Prior Authorization List Changes

HPSM periodically updates our list of codes requiring prior authorization to reflect current clinical guidelines. You can review these changes or archived Prior Authorization Required (PAR) Lists below.

 Removals of prior authorization requirements

  • Q3 2019 (effective 10/01/2019): A4281, A4282, A4283, A4284, A4285, A4286, J9355, L0180, L1830, J1453, J0881
  • Q2 2019 (effective 07/01/2019): L0120, L4350, 11102, 11103, 11104, 11105, 11106, 11107, 81329, E0114, E0147, E0148, E0149, E0153, E0154, E0155, E0156, L1820, L3660, L3808, L3908
  • Q1 2019 (effective 04/01/2019): E0602, E0603, 01480, 11042, 11043, 11044, 11047, 14040, 17110, 17111, 20605, 27650, 28124, 28193, 28415, 73700, Z7506. Additionally the following codes were deleted due to being discontinued: 10022, 11100, 11101, 20005, 27370, 33282, 33284, 43760, 50395, 64508, 64550, 66220,81211, 81213, 76001, 77058, 77059, 78270-78272, 92275, 95975, 95978, 95979, 96111, 96118, V5170, V5180 V5210, V5220, J9310, J0833, Q5102, C9275, C9497, C9741, K0903, Q4131, Q4172, C8904, C8907, C9744
  • Q4 2018 (effective 01/01/2019 unless otherwise noted): Z4304, Z4309, Z4312, Z4313, Z4306, 92552, 92557, 63057, J0606 (retroactively effective to 1/1/2018), and J0604 (retroactively effective to 1/1/2018)
  • Q3 2018 (effective 09/01/2018): 87631, 87632, A9520, A9515, 93976, A9588, A9587, 51728, 91040, 71045, 74018, 77399, 97803, 81203, 81243, 81244, 81245, 81246, 81275, 81292, 81294, 81295, 81297, 81298, 81300, 81317, 81319, 81370, 81381
  • Q2 2018 (effective 07/01/2018): 11100, 11101, 92082, 66821, 52005, 52356, 94621, 97802, 91200, 78014, V5011, 58300, 93295, 31237, 31238, 31239, 31240, 38222, 76999, 78205, 78206, 81220, 80299, 87633, 43259, G0248, G0249, G0250, L3650, 69990, 64859, E0100, E0143, E0163, A6545, L3762, L4316, L3170, and 33320

 Additions of prior authorization requirements:

  • Q3 2019 (effective 10/01/2019): J0570, A9606, J0129, 19499, 99152, 81215, 81217, C9044, C9045, J2326, J9036, Q5115, J9023, 95012, J1428, 27441, Q2041
  • Q2 2019 (effective 07/01/2019): J7311, J0887, J3262, A0130, A0425, A0426, A0428, T2005, 81455, C9408, J0584, J0599, J2186, J3245, J3397, J7177, J9153, J9229, Q5107
  • Q1 2019 (effective 04/01/2019): Q9995, 10004 – 10012, 11102 – 11107, 76391, 77046-77049, 81163 – 81167, 81173, 81174, 81204, 81177 - 81190, 81234, 81239, 81271, 81274, 81284 – 81286, 81289, 81306, 81312, 81329, 81336, 81337, 81343 - 81345, 81518, 81216, V5171, V5172, V5181, V5211 – V5215, V5221, A9513, C9038, J9044, J9057, J9173, J9311, J9312, Q2042, C9036, J0517, J0567, J1301, J1628, J1746, J3316, J3398, J7170, J9312, Q5109
  • Q4 2018 (effective 01/01/2019): Q4176, Q4177, Q4178, Q4179, Q4180, Q4181, and Q4182
  • Q3 2018 (effective 09/01/2018): G0422, G0423, A4281, A4282, A4283, A4284, A4285, A4286, Q4159, Q4160, K0903
  • Q2 2018 (updated 07/01/2018): 27090, 27091, 27125, 27130, 27132, 27134, 27236, 27137, 27138, 27438, 27446, 27447, 27486, 27487 and 27488

 Changes to prior authorization conditions:

  • Q3 2019 (effective 10/01/2019): 90586, J0604, J7170
  • Q1 2019 (effective 04/01/2019): removed no longer applicable comments from G0475,G0480, G0481, G0482, G0483, A9276, A9277, A9278
  • Q3 2018 (effective 09/01/2018): Providers may now request authorization for a 12 month period for codes 11055, 11056 and 11057 when rendered in a SNF/LTC facility as part of an authorized stay.

 Formatting Updates

  • Q4 2018 (effective 01/01/2019): removed comments from 17 codes that were no longer applicable, due to these codes no longer requiring prior authorization.
  • Q2 2018 (updated 07/01/2018): Introduced a change log and archive to catalog authorization requirement changes