CommercialPrior AuthHigh impact
Preauthorization List Reductions and Updates for 2022
EmblemHealth·Orthopedics, Podiatry, OB-GYN +4 more·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
EmblemHealth is removing 99 codes from their preauthorization list starting January 1, 2022, eliminating prior auth requirements for many orthopedic procedures including foot surgeries, arthroscopic procedures, and hysterectomies. However, 5 new codes will require preauthorization starting February 1, 2022, primarily for spinal neurostimulators, cancer treatment, and penile prostheses.
Action Required
By January 1, 2022: Billing team must update EmblemHealth prior authorization requirements by removing 99 codes from the preauthorization list including all listed foot surgery, arthroscopic, sinus, and hysterectomy codes. By February 1, 2022: Add prior authorization requirements for CPT codes 63664, Q2043, 54401, 54405, and 54416. Update billing software, encounter forms, and notify providers that these procedures no longer require prior auth (January codes) or now require prior auth (February codes).