Member services requiring prior authorization

Prior authorization means that your doctor must get approval from Blue Shield before prescribing specific medications or performing a particular medical service or operation. Without this prior approval, Blue Shield may not pay for your medication or medical procedure, and you will have to pay out of pocket.

To see if a particular service or drug requires prior authorization, you can search the prior authorization list below. Just enter the procedure or drug name in the “Search for Procedures” field. If your entry is on the list, then you will need to work with your doctor to get prior authorization before Blue Shield will pay.

Remember, it’s always important to check that the service or drug you need is a covered benefit under your plan. For any questions about prior authorization, please call Customer Service at the number on the back of your Blue Shield member ID card.

Prior authorization list

The document below lists prior authorization codes for Blue Shield (including Medicare 65+).

View Blue Shield Prior Authorization list (PDF, 113 KB)