CHPW is excited to announce a new Procedure Code Lookup Tool launching November 1, 2019.
With the new tool, you can search for services by procedure code and line of business to determine:
- If a prior authorization (PA) is required (indicates “yes” or “no”)
- If the service is a covered benefit (indicates “covered” or “not covered”)
- The benefit requirements (limits, frequency, etc.)
- Whether clinical review is needed
- Specific clinical criteria CHPW uses and documentation needed for prior authorization review
- If you select the Washington Apple Health Behavioral Health Services Only (BHSO) plan, the lookup tool provides PA and coverage information for behavioral health benefits only. Medical benefits for BHSO members are not provided.
- For Medicare Advantage supplemental benefits (acupuncture, naturopathy, dental, meals, rideshare, etc.), refer to the Member Benefit Grids for coverage information, Click to see member benefits. Some of these services are defined by provider specialty rather than procedure code, or are services covered outside the claims system, and therefore will not be listed within the tool.
- For Medicare Advantage, refer to local coverage determinations (LCD) and/or national coverage determinations (NCD) for full clinical criteria.
Accessing the Lookup Tool
Beginning November 1, 2019, use the new lookup tool at Click to access the lookup tool. in addition to the existing Prior Authorization list:
- Medicare Advantage: Learn more about Prior Authorization
The Procedure Code Lookup Tool is not intended to replace the use of the Prior Authorization list, nor is the tool necessarily complete. Providers should only use this tool as a supplement to and after first consulting the Prior Authorization List.
If you have questions about the Procedure Code Lookup Tool, please email Customer Service at Send email to our customer service.