Who is affected by this change?

This affects Sentara Health Plans Cardiology, Ophthalmology, Pulmonology, Sleep Medicine, Oncology, Pathology +8 more providers in VA on Commercial, Medicaid, Medicare Advantage plans.

When does this change take effect?

This change is effective Jan 1, 2027.

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Sentara Health PlansCommercial · Prior Auth · Prior Authorization · VA · Cardiology, Ophthalmology, Pulmonology +11 moreHigh impact

Authorization Updates - Effective January 1, 2027

Q: What do I need to do?

By January 1, 2027: Billing team and schedulers, for Sentara Health Plans members in Virginia (commercial and ASO/self-funded plans), get prior authorization before scheduling any code Sentara lists as requiring it, such as 97129, 97152, 95803, 93701, 93702 and 22860 (Medicare products). Add these codes to the prior auth tracker and to the scheduling checklist so front desk staff confirm authorization first. For 88380 on commercial, Medicaid and Medicare products, the source directs oncology programs to contact OncoHealth. For the codes Sentara lists as not covered for Virginia commercial and ASO/self-funded plans, such as G0556, 90637, 90638, H2001, S9002 and T1005, stop scheduling and billing them for those members, and tell providers and front desk staff. Before billing any patient for a not-covered service, check with Sentara, since the source does not say whether patient billing is allowed.

Act

by Jan 1, 2027

Effective date

Jan 1, 2027

Identified

Oct 8, 2026

Summary

Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.

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What to do

by Jan 1, 2027 · 5 steps

01Billing team and schedulers, for Sentara Health Plans members in Virginia (commercial and ASO/self-funded plans), get prior authorization before scheduling any code Sentara lists as requiring it, such as 97129, 97152, 95803, 93701, 93702 and 22860 (Medicare products).

02Add these codes to the prior auth tracker and to the scheduling checklist so front desk staff confirm authorization first.

03For 88380 on commercial, Medicaid and Medicare products, the source directs oncology programs to contact OncoHealth.

04For the codes Sentara lists as not covered for Virginia commercial and ASO/self-funded plans, such as G0556, 90637, 90638, H2001, S9002 and T1005, stop scheduling and billing them for those members, and tell providers and front desk staff.

05Before billing any patient for a not-covered service, check with Sentara, since the source does not say whether patient billing is allowed.

Codes mentioned

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

Original notice

Authorization Updates - Effective January 1, 2027

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Related changes

See all Sentara Health Plans changes →

Authorization Updates - Effective November 1, 2025MediumEffective Nov 1, 2025 · Prior Authorization Authorization Updates - Effective February 1, 2026HighEffective Feb 1, 2026 · Prior Authorization Medical and Clinical Policy Updates - Effective October 1, 2026HighEffective Oct 1, 2026 · Medical Policy Authorization Updates - Effective April 1, 2025MediumEffective Apr 1, 2025 · Prior Authorization Browse every Sentara Health Plans change in the policy list

