Our convenient code look up tool will instantly let you know if you need a pre-authorization for a specific procedure, medication or revenue code.
If an authorization is required for the requested procedure, to submit an authorization Login here.
Out-of-network providers must submit a pre-authorization for all procedures. Join Our Network
Please note: Certain services may not be covered. Please refer to the state specific benefit coverage and limitations, including behavioral health and long term care services, age/diagnosis-specific authorization requirements, and self-referral services.
|Type of service||Authorization Required?|
|Services in an Federally Qualified Health Center, Department of Health, or Rural Health Clinic||NO|
|Family Planning services billed with a V25 through V25.9 diagnosis||NO|
|Emergency Room and Urgent Care Services||NO|
|Services by an anesthesiology provider (other than pain management and dental anesthesia) do not require pre-authorization||NO|
|Evaluation and management services rendered in the office by a plastic surgeon||NO|
|All elective services arranged by or provided by a non-participating provider||YES|
Disclaimer: Code validation is not a guarantee of payment.