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Prior Authorization Procedure Search Tool

Use our Prior Authorization Procedure Search tool to determine if prior authorization is required for services/procedures to be provided to members enrolled in fully insured Horizon BCBSNJ plans.

Our Prior Authorization Procedure Search tool allows you to enter a CPT® or HCPCS code and select a place of service (e.g., inpatient, outpatient, office, home) to determine if the particular service provided in the selected service setting requires a prior authorization.

Please note that our Prior Authorization Procedure Search tool presently can only display results for insured Horizon BCBSNJ plans. Prior authorization information for members enrolled in self-insured, Administrative Services Only (ASO) plans, Medicare or Medicaid products cannot currently be accessed through this tool.

Search for Procedures

 

The information provided by this tool is not intended to replace or modify the terms, conditions limitations and exclusions contained within health benefit plans issued or administered by Horizon BCBSNJ. In the event a conflict between the information contained on the tool and member plan documents, member plan documents shall prevail.

 

This application is intended for informational purposes only. The results provided by this tool are not a guarantee of payment. Claim processing is subject to member eligibility and all member and group benefit limitations, conditions and exclusions.