P.M. MST
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