Services Not Requiring Prior Authorization

Prior authorization is not required for the following services, and services may be obtained from any qualified in-network or out-of-network provider:

• Minor Consent Services.
• Therapeutic and elective pregnancy termination.
• Family planning, sexually transmitted infection (STI) diagnosis and treatment, HIV testing and counseling, and sexual assault services.
• Biomarker testing related to advanced or metastatic stage 3 or 4 cancer (must be FDA-approved).

Referral and prior authorization are not required for Comprehensive Prenatal Services Program (CPSP) services. Services may be obtained from any participating CPSP providers.

Other services that do not require prior authorization include:

• Pregnancy care with in-network obstetrician.
• Preventive services.
• Services for emergency medical conditions.
• Specialist referral (initial referral to participating specialist).