Authorization Code Look-Up

* When Prior Authorization is 'Required', click SRA Create to create Service Request/Authorization

Error! While retrieving Prior Authorization LookUp Tool.

Code Query active for Q1 2020, January 1,2020 through March 1,2020

Authorization Code Look-Up

Remember all elective inpatient services must be prior authorized (PA).

Generally, office visits and office-based surgical procedures with a Molina Participating Provider do not require Prior Authorization.Verify prior authorization requirements by code query.

Generally referrals to a Molina Participating Specialist do not require Prior Authorization.Verify prior authorization requirements by code query.

Enter CPT / HCPCS Code

Coverage

IMPORTANT NOTE: Prior authorization is not a guarantee of payment for services. Payment is made in accordance with a determination of the member’s eligibility on the date of service, benefit limitations/exclusions, evidence of medical necessity, and other applicable standards during the claim review, including the terms of any applicable provider agreement.

Non-Participating Providers / Offices and Facilities

Prior authorization is not required for:

Emergency Dept Services
Professional fees associated with an Emergency Dept visit and approved Ambulatory Surgery Center (ASC) or in-patient stay
Local Health Dept (LHD) Services
Other services based on State requirements.
[MEDICAID] Child and Adolescent Health Center Services
[MEDICARE - DUALS] Radiology, anesthesiology and pathology services when billed in a place of service
Unassigned place of service (POS-19)
Inpatient hospital (POS-21)
Outpatient hospital (POS-22)
Hospital Emergency Room (POS-23)
Ambulatory Surgical Center (POS-24)
[MEDICARE – DUALS] Professional component services for services billed with modifier 26 (professional component) in any place of service

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Provider Self Services

Code Query active for Q1 2020, January 1,2020 through March 1,2020

Authorization Code Look-Up