Health benefits subject to prior authorisation

The following shall be subject to prior authorisation:

  1. Any kind of healthcare involving hospital accomodation of the patient for at least one night.
  2. Regardless of item 1, any techniques, technologies or procedures included in the National Health System's common portfolio of services which have been selected because they require the use of highly specialised medical procedures or equipment, the need to provide care to patients suffering complex problems or due to their cost-intensiveness, including:
    1. Positron Emission Tomography (PET) and in combination with CT (PET-CT) and SPECT.
    2. Assisted human reproduction.
    3. Dialysis.
    4. Major outpatient surgery requiring the use of a surgical implant.
    5. Radiotherapy treatments.
    6. Pharmacological treatments or treatments with biological products whose monthly cost exceeds €1,500.
    7. Radiosurgery.
    8. Genetic testing aimed at diagnosing complex cases, including prenatal and preimplantation diagnoses, presymptomatic genetic and carrier testing, pharmacogenetic testing and pharmacogenomics.
    9. Treatments of disabilities which require the following for their correction or improvement: electric wheelchairs, upper limb prostheses except partial hand prostheses, lower limb prostheses except partial foot prostheses, hearing aids and leg braces.
    10. Treatments involving complete formulae for home enteral nutrition, and formulae and modules for congenital carbohydrate, amino acid and lipid metabolism disorders.
    11. Healthcare for pathologies and performance of procedures for which services of reference have been designated in accordance with Royal Decree 1302/2006 of 10 November establishing the rules for the procedure to designate and accredit the National Health System's centres, services and units of reference included in Annex III of Royal Decree 1207/2006 of 20 October governing the management of the Healthcare Cohesion Fund, or which have been designated as services of reference in Europe.

Reasons for Refusal to Grant Prior Authorisation                            Information on Prior Authorisation

If you want to find any information related to this website, please use the search application on the top of the page