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.
For services that require preauthorization, please check the following areas of the Maryland Provider Information webpage:
- Professional Services: Refer to the most recent version of the Professional services Fee Schedule for CPT and HCPCS Level II codes, located in the Billing Guidance, Fee Schedules, and Preauthorization section.
- Laboratory Services: Refer to the most recent version of the Medical Laboratory Fee Schedule for CPT codes located in the Dental and Laboratory section.
The fee schedule is subject to change at any time; therefore, providers must check if a CPT/HCPCS code requires preauthorization.
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.
For preauthorization, please complete the appropriate forms for your request and fax it to 410-767-6034.