Searchable Medical Pharmacy Benefit HCPCS Listing

How to use the searchable tool

Definitions

  • Drug Name: Brand or Common Name of the HCPCS code
  • Authorization Required: If there is a check mark in this column, then this medication requires authorization prior to administration
  • Covered (No PA Required): If there is a check mark in this column, then there is No Authorization Required
  • Not Covered: If there is a check mark in this column, then this HCPCS code is not a covered benefit
  • Auth Required if Prescribed for an Oncology/Hematology Indication
    • If there is a check mark in this column, the corresponding HCPCS code will require authorization if prescribed for an Oncology/Hematology ICD-10 diagnosis code found on the ICD-10 Codes listing.
      • If not prescribed for an Oncology/Hematology Indication, the HCPCS Code is No Authorization Required.
  • Medicaid Listing
    • Medicaid Medical Pharmacy Benefit HCPCS
  • Commercial Listing
    • Commercial Medical Pharmacy Benefit HCPCS
  • INTEGRITY (MMP) Listing
    • Integrity (MMP) Medical Pharmacy Benefit HCPCS
  • EFP (Extended Family Planning) Listing
    • EFP Medical Pharmacy Benefit Covered HCPCS
  • ICD-10 Codes Listing
    • Listing of indications that require prior authorization for a designated HCPCS code that has a check mark in Auth Required if Prescribed for an Oncology/Hematology Indication.
  • Medical Pharmacy Benefit Authorization Criteria
  • Medicare Part B Step Therapy Document

Last Updated 1/13/2024

MEDICAIDINTEGRITY (MMP)CommercialEFP FormularyICD-10 Codes

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