Preauthorization Requirements – Changes Starting Jan. 13, 2026

A4421

Ostomy supply; miscellaneous

A5507

For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe

A6261

Wound filler, gel/paste, per fluid ounce, not otherwise specified

A6262

Wound filler, dry form, per gram, not otherwise specified

A6512

Compression burn garment, not otherwise classified

A6549

Gradient compression garment, not otherwise specified, for daytime use, each

A9279

Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified

A9901

DME delivery, set up, and/or dispensing service component of another HCPCS code

L0999

Addition to spinal orthosis, not otherwise specified

L3649

Orthopedic shoe, modification, addition or transfer, not otherwise specified

0540U

Transplantation medicine, quantification of donor-derived cell-free DNA using next-generation sequencing analysis of plasma, reported as percentage of donor-derived cell-free DNA to determine probability of rejection

81479

Unlisted molecular pathology procedure [when specified as gene analysis of V600K variant]

81595

Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral blood, algorithm reported as a rejection risk score