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Authorization Updates - Effective October 1, 2026
Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
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.
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What to do
by Sep 30, 2026 · 5 steps
01Billing 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.
02Remove these codes from the prior authorization checklist in encounter forms and provider templates.
03Update internal documentation and staff training to reflect that these codes no longer require precertification as of 10/1/2026.
04Do 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.
05Claims already submitted with prior auth requests for DOS on or after 10/1/2026 should be flagged for automatic reprocessing by Sentara.
Codes mentioned
L86139091290913A4459A4563A4224A4225A4226A4230A4231A4232E0830E0840E0850E0856E0860E0870E0880E0890E0900E0920E0930E0941E0942E0944E0945E0946E0947E0948H1000H100546999A4337E0849E0855
Original notice
Authorization Updates - Effective October 1, 2026
shc-p-001.sitecorecontenthub.cloud · Always check the source before changing claims.
Related changes
See all Sentara Health Plans changes →Authorization Updates - Effective October 1, 2025MediumEffective Oct 1, 2025 · Prior AuthorizationAuthorization Updates - Effective January 1, 2027HighEffective Jan 1, 2027 · Prior AuthorizationAuthorization Updates - Effective September 1, 2026MediumEffective Sep 1, 2026 · Prior AuthorizationMedical and Clinical Policy Updates - Effective October 1, 2026HighEffective Oct 1, 2026 · Medical PolicyBrowse every Sentara Health Plans change in the policy list
Related policy hubs
Sentara Health Plans policiesVA policy changesOrthopedicsPhysical TherapyPM&R (Physical Medicine & Rehab)Pain ManagementOB-GYNEndocrinologyGastroenterologyCode L8613Code 90912Code 90913Code A4459Code A4563Code A4224Code A4225Code A4226Code A4230Code A4231Code A4232Code E0830Code E0840Code E0850Code E0856Code E0860Code E0870Code E0880Code E0890Code E0900Code E0920Code E0930Code E0941Code E0942Code E0944Code E0945Code E0946Code E0947Code E0948Code H1000Code H1005Code 46999Code A4337Code E0849Code E0855