Important Prior Authorization Updates (Effective November 30, 2026)

Date: 09/21/26

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Managed Health Services 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 are noted in the table below. The 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.

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

Service Category	PA Rule	Services	Procedure codes
DME Supplies	No PA Required	Orthotic and Prosthetic	L5000, L5704
Drug Codes	PA Required	Specialty Drugs	Q5147
	PA Required	Diabetic Drugs and Supplies	A4238
Genetic Analysis	No PA Required	Genetic Testing	81161, 81200, 81206, 81207, 81219, 81243, 81251, 81255, 81279, 81297, 81304, 81319, 81338, 88230, 88280, 88291
Hearing Services	PA Required	Hearing Aids	V5130, V5140
Sleep Medicine	No PA Required	Sleep Studies	95805
Surgery Procedures	PA Required	Tonsil and Adenoid Procedures	42821, 42826, 42831
	No PA Required	Eye and Ocular Adnexa	67904
Transportation Services	PA Required	Medical Transportation	A0130