The services or drugs on these lists may require prior authorization by us, eviCore Healthcare® or Carelon Medical Benefits Management. These lists are not exhaustive and are not necessarily covered under the member benefits contract. Lists are updated quarterly to comply with AMA and CMS guidelines.
Consult Availity® or your preferred vendor for eligibility and benefits, the member/participant benefit booklet or contact a customer service representative to determine coverage for a specific medical service.
Digital Lookup Tool (For Fully Insured Only)
Review categories below to find out if a member’s procedure may require prior authorization.
2025 Fully Insured Plans
2025 Commercial Medical Surgical Prior Authorization Code List - Effective 1/2025
2025 Specialty Drugs and Infusion Site of Care Prior Authorization Code List - Effective 1/2025
2025 Behavioral Health Prior Authorization Code List - Updated 1/2025
Current Prior Authorization Requirements (Commercial) - Effective 1/2025
2024 Fully Insured Plans
2024 Commercial Medical Surgical Prior Authorization Code List - Updated 9/2024
2024 Specialty Drugs and Infusion Site of Care Prior Authorization Code List - Updated 9/2024
2024 Behavioral Health Prior Authorization Code List - Updated 1/2024
Current Prior Authorization Requirements (Commercial) - Effective 1/2024
Note: Changes reflect updates based on American Medical Association (AMA) code changes to add, revise or remove codes.
Blue Cross Medicare Advantage Prior Authorization Requirements