The code check tool only shows codes used for non-individual plan members (group, association, etc.) and doesn't provider member-specific information. You'll also find this tool by signing in to Availity. Look for it in the Premera Payer Space in Resources or through Authorization & Referrals > Additional Authorizations and Referrals.
This tool doesn't support the following Premera plans:
Individual, Medicare Advantage, FEP, and some Shared Admin plans. View prior authorization information for those plans.
For pharmacy, view drugs requiring approval.
1. Enter a 5-character code (CPT, ADA, or HCPCS)
This tool doesn't accept modifiers.
Note: We review all non-specific and unlisted
codes for medical necessity, even if they don't specifically relate to a medical policy. The code check tool isn't a guarantee of coverage since member contracts may differ in benefits.
2. Submit a prior authorization request
Sign in to Availity to submit prior authorizations. View our ;prior authorization resources page for
more information on submitting prior authorization requests for Individual, out-of-area, Federal Employee Program (FEP), and Medicare Advantage plan members.
Note: Prior authorizations can't be submitted by phone.
Learn more