Related policy hubs

Sentara Health Plans policies VA policy changes Cardiology Ophthalmology Pulmonology Sleep Medicine Oncology Pathology Physical Therapy Occupational Therapy Orthopedics Neurosurgery Urology Family Medicine Pediatrics Geriatrics Code 92499 Code V2531 Code J9213 Code J0219 Code J0491 Code J1306 Code J2356 Code J2779 Code J2998 Code V2599 Code J2770 Code J3031 Code J2793 Code J9219 Code Q4213 Code J0400 Code J1675 Code J3145 Code V2530 Code J3350 Code J1812 Code J3357 Code J1960 Code 90589 Code J0586 Code J1729 Code J3490 Code J9057 Code J2670 Code J1814 Code J7639 Code J2725 Code J0220 Code J1260 Code J2325 Code J7316 Code 11200 Code J9214 Code J2410 Code J1826 Code J7686 Code J7402 Code J0221 Code J1595 Code J2502 Code J7527 Code 11201 Code J9285 Code J8499 Code J2562 Code J3570 Code Q4171 Code J0364 Code J1600 Code J2797 Code J8999 Code 17999 Code J9225 Code J9022 Code J9332 Code J9230 Code 31299 Code 37799 Code 42299 Code 46999 Code 54125 Code 27299 Code J3472 Code J9248 Code J3520 Code 30999 Code 31599 Code 41899 Code 45999 Code 49999 Code 54520 Code 58661 Code 58720 Code 64999 Code 66999 Code 69799 Code 89280 Code E2367 Code Q4143 Code Q4177 Code Q4205 Code Q4238 Code E0739 Code 89281 Code E2372 Code Q4146 Code Q4178 Code Q4206 Code Q4239 Code 43659 Code E2104 Code 89290 Code K0462 Code Q4147 Code Q4179 Code Q4208 Code Q4240 Code 64510 Code E2298 Code 89291 Code L5969 Code Q4148 Code Q4180 Code Q4209 Code Q4241 Code 64517 Code E2616 Code 89335 Code L5990 Code Q4149 Code Q4181 Code Q4211 Code Q4242 Code 64520 Code E8000 Code 89337 Code L8608 Code Q4150 Code Q4183 Code Q4212 Code Q4245 Code 76977 Code E8001 Code 89342 Code L8701 Code Q4152 Code Q4184 Code Q4214 Code Q4246 Code 77080 Code E8002 Code 89343 Code L8702 Code Q4153 Code Q4185 Code Q4215 Code Q4247 Code 77081 Code K1037 Code 89344 Code M0076 Code Q4154 Code Q4188 Code Q4216 Code Q4248 Code 77085 Code L5783 Code 89346 Code Q4111 Code Q4155 Code Q4189 Code Q4217 Code Q4249 Code 97037 Code L5841 Code 89352 Code Q4113 Code Q4157 Code Q4190 Code Q4218 Code Q4250 Code 97129 Code L5856 Code 89353 Code Q4115 Code Q4159 Code Q4191 Code Q4219 Code Q4254 Code 97152 Code L5857 Code 89354 Code Q4117 Code Q4160 Code Q4192 Code Q4220 Code Q4255 Code 97755 Code L6694 Code 92145 Code Q4118 Code Q4161 Code Q4193 Code Q4221 Code S0810 Code 97761 Code L6695 Code 93701 Code Q4123 Code Q4164 Code Q4194 Code Q4222 Code S2080 Code 97763 Code L6696 Code 93702 Code Q4125 Code Q4165 Code Q4195 Code Q4226 Code S2348 Code A4271 Code Q4236 Code 41530 Code 95803 Code Q4126 Code Q4166 Code Q4196 Code Q4227 Code S9090 Code A4593 Code Q4251 Code 54400 Code 97026 Code Q4127 Code Q4167 Code Q4197 Code Q4229 Code A4594 Code Q4252 Code 54401 Code C1813 Code Q4134 Code Q4169 Code Q4198 Code Q4230 Code A9293 Code Q4253 Code 54405 Code C2622 Code Q4135 Code Q4170 Code Q4200 Code Q4232 Code C9399 Code Q4305 Code 89257 Code E2358 Code Q4138 Code Q4173 Code Q4201 Code Q4233 Code E0152 Code Q4306 Code 89268 Code E2360 Code Q4140 Code Q4174 Code Q4202 Code Q4234 Code E0468 Code Q4307 Code 89272 Code E2362 Code Q4141 Code Q4175 Code Q4203 Code Q4235 Code E0736 Code Q4308 Code Q4310 Code E2364 Code Q4142 Code Q4176 Code Q4204 Code Q4237 Code E0738 Code Q4309 Code G0556 Code V2500 Code V2502 Code V2510 Code V2512 Code V2520 Code V2522 Code 90637 Code J0591 Code V2121 Code V2501 Code V2503 Code V2511 Code V2513 Code V2521 Code V2523 Code 90638 Code H2001 Code H2013 Code 90882 Code A0420 Code G0531 Code G2076 Code H0002 Code H0021 Code H0037 Code H1001 Code H2010 Code H2016 Code 98966 Code A0888 Code G2067 Code G2077 Code H0008 Code H0022 Code H0039 Code H1002 Code H2026 Code H2028 Code 98967 Code A9273 Code G2068 Code G2078 Code H0009 Code H0026 Code H0041 Code H1003 Code H2027 Code H2029 Code 98968 Code A9900 Code G2069 Code G2079 Code H0011 Code H0027 Code H0042 Code H1004 Code H2030 Code H2032 Code A0100 Code G0176 Code G2073 Code G2080 Code H0012 Code H0028 Code H0043 Code H1010 Code H2031 Code H2037 Code A0120 Code G0447 Code G2074 Code G2211 Code H0013 Code H0029 Code H0044 Code H1011 Code S9002 Code S9449 Code A0130 Code G0473 Code G2075 Code H0001 Code H0016 Code H0030 Code H0045 Code H2000 Code S9452 Code S9470 Code T1005 Code T1016 Code 88380 Code 22860

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