Updated Preauthorization Lists: January 2026 Quarterly Code Updates

EmblemHealth updates our claims processing systems based on code updates received from American Medical Association (AMA), Current Procedural Terminology (CPT), and Centers for Medicare & Medicaid Services (CMS). Both the AMA and CMS release quarterly updates to their respective code sets. Here is the latest preauthorization list.

We strive to load and configure each code update within 60 days of the update’s effective date. The current process will hold the entire claim if it contains a new code while it is being configured. To avoid delaying critical payments to our providers, we adjudicate the claim for all services except for the new code(s) that need configuration. Once the new CPT and/or Healthcare Common Procedure Coding System (HCPCS) codes have been loaded into our claims processing system, we will reprocess the claims to ensure proper adjudication of the claim.