When to Get Prior Authorization 

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.