Prior Authorization Lookup Tool

Find out if a service needs prior authorization. Type a Current Procedural Terminology (CPT) code in the space below to get started.


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

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 nonparticipating provider.

The results of this tool are not a guarantee of coverage or authorization. If you have questions about this tool or a service, call 1-833-702-2262 or fax to the appropriate number below:

  • Physical Health: 1-844-412-7890.
  • Behavioral Health: 1-855-243-6352.

Vendor authorization rules

For codes that are delegated to a third-party vendor, codes requiring authorization are listed in the following document: National Imaging Associates (NIA) 2023 Utilization Review Matrix (PDF)