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Preauthorization is required for some professional services, medical procedures, and HCPCS Level II codes. Maryland Medicaid Fee-for-Service will preauthorize services when the provider submits adequate documentation demonstrating that the service is medically necessary.
For services that require preauthorization, please check the following areas of the Maryland Provider Information
Professional Services: Refer to the most recent version of the Professional services Fee Schedule for CPT and HCPCS Level II codes, located in the Billing Guidance, Fee Schedules, and Preauthorization section.
Laboratory Services: Refer to the most recent version of the Medical Laboratory Fee Schedule for CPT codes located in the Dental and Laboratory section.
The fee schedule is subject to change at any time; therefore, providers must check if a CPT/HCPCS code requires preauthorization.
Effective January 1, 2019, SpinrazaTM and Cinryze© will be carved out of the HealthChoice Managed Care benefit and covered by Maryland Medicaid Fee-for-Service. Medical services related to the administration of these medications are the responsibility of the MCO. MCOs may require providers to get a preauthorization for medical services as appropriate.
For preauthorization, please complete the appropriate forms for your request and fax it to 410-767-6034.
Physicians Services Preauthorization Form
Preauthorization Request Form - Physician- Administered Injectable Drugs
Laboratory Services Preauthorization Form
(This form is not for the use of CPT codes 81406 and 81420)
PALB2 (CPT 81406) Reimbursement Form and Billing Instructions
end dated 2/29/2020
Non-Invasive Prenatal Testing for Fetal Aneuploidy Preauthorization Form - CPT 81420 (coverage criteria and billing instructions included)
Transplant Preauthorization Criteria
Professional Services Codes Requiring Preauthorization
Gender Transition Preauthorization Policy and Form
201 W. Preston Street, Baltimore, MD 21201-2399
(410) 767-6500 or 1-877-463-3464
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