Use this tool to check if prior authorization is required. Find request and medical policy information on our Prior Authorization and Medical Policies page. For urgent assistance 24/7, contact us at UtilMgmt@azblue.com.
Search by Current Procedure Terminology (CPT) codes, procedures or generic drug name(s).
Updates: AZ Blue makes reasonable effort to keep the lookup tool and code lists current. However, new drugs, devices, and codes (“items”) are released at a rapid pace. Codes also get updated frequently. AZ Blue reserves the right to require prior authorization for such newly released and updated items even though the tool and code lists have not yet been updated to include them.
Prior authorization is not a guarantee of payment: Prior authorization helps determine a member’s eligibility for a requested procedure or service before the service is rendered. Prior authorization approval decisions are based on information provided during the request process and typically requires medical records. Even if a service is authorized, the claim for the rendered service is reviewed and processed according to specific benefit plan coverage, including any applicable limitations, exclusions, maximums, and waivers. Although prior authorization may not be required for a particular service, any claim may still be subject to review for medical necessity.
Penalties: If a required prior authorization is not obtained prior to service, a penalty is applied to the contracted servicing provider or facility. If an out-of-network provider is used, the penalty is applied to the member.
CPT® (Current Procedural Terminology) codes are © 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
CDT® (Current Dental Terminology) codes are © 2024 American Dental Association. CDT is a registered trademark of the American Dental Association. All rights reserved.
