Code Check Tool for Non-Individual Plan Members

  • The code check tool only shows codes used for non-individual plan members (group, association, etc.) and doesn't provide 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 benefits, 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