Virginia MedicaidInteroperability & Prior Authorization
Virginia Medicaid Service Authorization Metrics for Medical Items and Services (Excluding Drugs)
To comply with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization final rule, the Department of Medical Assisted Services (DMAS) is required to annually report aggregated prior authorization metrics on our website. Specifically, this includes a list of all medical items and services (excluding drugs) that require prior authorization, as well as data on prior authorization requests for those items and services (e.g. approval, denials, etc.) over the previous calendar year. Publicly reporting these metrics promotes transparency and accountability.
For questions on the data below, members can contact the member helpline at 804-786-6145 (TDD: 1-888-221-1590). Providers can contact the provider helpline at 804-786-6273 or 1-800-552-8627.
For medical items and services that require prior authorization (excluding drugs) select the appropriate link below:
Fee for Service (FFS) Medical Items and Services:
Search by Procedure Fee Files and CPT codes on the DMAS website.
Enter a CPT code or scroll down to download a report. Each report contains specific sections of codes. HCPC codes are also included further down on the webpage. Any code on the report with a PA Type 01, 02, 03 require authorization. Codes with PA Type 00 or null do not require authorization. Codes that have a 999 flag in column AQ is not a covered service. For more information search for CPT codes here.
Medical and Behavioral Health Contractor: Acentra
The MES SA/Acentra Site has a service authorization Checklist and Atrezzo FAQs.
Dental Contractor: DentaQuest
Search by Procedure Codes on the DMAS website.
This includes the listing of all procedure codes broken down by plan (under 21, over 21, pregnant members) beginning on page 50. There is a column that indicates if a service authorization is required.
Developmentally Disabled Waiver Partner: DBHDS
Appendix D of the DD Waiver manual includes the services that require SA (beginning on page 5).
Prior to January 1, 2026, prior authorization decisions were required to meet the following timeframes:
• 72 hours for expedited requests (urgent)
• 14 calendar days for standard requests (non-urgent)
Beginning January 1, 2026, the Interoperability and Prior Authorization final rule requires prior authorization decisions to meet the following timeframes:
• 72 hours for expedited requests (urgent)
• 7 calendar days for standard requests (non-urgent)
Click here to review the FFS annual performance metrics for prior authorization processes.
Managed care performance metrics for each health plans’ prior authorization processes are located at the following links: