Check authorization requirements
Enter a CPT/HCPCS code to confirm prior authorization requirements for many in-network outpatient services covered under the Medical Benefit.
A few helpful hits:
- Category II CPT codes are for tracking purposes only and have no coverage or prior authorization requirements.
- This tool does not support revenue codes, services that are only covered when specific diagnosis codes are recorded on the claim (example, routine foot care, Vitamin D testing), transplant services, visit or dollar limits or other accumulator related restrictions.
- This tool cannot confirm coverage for an individual member on a specific date of service. Please confirm eligibility and benefits for coverage.
|Code||Description||Is Covered||Is PA Required|
Confirmation of coverage and prior authorization does not guarantee payment, which is based on member eligibility on the date of service, specific payment policies, individual provider contract terms and fee schedules. AllWays Health Partners applies standard industry billing and coding rules to claims.