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Government Programs Prior Authorization Summary/Code List Archive

This page includes the final non-delegated Medicare Advantage (MA) and Medicaid prior authorization summaries and code lists that were posted at the end of the year for the past two years.

2021

MA PPO

Medicaid

2020

MA PPO

Medicaid

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.