CommercialPrior AuthHigh impact
Authorization Updates - Effective October 1, 2026
Sentara Health Plans·VA · Orthopedics, Physical Therapy, PM&R (Physical Medicine & Rehab) +4 more·Prior Authorization
Effective date
Oct 1, 2026
We identified it
Sep 3, 2026
Summary
Effective October 1, 2026, Sentara Health Plans is removing prior authorization requirements for 48 medical codes across Commercial, Medicaid, and Medicare products in Virginia. These codes cover traction equipment, fracture frames, biofeedback training, insulin pump supplies, ossicle implants, prenatal care, and rectal control systems. Claims with dates of service on or after 10/1/2026 will automatically be reprocessed without prior auth.
Action Required
By September 30, 2026: Billing team must update prior authorization workflows in the billing system to remove prior auth requirements for all 35 listed HCPCS codes (A, E, H series and L8613) and 2 CPT codes (90912, 90913, 46999) across all Sentara Health Plans Commercial, Medicaid, and Medicare products in Virginia. Remove these codes from the prior authorization checklist in encounter forms and provider templates. Update internal documentation and staff training to reflect that these codes no longer require precertification as of 10/1/2026. Do NOT submit prior authorizations for claims with dates of service on or after October 1, 2026 for these codes, as doing so will delay processing. Claims already submitted with prior auth requests for DOS on or after 10/1/2026 should be flagged for automatic reprocessing by Sentara.