There are some exceptions to this listing, which can be determined by using the Authorization Requirements Search. You can search the database by selecting a place of service code and inputting a CPT code to determine if the procedure requires prior authorization.
Medical Necessity Form
Download Medical Necessity Form – PDF
If you need additional forms or other documents, you can either download them from the Plan Documents and Forms page or you can call your provider representative to receive printed copies.
Evacuation Communication Information Form
Download Evacuation Communication Information Form – PDF