PA Optimization Outpatient Initiative

Date: 05/30/25

Effective September 1, 2025, the following codes will require prior authorization to be submitted to Managed Health Services (MHS).

J1439 Injection, ferric carboxymaltose, 1 mg

The following codes will no longer require prior authorization:

93308 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study

20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")

81257 HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant Spring)

If you have questions, please contact MHS Provider Services.