Prior Authorization Lookup Tool

To find out if a service needs prior authorization, please enter a CPT code or an HCPCS code in the space below to get started. If an authorization is required, you can access NaviNet and submit electronically (PDF).

Important notice

This lookup tool provides general information for outpatient services performed by an AmeriHealth Caritas Florida participating provider. Prior authorization requirements also apply to secondary coverage.

The following services always require prior authorization: 

• Inpatient services (elective and urgent)
• Services with a non-participating provider
• Become an AmeriHealth Caritas Florida Provider — Join Our Network
• Codes not listed on the Florida Medicaid Fee Schedule

Directions

1. Enter a CPT or HCPCS code in the space below.
2. Click “Submit”.
3. The tool will tell you if that service needs prior authorization.

Disclaimer

The Prior Authorization Lookup Tool attempts to share the most current information available with the provider. Please note that this information may be subject to change, and a prior authorization is NOT a guarantee of payment. Payment is dependent on several  factors, including but not limited to, member eligibility on the date of service, coverage limitations and exclusions, provider contracts, and correct coding and billing for the services at issue. AmeriHealth Caritas Florida reserves the right to adjust any payment made following a review of the medical records and determination of medical necessity for the services rendered. All non-participating providers must submit requests for prior authorization, except as may be required by law. For additional details, or if you are uncertain that a prior authorization is needed, please see the Provider Manual on the AmeriHealth Caritas Florida website.