Important Prior Authorization Updates (Effective October 1, 2026)
Date: 07/29/26
As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Meridian wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.
Code change details are noted in the table below. The changes may include:
- Removing PA requirements based on criticality of review and clinical need.
- Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.
For questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.
Service Category | PA Rule | Services | Procedure codes |
|---|---|---|---|
Behavioral Health | PA Required | Treatment and Services | 97157 |
DME and Supplies | No PA Required | Respiratory Devices and Supplies | E0434 |
Mobility Devices | E0630 | ||
Wheelchairs | E0954 | ||
Orthotic & Prosthetic | L1932, L5000, L5620, L5629, L5631 L5637, L5704, L5920, L5950 | ||
Drug Codes | No PA Required | Diabetic Drugs and Supplies | A4238 |
Specialty Drugs | J1453 | ||
Genetic Analysis | PA Required | Genetic Testing | 81519 |
No PA Required | Genetic Testing | 81161, 81200, 81206, 81207, 81219, 81240, 81241, 81242, 81243, 81250, 81251, 81255, 81256, 81260, 81279, 81297, 81304, 81319, 81338, 81339, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81378, 81379, 81380, 81381, 81382, 81383, 81400, 81401, 88230, 88280, 88291 | |
Hearing Services | No PA Required | Implants and Supplies | L8624 |
Hearing Aids | V5130, V5140 | ||
Home Services | PA Required | Home Visit | S9122 |
Hospice | PA Required | Hospice Services | 651 |
Other Medical Services | PA Required | Other Services | T1999 |
Sleep Medicine | No PA Required | Sleep Studies | 95805 |
Surgery Procedures | PA Required | Surgery Procedures | 42821 |
No PA Required | Tonsil and Adenoid Procedures | 42820, 42825, 42830, 42835, 42836 | |
Eye and Ocular Adnexa | 67904 | ||
Transportation Services | PA Required | Medical Transportation | A0130 |