Medicare Policy Search - Retired

Please access the Prior Authorization Code Lookup to determine if a drug/HCPCS code requires authorization. To submit authorization requests, please visit the Highmark Wholecare Provider Portal via NaviNet: https://navinet.navimedix.com.

Highmark Wholecare Policy Disclaimer

• The Policies neither constitutes nor substitutes for medical advice. Highmark Wholecare’s Policies should not be construed as providing medical advice or treatment or guaranteeing the outcome or results of any medical services/treatments and/or procedures Providers are responsible for providing medical advice and treatment, are independent contractors, and are not employees or agents of Highmark Wholecare. If members have a specific question about their medical condition, they should consult with their provider.
• In the event of a conflict between the Policy and Member Handbook or Evidence of Coverage, the express terms of the Member Handbook or Evidence of Coverage will govern. The existence of a medical guideline is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the medical guideline.  The Policies are used in making decisions as to medical necessity only and they do not guarantee payment of services. Policies serve as one of the sets of guidelines for coverage decisions.
• The information on this website may not reflect a recent policy change or all of the applicable medical guidelines.