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When to Get Prior Authorization 

For emergency care, you never need prior authorization (pre-approval)

Even out-of-network emergency care is covered. This includes having a baby.

The following always need pre-approval

even if you get them from an HPSM network provider.

  • Hospitalization, including long term care
  • Services outside of the HPSM service area
  • Outpatient surgery
  • Long-term therapy
  • Specialized care
  • Specialized radiology procedures (such as a CT scan or an MRI)

Not sure if you need pre-approval?

  • Ask your primary care provider (PCP).
    Your PCP's phone number is on your HPSM member ID card.

OR

  • Check HPSM's Prior Authorization Required List
    Note that a treatment can have multiple procedure codes. If you do not know the procedure code(s) for the treatment you want, ask your PCP.

PDF PAR Code Lists

Only CPT codes that require prior authorization are listed in these PDFs. Codes that are not on these lists do not require prior authorization. To use these lists offline, download and save the PDFs to your computer or device.

Medical PAR list

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Dental PAR list

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