This page includes the prior authorization summaries and code list documents that were previously posted.
2024 Procedure Code Lists
- Commercial Specialty Pharmacy Prior Authorization Drug List for Administrative Services Only (ASO) Members
- Medicare Procedure Codes Requiring Prior Authorization
- New Mexico Medicaid Procedure Codes Requiring Prior Authorization
- Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Administrative Services Only (ASO) Members
- Recommended Clinical Review - Administrative Services Only (ASO)
- Recommended Clinical Review - Fully Insured
- Summary of Medical/Surgical and Behavioral Health Services, and Specialty Pharmacy Drugs Requiring Prior Authorization for Administrative Only (ASO) Members
- Summary of Medical/Surgical and Behavioral Health Services, and Specialty Pharmacy Drugs Requiring Prior Authorization for Fully Insured Members