Medicare AdvantagePrior AuthHigh impact
Authorization Updates - Effective January 1, 2026
Sentara Health Plans·VA · Orthopedics, General Surgery, OB-GYN +9 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jan 5, 2026
Summary
Effective January 1, 2026, Sentara Health Plans is removing prior authorization requirements for 50+ surgical and diagnostic procedures across Medicare Advantage and Medicaid products in Virginia. This eliminates the need for precertification before performing these procedures, streamlining billing workflows and reducing administrative delays for affected specialties.
Action Required
By December 15, 2025: Billing team must update prior authorization workflows in the billing system to remove auth requirements for the 50+ affected CPT codes (29828, 29867, 29870, 29873, 29886, 29906, 54530, 56620, 56625, 57110, 58550, 65778, 65779, 65780, 69420, 11719, 11720, 11721, 58260, 58541 and others listed in the policy) when processed under Sentara Health Plans Medicare Advantage and Medicaid products in Virginia. Update billing software authorization rules and encounter forms to reflect that these procedures no longer require precertification. Notify providers and front desk staff that they should NOT submit prior auth requests for these codes to Sentara effective January 1, 2026. Verify changes are live in the system before the effective date. Failure to update workflows may result in unnecessary authorization delays and administrative inefficiencies, though claims should still process without the auth.