CommercialPrior AuthMedium impact
Preauthorization List Updates
EmblemHealth·Dermatology, Plastic Surgery, Oral & Maxillofacial Surgery·Prior Authorization
Effective date
Nov 15, 2022
We identified it
Jun 20, 2026
Summary
Starting November 15, 2022, six CPT codes (10040, 15730, 17380, 21086, 21087, and 40500) will require preauthorization for ConnectiCare Commercial, ConnectiCare Medicare, and EmblemHealth plans. These changes align with existing medical policies regarding cosmetic procedures.
Action Required
By November 15, 2022: Billing team must update system to require prior authorization for CPT codes 10040, 15730, 17380, 21086, 21087, and 40500 for ConnectiCare Commercial, ConnectiCare Medicare, and EmblemHealth plans. Update encounter forms and provider workflow to obtain preauthorization before performing these procedures. Use the Preauthorization Check Tool in provider portals to verify requirements. Claims submitted without proper preauthorization will be denied.