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 CPT codes from their preauthorization list effective January 1, 2022, and adding 5 new codes requiring preauthorization starting February 1, 2022. The removed codes primarily include foot/ankle surgeries, arthroscopic procedures, sinus surgeries, and hysterectomies, while new codes focus on spinal neurostimulators, cancer treatment, and penile prostheses.
Action Required
By January 1, 2022: Update billing system to remove preauthorization requirements for 99 specified codes including foot/ankle surgeries, arthroscopic procedures, sinus surgeries, and hysterectomies. By February 1, 2022: Add preauthorization requirements for CPT codes 63664, Q2043, 54401, 54405, and 54416. Update encounter forms and staff training materials to reflect these changes. Failure to obtain required preauthorizations will result in claim denials.