Authorization quick reference list
Linked below is a list of all services currently requiring prior authorization. This list is updated as changes are made. Bookmark our authorization news section to stay up-to-date.
Ready to submit an authorization request? Learn how.
Full list of services requiring prior authorization
Click the button below to see a full list of services current requiring prior authorization. To search the list, click Ctrl + F on your computer’s keyboard to open the search function.
Note: This prior authorization list is for reference only and isn't intended to be a substitute for benefit verification or Priority Health's medical policies. This list isn't exhaustive and services aren't necessarily covered under the member benefits coverage. Check a member's benefits coverage in the Member Inquiry tool in prism. Checking eligibility and/or benefit information and/or obtaining prior authorization isn't a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s individual/group coverage, including, but not limited to, network requirements, exclusions and limitations, deductibles, copayments and coinsurance applicable on the date services were rendered. If you have questions, contact our Provider Helpline at 800.942.4765.
Service types that commonly require prior authorization
|
Admissions: All non-acute inpatient, partial and residential admissions, both medical and behavioral health |
Genetic testing |
| Advanced imaging: Such as CT, MRI, PET scans | Home health |
| Applied Behavioral Analysis (ABA) | Intensity-modulated radiation therapy (IMRT) and Radiation Therapy |
| Bariatric services |
Pain and headache comprehensive programs |
| Cardiac diagnostic services | Referrals to non-participating providers if the member's plan doesn't have out-of-network benefits |
| Clinical trials | Sleep studies |
| Durable Medical Equipment (DME) and Prosthetics & Orthotics over $1,000 ($500 for Medicaid) | Stimulators |
| Elective procedures done in a hospital inpatient or outpatient ambulatory surgical center | Supplemental feedings given by tube or IV |
| Gender dysphoria treatment and gender affirming surgery | Transplants and evaluations for transplants |