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.

Please note that as of January 1, 2025, prior authorization requirements for more than 240 physical and behavioral health procedure codes have been eliminated. The Prior Authorization Lookup Tool has been updated to reflect these changes.

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 (elective and urgent)
  • Services with a non-participating provider (Join Our Network)
  • Codes not on the NC Medicaid Fee Schedule

If you have questions about this tool or a service, or to request a prior authorization, contact Utilization Management at 1-888-738-0004.

Note: To request services beyond established benefit limits, contact Utilization Management at 1-888-738-0004.

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.
Disclaimer
The Prior Authorization Lookup Tool attempts to provide the most current information for the providers. Please note that this information may be subject to change, and a preauthorization 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 North Carolina 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 preauthorization, except as may be required by law. For additional details, or if you are uncertain that preauthorization is needed, please see the Provider Manual on the AmeriHealth Caritas North Carolina website.
Providers