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

To check the status of procedure/service codes other than outpatient provider administered medications please click here to access the Prior Authorization Search Tool. Providers can simply enter the procedure/service code in question and select the member’s line of business to determine if prior authorization from Neighborhood is required.

Last Updated 10/1/2024