Healthfirst Prior auth updates 11/1/26

September 28, 2026

The following codes will require an auth beginning for any DOS 11/1/26.

Please note which vendor that the privider would need to submit the prior auth request.

Orthonet: the following codes fall under Orthonet (a subsidiary of Optum)

27096- escription
Authorization
Managed By
27096 CPT-CAT I
Injection procedure for sacroiliac joint,
anesthetic/steroid, with image guidance (fluoroscopy
or CT) including arthrography when performed
64633- Description
Authorization
Managed By
64633 CPT-CAT I
Destruction by neurolytic agent, paravertebral facet
joint nerve(s), with imaging guidance (fluoroscopy or
CT); cervical or thoracic, single facet joint
64634- Destruction by neurolytic agent, paravertebral facet
joint nerve(s), with imaging guidance (fluoroscopy or
CT); cervical or thoracic, each additional facet joint
(List separately in addition to code for primary
procedure)
64635- procedure)
OrthoNet
(a subsidiary of
Optum)
64635 CPT-CAT I
Destruction by neurolytic agent, paravertebral facet
joint nerve(s), with imaging guidance (fluoroscopy or
CT); lumbar or sacral, single facet joint

EviCore – the following codes need to be requested through EviCore:

70471- Computed tomographic angiography (CTA), head
and neck, with contrast material(s), including
noncontrast images, when performed, and image
postprocessing
70472- Computed tomographic
(CT) cerebral perfusion analysis with contrast
material(s), including image postprocessing
performed with concurrent CT or CT angiography of
the same anatomy (List separately in addition to code for primary procedure)
70473- Computed tomographic
(CT) cerebral perfusion analysis with contrast
material(s), including image postprocessing
performed without concurrent CT or
CT angiography of the same anatomy
C0081- 3D anatomical segmentation imaging for preoperative planning, data preparation and
transmission, obtained from previous diagnostic computed tomographic
or magnetic resonance examination of the
same anatomy
75577-Quantification and characterization of coronary
atherosclerotic plaque to assess severity of coronary
disease, derived from augmentative
software analysis of the data set from a coronary computed tomographicangiography, with interpretation and report by a physician or other qualified health care professional

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