Prior Authorization Lookup Tool

Find out if a service needs prior authorization. Type a Current Procedural Terminology (CPT) code or a Healthcare Common Procedure Coding System (HCPCS) code in the space below to get started.

Important notice

This tool provides general information for outpatient services performed by a participating provider.

The following services always require prior authorization:

  • Elective inpatient services.
  • Urgent inpatient services.
  • Services from a non-participating provider.

The results of this tool are not a guarantee of coverage or authorization. All results are subject to change in accordance with plan policies and procedures and the Provider Manual (PDF).

If you have questions about this tool or a service or to request a prior authorization, call 1-202-408-4823 or 1-800-408-7510. Requests can also be made by fax at 1-202-408-1031 or 1-877-759-6216.

Directions

  1. Enter a CPT code in the space below.
  2. Click “Submit”.
  3. The tool will tell you if that service needs prior authorization.

Disclaimer

The prior authorization lookup tool attempts to provide the most current information for the provider. Please note that this information may be subject to change, and a prior authorization is NOT a guarantee of payment. Payment is dependent on a number of factors, including but not limited to member eligibility on the date of service, coverage limitations and exclusions, provider contracts, and correct coding and billing for the services at issue. AmeriHealth Caritas DC reserves the right to adjust any payment made following a review of the medical records and determination of medical necessity for the services rendered. All non-participating providers must submit requests for prior authorization, except as may be required by law. For additional details, or if you are uncertain that prior authorization is needed, please see the provider manual on the AmeriHealth Caritas DC website.

Providers