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Prior Authorization Metrics
To comply with the CMS Interoperability and Prior Authorization final rule, Highmark Wholecare is required to annually report aggregated prior authorization metrics on our website. Specifically, this includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (e.g., approvals, denials, etc.) over the previous calendar year.
Reporting Period: January 1, 2025 to December 31, 2025
- To view view detailed information on prior authorization requests, including turnaround times, click here.
- To view the list(s) of procedure codes requiring authorization, reference the lists below.
Now you can search CPT codes from anywhere on the Highmark Wholecare Provider Resource Center. Simply enter the code in the main site search bar above to determine whether prior authorization is required.
For additional information about prior authorization and the authorization submission process, review the Prior Authorization Code Lookup page.
