Prior authorization requirements
Please verify benefit coverage prior to rendering services. Inpatient services and non-participating providers always require prior authorization.
Services billed with the following revenue codes ALWAYS require prior authorization:
Elective services provided by or arranged at nonparticipating facilities. All services billed with the following revenue codes:
| 0023 | Home health prospective payment system |
| 0240–0249 | All-inclusive ancillary psychiatric |
| 0570–0572, 0579 | Home health aide |
| 0632 | Pharmacy multiple sources |
| 0901, 0905–0907, 0913, 0917 | Behavioral health treatment services |
| 0944–0945 | Other therapeutic services |
| 0961 | Psychiatric professional fees |
| 3101–3109 | Adult day and foster care |
Behavioral health
Fax all requests for services that require prior authorization to:
Inpatient:
1-877-434-7578
Outpatient:
1-800-505-1193
Pharmacy
Check the latest Formulary for the members’ service area on our Benefits and Pharmacy page.
Prior authorization code look-up
Please note:
- This tool is for outpatient services only.
- Inpatient services and non-participating providers always require prior authorization.
- This tool does not reflect benefits coverage1 nor does it include an exhaustive listing of all noncovered services (for example, experimental procedures, cosmetic surgery, etc.). Refer to your Provider Manual for coverage/limitations.
1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.
To determine coverage of a particular service or procedure for a specific member:
- Access eligibility and benefits information on the Availity Essentials .
- Use the Prior authorization Lookup Tool accessed through Payer Spaces in Availity.
- Call Provider Services at 1-866-805-4589 for Amerigroup Amerivantage (Medicare Advantage).