Prior Authorization Lookup Tool

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 would like to request a prior authorization, call 1-800-521-6622.

Find out if a service needs prior authorization. Type a CPT code into the tool to get started.

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.

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. Keystone First - CHIP 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 Keystone First - CHIP website.