Prior Authorization Updates Effective 7/1/2024
`Ohana Health plan prior authorization updates effective 7/1/2024 for new American Medical Association Current Procedural Terminology (CPT®) codes.
The following new CPT Proprietary Laboratory Analyses (PLA) codes and CPT Category III codes will require prior auth, unless determined to be a non-covered service, upon their effective date of 7/1/2024. For other established codes, please use the Pre-Auth Check Tools on our websites to confirm if the code(s) requires prior authorization. Prior authorization requirements vary based on the line of business, so please select the applicable Pre-Auth Check Tool by the line of business.
CODE | DESCRIPTION |
0020M | ONC CNS ALYS 30000 DNA METHYLATION LOCI TUM TISS |
0450U | ONC MM LC-MS/MS MONOCLONAL P-PRTN SEQ ALYS SERUM |
0451U | ONC MM LC-MS/MS PEPTIDE ION QUANTIFICATION SERUM |
0452U | ONC BLADDER MTHYL PENK DNA DETCJ LTE-QMSP URINE |
0453U | ONC CLRCT CA CFDNA MTHYLTN BSD QUAN PCR ASY PLSM |
0454U | RARE DS ID VRTJ INVRJ INSJ TLCJ OPT GENOME MAPG |
0456U | AI RA NGS GEN XPRSN 19 GEN WHL BLD ALYS ANTI-CCP |
0457U | PFAS 9 PFAS COMPOUNDS LC-MS/MS PLASMA/SERUM QUAN |
0458U | ONC BREAST CA S100 A8&A9 ELISA TEAR FLUID ALG |
0459U | ABETA42 & TTAU ECLIA CEREBRAL SPINAL FLUID RATIO |
0460U | ONC WHL BLD/BUCCAL DNA SNP GNOTYP RT-PCR 24 GENE |
0461U | ONC RX-GENOMIC ALYS SNP GNOTYP RT-PCR 24 GENES |
0462U | MELATONIN LVL TEST SLEEP STUDY 7/9 SAMPLE ELISA |
0463U | ONC CERVIX MRNA GENXPRSN 14 BMRK E6&E7 HPV NASBA |
0465U | ONC UROTHELIAL CARC DNA QMSP 2 GENES ALG ALYS |
0466U | CRD CAD DNA GWAS 564856 SNP TRGT VARIANT GNOTYP |
0467U | ONC BLDR DNA NGS 60 GEN&WHL GENOME ANEUP UR ALG |
0468U | HEP NASH MIR-34A-5P A2M YKL40 HBA1C SRM&WHL BLD |
0469U | RARE DS WHL GENOM SEQ ALYS CHRMOML ABNR FTL SAMP |
0470U | ONC OROP DETCJ MRD NGS QUAN EVAL 8DNA CFHPV16&18 |
0472U | CA VI PSP&SP1 ANTB ELISA SEMIQL BLD SJOGREN SYND |
0473U | ONC SOLID TUMOR NGS DNA FFPE TISS BLD/SLV 648GEN |
0474U | HERED PAN CA GSAP 88 GENES 20DUP/DEL NGS BLD/SLV |
0475U | HERED PRST8 CA-RLTD DO GSAP NGS CGH EVAL 23 GENE |
0867T | TPLA B9 PROSTATIC HYPERPLASIA PRST8 VOL>=50 ML |
0868T | HIGH-RESOLUTION GASTRIC ELECTROPHYSIOLOGY MAPG |
0869T | NJX B1 SUB MATRL B1&/SFT TISSUE HW FIXJ AGMNTJ |
0870T | IMPLANTATION SUBQ PERITONEAL ASCITES PUMP SYS |
0871T | REPLACEMENT SUBCUTANEOUS PERITONEAL ASCITES PUMP |
0872T | RPLCMT INDWELLING BLADDER & PERITONEAL CATHETERS |
0873T | REVJ SUBQ IMPL PERITONEAL ASCITES PUMP SYSTEM |
0874T | REMOVAL PERITONEAL ASCITES PUMP SYSTEM |
0876T | DUPLEX SCAN HEMODIALYSIS FISTULA CPTR AIDED LMTD |
0877T | AUGMNT ALYS CH CT IMG DATA ILD WO CNCRNT CT EXAM |
0878T | AUGMNT ALYS CH CT IMG DATA ILD W/CNCRNT CT EXAM |
0879T | AUGMNT ALYS CH CT IMG DATA ILD DATA PREP&TRNSMS |
0880T | AUGMNT ALYS CH CT IMG DATA ILD PHYS/QHP I&R |
0881T | CRTX ORAL CAVITY TEMP REGULATED FLU COOLING SYS |
0884T | ESPHGSC FLX TRNSORL 1ST TNDSC DILAT RX BALO CATH |
0885T | COLSC FLX TRNSORL 1ST TNDSC DILAT RX BALO CATH |
0886T | SGMDSC FLX TRNSORL 1ST TNDSC DILAT RX BALO CATH |
0888T | HISTOTRIPSY MALIGNANT RENAL TISSUE W/IMG GDN |
0889T | PERSONALIZED TARGET DEVELOPMENT ARHFCMRIGTBS |
0890T | ARHFCMRIGTBS 1ST MOTOR THRESHOLD DETER 1ST TX D |
0891T | ARHFCMRIGTBS SUBSEQUENT TREATMENT DAY |
0892T | ARHFCMRIGTBS SBSQ MOTOR THRESHLD REDETER PR TX D |
0893T | N-INVAS ASSMT BLD OXY GAS XCHNG EFF&CARDRESP I&R |
0897T | N-INVAS AUGMNT ARRHYT ALYS QUAN CAR ARRHYT SIMUL |
0898T | NONINVASIVE PROSTATE CANCER ESTIMATION MAP |
0899T | N-INVAS DETER AQMBF AUGMNT ALG ALYS DATASET CMR |
0900T | N-INVAS EST AQMBF ASSITIVE ALG ALYS DATASET CMR |