Prior Approvals

New Policy Updates 30.05.2025

The effective start date of the new policy will be 22nd June 2025. 

 The specific changes in the new policy are: 

1. Amended the structure taking into account CSS process/onward referral flow. 

2. Front sheet amended to reflect Clinical Policy Sub-group rather than SMODG as the responsible committee. 

3. Review date will be 12 months following discussion at Clinical Policy Sub-group committee. 

4. Prior Approval Required for Some CSS Procedures (From 30th June 2025) 

The below are the lists of procedures with the changes to date. 

The first list relates to those that have changed from “prior approval not required” to “requiring prior approval” (this is for secondary care only, it does not include CSS): 

• Frenulotomy of ankyloglossia (tongue-tie) 

• Surgical treatment of varicose veins 

• Acromioplasty (subacromial decompression for shoulder pain) 

• Bunion 

• Discectomy – cervical spine 

• Discectomy – lumbar spine 

 Knee arthroscopy in conditions other than osteoarthritis 

• Knee arthroscopy for patients with osteoarthritis 

• Lumbar radiofrequency denervation 

The following list have been moved to Not routinely commissioned: 

• Breast implant removal/insertion 

• Breast reduction 

• Breast surgery – other including prosthesis (The above 3 do not affect those requiring surgery due to cancer as was discussed at clinical cell) 

• Botulinum toxin treatment for hyperhidrosis 

• Rhinoplasty 

• Scar reduction/revision 

• Functional electrical stimulation (FES) – lower limb 

• Lower back pain imaging without sciatica 

• Pinnaplasty 

• Spinal injections as a treatment for chronic back pain 

• Surgery for benign prostatic hyperplasia (BPH)