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, open the Blue Shield and FEP Prior authorization list PDF below. 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 and Federal Employee Program (FEP) members.
View Blue Shield and FEP Prior Authorization list (PDF, 213 KB)
The Blue Shield medical policies share requirements and criteria for new technologies, devices, and procedures that are safe and effective.
Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. Please call customer service number on the back of your member ID card.
For any questions about prior authorization, please call customer service number on the back of your member ID card.
