Prior Authorization Lookup Tool

Directions

1. Review the NC Medicaid Fee Schedule. If a code is NOT on the fee schedule, an authorization IS REQUIRED.
2. Enter a CPT code in the space below.
3. Click “Submit.”
4. The tool will tell you if that service needs prior authorization.

Important notice

This tool provides general information for outpatient services performed by a participating provider.
The following services always require prior authorization:

• Elective inpatient services.
• Urgent inpatient services.
• Services from a non-participating provider.

The results of this tool are not a guarantee of coverage or authorization. If you have questions about this tool or a service, call 1-888-738-0004.