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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.
- 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.