Effective October 1, 2026, several prior authorization service categories will be updated

Date: 06/17/26

As part of our ongoing work to improve the prior authorization (PA) process, Meridian will apply updates to the PA requirements noted below, effective October 1, 2026. 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; changes may include:

• Removing PA requirements based on criticality of review and clinical need
• Creating a more uniform set of prior authorization requirements, 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 Provider Engagement representative.

Service Category	PA Rule	Services	Procedure codes
Behavioral Health	PA Required	Treatment Services	97157
DME and Supplies	No PA Required	Respiratory Devices and Supplies	E0434, E0443, K0738
		Mobility Devices	E0630
		Orthotic and Prosthetic	L5704
Drug Codes	PA Required	Specialty Drugs	Q5147
Genetic Analysis	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, 81372, 81374, 81375, 81378, 81381, 81382, 81383, 81400, 81401
Genitourinary Procedures	PA Required	Surgery – Male Genitalia	55899
Home Services	No PA Required	Home Visit	S9211
Hospice	PA Required	Hospice Services	651
Physician Services	PA Required	Diagnostic Testing	91299
Sleep Medicine	No PA Required	Sleep Studies	95805
Surgery Procedures	No PA Required	Eye and Ocular Adnexa	67904
		Auditory System	69631
Transportation Services	PA Required	Medical Transportation	A0130