Prior Authorization Lists

The services or drugs on these lists may require prior authorization by us, eviCore Healthcare® or AIM Specialty Health® (AIM). These lists are not exhaustive and are not necessarily covered under the member benefits contract. Lists are updated quarterly to comply with AMA and CMS guidelines.

Consult Availity® or your preferred vendor for eligibility and benefits, the member/participant benefit booklet or contact a customer service representative to determine coverage for a specific medical service.

Digital Lookup Tool (For Fully Insured Only)

Review categories below to find out if a member’s procedure may require prior authorization.

2022 Fully Insured Plans

Commercial Procedure Code Look Up 2022 - Updated 5/1/2022 (Excel Document)

Current Prior Authorization Requirements (Commercial) Effective 1/1/2022

2022 Commercial Medical Surgical Prior Authorization Code List - Updated 7/1/2022

2022 Specialty Drugs and Infusion Site of Care Prior Authorization Code List - Updated 7/1/2022

2022 Behavioral Health Prior Authorization Code List - Updated 1/1/2022

2021 Fully Insured Plans

Current Prior Authorization Requirements (Commercial) Effective 1/1/2021

2021 Commercial Medical Surgical Prior Authorization Code List - Updated 11/1/2021

2021 Specialty Drugs and Infusion Site of Care Prior Authorization Code List - Updated 7/1/2021

2021 Behavioral Health Prior Authorization Code List - Updated 3/1/2021

Note: Changes reflect updates based on American Medical Association (AMA) code changes to add, revise or remove codes.

Blue Cross Medicare Advantage Prior Authorization Requirements