New CPT Codes Requiring Preauthorization
Priority Partners, Advantage MD, and USFHP.
Effective Date: September 1, 2021
The following list of procedure codes requiring prior authorization is provided for reference purposes only and may not be all inclusive. The listing of a code does not imply that the service described by the code is a covered or non‐covered health service.
Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies and Guidelines may apply.
Please refer to the Johns Hopkins Prior Authorization Lookup tool (JPAL), located in the HealthLINK portal, to check and verify preauthorization requirements for outpatient procedures and services.
There are no preauthorization requirements for the new codes for Johns Hopkins Employer Health Programs (EHP).
Preauthorization required for Advantage MD and Priority Partners
| Procedure Code | Procedure Description |
|---|---|
| 0248U | Oncology (brain), spheroid cell culture in a 3D microenvironment, 12 drug panel, tumor-response prediction for each drug |
| 0249U | Oncology (breast), semiquantitative analysis of 32 phosphoproteins and protein analytes, includes laser capture microdissection, with algorithmic analysis and interpretative report |
| 0250U | Oncology (solid organ neoplasm), targeted genomic sequence DNA analysis of 505 genes, interrogation for somatic alterations (SNVs [single nucleotide variant], small insertions and deletions, one amplification, and four translocations), microsatellite instability and tumor-mutation burden |
| 0662T | Scalp cooling, mechanical: initial measurement and calibration of cap |
| 0663T | Scalp cooling, mechanical; placement of device, monitoring, and removal of device (List separately in addition to code for primary procedure) |
Preauthorization required for USFHP
| Procedure Code | Procedure Description |
|---|---|
| 0248U | Oncology (brain), spheroid cell culture in a 3D microenvironment, 12 drug panel, tumor-response prediction for each drug |
| 0249U | Oncology (breast), semiquantitative analysis of 32 phosphoproteins and protein analytes, includes laser capture microdissection, with algorithmic analysis and interpretative report |
| 0250U | Oncology (solid organ neoplasm), targeted genomic sequence DNA analysis of 505 genes, interrogation for somatic alterations (SNVs [single nucleotide variant], small insertions and deletions, one amplification, and four translocations), microsatellite instability and tumor-mutation burden |