Enter CPT and HCPCS codes in the search to determine if they require prior authorization. Codes that require prior authorization will have a link to direct you to related requirements and instructions. Codes are reviewed by Carelon if the drugs are being used for an oncology diagnosis.
You can view Carelon Medical Benefits Management clinical appropriateness guidelines on the Carelon website.
Carelon Medical Benefits Management does not currently review drugs with unlisted, miscellaneous, or unclassified codes. Refer to either the CPT Code Search Tool or the Blue Medicare Prior Authorization Guidelines for other prior authorization requirements.
