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Service Authorization and Referral Requirements

This table tells you whether or not you need permission from your primary care provider (PCP) or WellCare before you see certain types of providers or receive certain services. Permission to see providers is called a "referral" and permission to receive services is called "authorization." If you need either type of permission, your PCP will request it for you. If you have been referred to a specialist and he or she believes you need services requiring authorization, he or she will request it for you.

Please note: Authorization and referral requirements only apply to services covered by your plan. For a detailed explanation of what services are covered by your plan and how to receive them, please reference your plan’s Evidence of Coverage (EOC) on the Plan Materials page.

Provider/Service

Is permission

from your PCP 

required?

Is permission

from WellCare

required?

Acupuncture and other alternative therapies

Yes Yes

Ambulance services (non-emergency)

No Yes

Ambulatory surgical center services

Yes Yes

Annual physical exam

Yes Yes

Cardiac and pulmonary rehabilitation services

No Yes

Chiropractic services 

Yes Yes

Dental care

Yes Yes

Diabetes self-management training

Yes Yes

Diabetic services and supplies

No Yes

Durable medical equipment (DME) and related supplies

No Yes

Emergency care

No No

Eye exams

Yes Yes

Eye Wear

Yes Yes

Hearing Aids

Yes Yes

Hearing Exams

Yes Yes

Home health agency care

Yes Yes

Inpatient hospital care 

Yes Yes

Inpatient mental health care

Yes Yes

Kidney disease education services

Yes Yes

Meals benefit (chronic and post-acute)

Yes Yes

Medicare Part B prescription drugs

No Yes

Medicare-covered preventive services

No No

Non-emergency medical transportation

Yes Yes

Occupational therapy services

Yes Yes

Other health care professional services

Yes Yes

Outpatient blood services

Yes Yes

Outpatient diagnostic tests, lab services and therapeutic services and supplies

Yes Yes

Outpatient hospital services

Yes Yes

Outpatient mental health care

Yes Yes

Outpatient substance abuse services

Yes Yes

Over-the-counter items

No No

Partial hospitalization services

Yes Yes

Physical therapy and speech language therapy services

Yes Yes

Physician specialist services

Yes Yes

Podiatry services

Yes Yes

Primary care physician (PCP) services

No No

Prosthetic devices and related supplies

No Yes

Psychiatric services

Yes Yes

Services to treat kidney disease and conditions

Yes Yes

Skilled nursing facility (SNF) care

Yes Yes

Supplemental education/health management programs

Yes Yes

Urgently needed care

No No

Worldwide emergency/urgently needed care

No No
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Y0070_WCM_06390E CMS Approved 10/23/2017 Last Updated On: 10/1/2017