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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.

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:

Important notes about precertification and the use of this tool

  • Use the Precertification Lookup Tool for outpatient services only
  • Inpatient Services always require precertification. To obtain precertification for inpatient services:
    • Medicaid/FAMIS Providers: Call our Provider Services team at 1-800-901-0020
    • Fax inpatient services requests to 1-800-964-3627

This tool does not reflect benefits coverage*. To determine whether a service is covered, you can either:

  • Access eligibility and benefits information on the Availity Web Portal.
  • Call Provider Services at 1-800-901-0020 (Medicaid/FAMIS)

*Services may be listed which do not require precertification and are not covered benefits. Verify benefit coverage prior to rendering services.