This page includes some of the previously posted Medicare and Medicaid summaries and code lists.
Government Programs Prior Authorization Summary and Code List Archive
-
2025
Medicare Advantage (PPO and HMO Non-Delegated)
Medicaid (Blue Cross Community Health PlansSM)
- 2025 Medicaid Prior Authorization Requirements Summary (Effective 8/1/25 through 11/1/25)
- 2025 Medicaid Prior Authorization Code List (Effective 11/1/25 through 12/31/25)
- 2025 Medicaid Prior Authorization Change Log
Medicare-Medicaid (MMAI)
-
2024
Medicare Advantage (PPO and HMO Non-Delegated)
Medicaid (BCCHP and MMAI)
Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.