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.

Important notice

This tool provides general information for outpatient services performed by a participating provider.

The following services always require prior authorization:

  • Elective inpatient services
  • Urgent inpatient services
  • Services from a nonparticipating provider. (Join Our Network.)

If you have questions about this tool or a service, or to obtain an authorization, contact Utilization Management at 1-844-214-2473 or fax to the appropriate number below:

  • Physical Health: 1-844-412-7887
  • Behavioral Health: 1-855-251-0959

Vendor authorization rules

For codes that are delegated to a third-party vendor, codes requiring authorization are listed in the following documents:

  • Evolent (formerly National Imaging Associates) Utilization Review Matrix 2025 (PDF)

    Directions

    1. Enter a CPT/HCPCS code in the space below.
    2. Click Submit.
    3. The tool will tell you if that service needs prior authorization.