Effective November 1, 2019, acupuncture no longer requires prior authorization. This applies to all fully-insured plans — self-funded plans-must check with Customer Service to verify if prior authorization is needed.
- Services are covered for up to 12 treatments per benefit year
- Treatment must be provided by an in-network provider
- Members should contact Customer Service for a current list of providers
Effective January 1, 2020, the HCPCS Code E0604 (Hospital Grade Breast Pump) will no longer be covered. Previous coverage was allowed with a Prior Authorization. Members will continue to have access to the electric breast pumps (E0603).
Continuous Glucose Monitoring (CGM) Systems
For commercial members, Quartz will offer coverage of the Dexcom G6 CGM system under both the pharmacy and medical benefit starting January 1, 2020. Coverage of CGMs will require prior authorization using existing prior authorization criteria.
Pharmacy coverage requests –
- Review the Medication Prior Authorization Criteria
- Submit online: Medication Coverage Request Form
- Fax: Download the Medication Coverage Request Form and fax to (888) 450-4711
Medical coverage requests –
- Review the Medical Policies
- Review the General Prior Authorization List or General Prior Authorization List – PPO
- Fax: Download the Quartz Medication Coverage Request Form and fax to (608) 821-4207
Pharmacy coverage of CGMs will not apply to Medicare plans or members who do not have Quartz pharmacy coverage (i.e., BadgerCare Plus, State Plans and self-funded participants who have their pharmacy benefit with someone other than Quartz). For these members, CGM coverage will continue under the medical benefit only.
Questions? Contact Quartz Customer Service at (800) 362-3310 (fully insured members) or (800) 805-0693 (self-funded participants).