Effective Date: Oct. 1, 2026

Health Plans Affected: Employer Health Programs (EHP), Priority Partners 

Type of Change: Authorization Requirements Status

Explanation of Change:

Authorization status code changes have been confirmed for EHP and Priority Partners and will go into effect starting Oct. 1, 2026. These requirements affect members of all ages.

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

EHP Code Changes

• 81479 - Unlisted molecular pathology procedure; PA
• 89343 - Storage (per year); sperm/semen; PA for PPO, EPO, DPC; NC > 1 visit
• 58345 - Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography; NPA for PPO, EPO, DPC (no visit limits)
• 89300 - Semen analysis; presence and/or motility of sperm including Huhner test (post coital); NPA for PPO, EPO, DPC
• 89310 - Semen analysis; motility and count (not including Huhner test); NPA for PPO, EPO, DPC
• 89320 - Semen analysis; volume, count, motility, and differential; NPA for PPO, EPO, DPC
• 89321 - Semen analysis; sperm presence and motility of sperm, if performed; NPA for PPO, EPO, DPC
• 89322 - Semen analysis; volume, count, motility, and differential using strict morphologic criteria (eg, Kruger); NPA for PPO, EPO, DPC

Priority Partners Code Changes

• E0691 - Ultraviolet light therapy system, including bulbs/lamps, timer and eye protection; treatment area 2 sq ft or less; NC
• E0692 - Ultraviolet light therapy system panel, including bulbs/lamps, timer and eye protection, 4 ft panel; NC
• E0693 - Ultraviolet light therapy system panel, including bulbs/lamps, timer and eye protection, 6 ft panel; NC
• E0694 - Ultraviolet multidirectional light therapy system in 6 ft cabinet, including bulbs/lamps, timer, and eye protection; NC
• E1831 - Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories; NC
• L8684 - Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement; NC
• L8689 - External recharging system for battery (internal) for use with implantable neurostimulator, replacement only; NC
• 96121 - Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [e.g. acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour (List separately in addition to code for primary procedure); NC