Prior Authorization Code Lookup

Find out if prior authorization from Highmark Health Options is required for medical procedures and services. Enter a Current Procedural Terminology (CPT) code in the space below to get started. 

Prior authorizations are required for:

• All non-par providers. Out-of-state providers. All inpatient admissions, including organ transplants.
• Durable medical equipment over $500.
• Elective surgeries.
• Any service that requires an authorization from a primary payer, except nonexhausted Original Medicare Services.
• Any exhausted or noncovered Original Medicare service.

The Provider Authorization List was last updated April 1, 2023. Recommendations contained in InterQual guidelines are not a guarantee of coverage. The contents of this list are subject to change in accordance with plan policies and procedures and the Provider Manual. Providers should consult applicable medical policies for information regarding covered benefits.

As a reminder, third-party prior authorizations for Highmark Health Options include CoverMyMeds, Davis Vision, eviCore, and United Concordia Dental.

Have questions? 

We can help. Review the Prior Authorizations section of the Provider Manual. Call Provider Services at 1-855-401-8251 from 8 a.m. – 5 p.m., Monday through Friday. Or contact your Provider Account Liaison.