GLO-PRV-Authorization-Clear Coverage-Outage Message
Page Title for page template
Search for Required Medical Services-Request Authorization Page Tab Content
GLO-PRV-Search Authorization Page-Row 1 Content
The medical services including provider administered drugs below require prior review by the plan to determine clinical medical necessity.
Authorization - Preauthorization - Basic Web Content
The services below require prior review by the Plan to determine clinical medical necessity for all places of service. Not all services are covered by all medical plans. There may be services that require preauthorization or notification that do not require clinical review. Final determination of coverage is subject to the member’s benefits and eligibility on the date of service.
- All eviCore services can also be validated for prior authorization requirements via eviCore.com
Who Can Request: For HMO/POS plans, the member’s PCP or specialist with a valid referral. Other members, the member's PCP or treating provider.
Medical Health Procedure Codes Requiring Prior Authorization:
- Procedure Codes Requiring Preauthorization - July 1, 2019Open a PDF
- Procedure Codes Requiring Preauthorization - February 28, 2019Open a PDF
- Sleep Management Program Update
- Durable Medical Equipment - July 1, 2019Open a PDF
- Medical Specialty Drug (For Commercial, Exchange and Medicare)Open a PDF
- Medical Specialty Drug (For Medicaid and Child Health Plus)Open a PDF
- eviCore Codes Requiring Preauthorization - Master GridOpen a PDF
Behavioral Health Procedure Codes Requiring Preauthorization:
- Commercial Medicare & Child Health Plus Products - July 1, 2019Open a PDF
- Managed Medicaid & Health and Recovery Plan Products - July 1, 2019Open a PDF