Does this Medi-Cal Service Need Authorization?

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Authorization Guide

The search tool is for services to members in the CHN and UCS groups. For patients in other networks, contact the network directly for authorizations information.

The data in this lookup tool reflects whether a service requires authorization as of this day. If you need to find out whether a service required authorization on a specific date in the past, please contact Customer Service for assistance.

Outpatient Out of Network Provider Always Needs Authorization

Contact medical groups network below for authorizations out of network.

Needs Authorization for CHN/UCS medical group members
  • Any service performed by a provider not contracted with SF Health Plan.
  • Hospital Admissions
  • Skilled Nursing Facility
  • Post-Acute Care Facility
  • Select outpatient surgeries, procedures, infusions, and Durable Medical Equipment do not require authorization. Use the search tool for specific services.
  • Dental Anesthesia
  • Acupuncture » No referral needed
  • Non-emergency Medical Transportation (NEMT)
    From Home
     » Wheelchair van, gurney/litter van, ambulance, air ambulance transport for needed medical care, such as dialysis, medical appointments, and pharmacy.
  • Palliative Care » Service provided under the state SB1004 law to help people with serious illnesses live better with their disease.
  • Chiropractic Care » Chiropractic providers can be found through ASH Plans of California: call 1(800) 678-9133 or 1(877) 710-2746 TDD/TTY. No referral needed.
Always Covered
Without Authorization
  • Emergency Services
  • Urgent Services in Urgent Care Setting
  • Services related to HIV and other STIs, family planning (contraception), and pregnancy termination
  • Non-Medical Transportation
    Members can call SFHP Customer Service at 1(415) 547-7800 to access assistance with car, taxi and bus transport for needed medical care.

There might be exceptions to certain services that require an authorization, please verify by entering a code in the lookup tool.

Authorization Guide

The search tool is for services to members in the CHN medical group. For patients in other networks, contact the network directly for authorizations information.

The data in this lookup tool reflects whether a service requires authorization as of this day. If you need to find out whether a service required authorization on a specific date in the past, please contact Customer Service for assistance.

Outpatient Out of Network Provider Always Needs Authorization

Contact medical groups network below for authorizations out of network.

Needs Authorization for CHN medical group members
  • Any service performed by a provider not contracted with SF Health Plan.
  • Hospital Admissions
  • Skilled Nursing Facility
  • Post-Acute Care Facility
  • Select outpatient surgeries, procedures, infusions, and Durable Medical Equipment do not require authorization. Use the search tool for specific services.
  • Dental Anesthesia
Always Covered
Without Authorization
  • Emergency Services
  • Urgent Services in Urgent Care Setting
  • Services related to HIV and other STIs, family planning (contraception), and pregnancy termination
  • Non-Medical Transportation
    Members can call SFHP Customer Service at 1(415) 547-7800 to access assistance with car, taxi and bus transport for needed medical care.

There might be exceptions to certain services that require an authorization, please verify by inputting a code in the code looking up tool.

Searching...

Results as of : 09/06/2019

Code

99215

Description

OFFICE/OUTPATIENT VISIT EST

Outpatient Services

OUT OF MEDICAL GROUP / NONPAR

OUT OF MEDICAL GROUP / NONPAR
Prior Authorization Required: YES

IN MEDICAL GROUP
Prior Authorization Required: NO

The "SFHP network" are the group of participating (contracted with San Francisco Health Plan) providers and clinics. Additional services such as MRI, Dialysis, Durable Medical Equipment, Orthotics/Prosthetics, Home Care Supplies, and Family Planning are available to San Francisco Health Plan members through our network of contracted ancillary providers.

“Member’s medical group” is the group of doctors who work together and have a contract with SFHP to provide services to SFHP members. A medical group consists of physicians, specialists and other providers of health care services. Examples include the UCSF medical group and the Community Health Network (CHN). Ancillary providers contracted with SFHP (“in SFHP network”) are also “in member’s medical group”.

For more information on the SFHP network and medical groups, please see “Our Network”: https://www.sfhp.org/providers/our-network/