Search Codes Requiring Prior Authorization

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This document is intended only to provide information related to which CPT/HCPCs codes require prior authorization. It does not indicate/list codes which may be excluded from coverage or not covered for other reasons. In addition, inclusion on this list indicates, if covered the code would require prior authorization for coverage.

These lists are modified periodically with appropriate notice of these changes consistent with state and federal requirements. Inclusion of a procedure or device code(s) does not constitute or imply coverage nor does it imply or guarantee provider reimbursement. Coverage is determined by the member specific benefit plan document and any applicable laws regarding coverage of specific services. Providers should verify eligibility, benefits and whether prior authorization is required for all members prior to rendering services by contacting Health Plans at the following numbers:
Medical Questions
Call the Customer Service team serving the member’s benefit plan
  • Healthy U Medicaid Members: 801-213-4104; Toll Free 833-981-0212
  • Individual Exchange Members: 801-213-4111; Toll Free 833-981-0214
  • Commercial Group Members: 801-213-4008; Toll Free 833-981-0213
  • Mountain Health CO-OP Members: 844-262-1560
  • Carson Tahoe Health Members: 801-213-0150; Toll Free 833-661-3915
Retail Pharmacy Medications Questions
Call the Pharmacy Customer Service team serving the member’s benefit plan
  • Healthy U Medicaid Members – 855-856-5694
  • Individual Exchange Members – 855-869-4769
  • Commercial Groups Members – 855-859-4892
  • Mountain Health CO-OP Members – 855-885-7695
  • Carson Tahoe Health Members– 855-859-4892
Upcoming Changes to Codes Requiring Prior Authorization
Medicare Lines of Business are no longer effective as of 01/01/2024

Plan Types: All | Commercial | Individual | Medicaid | CHIP | Employee Plan | Mtn Health CO-OP ID | Mtn Health CO-OP MT | Mtn Health CO-OP WY | Carson Tahoe Health | Medicare(No longer effective as of 12/31/2023)

0 Codes Found.