pluto-app.css

Precertification

Fax: 1-800-964-3627
Call: 1-855-661-2028

Nonparticipating providers

All services a nonparticipating provider renders require precertification

Participating Providers

Precertification Lookup Tool

This tool:

  • is for outpatient services-inpatient services always require precertification
  • does not show benefits coverage–refer to our state-specific provider manuals for coverage/limitations
  • Please note: Drug description search is case sensitive. You must search using generic/chemical ingredient name and use lower case only.
  • CPT/HCPCS codes returned as requiring precertification in the Precert Look-up Tool are current and effective at the time of the search/inquiry. Any codes removed from Precert Look-up Tool since the last update do not require prior authorization. Codes requiring prior authorization may still require medical review prior to claims payment.

Please note: Benefits coverage not shown — refer to our state-specific provider manual for coverage/limitations.

Forms and Other Resources

Click select to view code requirements

No Procedure Found.

To refine your search, consider the following:

  • Enter a valid 5-digit code for best results
  • If you are searching by code description, limit your search to a single term for more matches
  • The code you are searching for may be invalid or expired. Such procedures are not available for authorization and will be denied.
The following errors occurred: