Verify if a Prior Authorization is Required by CPT Code
- Prior Authorizations
Instantly determine whether a prior authorization is required based on CPT code, payer, and plan details.
A patient is scheduled for a high-value procedure. Before the visit, your Patient Access team begins the prior authorization process. They gather clinical documentation, log into payer portals, and prepare a submission.
In many cases, that work was never required.
The cost of submitting “just in case”
Based on maxRTE data, more than 50% of prior authorizations submitted do not require submission at all. They return with a simple response: no authorization required.
Why does this happen? Most organizations rely on static payer grids, internal reference sheets, or manual portal checks. These methods are often outdated and rarely reflect real-time plan variations. When there is uncertainty, staff default to submitting the authorization to avoid risk.
This administrative burden adds up quickly. Physicians and their staff spend an average of 13 hours per week per physician on prior authorizations, nearly two full business days. (American Medical Association).
maxRTE’s ‘No Authorization Required’ feature removes this uncertainty before submission. The platform evaluates CPT code, payer, and plan-specific rules in real time to determine whether authorization is actually required. Your team gets a clear answer immediately.
A more precise way to verify prior authorization
maxRTE verifies prior authorization requirements before submission using real-time logic:
- Intelligent Evaluation: The platform evaluates the CPT code alongside payer and plan-specific rules to determine whether authorization is actually required.
- Immediate Clarity: If authorization is not required, your team knows immediately and can move forward without initiating a request.
- Proactive Strategy: This shifts prior authorization from a reactive workflow to a precise, pre-service decision
Learn more
Healthcare organizations using maxRTE reduce unnecessary prior authorization submissions, improve staff efficiency, and accelerate patient access. Learn how maxRTE helps you verify prior authorization requirements by CPT code and eliminate avoidable administrative work.
