Johns Hopkins Health Plans - Prior Authorization Tool

Code	Modifier	Description	AMD	PP	USFHP	EHP

For cell and gene therapies, transplant conditioning regimens, and all other drugs to be administered as part of an inpatient hospital admission, submit the drug name(s) as part of the request for Inpatient admission to the Utilization Management Department. Outpatient drug authorizations, including those for hospital outpatient departments, should be sent to the Pharmacy Department.
Authorization status can change often. Please confirm the status of each procedure just before delivery of services.
Authorization is not a guarantee of payment.
Please follow Johns Hopkins Health Plans policies and procedures
JPAL may indicate more than one status for a procedure (Authorization Required/Authorization Not Required). In these cases, always request authorization prior to delivery of services.
If you copy or screenshot the authorization requirement results page, do not include member PHI but do include the version number in the upper right hand corner.

Coverage

Code: Modifiers: Description:

For cell and gene therapies, transplant conditioning regimens, and all other drugs to be administered as part of an inpatient hospital admission, submit the drug name(s) as part of the request for Inpatient admission to the Utilization Management Department. Outpatient drug authorizations, including those for hospital outpatient departments, should be sent to the Pharmacy Department.
Authorization status can change often. Please confirm the status of each procedure just before delivery of services.
Authorization is not a guarantee of payment.
Please follow Johns Hopkins Health Plans policies and procedures
JPAL may indicate more than one status for a procedure (Authorization Required/Authorization Not Required). In these cases, always request authorization prior to delivery of services.
If you copy or screenshot the authorization requirement results page, do not include member PHI but do include the version number in the upper right hand corner.