Preauthorization is required for some professional services, medical procedures and HCPCS Level II codes. Maryland Medicaid Fee-for-Service will preauthorize services when the provider submits adequate documentation demonstrating that the service is medically necessary. 

Prior authorization of benefits is not the practice of medicine nor the substitute for the independent medical judgment of a treating medical provider. The materials provided are a component used to assist in making coverage decisions and administering benefits. Prior authorization does not constitute a contract or guarantee regarding member eligibility or payment. Prior authorization criteria are established based on a collaborative effort using input from the current medical literature and based on evidence available at the time. ​

Services Requiring Preauthorization

• Professional Services:  Refer to the most recent version of the Professional services Fee Schedule for CPT and HCPCS Level II codes, see Medicaid Provider Program Resources and Fee Schedules > Fee Schedules - Other .
  
• Laboratory Services:  Refer to the most recent version of the Medical Laboratory Fee Schedule for CPT codes, see Medicaid Provider Program Resources and Fee Schedules​ > Dental and Laboratory.
  

The fee schedule is subject to change. P​roviders must check if a CPT/HCPCS code requires preauthorization.

Resources

• Professional Services Codes Requiring Preauthorization 
  
• ​​Reference Guide for Completing a Preauthorization Request​