CommercialPrior AuthMedium impact
Updated Preauthorization Lists: January 2026 Quarterly Code Updates
EmblemHealth·Prior Authorization
Effective date
Feb 1, 2026
We identified it
Jun 20, 2026
Summary
EmblemHealth updated their quarterly preauthorization lists for January 2026 based on new CPT and HCPCS codes from AMA and CMS. Claims containing new codes will be partially processed, with configured services paid immediately and new codes processed separately once loaded into their system within 60 days.
Action Required
Immediately: Review the updated preauthorization list at the provided URL to identify which procedures now require prior authorization. Update billing workflows to expect partial claim processing for any new CPT/HCPCS codes until EmblemHealth completes their system configuration within 60 days. Monitor claims with new codes for separate reprocessing.