Medicare:
Starting February 1, 2026, these services with the listed billing codes will require prior authorization.
- C9781 - Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g., balloon), includes debridement (e.g. limited or extensive), subacromial decompression, acromioplasty, and biceps tenodesis when performed
- E0486 - Oral device/appliance
- 29999 - Unlisted procedure, arthroscopy
- 31299 - Unlisted procedure, accessory sinuses
- 31599 - Unlisted procedure, larynx
- 31899 - Unlisted procedure, trachea, bronchi
- 39599 - Unlisted procedure, diaphragm
- 43659 - Unlisted laparoscopy procedure, stomach
- 47379 - Unlisted laparoscopic procedure, liver
- 49329 - Unlisted laparoscopy procedure, abdomen, peritoneum and omentum
- 50949 - Unlisted laparoscopy procedure, ureter
- 51999 - Unlisted laparoscopy procedure, bladder
- 60699 - Unlisted procedure, endocrine system
- 64912 - Nerve repair; with nerve allograft, each nerve, first strand (cable)
- 64999 - Unlisted procedure, nervous system
- 78499 - Unlisted cardiovascular procedure, diagnostic nuclear medicine
- 93702 - Bioimpedance spectroscopy (BIS), extracellular fluid analysis for lymphedema assessment(s)
- 95965 - Magnetoencephalography (MEG), recording and analysis; for spontaneous brain magnetic activity (e.g., epileptic cerebral cortex localization)
- 95966 - Magnetoencephalography (MEG), recording and analysis; for evoked magnetic fields, single modality (e.g., sensory, motor, language, or visual cortex localization)
- 97799 - Unlisted physical medicine/rehabilitation service or procedure
Starting February 1, 2026, services with the following billing codes will require prior authorization for amounts greater than $500 under Medicare:
- L2999 - Lower extremity orthoses, not otherwise specified
- L8699 - Prosthetic implant, not otherwise specified
- 37243 - Vascular embolization or occlusion, multiple indications
Please check codes using our Provider Authorization Grid tool prior to services being rendered.
Medicaid:
Starting February 1, 2026, these services with the listed billing codes will require prior authorization.
- 64912 - Nerve repair; with nerve allograft, each nerve, first strand (cable)
- 93702 - Bioimpedance spectroscopy (BIS), extracellular fluid analysis for lymphedema assessment(s)
Please check codes using our Provider Authorization Grid tool prior to services being rendered.