Important Prior Authorization Updates - Effective October 1, 2026

Date: 06/11/26

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Peach State Health Plan 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 can be found below. These 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. 

If you have 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	Substance Abuse Treatment	H0010, H0011
		Therapy	97157
	No PA Required	Behavioral Assessment	96121
DME Services	No PA Required	Mobility Services	E0630
		Orthotic and Prosthetic	L1932, L5000, L5631, L5704, L5920, L5950
Genetic Analysis	PA Required	Genetic Testing	81519
	No PA Required	Genetic Testing	81279, 81338, 81339
Hearing Services	No PA Required	Hearing Aids	V5160
Home Services	No PA Required	Other Services	H0045
		Home Visit	S9213, T1028
Hospice	PA Required	Hospice Services	651
Other Medical Services	No PA Required	Nutritional Services	97802
Physician Services	No PA Required	Diagnostic Testing	91113
Surgery Procedures	PA Required	Tonsil and Adenoid Procedures	42821, 42826
	No PA Required	Eye and Ocular Adnexa	67904
Transportation Services	PA Required	Medical Transportation	A0130