PLUTO | Providers – Amerigroup
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Precertification/ Notification Requirements

Participating providers

  • Behavioral Health

  • Fax all requests for services that require precertification to:
    Inpatient 1-877-434-7578
    Outpatient1-800-505-1193

  • The following markets may fax Behavioral Health Outpatient Requests to the specified fax line below to meet turnaround time (TAT) requirements: Iowa and Texas.
    Outpatient 1-866-877-5229

  • Services billed with the following revenue codes ALWAYS require precertification:

  • 0240–0249 — All-inclusive ancillary psychiatric
  • 0901, 0905–0907, 0913, 0917 — Behavioral health treatment services
  • 0944–0945 — Other therapeutic services
  • 0961 — Psychiatric professional fees
  • Pharmacy

    Check our preferred drug list by product and state

  • Services billed with the following revenue codes ALWAYS require precertification:

  • 0632 — Pharmacy multiple sources
  • The following ALWAYS require precertification:

    • Elective services provided by or arranged at nonparticipating facilities

    All services billed with the following revenue codes:

    • 0023 — Home health prospective payment system
    • 0570–0572, 0579 — Home health aide
    • 0944–0945 — Other therapeutic services
    • 3101–3109 — Adult day and foster care

Florida

Medicare

Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.

Long-Term Services and Supports

Providers needing an authorization should call 1-877-440-3738.

Georgia

Medicare

Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.

Kansas

Long-Term Services and Supports

All services require precertification by fax to 1-855-225-9937.

Maryland

There are no additional products or services with special instructions at this time.

New Jersey

Medicare

Precertification is not required for physician E&M services for members of the Medicare Advantage Balance plan.

Long-Term Services and Supports

All services require precertification.

  • Personal Care Assistants: Call 732-452-6050 and select option 1 or fax requests to 1-888-240-4716
  • Adult Medical Day Care: Fax all requests to 1-888-240-4717

New York

Medicare

Precertification is not required for physician E&M services for members of Medicare Advantage Balance and Classic Choice plans.

Long-Term Services and Supports

All services require precertification. Fax requests to 1-866-574-6721 or call 212-563-5570, ext. 66713.

New Mexico

Medicare

Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.

Long-Term Services and Supports

All services require precertification by fax to 1-866-920-8356.

Ohio

There are no additional products or services with special instructions at this time.

Tennessee

Medicare

Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.

Long-Term Services and Supports

All services require precertification by calling 1-866-840-4991.

Texas

Medicare

Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.

Long-Term Services and Supports

All services require precertification. Please use the fax numbers below to submit your requests.

STAR Kids – Fax: 1-844-756-4604

STAR+PLUS

  • Austin - Fax: 1-877-744-2334
  • El Paso - Fax: 1-888-822-5790
  • Houston/Beaumont - Fax: 1-888-220-6828
  • Lubbock - Fax: 1-888-822-5761
  • San Antonio - Fax: 1-877-820-9014
  • Tarrant/RSA - Fax: 1-888-562-5160

STAR+PLUS Nursing Facility - Fax: 1-844-206-3445

Virgina

There are no additional products or services with special instructions at this time.

  • Search all other services requiring precertification

This tool:

  • Is for outpatient services — inpatient services always require precertification
  • Does not show benefits coverage — refer to our state-specific provider manuals for coverage/limitations

Click select to view code requirements

No Procedure Found.

To refine your search, consider the following:

  • Enter a valid 5-digit code for best results
  • If you are searching by code description, limit your search to a single term for more matches
  • The code you are searching for may be invalid or expired. Such procedures are not available for authorization and will be denied.
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