Procedure Code Lookup Tool - Washington State Local Health Insurance - CHPW

Procedure Code Lookup Tool

CHPW’s Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:

  • If a prior authorization (PA) is required (indicates “yes” or “no”)
  • If there are PA conditions
  • If the service is a covered benefit (indicates “covered” or “not covered”)
  • The benefit requirements (limits, frequency, etc.)
  • Whether clinical review is needed
  • Specific clinical criteria CHPW applies and documentation needed for prior authorization (PA) review

Please note:

  • The Procedure Code Lookup Tool is not intended to replace the use of the Prior Authorization list, nor is the tool necessarily complete. Providers should only use this tool as a supplement to and after first consulting the Prior Authorization lists.
  • If you select the Washington Apple Health Behavioral Health Services Only (BHSO) plan, the lookup tool provides PA and coverage information for behavioral health benefits only. Medical benefits for BHSO members are not administered by CHPW.
  • For Medicare Advantage, refer to local coverage determinations (LCD) and/or national coverage determinations (NCD) for full clinical criteria.
  • For additional benefit information, see the Member Benefit Grids:

See also the “Examples” section at the end of this bulletin.

Accessing the Lookup Tool

Please make sure to check the existing Prior Authorization lists first, then check the lookup tool at https://forms.chpw.org/pclt in addition to the PA lists:

Questions?

If you have questions about the Procedure Code Lookup Tool, please email Customer Service at [email protected].

Examples
Here are some examples from the tool.

Home Page

Medicaid Procedure Lookup Tool

Medicaid Plan

Procedure Lookup Tool for Medicaid Members

Behavioral Health Services Only (BHSO) Plan

BHSO Procedure Lookup Tool

Cascade Select Plan

Cascade Select Procedure Lookup Tool

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