Coverage and Exclusions

The Coverage and Exclusion List represents all of the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) and their code status. The code status will either be NPA for No Prior Authorization Required, PA for Prior Authorization Required, or NC for non-covered code. When you click into the URL provided below and the PDF populates, you can use Ctrl + F (control find) to search for whichever procedure code you are looking for to determine its coverage.

View the Coverage and Exclusion List

Here is some important information about the Coverage and Exclusion List:

  • If a code requires a prior authorization please reference this webpage to assist with additional information on how prior authorization is obtained.
  • More specific information on plan coverage and exclusions can also be accessed in our member Evidence of Coverage.
  • If there are any additional questions, please reach out to our customer service team at 1-844-201-4672.