FLASH: Prior Authorization Changes for 2025

Each year, Health Alliance^TM performs a comprehensive review and analysis around services needing prior authorization. As a result of our recent review, we are preparing to remove several items from prior authorization effective 1/1/25.

Health Alliance did not make any additions to the 2025 Prior Authorization List. As your trusted partner, we are committed to evidence-based clinical guidelines that help ensure optimal clinical outcomes and value for your patients and our members. The eviCore guidelines can be found here.

Please login into the Provider Portal to perform a member-plan specific search to determine whether the requested CPT and HCPCS codes require prior authorization. You can contact our Customer Solutions team with any questions.

Codes Removed from Standard Prior Authorization List

• Hyperbaric Oxygen Therapy (complete category).
  • 99183 – Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session.
  • G0277 – Hyperbaric oxygen under pressure, full body chamber, per 30-minute interval.
• Hospital Beds/Mattresses/Support Services (partial category).
  • E0265 – Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, with mattress.
  • E0266 – Hospital bed, total electric (head, foot, and height adjustments), with any type side rails, without mattress.
• Select Surgical Procedures Requiring an Elective Inpatient (partial category).
  • 38221 – Diagnostic bone marrow; biopsy(ies).
  • 32608 – Thoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral.
  • 32550 – Insertion of indwelling tunneled pleural catheter with cuff.
• Removing prior authorization, adding criteria for claim to include diabetes mellitus diagnosis code:
  • A5512 – For diabetics only, multiple-density insert, direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher, total contact with patient’s foot, including arch, base layer minimum of 1/4-inch material of Shore A 35 durometer or 3/16-inch material of Shore A 40 durometer (or higher), prefabricated, each.
  • A5500 – For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multidensity insert(s), per shoe.
  • A5510 – For diabetics only, direct formed, compression molded to patient’s foot without external heat source, multiple-density insert(s) prefabricated, per shoe.