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 10/2022 (Excel Document)
Current Prior Authorization Requirements (Commercial) Effective 1/1/2022
2022 Commercial Medical Surgical Prior Authorization Code List - Updated 10/01/2022
2022 Specialty Drugs and Infusion Site of Care Prior Authorization Code List - Updated 11/01/2022
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