New CPT Codes Requiring Prior Authorization for EHP and USFHP
This list 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 prior authorization requirements for outpatient services and procedures. Prior authorization requirements are subject to change.
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New Codes Requiring Prior Authorization for Employer Health Programs (EHP) and US Family Health Plan (USFHP)
Effective Date: Feb. 19, 2024
| Procedure Codes | Effective Date | Procedure Description | USFHP Prior Authorization YES/NO |
EHP Prior Authorization YES/NO |
|---|---|---|---|---|
| 75580 | 2/19/2024 | Noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified health care professional | YES | NO |
| 81457 | 2/19/2024 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis, microsatellite instability | YES | YES |
| 81458 | 2/19/2024 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis, copy number variants and microsatellite instability | YES | YES |
| 81459 | 2/19/2024 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements | YES | YES |
| 81462 | 2/19/2024 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants and rearrangements | YES | YES |
| 81463 | 2/19/2024 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis, copy number variants, and microsatellite instability |
YES | YES |
| 81464 | 2/19/2024 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements | YES | YES |