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Effective for Dates of Service Starting May 1, 2008
CPT list is updated nightly as changes are made to the requirements. Check back frequently. Contains all current 2011 CPT Codes.
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These authorization requirements pertain only to local in-network providers.

All out of area and/or out of network services require prior authorization.
Providers must confirm with the health plan that the members health plan coverage is still in effect within 5 days before the actual date of service. The health plan reserves the right to revoke this authorization prior to services being rendered based on cancellation of the members eligibility.
Final determination of benefits will be made after review of the claim for and in light of medical necessity requirements and other limitations or exclusions.