- Please review the eMedNY website for benefit coverage of specific codes prior to submitting a preauthorization request for MMC or HARP members.
The medical services including provider administered drugs below require prior review by the plan to determine clinical medical necessity.
The services below require prior review by the Plan to determine clinical medical necessity for all places of service. Not all services are covered by all medical plans. There may be services that require preauthorization or notification that do not require clinical review. Final determination of coverage is subject to the member’s benefits and eligibility on the date of service.
- All eviCore services can also be validated for prior authorization requirements via eviCore.com
Who Can Request: For HMO/POS plans, the member’s PCP or specialist with a valid referral. Other members, the member's PCP or treating provider.
Medical and Behavioral Health Procedure Codes Requiring Prior Authorization:
New single Prior Auth document:
Older individual Prior Auth documents: