Medicare AdvantagePrior AuthMedium impact
Preauthorization List Updates
EmblemHealth·Neurosurgery, Orthopedics, Pain Management·Prior Authorization
Effective date
Nov 1, 2022
We identified it
Jun 20, 2026
Summary
EmblemHealth updated their preauthorization lists with enhanced guidance showing who to contact for preauth and eviCore radiology services. Starting Nov 1, 2022, spinal surgery CPT codes 64628 and 64629 require preauth for ConnectiCare Medicare members, while certain ambulance codes were removed from preauth requirements.
Action Required
Billing team must verify current preauthorization requirements for spinal surgery codes 64628 and 64629 for ConnectiCare Medicare members and update billing software accordingly. Review enhanced EmblemHealth and GHI PPO preauthorization lists to identify correct contact information for preauth requests and note eviCore management of radiology services. Update encounter forms to reflect removal of preauth requirements for ambulance codes A0384, A0396, and A0424 for ConnectiCare plans.