Prior Authorization Requirements

Disclaimers:

• This tool can be used to check whether an outpatient procedure or service requires prior authorization or referral for coverage for this specific member.
• Please be aware that out-of-network providers must always request authorization for managed care members, and EPO and Blue High Performance Network plans. ℠
• This tool does not include requirements for prescription drugs covered under the pharmacy benefit. Refer to our Medication Lookup for prescription coverage requirements.
• The information is not a guarantee of coverage or payment.
• The existence or lack of a prior authorization requirement is based solely on the accuracy of the information entered by the user and does not imply that a service is or will be covered for a particular member. Please verify benefits before rendering services.
• This tool does not reflect benefit coverage and limitations and does not include an exhaustive list of all non-covered services and supplies.
• Inpatient services always require authorization, except for maternity services.
• Out-of-network providers must always request authorization for managed care members, including EPO and HPN.
• Referrals are required for managed care plans.
• Results are based on the current date and time.
• This tool explains our standard policy. Your provider Agreement may contain exceptions to this policy. If it does, you should always follow your provider Agreement.