Get Functional Endoscopic Sinus Surgery Prior Review Fax Form
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How to fill out the Functional Endoscopic Sinus Surgery Prior Review Fax Form online
Filling out the Functional Endoscopic Sinus Surgery Prior Review Fax Form is essential for ensuring appropriate medical review and authorization. This guide provides clear, step-by-step instructions to aid users in completing the form accurately and efficiently.
Follow the steps to accurately complete the form online
- Press the ‘Get Form’ button to obtain the form and open it for editing.
- In the 'Prescriber Information' section, enter the physician's name along with the provider ID or tax ID if required, especially if out-of-state.
- Provide the patient's information by filling in their BCBSNC ID, name, date of birth, and contact details, including the practice name, phone number, fax number, and address.
- Indicate the requested CPT code(s) by marking the appropriate boxes. Make sure to check all applicable codes related to the procedure.
- Answer the yes or no questions related to the patient's condition and previous treatments for sinusitis. Be thorough in providing accurate responses.
- Include the diagnosis code, date of the procedure, and place of service in their respective fields to ensure complete information is submitted.
- The physician must sign and date the attestation at the end of the form, confirming authorization for the requested services. Remember that original signatures are required.
- Once all information is filled out, review the form for accuracy. You can then save changes, download a copy, print it, or share accordingly.
Complete your functional endoscopic sinus surgery prior review fax form online today for a seamless submission process.
The Current Procedural Terminology (CPT) code for Functional Endoscopic Sinus Surgery (FESS) varies based on the specific procedure performed. Common codes include 31255 for the endoscopic approach to the maxillary sinus and 31267 for the sphenoid sinus. Always consult with your healthcare provider or check coding resources for the most accurate code for your situation.
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