By September 15, 2026: Billing team must perform the following in priority order: (1) Update billing software to REQUIRE prior authorization for 16 orthopedic procedure codes (27138, 27437, 27438, 27440, 27442, 27446, 27447, 27486, 23470, 19340, L1320, 22860, 27703, A9506, S2260, S2267) for Commercial plans; (2) Configure system to flag code 86152 and require routing to OncoHealth for prior auth approval on all plan types; (3) Set codes T1000, G0299, G0300 to show benefit restrictions/limits in patient eligibility; (4) BLOCK billing for 25 codes (T1018-T1022, T1027, T1040, T1041, T2012-T2022, H2040, G2212, 90738, 90758, 90589, 90593, 90625) - mark as NOT COVERED for Commercial plans; (5) Update encounter forms and templates to alert providers of prior auth requirements for orthopedic, breast, and disc procedures; (6) Train front desk to verify benefits before scheduling surgeries; (7) Configure separate rules for Medicaid (codes 22860, 27703, S9365-S9367 require prior auth only). Failure to implement prior auth will result in automatic claim denials for orthopedic procedures. Failure to block non-covered codes will result in patient financial liability and claim denials.