Masshealth Prior Authorization Lookup
Latest Masshealth prior authorization updates10
- Prior AuthReimbursement/Payment PolicyEff. 2024-10-01Continuous Skilled Nursing Agency Bulletin 22 — Authorization of In-Home, Member-Specific CSN Training TimeEstablishes authorization, billing, payment rates, documentation, and prior authorization procedures for in-home, member-specific training time for CSN agency nurses newly assigned to MassHealth CCM members; affects MassHealth-participating CSN agencies and their nurses.All masshealth updates
- Prior AuthReimbursement/Payment PolicyEff. 2024-06-01Authorization of In-Home, Member-Specific Training Time for CSN Agency Nurses Newly Assigned to a Member’s CareGoverns prior authorization, allowable units, billing modifiers, documentation, and conditions of payment for Continuous Skilled Nursing (CSN) in-home, member-specific training when a CSN agency nurse is newly assigned to a MassHealth CCM member.All masshealth updates
- Prior AuthAdministrative/Operational PolicyEff. 2023-05-12Home Health Agency Bulletin 83 — COVID-19 Flexibilities after the End of the Public Health EmergencySets which COVID-19–related flexibilities for MassHealth home health agencies end or continue after the federal Public Health Emergency ended on May 11, 2023, and specifies requirements for telehealth, documentation, prior authorization, and aide supervision for MassHealth-covered home health services.All masshealth updates
- Prior AuthAdministrative/Operational PolicyEff. 2001-02-15Injectable and Infusible Drugs and DevicesGoverns prior-authorization, billing, and supply options for injectable and infusible drugs and devices administered in physicians' offices or supplied for self-administration to MassHealth members; affects MassHealth participating physicians, pharmacies, and community health centers.All masshealth updates
- Prior AuthReimbursement/Payment PolicyEff. 2000-07-01Payment and billing rules for freestanding MRI/MRA servicesDefines which MRI/MRA service codes MassHealth will pay for at freestanding diagnostic and surgical facilities, billing modifiers for technical/professional components, prior authorization and documentation requirements, and where fee schedules are published.All masshealth updates
- Prior AuthClinical/Medical PolicyEff. 2000-04-01Prior Authorization for Sedative-Hypnotic Sleep MedicationsMassHealth requires written prior authorization for all medications FDA-approved primarily to treat insomnia for MassHealth patients; this bulletin instructs participating prescribers, pharmacists, and providers on the prior authorization process and limits.All masshealth updates
- Prior AuthClinical/Medical PolicyEff. 2000-03-15Prior authorization for certain brand-name multi-source drugsMassHealth requires prior authorization for certain brand-name multi-source analgesics, benzodiazepines, and muscle relaxants that are AB-rated multi-source products; this bulletin informs participating pharmacies and prescribers about the requirement and submission procedures.All masshealth updates
- Prior AuthAdministrative/Operational PolicyAuthorization of Home Health Aide Services with a Personal Care Attendant Prior AuthorizationTemporary MassHealth policy allowing home health agencies to provide home health aide services to members who have an existing prior authorization for Personal Care Attendant (PCA) services when PCA services are disrupted due to COVID-19; applies to MassHealth-participating home health agencies and affected members for the duration of the state of emergency.All masshealth updates
- Prior AuthReimbursement/Payment PolicyAuthorization of In‑Home, Member‑Specific Training Time for CSN Agency Nurses Newly Assigned to a Member's CareAmends MassHealth prior authorization process to proactively authorize CSN training time units and define coverage, billing, and documentation rules for in‑home, member‑specific training when a CSN agency nurse is newly assigned to a CCM member.All masshealth updates
- Prior AuthAdministrative/Operational PolicyOutpatient Hospital Services program regulations (130 CMR 410.000)This document lists the program regulations and table of contents for MassHealth outpatient hospital services (130 CMR 410.000), outlining sections such as definitions, eligible members, provider eligibility, payment, prior authorization, and specific service areas; it affects MassHealth providers delivering outpatient hospital services.All masshealth updates
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Tool Description
Search Masshealthprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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