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Virginia DMAS-351: Procedures/Devices Authorization

Virginia's Department of Medical Assistance Services uses the DMAS-351 for fee-for-service service authorization of surgical procedures and medical devices, services and maintenance. A clinician meets it when scheduling a procedure or ordering a device that needs approval for a Medicaid, FAMIS or FAMIS Plus member outside managed care. Acentra Health, DMAS's contractor, reviews it, and the DMAS fiscal agent gives final approval.

Who completes it

The requesting provider completes the whole form: request type, member and eligibility details, requesting and referring provider NPIs with 9-digit ZIP codes, diagnoses, service type, severity of illness, intensity of services and line items with codes and units.

Submitting and payment

How to submit it
Enter the request directly in Acentra Health's Atrezzo provider portal, which DMAS calls the preferred and quicker route, or fax the DMAS-351; requests may be sent up to 30 days before the scheduled procedure.
Who pays
Service authorization does not guarantee payment, which still depends on claim edits, continued Medicaid eligibility and ongoing medical necessity.

Good to know

  • Service type codes on this form are 0302 for surgical procedures and 0304 for medical device, services or maintenance; outpatient and inpatient requests use DMAS-363 and DMAS-362.
  • Severity of illness should give chief complaint, history, abnormal findings, prior treatment and dated test results; intensity of services lists the planned treatment.
  • There are no automatic renewals: submit a recertification before the current authorization ends.
  • Most Virginia Medicaid members are in Cardinal Care managed care plans, which use their own prior authorization forms.

Get the official form

Download the current version from the source each time; forms change without notice.

Procedures/Devices Service Authorization Request

Official pageWord file

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Frequently asked questions

What happens after Acentra Health approves a DMAS-351 request?

The request is tentatively approved and sent to the DMAS fiscal agent for final approval, which depends on member and provider eligibility and enrollment edits. The service authorization number is mailed and appears in the Atrezzo portal within 24 hours, or the next business day, when transmitted before the evening cutoff.

How do I change or cancel an approved DMAS-351 authorization?

Submit the form again as a Change or Cancel request with the service authorization number being changed or canceled. A change can adjust units, dollar amounts or dates of service, but cannot be filed for items that were denied or are pended. Resubmitting after a rejection counts as a new initial request.