Important Prior Authorization Updates 

Date: 12/10/25

Important Prior Authorization Updates   

(Effective Feb. 1, 2026) 

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Managed Health Services (MHS) wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care. 

Code change details can be found below. These changes may include:   

• Removing PA requirements based on criticality of review and clinical need. 

• Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests. 

If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.

This document provides initial authorization requirements and does not list conditional authorization benefit limits for any codes set by IHCP.  MHS reminds all providers the most current and accurate Prior Authorization information is available through the Prior Authorization Tool. This resource allows providers to verify in real time whether prior authorization is required for specific services.

 

Service Category	PA Rule	Services	Procedure codes
Behavioral Health	PA Required	Psychotherapy	90847, 90853
		Substance Abuse Treatment	H0004, H2022, H2027
		Therapy	H2014, H2017, H2019
		Treatment Services	H0036
Cardiovascular	PA Required	Heart Surgery	93656
DME Services	PA Required	Incontinence Supplies	T4521, T4522, T4523, T4524
		Neurostimulators	C1767
	No PA Required	Wheelchairs	K0739
Drug Codes	PA Required	Diabetic Drugs and Supplies	A4239
		Injections	J1437, Q4081
		Medications	J2427
Genetic Analysis	No PA Required	Genetic Testing	81244
Home Services	PA Required	Nursing Services	T1002
		Other Services	S5165
Hospice	PA Required	Hospice Services	Q5001, Q5002, Q5003, T2042
Other Medical Services	PA Required	Other Services	A4554, T1025
Physical Medicine	PA Required	Orthotic and Prosthetic	Q4160
Skin Procedures	PA Required	Muscle Flap Procedures	15734
	No PA Required	Skin Grafts	15272
Surgery Procedures	PA Required	Digestive System	49505, 49591, 49593, 49595, 49650
		Female Genitalia	58662
		Integumentary System	19301, 19357
		Male Genitalia	54360
	No PA Required	Vascular	36471, 36479
Transportation Services	PA Required	Medical Transportation	A0428, A0431, A0436