The Alliance Procedure Code Lookup Tool

Certain procedures require prior authorization (i.e. Treatment Authorization Request, abbreviated TAR) before the procedure is rendered and reimbursement can be made.

An authorization is needed to ensure that requested benefits:

Are medically necessary.
Do not exceed benefit limits.
Are the lowest cost item or service covered by the program that meets the member's medical needs.

Use the search tool to determine whether a procedure code requires a prior authorization. The tool also provides information about the procedure code age, service, frequency and diagnosis code limits/requirements upon claim submission. This information is displayed as billable units based on the procedure code description.

To search for a procedure code or name, enter at least 3 characters of the procedure code or the main identifying word of the procedure name. Once you identify the procedure code, click "Select." You will be redirected to the main screen, where you can select a date of service and click "Retrieve Info."

Note: This tool is for determining TAR requirements only, and does not include Referral Authorization Forms (RAFs). For RAF requirements, please refer to the Provider Manual or contact Utilization Management at 831- 430-5506. Go here for the Treatment Authorization Form (TAR).

Plan:
Procedure Code:
Date of Service:
Description:
Age Restriction:
Gender Restriction:
Procedure Category Name:
Benefit Status:
Authorization Required:
Referral Required:
Service Restriction:

Disclaimers

All efforts are made to provide the most current information on the Prior Authorization Search Tool. The results of this tool does not guarantee coverage, payment, or authorization
Prior authorization is not a guarantee of payment for services. Payment is made in accordance with a determination of the member‘s eligibility on the date of service, benefit limitations/exclusions, evidence of medical necessity, and other applicable standards during the claim review, including the terms of any applicable provider agreement
A Referral Authorization Form/Approval does not eliminate the need for a prior authorization
For additional information on prior authorization submission please visit:
- https://thealliance.health/for-providers/resources/provider-manual/
- https://thealliance.health/for-providers/manage-care/clinical-resources/referrals-and-authorizations/
Procedure codes available for purchase and rental, will only show the frequency limit for the purchase, when applicable. Rental limits are based on a rental period of one calendar month unless otherwise stated in the additional information section for that code.