Prior Authorization

The procedures, services, and items below require prior authorization review before they are performed. Search the list by code or description, filter by category, or download the full list.

Effective July 20, 2026. This list is subject to periodic revision.

Before you schedule

What prior authorization means.

Prior authorization (also called preauthorization, precertification, or prior approval) is a review that confirms a requested service is medically necessary and appropriate before it is provided. If a code appears on the list below, prior authorization must be obtained before the service is rendered.

Always requires prior authorization

Regardless of whether a specific procedure, service, or HCPCS/CPT code appears on this list, the following categories always require prior authorization review and clinical determination:

Consultations
Follow-up visits
Facility admissions

Emergency and urgent care

Prior authorization is never required for emergency care. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room.

Code lookup

Search the prior authorization code list.

Download the full list (Excel)

Search by CPT/HCPCS or revenue code, or by description, and narrow by category. The full list can also be downloaded for offline reference.

Facility care

Inpatient and facility settings.

Facility admissions always require prior authorization. The following inpatient and observation revenue codes and place-of-service settings are provided for reference.

Inpatient & observation revenue codes

Revenue code	Description
`0100`	All-Inclusive Room and Board Plus Ancillary
`0124`	Room and Board — Semi-Private, Psychiatric
`0128`	Room and Board — Semi-Private, Rehabilitation
`0190`	Subacute Care — General Classification
`0450`	Emergency Room — General Classification
`0656`	Hospice — General Classification
`0762`	Observation Room

Inpatient place-of-service settings

POS code	Setting	Definition
`21`	Inpatient Hospital	Formal admission to a hospital for 24-hour institutional care (excludes psychiatric admissions).
`31`	Skilled Nursing Facility (SNF)	Daily skilled nursing or rehabilitative inpatient care, typically following a qualifying hospital stay.
`33`	Custodial Care Facility	Long-term custodial care provided to individuals who don’t require medical care but do need help with activities of daily living.
`34`	Hospice	End-of-life care for terminally ill patients — inpatient hospice facility (residential) or hospice unit in a hospital.
`51`	Inpatient Psychiatric Facility	24-hour institutional care for mental health or substance-use disorders.
`61`	Comprehensive Inpatient Rehabilitation Facility	24-hour interdisciplinary rehabilitation care (typically post-acute).

Please note

Important information about this list.

This list is not exhaustive and is subject to periodic revision. Codes may be added or removed as clinical guidelines, benefits, and regulatory requirements change; always verify current requirements before rendering services.
Inclusion of a code on this list is not a guarantee of coverage or payment. Prior authorization confirms medical necessity only; payment also requires that the member be eligible on the date of service and that the service be a covered benefit under the member’s plan. All services are subject to Medicare and health plan benefit rules.