All PlansPrior AuthHigh impact
Prior Authorization Required for Newly Released Codes Starting July 1, 2026
Healthfirst·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jul 1, 2026
Summary
Starting July 1, 2026, newly released AMA codes will require prior authorization. The policy references a list of new codes with prior authorization requirements, but specific codes are not detailed in the provided policy summary. Billing teams must identify which new codes apply to their practice and implement prior authorization workflows before the effective date.
Action Required
By June 1, 2026: Billing team must obtain the complete list of newly released AMA codes requiring prior authorization from the source URL (https://hfproviders.org/whatsnew/prior-authorization-required-for-newly-released-codes-starting-july-1-2026). Once identified, update billing software to flag these codes for prior authorization requirement. Configure claim submission rules to require prior auth documentation before processing claims for these codes. Notify all providers and front desk staff of the new codes and prior authorization requirements. Document the new codes in billing procedures and encounter forms. Claims submitted without prior authorization for affected codes will be denied by the payer.