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. Prior authorization requirements also apply to secondary coverage.
The following services always require prior authorization:
- Inpatient services (elective and urgent)
- Services with a non-participating provider (Join Our Network)
- Codes not on the Ohio Medicaid Fee Schedule
If you have questions about this tool, a service or to request a prior authorization, contact Utilization Management at 1-833-644-6001.
Directions
- Enter a CPT or HCPCS code in the space below.
- Click Submit.
- The tool will tell you if that service needs prior authorization.
DISCLAIMER
The following attempts to provide the most current information for the Pre-Authorization Look-Up Tool. Please note that this information may be subject to change, and a Pre-Authorization is NOT a guarantee of payment. Payment is dependent on a number of factors, including but not limited to member eligibility on the date of service, coverage limitations and exclusions, provider contracts, and correct coding and billing for the services at issue. AmeriHealth Caritas reserves the right to adjust any payment made following a review of the medical records and determination of medical necessity for the services rendered. All non-participating providers must submit requests for pre-authorization, except as may be required by law. For additional details, or if you are uncertain that pre-authorization is needed, please see the Provider Manual on the AmeriHealth Caritas website.