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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.