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Coverage Policy and Pre-certification/Pre-authorization

The Coverage Policy informs members and their doctors or healthcare providers why certain medical procedures may or may not be covered under their health plan.

In addition, all health plans or contracts include more generally applicable coverage standards known as the Primary Coverage Criteria. This applies to ALL benefits members may claim under their plan, no matter what types of health intervention may be involved, when or where members obtain the intervention.

Find out about coverage criteria

Search for a policy

You can search for specific policy coverage by asking your doctor or healthcare provider for the name of your procedure or procedure code (often called the CPT/HCPCS code).

You can use this information to search by keyword, coverage policy number, CPT or title. Ready to search?

Search for a policy

Do you need a prior authorization?

At times you may need to find out if a covered procedure requires prior authorization before scheduling with your doctor or healthcare provider. You can find this information for general pre-certification/pre-authorizing using our search.

You will need to enter the first three characters on your member ID card.

Check for prior authorization

More information

  • Coverage Policy FAQ (Frequently Asked Questions)
    • What is a coverage policy?
    • How are coverage decisions made?
    • What is a CPT code?