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HighmarkAll Plans · Prior Auth · Coding · PA, NY, DE, WV · Vascular Surgery, Cardiothoracic Surgery, RadiologyHigh impact

Prior Authorization Changes: One Code Added and Nine Removed

Effective date
Sep 1, 2026
Identified
Aug 28, 2026

Summary

Effective September 1, 2026, nine surgery codes (five vascular and four cardiac) will be removed from Highmark's prior authorization requirement list. Separately, effective November 1, 2026, imaging code 70471 (CT angiography of head and neck) will be added to the prior authorization requirement list across all lines of business.

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What to do

Action · 7 steps
01DEADLINE: By August 15, 2026 – Billing team must update prior authorization workflows to REMOVE requirements for CPT codes 35301, 37215, 37216, 37217, 37218, 92937, 92943, 92920, and 92928.
02These vascular and cardiac surgery codes no longer require prior auth effective September 1, 2026.
03Update billing system rules, EMR templates, and provider alerts.
04DEADLINE: By October 15, 2026 – Billing team must update prior authorization workflows to ADD CPT code 70471 (CT angiography, head and neck with contrast) to the prior authorization requirement list, effective November 1, 2026.
05Update billing system, payer verification tools, and front desk check-in procedures.
06Ensure all claims for removed codes after Sept 1 are billed without auth requests to avoid payment delays.
07Ensure all claims for code 70471 on or after Nov 1 include prior authorization or will face denial.

Codes mentioned

70471353013721537216372173721892937929439292092928

Original notice

Prior Authorization Changes: One Code Added and Nine Removed
providers.highmark.com · Always check the source before changing claims.
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Related policy hubs

Highmark policiesPA policy changesNY policy changesDE policy changesWV policy changesVascular SurgeryCardiothoracic SurgeryRadiologyCode 70471Code 35301Code 37215Code 37216Code 37217Code 37218Code 92937Code 92943Code 92920Code 92928

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