# Blue Cross PPO Prior Authorization

- PPO members require prior authorization for inpatient surgery, outpatient surgery over $1,500,
  and advanced imaging tied to surgical planning.
- Knee surgery consults do not require prior authorization by themselves.
- MRI or CT imaging ordered after the consult may require prior authorization if performed at a
  hospital outpatient department.
- If referral status is pending, route to auth review before scheduling imaging.
- Required fields: member ID, date of birth, ordering provider, CPT code, diagnosis code.
