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My Health Plan
CareAdvantage 2024
Choose a Provider
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CareAdvantage 2025
Medicine Costs
Medicine Transition Policy
Coverage Determination
Coverage Redetermination
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Fill Your Prescription for 90 Days
Pharmacy Services
HPSM Dental
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Ride Benefit
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Quick-Start Guide
Welcome to HPSM
Six Steps to a Healthy Start
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Don't Lose Your Medi-Cal
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End My Membership
Nondiscrimination Notice
Contact CareAdvantage
Join CareAdvantage
Grove San Mateo
CareAdvantage 2025
Eligibility
Doctors & Specialists
Where Can I Get Care?
Vision Benefits
Worldwide Emergency Benefit
Over-the-Counter (OTC) Benefit
Mail-Order Pharmacy Benefit
Medicine Coverage
ACE Program
Medicine Costs
Medicine Transition Policy
Coverage Determination
Coverage Redetermination
Medication Therapy Management
Fill Your Prescription for 90 Days
Pharmacy Services
Medicare Prescription Payment Plan
HPSM Dental
Preventive Services
Behavioral Health Care
Fitness Membership Program
Ride Benefit
Language Services
Member Materials
Quick-Start Guide
Welcome to HPSM
Six Steps to a Healthy Start
Your Member ID Cards
CareAdvantage Benefits
Other Programs & Services
Don't Lose Your Medi-Cal
Problems and Complaints
End My Membership
Nondiscrimination Notice
Contact CareAdvantage
Join CareAdvantage
Grove San Mateo
CareAdvantage 2024
Eligibility
Primary Care Provider Clinics
Prescriptions & Pharmacies
Where Can I Get Care?
Vision Benefits
Language Services
ACE Payments
Participant Resources
Quick-Start Guide
Medi-Cal
Welcome to HPSM
Four Steps to a Healthy Start
Your Member ID Card
Program Services
Other Programs & Services
Problems and Complaints
Contact Us
Eligibility
Benefits & Services
Member Costs
Doctors & Specialists
Prescriptions & Pharmacies
HealthWorx HMO
Your New ID Cards
Find a Pharmacy
List of Covered Medicines
Appeals and Complaints
Helpful Contact Information
HPSM Dental
Where Can I Get Care?
Initial Health Assessment
Continuity of Care
Whole Child Model
Ride Benefit
Language Services
Member Materials
Quick-Start Guide
Welcome to HPSM
Six Steps to a Healthy Start
Know Your ID Cards
HPSM Benefits
Other Programs & Services
Don't Lose Your Medi-Cal
Problems and Complaints
Nondiscrimination Notice
Contact Us
Language Interpreter Services
Benefits of Using Professional Interpreters
Translated and Alternative Format Materials
Health Tips
Children's Health
Exercise
Health Conditions
Prior Authorization
Member Resources
Addiction and Recovery
Asthma
Breast Cancer
LGBTQIA+ Health
What is Breast Cancer?
Detecting Breast Cancer
Treating Breast Cancer
Preventing Breast Cancer
Coping with Cancer
Diabetes
Symptoms of Diabetes
Types of Diabetes
Tips for Managing Diabetes
Know Your Diabetes ABCs
Diabetes Control Checklist
More Diabetes Resources
Diabetes Prevention Program
Heart Disease & Stroke
HIV / AIDS
Understanding Sexual Orientation and Gender Identity (SOGI)
The Importance of Primary Care for LGBTQIA+ People
LGBTQIA+ Mental Health and Safety
Gender-Affirming Care
Resources for Families of the LGBTQIA+ Community
Managing Your Medicines
Take Your Medicines as Prescribed
Tips for Taking Medicines as Prescribed
Questions to Ask About Your Medicines
Mental Health
Get Mental Health Care
Depression
Maternal Mental Health
Stress Management
Positive Thinking
Alternative Care
Nutrition
Older Adult Health
Pain Management
Types of Physical Pain
Problems That Pain Can Cause
Make a Pain Management Plan
Risks of Long-Term Opioid Use
Non-Opioid Pain Management
People with Disabilities
Pregnancy
HPSM's Baby + Me Program
Breastfeeding
Nutrition & Exercise
Maternal Mental Health
Pregnancy & COVID-19
Doula Services
Free Pregnancy Resources
Preventative Care
Your First Health Visit
When to Visit Your PCP
Get the Flu Shot Every Year
Self-Care Tips to Help You Stay Healthy
Be Healthy – Get the Flu Shot!
Get the Flu Vaccine
More Ways to Avoid Getting the Flu
What to Do If You Have the Flu
Who is at High Risk?
Differences Between the Flu and COVID-19
Helpful Flu Resources
Quit Smoking
The Dangers of Smoking
The Dangers of Vaping
The Benefits of Quitting
What to Expect When Quitting Smoking
Resources to Help You Quit Smoking
Self-Management Tools
Sexual and Reproductive Health
Sexual Communication, Consent and Respect
Sexually Transmitted Infections – Prevention and Treatment
Birth Control (Contraception)
Abortion
Talking With Your Health Care Provider About Sexual Health
Know Your Sexual Health Rights As a Minor
Teen Health
Weight Management
Health Information Library
Member Handbooks
Find a Form / Request Records
Member Education Materials
Member Newsletter
News and Announcements
Food Assistance Programs
New Member Quick-Start Guides
HPSM's Ride Benefit
HPSM Dental
Start Using Your Dental Plan
Choose a Dentist
Covered Dental Services
Cost of Dental Services
Benefits of Getting Dental Care
What to Expect When You Visit the Dentist
Get Help in Other Languages
Appeals and Complaints
Telemedicine
File a Complaint
Member Stories
Urgent Messages
Mpox (Monkeypox) Information
Be Prepared
Contact Member Services
Member Portal Login
Protect Yourself from Wildfire Smoke
Prepare for Wildfires
Protect Yourself and Your Information From Scams
Get Warnings About Wildfires
Gather Emergency Supplies
Create an Evacuation Action Plan
Protect Your Home Against Wildfires
Wildfire Preparation Resources
Prepare for Power Outages
Storm Safety & Health Resources
When to Get Prior Authorization
For emergency care, you never need prior authorization (pre-approval)
Even out-of-network emergency care is covered. This includes having a baby.
The following always need pre-approval
even if you get them from an HPSM network provider.
- Hospitalization, including long term care
- Services outside of the HPSM service area
- Outpatient surgery
- Long-term therapy
- Specialized care
- Specialized radiology procedures (such as a CT scan or an MRI)
Not sure if you need pre-approval?
- Ask your primary care provider (PCP).
Your PCP's phone number is on your HPSM member ID card.
OR
- Check HPSM's Prior Authorization Required List
Note that a treatment can have multiple procedure codes. If you do not know the procedure code(s) for the treatment you want, ask your PCP.
PDF PAR Code Lists
Only CPT codes that require prior authorization are listed in these PDFs. Codes that are not on these lists do not require prior authorization. To use these lists offline, download and save the PDFs to your computer or device.
Medical PAR list
Dental PAR list