MedicaidPrior AuthMedium impact
Authorization Updates - Effective July 1, 2026
Sentara Health Plans·VA · Cardiology, Allergy & Immunology, OB-GYN +1 more·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jul 21, 2026
Summary
Effective July 1, 2026, Sentara Health Plans is removing prior authorization requirements for CPT 75577 (cardiac plaque assessment) for all Virginia Commercial products, and expanding the RSV vaccine (90678) exception to include pregnant individuals at 32-36 weeks gestation across Virginia Medicaid and Commercial plans. Affected claims will be automatically reprocessed.
Action Required
By June 30, 2026: Billing team must update authorization rules in billing software to REMOVE prior authorization requirement for CPT 75577 for all Virginia Commercial plans offered by Sentara Health Plans. For CPT 90678 (RSV vaccine), update authorization exceptions to include pregnant individuals at 32-36 weeks gestation for both Virginia Medicaid and Commercial products. Verify that claims with date of service on or after July 1, 2026 no longer require prior authorization for these codes. Configure system to automatically reprocess any claims submitted after the effective date. Train billing staff on the changes. Failure to update may result in unnecessary authorization delays and claim processing errors.