Prior Authorization Lookup Tool
Find out if a service needs prior authorization. Type a Current Procedural Terminology (CPT) code or a Healthcare Common Procedure Coding System (HCPCS) code in the space below to get started.
Prior authorization is NOT required for Emergency Room Services, or for Family Planning services billed with a contraceptive management diagnosis.
For specialty vendors, please verify prior authorization requirements with the following contracted vendors:
- Vision: Avesis, 1-855-214-6777
- Dental: Skygen USATM, 1-262-946-4400
- Imaging: NIA MagellanSM, 1-800-327-0641
Prior authorization must be submitted for all services delivered by nonparticipating providers. Nonparticipating providers can also choose to join our network (PDF).
This tool provides general information for outpatient services performed by a participating provider. Prior authorization requirements also apply to secondary coverage.
The following services always require prior authorization:
- Inpatient services.
- Services from a non-participating provider.
The results of this tool are not a guarantee of coverage or authorization. All results are subject to change in accordance with plan policies and procedures and the Provider Manual (PDF).
Find more information on submitting prior authorization requests.
If you have questions about this tool, a service or to request a prior authorization, contact Utilization Management at 1-833-472-2264.
- Enter a CPT/HCPCS code in the space below.
- Click “Submit”.
- The tool will tell you if that service needs prior authorization.