20 states publish prior-authorization flags directly on their Medicaid fee schedules, 16,134 codes marked always-required among them. The rest keep PA rules in provider manuals, which is why no billing team should read absence as approval.
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Per-code PA flags appear on every state category page and in the full-schedule CSV exports that come with the Rates plan.
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. States absent from a table publish no PA indicator on that schedule; their requirements live in provider manuals and portals.
Frequently asked questions
Which states publish prior-authorization requirements on their Medicaid fee schedules?
20 states publish machine-readable PA flags directly on their fee schedules, together marking 16,134 codes as always requiring prior authorization. The remaining states document PA in provider manuals and portals instead, so absence from this page never means "no PA required".
Does Medicaid require prior authorization for durable medical equipment or imaging?
It depends entirely on the state, and DME is where published PA flags concentrate most heavily. The tables on this page show, per state and category, how many codes carry a published always-required flag, a conditional flag (required after limits or in specific circumstances), or a varies flag. Click through to a state's category page for the per-code flags.
What does it mean when a state shows no PA numbers here?
Only that the state publishes no PA indicator column on its fee schedule. Most states that omit flags still require prior authorization for many services; the requirements live in provider manuals, portal lookups, or MCO policies instead of the schedule file. Always confirm through the state's provider resources before billing.