The services or drugs on these lists may require prior authorization by us, eviCore Healthcare® or Carelon Medical Benefits Management (formerly known as AIM Specialty Health). 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.
2023 Fully Insured Plans
Commercial Procedure Code Look Up 2023 - Updated 6/2023 (Excel Document)
Current Prior Authorization Requirements (Commercial) Effective 1/2023
2023 Commercial Medical Surgical Prior Authorization Code List - Updated 6/2023
2023 Specialty Drugs and Infusion Site of Care Prior Authorization Code List - Updated 6/2023
2023 Behavioral Health Prior Authorization Code List - Updated 4/2023
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 12/2022
2022 Specialty Drugs and Infusion Site of Care Prior Authorization Code List - Updated 12/2022
2022 Behavioral Health Prior Authorization Code List - Updated 1/1/2022
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