FEP® Updates to Prior Approval Requirements and Benefits


As of January 1, 2024, the following changes will be in effect for FEP policy types:

  1. For Standard and Basic, Hearing Aids will require Prior Approval and will NOT be covered with a post service review.   Blue Focus will continue to have hearing aids not covered.
  2. All genetic testing will require Prior Approval.
  3.  Proton Beam Therapy, Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy require prior approval.
  4. Certain High-Cost High Dollar Drugs will require Prior Approval in addition to all Gene Therapy and CAR-T drugs.
  5.  All transplants require Prior Approval, regardless of policy type, except corneal.
  6. Gender Affirming Care is being broadened to include breast augmentation and certain facial surgeries.  All Gender Affirming Services still require Prior Approval.
  7. We now provide coverage for Artificial Insemination; Prior Approval is required.
  8. Benefits for drugs associated with Artificial Insemination (AI) procedures, where the procedure has been prior approved, may be covered.
  9. In vitro fertilization (IVF) related drugs are limited to three cycles annually, prior approval required, and must be completed through the pharmacy benefit.
  10. For Standard members, we now provide coverage for Assisted Reproductive Technology (ART) procedures and services, limited to $25,000 annually for some infertility diagnosis and Prior Approval required.
  11. We no longer require written consent in a case management program prior to admission for inpatient care provided by a Residential Treatment Center (RTC) or Skilled Nursing Facility (SNF).
  12. We now provide coverage for marital and family counseling.
  13. For eligible members who do not opt out, prescription drug benefits will now be provided under a new FEP Medicare Prescription Drug Program (Medicare Part D).

FEP Resources

  • Learn more on how to submit a request via Availity® Essentials
  • Call 800-441-9188 for questions regarding FEP prior authorizations or you may utilize the Automatic Interactive Voice Response (AIVR)
  • Fax numbers for prior authorizations 877-404-6455 or 888-368-3406 (fax along with a Recommended Clinical Review (Predetermination) form).
  • For FEP expedited appeals only, the fax number is 972-766-9776.
  • For additional assistance please contact Customer Service 800-442-4607 or use contact number on back of the member’s card.

In addition to the details provided above, visit fepblue.org for more information about our FEP members, including the benefit brochure.