DATA UPDATED
Enter any medical service, medical drug, behavioral health service or procedure code in the search field above to see if prior authorization may be required for Blue Cross Community Health Plans (BCCHP) or Blue Cross Community MMAI (Medicare-Medicaid) plan members.
For example you can search by CPT codes or by service like "Cardiology".
You can also search by 5-digit code, drug name or service description such as:
"Avastin", or "gene analysis" or "behavioral health".
Data Updated | Showing result(s) for:
Below are the procedures that require prior authorization based on your search. If you require prior authorization for any of the procedures below or if you have other questions, please call the number on the BCBSIL member ID card. We'll help you begin the process.
Data Updated | Showing 0 result(s) for:
No results were found for
This could mean two things:
- The procedure/service name was mis-typed or description/wording was not recognized. Please retry with correct name or search by another keyword.
- This procedure/service likely does not require prior authorization; however, please be sure to see the important reminders below.
Important reminders:
- This PA Look Up Tool is not exhaustive. Providers must always check eligibility and benefits first via the Availity® Provider Portal or other preferred vendor before rendering services to determine prior authorization requirements and utilization management vendor information, if applicable. Even if prior authorization isn’t required, services may still be subject to post-service medical necessity review.
- While not included in this Look Up tool, prior authorization is required for: Inpatient Facility Admissions and Transfers, Private Duty Nursing, Home Health/Hospice Care, Home Infusion Therapies, Home Hemodialysis, Transplant Evaluation and Transplants, and some outpatient therapies and Durable Medical Equipment that incur costs over benefit limits.
Non-covered benefit services and codes will not be listed in this Look Up tool. If there are any questions on member benefits, refer to the Member Benefit Booklet or call the number on the member's BCBSIL ID card for more information.