Prior Auth Lookup

• If the code entered into the "look up" results in the provision of a description — that code REQUIRES PRIOR AUTHORIZATION.

• If the code entered into the "look up" results in a message of "NO RESULTS FOUND" prior authorization is NOT required*

• • EXCEPTIONS TO ABOVE INCLUDE:
• • • INVALID CODES will also appear with this message. You MUST be sure that the code is valid.
    • NON COVERED CODES will also appear with this message. You MUST be sure that the service/item you are requesting to provide is a STATE COVERED BENEFIT. All non-covered codes or services will require prior authorization.
    • Prior authorization is Always Required if the request is related to Gender Affirming Care, Gender Affirmation Surgery, or including but not limited to Diagnoses Codes F64.0, F64.1, F64.2, F64.8, F64.9, or Z87.890.
    • This tool is for outpatient services provided by a participating provider. Inpatient services and non-participating providers always require prior authorization.