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Johns Hopkins Health Plans

Authorization Changes Effective Nov. 1 for Johns Hopkins Health Plans

Effective Date: Nov. 1, 2026

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

Type of Change: Authorization Requirements Status

Explanation of Change:

Authorization status code changes have been confirmed for Johns Hopkins Health Plans and will go into effect starting Nov. 1, 2026. These requirements affect members of all ages enrolled in Johns Hopkins Health Plans.

Key: PA=Prior Authorization Required; NPA=No Prior Authorization Required; NC=Not Covered

Advantage MD Code Authorization Changes:

  • 33274 - Tcat insj/rpl perm leadless pacemaker rv w/img; PA
  • 33275 - Tcat removal perm leadless pm right ventr w/img; PA
  • 0795T - Tcat insj perm dual chamber ldls pm compl sys; PA
  • 0796T - Tcat insj perm 2chmbr ldls pm r atr pm compnt; PA
  • 0798T - Tcat rmvl perm dual chamber ldls pm compl sys; PA
  • 0799T - Tcat rmvl perm 2chmbr ldls pm r atr pm compnt; PA
  • 0800T - Tcat rmvl perm 2chmbr ldls pm r ventr pm compnt; PA
  • 0801T - Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys; PA
  • 0802T - Tcat rmvl&rplcmt perm 2chmbr ldls pm r atr cmpnt; PA
  • 0803T - Tcat rmvl&rplcmt prm 2chmbr ldls pm r vntr cmpnt; PA
  • 0804T - Prgrmg dev eval ldls pm sys 2chmbr in person; PA
  • 43290 - Egd flx trnsorl w/dplmnt ntrgstr bariatric balo; PA
  • 43291 - Egd flx trnsorl w/rmvl ntrgstr bariatric balo; PA

 

EHP Code Authorization Changes:

  • 33274 - Tcat insj/rpl perm leadless pacemaker rv w/img; NPA
  • 33275 - Tcat removal perm leadless pm right ventr w/img; NPA
  • 0795T - Tcat insj perm dual chamber ldls pm compl sys; NPA
  • 0796T - Tcat insj perm 2chmbr ldls pm r atr pm compnt; NPA
  • 0798T - Tcat rmvl perm dual chamber ldls pm compl sys; NPA
  • 0799T - Tcat rmvl perm 2chmbr ldls pm r atr pm compnt; NPA
  • 0800T - Tcat rmvl perm 2chmbr ldls pm r ventr pm compnt; NPA
  • 0801T - Tcat rmvl&rplcmt perm 2chmbr ldls pm 2chmbr sys; NPA
  • 0804T - Prgrmg dev eval ldls pm sys 2chmbr in person; NPA

 

Priority Partners Code Authorization Changes:

  • 33274 - Tcat insj/rpl perm leadless pacemaker rv w/img; PA
  • 33275 - Tcat removal perm leadless pm right ventr w/img; PA
  • 43290 - Egd flx trnsorl w/dplmnt ntrgstr bariatric balo; PA
  • 43291 - Egd flx trnsorl w/rmvl ntrgstr bariatric balo; PA
  • 48550 - Donor pancreatectomy duodenal sgm transplant; PA
  • S2112 - Arthroscopy knee surgical harvesting cartilage; PA
  • J7330- Autologous cultured chondrocytes implant; PA

 

USFHP Code Authorization Changes:

  • A6212 - Foam dress sterl pad sz 16 sq/> w/adhes bordr ea; NPA
  • A6215 - Foam dressing wound filler sterile per g; NPA
  • A6217 - Gauze non-impreg nonsterl >16 </=48 sq w/o adhes; NPA
  • A6218 - Gauze non-impreg nonsterl > 48 sq w/o adhes ea; NPA
  • 90840 - Psychotherapy for crisis each addl 30 minutes; NPA
  • 90845 - Psychoanalysis; NPA
  • 90849 - Multiple family group psychotherapy; NPA
  • A4459 - Manual transanal irr sys w/o catheter any type; NPA
  • 92605 - Eval rx n-sp-gen augmt alt commun dev f2f 1st hr; PA
  • S2112 - Arthroscopy knee surgical harvesting cartilage; PA
  • J7330- autologous cultured chondrocytes implant; PA