This page includes the final non-delegated Medicare Advantage (MA) and Medicaid prior authorization summaries and code lists that were posted at the end of the previous years.
2024
MA PPO/HMO Non-Delegated
Medicaid
2023
MA PPO/HMO Non-Delegated
- 2023 MA PPO and MA HMO Non-Delegated Prior Authorization Requirements Summary
- 2023 MA PPO and MA HMO Non-Delegated Prior Authorization Code List
Medicaid
2022
MA PPO/HMO Non-Delegated
- 2022 MA PPO and MA HMO Non-Delegated Prior Authorization Requirements Summary
- 2022 MA PPO and MA HMO Non-Delegated Prior Authorization Code List
Medicaid
2021
MA PPO
Medicaid
2020
MA PPO
Medicaid
Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.