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 non-participating provider.

The results of this tool are not a guarantee of coverage or authorization. All results are subject to change in accordance with plan policies and procedures and the Provider Manual (PDF).

If you have questions about this tool or a service or to request a prior authorization, call 1-202-408-4823 or 1-800-408-7510. Requests can also be made by fax at 1-202-408-1031 or 1-877-759-6216.

Directions

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