FLASH: Prior Authorization Changes

Reminder: Removal of Prior Authorization for Ultrasound Imaging Tests

Health Alliance™ performs an annual review of all prior authorization required services for utilization and value. We have some great news to share with our provider community. General and obstetric ultrasound imaging will no longer require prior authorization effective August 1, 2022 and will be removed from the Health Alliance Standard Prior Authorization list. Some limited specialty ultrasounds will continue to require prior authorization.

** Please continue to submit requests for other prior authorization such as advancing imaging which includes CT, MRI, and PET, by accessing our provider portal at provider.healthalliance.org. A code look-up for these procedures will direct you to our partner, eviCore healthcare.

All obstetric ultrasounds are included in the removal of prior authorization change. We value the excellent care you provide our members and in the absence of prior authorization, we encourage you to continue following the current standard of care guidelines for obstetric ultrasound when making decisions about the appropriate use of ultrasounds in prenatal care:

• American College of Obstetricians and Gynecologist (ACOG) practice bulletin for Ultrasound in Pregnancy
• The collaborative ultrasound practice guideline issued by the American Institute of Ultrasound in Medicine (AIUM), Society for Maternal-Fetal Medicine (SMFM), American College of Radiology (ACR), Society of Radiologists in Ultrasound (SRU), and ACOG

Ultrasound CPT Code List Removal, Effective 8/1/2022*

*This list is not representative of all codes that do not require prior authorization.  The above codes describe services that currently required prior authorization and will no longer require prior authorization effective 8/1/2022.

**Please login to provider.healthalliance.org to perform a member plan specific search whether specific CPT and HCPCS codes require Prior Authorization or please contact your provider specialist.

Removal of Prior Authorization for Two Prenatal Genetic Screening Tests

Health Alliance removed prior authorization requirements from two specific prenatal genetic screening tests effective 7/1/2022.  This change was prompted by the American College of Obstetricians and Gynecologists (ACOG) guidance and new regulatory requirements for Washington State around cell-free DNA prenatal screening testing.

CPT codes 81420– Fetal chromosomal aneuploidy (e.g., Trisomy 21, Monosomy X) genomic analysis panel and 81507– Fetal aneuploidy (Trisomy 21, 18, and 13) DNA sequence analysis of selected regions will be covered without requiring pre-service medical necessity review.

Providers should use in-network testing labs to ensure members’ care is covered at their in network benefit level. Some Self-Funded plans may still require prior authorization. Please contact Health Alliance Customer Solutions department by visiting healthalliance.org or calling the number on the member’s Health Alliance membership card.