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.

Prior authorization is NOT required for Emergency Room Services, or for Family Planning services billed with a contraceptive management diagnosis.

Note: All chiropractic and acupuncture services require authorization through the Living Beyond Pain program. For authorization, please call 1-833-212-2264.

For specialty vendors, please verify prior authorization requirements with the following contracted vendors:

Prior authorization must be submitted for all services delivered by nonparticipating providers. Nonparticipating providers can also choose to join our network (PDF).

Important notice

This tool provides general information for outpatient services performed by a participating provider. Prior authorization requirements also apply to secondary coverage.

The following services always require prior authorization:

  • Inpatient services.
  • Services from a non-participating provider.
  • Codes not on the NH Medicaid Fee Schedule

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).

Find more information on submitting prior authorization requests.

If you have questions about this tool, a service or to request a prior authorization, contact Utilization Management at 1-833-472-2264.

DISCLAIMER

The following attempts to provide the most current information for the Pre-Authorization Look-Up Tool. Please note that this information may be subject to change, and a Pre-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 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 pre-authorization, except as may be required by law. For additional details, or if you are uncertain that pre-authorization is needed, please see the Provider Manual on the AmeriHealth Caritas website.

Directions

  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.
Providers