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 hints:
- Category II CPT codes are for tracking purposes only and have no coverage or prior authorization requirements.
* This tool does not support the following codes/scenarios:
- 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
- Modifiers that apply to coverage (example - ambulance services)
- Unlisted Codes (An unlisted code represents an item, service, or procedure for which there is no specific CPT or Level II alphanumeric HCPCS code). “DO Not enter UNLISTED CODES. Coverage information is not available for ANY UNLISTED CODE through this tool” Documentation is required to determine coverage for these codes. The General Coding and Billing Payment Policy Guideline on the AllWays Health Partners website for additional information.
- 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.