Click the link here to download a PDF of MVP Elective Procedures Prior Authorization Update.
135 Corporate Woods, Suite 320
Rochester, New York 14623-1466
Phone: (585) 758-7823
Fax: (585) 424-1268
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|Greater than 1.4||Calcification/vessel hardening||Refer to vascular specialist|
|1.0 - 1.4||Normal||None|
|0.9 - 1.0||Acceptable||None|
|0.8 - 0.9||Some arterial disease||Treat risk factor|
|0.5 - 0.8||Moderate arterial disease||Refer to vascular specialist|
|Less than 0.5||Severe arterial disease||Refer to vascular specialist|
Medicare/Medicare HMO patient must be homebound (trouble leaving home without help [e.g., using a cane, wheelchair, walker, or crutches]; needing special transportation; or requiring help from another person) because of an illness or injury, or leaving home isn't recommended because of condition, normally unable to leave home because it's a major effort