Preauthorization Information

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

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

Preauthorization Forms 


Submit Forms

Submit preauthorization requests for professional services, injectable drug or laboratory services: