Prior authorization requirement effective 2/9/25

Beginning 2/9/25, updates to the prior authorization for the HCPCS code and service listed in the table below requires prior authorization for in-network providers:

Title

Codes

Change

Eff. Date

J3490

(Unclassified drugs)

Authorization required if >$750

02/09/2025

As a reminder, to verify whether a service requires prior authorization, use the Prior Authorization Lookup Tool on the provider website. Remember, you can save time by submitting your medical authorizations electronically via NaviNet.

Questions? Please contact your Provider Account Executive or call Provider Services at 

1-833-644-6001.

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