Requestor & Procedure Exclusions/Exceptions Auth Req Policy Forms Adenoidectomy for Children Not routinely funded. with Recurrent Upper When offered in combination with myringotomy (grommet insertion) and/or IFR Secondary Care Respiratory Tract Infections tonsillectomy which are subject to separate prior authorisation arrangements. Appliances and devices for Primary Care cosmetic purposes (high-grade None. IFR silicon cosmesis and/or Secondary Care Arthroscopic PS006 Surgery for Hip None. IFR Secondary Care Impingement (Arthroscopic & Open Approaches) PS148 Asymptomatic Inguinal Hernias are not routinely funded. Surgery for Symptomatic Asymptomatic Inguinal Hernia IFR Primary Care hernias do not require approval. PS024 Primary Care Autologous Injections for None. IFR Musculoskeletal Conditions Secondary Care PS018 Balloon Catheter sinus dilation Not routinely funded, however patients that represent an anaesthetic risk may be IFR Secondary Care for Chronic Rhinosinusitis considered under IFR arrangements if exceptional. Patients who have not completed a recognised specialist weight management programme may be referred for bariatric surgery if exceptional circumstances can Bariatric surgery procedures in be demonstrated and patients meet the pre-surgery criteria. severely obese adults who Primary have failed to respond to PS013 IFR Care/Secondary Individual funding requests (IFR) should be made to the CCG and should also lifestyle and Tier 3 Care consider the pre-surgery criteria for patients set out in PS013. interventions Note: Bariatric surgery is limited to adjustable gastric banding, sleeve gastrectomy and Roux-en-Y bypass performed at a recognised specialist centre. Complications
Procedure Policy Exclusions/Exceptions Auth Req Requestor & Forms Adenoidectomy for Children with Recurrent Upper Respiratory Tract Infections Not routinely funded. When offered in combination with myringotomy (grommet insertion) and/or tonsillectomy which are subject to separate prior authorisation arrangements. IFR Secondary Care Appliances and devices for cosmetic purposes (high-grade silicon cosmesis and/or None. IFR Primary Care Secondary Care Arthroscopic Surgery for Hip Impingement (Arthroscopic & Open Approaches) PS006 None. IFR Secondary Care Asymptomatic Inguinal Hernia PS148 Asymptomatic Inguinal Hernias are not routinely funded. Surgery for Symptomatic hernias do not require approval. IFR Primary Care Autologous Injections for Musculoskeletal Conditions PS024 None. IFR Primary Care Secondary Care Balloon Catheter sinus dilation for Chronic Rhinosinusitis PS018 Not routinely funded, however patients that represent an anaesthetic risk may be considered under IFR arrangements if exceptional. IFR Secondary Care Bariatric surgery procedures in severely obese adults who have failed to respond to lifestyle and Tier 3 interventions PS013 Patients who have not completed a recognised specialist weight management programme may be referred for bariatric surgery if exceptional circumstances can be demonstrated and patients meet the pre-surgery criteria. Individual funding requests (IFR) should be made to the CCG and should also consider the pre-surgery criteria for patients set out in PS013. Note: Bariatric surgery is limited to adjustable gastric banding, sleeve gastrectomy and Roux-en-Y bypass performed at a recognised specialist centre. Complications IFR Primary Care/Secondary Care
Appendix%205%20Forms%20NCP%20PLCV%20Oct%202018.docx