Preauthorization and notification lists

The documents below list services and medications for which preauthorization may be required for patients with Medicaid, Medicare Advantage, dual Medicare-Medicaid and commercial coverage. Please review the detailed information at the top of the lists for exclusions and other important information before submitting a preauthorization request.

Please note: We are currently changing the layout of our lists to allow for easier searching. In the latest commercial list below, we have provided individual links to the medical services and medications that require preauthorization. We will be doing the same soon for our other preauthorization lists.

Summary of Preauthorization and Notification List Changes

Current lists

Previous lists