7/18/25

Removal of prior authorization for certain services is part of our continued efforts to make the prior authorization process more efficient and transparent. Our goal is to enhance the provider experience by making it easier for providers to navigate the prior authorization process, helping ensure timely member access to necessary services. 

 

Beginning 07/01/2025, the procedure codes listed in Table 1 do not require prior authorization.

Table 1 Prior Authorization NOT Required
CPT/HCPCS Codes
0948T	0973T	90635
0949T	0974T	91323
0956T	0975T	J0165
0957T	0976T	J0166
0958T	0981T	J0167
0959T	0982T	J0168
0960T	0983T	J0169
0961T	0984T	J0616
0962T	0985T	J0618
0963T	0986T	J1163
0967T	0987T	J2312
0969T	90382	J2313
0970T	90612	J3373
0971T	90613	J3374
0972T	90631	J3375
		J9220

Prior authorization is required for the codes listed in Table 2: 

Table 2 Prior Authorization Required
CPT/HCPCS Codes
0552U	0574U	Q4376
0553U	0950T	Q4377
0554U	0951T	Q4378
0555U	0952T	Q4379
0556U	0953T	Q4380
0557U	0954T	Q4382
0558U	0955T	C9174
0559U	0964T	C9175
0560U	0965T	J1326
0561U	0966T	J3391
0562U	0968T	J7172
0563U	0977T	J7356
0564U	0978T	J9174
0565U	0979T	J9275
0566U	0980T	J9276
0567U	Q4368	J9289
0568U	Q4369	J9341
0569U	Q4370	J9342
0570U	Q4371	J9382
0571U	Q4372	Q2058
0572U	Q4373	Q5098
0573U	Q4375	Q5099
	Q5100	Q5153

As a reminder, to verify whether a service requires prior authorization, use the Prior Authorization Lookup Tool on the provider website. Remember, you can save time by submitting your medical authorizations electronically via NaviNet.

Questions? Please contact your Provider Account Executive or call Provider Services at 

1-833-644-6001.