Prior Authorization Changes Occurring in the New Year
Wed, Nov 26, 2025
Effective Feb. 1, 2026, 11 codes will be added to the prior authorization list related to intra-operative neuromonitoring, skin substitutes, histotripsy, and one medical injectable drug. Other Feb. 1 changes include the removal of six breast tomography codes and a medical injectable code.
In addition, five codes for osteopathic manipulative treatment (98925–98929) were removed from the prior auth list on Sept. 22, 2025.
Prior Authorization List – Codes to be Added on Feb. 1, 2026
Code |
Description |
0686T |
Histotripsy (i.e., non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance |
95940 |
Continuous intraoperative neurophysiology monitoring in the operating room, one-on-one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure) |
95941 |
Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby) or for monitoring of more than one case while in the operating room, per hour (List separately in addition to code for primary procedure) |
G0453 |
Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure) |
J1551 |
Injection, immune globulin (Cutaquig), 100 mg |
Q4100 |
Skin substitute, not otherwise specified |
Q4107 |
GRAFTJACKET, per sq cm |
Q4116 |
AlloDerm, per sq cm |
Q4159 |
Affinity, per sq cm |
Q4187 |
Epicord, per sq cm |
V2790 |
Amniotic membrane for surgical reconstruction, per procedure |
Prior Authorization List – Codes to be Removed on Feb. 1, 2026
Code |
Description |
0633T |
Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material |
0634T |
Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s) |
0635T |
Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast, followed by contrast material(s) |
0636T |
Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s) |
0637T |
Computed tomography, breast, including 3D rendering, when performed, bilateral; with contrast material(s) |
0638T |
Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast, followed by contrast material(s) |
J0480 |
Injection, basiliximab, 20 mg (Simulect) |
Prior Authorization List – Codes Removed on Sept. 22, 2025
Code |
Description |
98925 |
Osteopathic manipulative treatment (OMT); one (1) to two (2) body regions involved |
98926 |
Osteopathic manipulative treatment (OMT); three (3) to four (4) body regions involved |
98927 |
Osteopathic manipulative treatment (OMT); five (5) to six (6) body regions involved |
98928 |
Osteopathic manipulative treatment (OMT); seven (7) to eight (8) body regions involved |
98929 |
Osteopathic manipulative treatment (OMT); nine (9) to ten (10) body regions involved |
To view the List of Procedures/DME Requiring Authorization, go to the Obtaining Authorizations page and scroll down to the Prior Authorization Coding Lists section.
Quick Info
Never miss out on what matters. Subscribe to our emails and stay informed.
