While not all treatments need an additional review, some may require prior authorization to ensure they are medically necessary, effective, and safe. This process is in place to protect you and to help you receive the highest quality care possible.
Search by Current Procedure Terminology (CPT) codes, procedures or generic drug name(s).
Understand your plan's coverage, including your deductibles, copays and doctor network.
Updates: AZ Blue makes reasonable effort to keep the lookup tool and code lists current. However, new drugs, devices, and codes (“items”) are released at a rapid pace. Codes also get updated frequently. AZ Blue reserves the right to require prior authorization for such newly released and updated items even though the tool and code lists have not yet been updated to include them.
Prior authorization is not a guarantee of payment: Some codes in this tool may not be covered under your specific plan. Ask your provider to confirm the services that will be performed. Right before your appointment, confirm your member eligibility and coverage for the services. If your provider is out of network, you’ll need to get prior authorization. Ask if the provider can complete and submit this form for you. Even when prior authorization isn’t required, AZ Blue may still need to review your claim for coverage.
Penalties: If a required prior authorization is not obtained prior to service, a penalty is applied to the contracted servicing provider or facility. If an out-of-network provider is used, the penalty is applied to the member.
CPT® (Current Procedural Terminology) codes are © 2024 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
CDT® (Current Dental Terminology) codes are © 2024 American Dental Association. CDT is a registered trademark of the American Dental Association. All rights reserved.
