Peoples Health Authorization Requirements Search
Click
here if you have problems viewing the search options below.
This search tool allows you to identify authorization requirements for specific procedure codes by place of service.
Please note for Medicare plan members: Any service that cannot be provided
in network requires authorization.
Use the options below to define your search.
Place-of-Service Key
- Telecomunications (remote) – 02
- Physician office or approved provider-based clinic – 11
- Outpatient surgery or services – 19/22
- Ambulatory surgery center – 24
- All services in locations 12 and 32 require authorization.
Search Results Key
- N – No authorization required for services rendered in this place of service
- Y – Prior authorization required for services rendered in this place of service;
please submit a Medical Necessity Form online by logging in to Provider
Resource Central and clicking on the green Medical
Necessity Request button under your patient’s member tab or complete the form
here and fax it to us.
- ** – Not applicable; the code should not be billed for this place of service per
American Medical Association coding guidelines
For highlighted codes, please refer to the comments.
If no results are provided,
contact us, and
we will ensure that the search function is up-to-date.
Authorization information does not guarantee payment, as services must be medically
necessary. Special authorization configurations that are indicated in individual
contracts or agreements will not be indicated on this search. For more information,
contact the provider relations department at 504-849-4500, 225-346-6380 or
1-800-631-8443, Monday through Friday, from 8 a.m. to 5 p.m.
Services requiring prior authorization are screened against medical necessity criteria, Medicare guidelines and/or Peoples Health policy.
Procedures that do not require initial medical necessity review must still meet medical necessity criteria, Medicare guidelines and/or
Peoples Health policy, and are subject to retrospective review. To request medical necessity criteria for a specific procedure, contact our
medical management department at 1-866-553-5705.
System Refresh Date:
7/10/2020