§ 17.273 Preauthorization.

Preauthorization or advance approval is required for any of the following, except when the benefit is covered by the CHAMPVA beneficiary's other health insurance (OHI): (a) Non-emergent inpatient mental health and substance abuse care including admission of emotionally disturbed children and adolescents to residential treatment centers. (b) All admissions to a partial hospitalization program (including alcohol rehabilitation). (c) Dental care. For limitations on dental care, see § 17.272(a)(21)(i) through (xii). (d) Organ transplants. (e) CHAMPVA will perform a retrospective medical necessity review during the coordination of benefits process if: (1) It is determined that CHAMPVA is the responsible payer for services and supplies but CHAMPVA preauthorization was not obtained prior to delivery of the services or supplies; and, (2) The claim for payment is filed within the appropriate one-year period.