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Change in Tonsillectomy and Adenoidectomy Prior Authorization Requirements

Effective June 15, 2024, the following tonsillectomy and adenoidectomy services will require prior authorization:

Code

 Code Description

42825

TONSILLECTOMY PRIM/SECNDRY; UNDER AGE 12

42826

TONSILLECTOMY PRIM/SECNDRY; AGE 12/OVER

42831

ADENOIDECTOMY PRIM; AGE 12/OVER

42835

ADENOIDECTOMY SECNDRY; UNDER AGE 12

42836

ADENOIDECTOMY SECNDRY; AGE 12/OVER

42820

TONSILLECTOMY & ADENOIDECTOMY; UNDER AGE 12

42830

ADENOIDECTOMY PRIM; UNDER AGE 12

Please reach out to your Provider Network Representative if you have additional questions or concerns, or call Provider Services at 888-773-2647.

Last Updated: 11/25/2024