Procedure Code Lookup

The updated Procedure Code Lookup (PCL) tool is even better equipped to help your office look up:

  • Procedure codes,
  • Benefit coverage, and
  • Individual patient history

With its easy-to-use self-service options, the PCL tool can help you answer questions more efficiently and effectively with these features at your fingertips:

  • Convenient access: The tool is located on our Patient Benefits Details page and can be accessed after you enter patient-specific information.
  • Comprehensive information: Upon entering a procedure code, the tool is designed to display the following categories of information:
    • Class of Service
    • Covered | Not Covered | Elective | COTC & Preauthorization Requirements | Age limitations (code and/or contractual)
    • Frequency limitations and usage
    • Treatment History and Related Treatment History returned for the dates within the procedure frequency time limitations.

Some instances may still require a call, including inquiries about DeltaCare and Flagship.

Watch this short video to learn more.