Effective Date: Oct. 1, 2026

Health Plans Affected: Employer Health Programs (EHP), Priority Partners, US Family Health Plan (USFHP) 

Type of Change: ER Sudden & Serious List

Explanation of Change:

The Johns Hopkins Health Plans Reimbursement and Coding Committee (RAC) approved additions to the Sudden and Serious List, which is a list of ICD-10 codes for which Emergency Department (ED) payment does not require medical review. 

New Sudden and Serious Codes Effective Oct. 1, 2026:

• E89.830 - Post bariatric hypoglycemia
• I47.22 - Catecholaminergic polymorphic ventricular tachycardia [CPVT]
• I49.81 - Brugada syndrome
• I49.89  - Other specified cardiac arrhythmias not elsewhere classified
• K6A.01 - Prevesical abscess
• K6A.09 - Other pelvic abscess
• L02.237 - Carbuncle of flank
• O00.121 - Right interstitial ectopic pregnancy without intrauterine pregnancy
• O00.122 - Left interstitial ectopic pregnancy without intrauterine pregnancy
• O00.129 - Unspecified interstitial ectopic pregnancy without intrauterine pregnancy
• O00.131 - Right interstitial ectopic pregnancy with intrauterine pregnancy
• O00.132 - Left interstitial ectopic pregnancy with intrauterine pregnancy
• O00.139 - Unspecified interstitial ectopic pregnancy with intrauterine pregnancy
• O00.31 - Cesarean scar ectopic pregnancy without intrauterine pregnancy
• O00.32 - Cesarean scar ectopic pregnancy with intrauterine pregnancy
• O00.41 - Cervical ectopic pregnancy without intrauterine pregnancy
• O00.42 - Cervical ectopic pregnancy with intrauterine pregnancy
• O00.511 - Right cornual ectopic pregnancy without intrauterine pregnancy
• O00.512 - Left cornual ectopic pregnancy without intrauterine pregnancy
• O00.519 - Unspecified cornual ectopic pregnancy without intrauterine pregnancy
• O00.521 - Right cornual ectopic pregnancy with intrauterine pregnancy
• O00.522 - Left cornual ectopic pregnancy with intrauterine pregnancy
• O00.529 - Unspecified cornual ectopic pregnancy with intrauterine pregnancy
• T52.811A - Toxic effect of alkenes, accidental (unintentional), initial encounter
• T52.813A - Toxic effect of alkenes, assault, initial encounter
• T52.814A - Toxic effect of alkenes, undetermined, initial encounter
• T52.821A - Toxic effect of cycloparaffins, accidental (unintentional), initial encounter
• T52.823A - Toxic effect of cycloparaffins, assault, initial encounter
• T52.824A - Toxic effect of cycloparaffins, undetermined, initial encounter
• T52.891A - Toxic effect of other organic solvents, accidental (unintentional), initial encounter
• T52.893A - Toxic effect of other organic solvents, assault, initial encounter
• T52.894A - Toxic effect of other organic solvents, undetermined, initial encounter
• T59.821A - Toxic effect of hexamethylene diisocyanate, accidental (unintentional), initial encounter
• T59.823A - Toxic effect of hexamethylene diisocyanate, assault, initial encounter
• T59.824A - Toxic effect of hexamethylene diisocyanate, undetermined, initial encounter
• T65.851A - Toxic effect of medetomidine, accidental (unintentional), initial encounter
• T65.853A - Toxic effect of medetomidine, assault, initial encounter
• T65.854A - Toxic effect of medetomidine, undetermined, initial encounter

Policy APL009 describing the Emergency Department Review Process has been updated and includes language that the Sudden and Serious list may be updated monthly. Please reference the posted list directly for updates. 

To view the full descriptions of policies, please visit the Johns Hopkins Health Plans website on or after the effective date or call Provider Relations at 888-895-4998 (option 4).