All PlansPrior AuthHigh impact
Prior Authorization Updates: Two Additions and 90+ Removals
Highmark·PA, DE, NY, WV · Nuclear Medicine, Rheumatology, Orthopedics +2 more·Provider Bulletin
Effective date
Jun 1, 2026
We identified it
May 19, 2026
Summary
Highmark is adding prior authorization requirements for 2 specialty drug injections (tildrakizumab and cultured chondrocytes) starting September 1, 2026, while removing prior auth requirements for over 90 nuclear medicine procedures, chiropractic services, and one specialty drug starting June 1, 2026. This significantly streamlines authorization requirements for most affected procedures.
Action Required
By June 1, 2026: Billing team must update authorization requirements in billing system to remove prior auth for J2469 and all listed nuclear medicine codes (78xxx series) and TEE codes (93312-93317). By September 1, 2026: Add prior authorization requirements for J3245 (tildrakizumab injection) and J7330 (cultured chondrocytes implant). Update encounter forms and staff training materials. Claims for J3245 and J7330 will be denied without prior authorization after September 1, 2026.