CommercialPrior AuthHigh impact
Prior authorization update for prosthetics
Harvard Pilgrim Health Care·Orthopedics, PM&R (Physical Medicine & Rehab), General Surgery·Prior Authorization
We identified it
Jun 20, 2026
Summary
Point32Health has eliminated prior authorization requirements for standard prosthetic build codes, now only requiring prior auth for microprocessor/complex prosthetic components. This change affects both upper and lower limb prosthetic devices across Commercial, Public Plans, and Medicare plans.
Action Required
Immediately: Billing team must update prior authorization workflows to remove PA requirements for standard prosthetic build codes. Only request prior authorization for microprocessor/complex prosthetic components. Update billing system rules and staff training materials to reflect these changes. Review current pending authorizations for standard prosthetics as they may no longer be needed.