Effective Date: Sept. 7, 2026

Health Plans Affected: Advantage MD, Priority Partners

Type of Change: Authorization Requirements Status

Explanation of Change: 

Authorization status code changes have been confirmed for Advantage MD and Priority Partners, which go into effect Sept. 7, 2026. These requirements affect members of all ages enrolled in these two plans.

Key: PA=Prior Authorization Required; NPA=No Prior Authorization Required

Advantage MD Code Changes

• K0001 - Standard manual wheelchair used for patients with limited mobility; NPA
• K0195 - Pair of elevating leg rests for capped rental wheelchairs; NPA
• 95251 - Professional analysis, interpretation, and report of continuous glucose monitoring (CGM) data collected via a subcutaneous sensor for at least 72 hours; NPA
  

Priority Partners Code Changes

• A5500 - Fitting of custom or depth-inlay shoes for diabetic patients to prevent foot complications; NPA
• E2601 - General use wheelchair seat cushion, width less than 22 inches, any depth; NPA
• E1392 - Portable oxygen concentrator, rental; NPA 
• 77080 - Dual-energy X-ray absorptiometry (DXA) scans of the axial skeleton, including the spine and hips, to assess bone mineral density and osteoporosis risk; NPA 

Prior Authorization Process
Please use our secure online portal, Availity, to submit electronic prior authorization requests.