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Authorization Lookup

Please select your line of business from the drop-down menu, enter the desired CPT code, and click search


The codes contained in this list are limited to Current Procedural Terminology (CPT codes) and do not include most HCPCS codes. Separate authorization requirements may apply for HCPCS codes.

 

CPT codes covered under CareCore National programs:

 

Authorization is required for the following services:

  • Services rendered by non-participating providers and facilities.
  • Inpatient confinements including: Elective Inpatient, Acute Inpatient, Skilled Nursing Facility, Behavioral Health, Rehabilitation and Long-term/Sub-acute care services.
  • CareCore National manages certain services including Advanced Radiological, Diagnostic Cardiac, Musculoskeletal (Pain Management), Diagnostic Sleep Services, Radiation Therapy and certain Molecular and Genetic Laboratory Tests. Please refer to your state-specific Quick Reference Guide to find out which services apply to your market.
  • Behavioral Health.
  • Cosmetic Procedures.
  • Select Durable Medical Equipment (DME) items.
  • Home Health Care.
  • Preplanned Observation services are subject to Outpatient (Place of Service 22) Authorization requirements.
  • Select Pharmaceuticals.
  • Skilled Therapy Services: Please refer your state-specific Quick Reference Guide for vendor contact information.
  • Transplant services.

We encourage you to verify member eligibility and confirm benefits prior to rendering services. Reimbursement for these services will be in accordance with the terms and conditions of your agreement.
 

 

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