Issued: January 28, 2026
Partners Health Management, in collaboration with Carolina Complete Health (CCH), is sharing updates to physical health prior authorization (PA) requirements that will take effect April 1, 2026. These changes are part of ongoing efforts to streamline administrative processes, reduce provider burden, and improve timely access to care for members.
What is changing?
As part of continued efforts to improve the prior authorization process:
- Certain PA requirements are being removed based on clinical urgency and medical necessity.
- Other PA requirements are being added, modified, or aligned across service categories to improve consistency and support future enhancements to authorization workflows.
- A list of service categories and requirements is at the bottom of this alert.
What providers need to know
- Providers should continue to verify prior authorization requirements before rendering services.
- Authorization determinations are based on procedure codes, clinical criteria, and member benefit coverage.
- The updated PA requirements below apply to dates of service on or after April 1, 2026.
Who can providers contact if they have questions?
Providers can contact Physical Health Utilization Management by sending an email to phumquestions@partnersbhm.org.
Prior Authorization Requirements by Service Category
| Service Category | Prior Authorization Requirement | Procedure Codes / Notes |
| Durable Medical Equipment (DME) | No PA required for PAR providers | Neurostimulators: E0730 Wheelchairs: E0950, E0956 |
| DME: Nutritional Services | No PA required for members under age 21; PA required for all others | B4100 |
| Physician Services | PA required | Neurological testing: 95700, 95711, 95718, 95720, 95721, 95722, 95723, 95724, 95725, 95726 |
| Skin Procedures | PA required after 12 visits per calendar year | Surgery-Integumentary System: 11043 |
| Skin Grafts | PA required when billed with a diagnosis of gender dysphoria; otherwise, PA required for non-PAR providers only | 14060, 14061, 15100, 15101, 15120 |
| Surgery – Musculoskeletal System | No PA required for PAR providers | 29848 CPT code 29848 describes an endoscopic surgical procedure for the wrist, specifically for the release of the transverse carpal ligament, commonly known as an endoscopic carpal tunnel release (ECTR) |
| Surgery – Nervous System | No PA required for PAR providers | 64721 – CPT code 64721 describes the open surgical release of the median nerve at the carpal tunnel, known as neuroplasty and/or transposition of the median nerve, used to treat severe carpal tunnel syndrome |
| Surgery – Nervous System | PA required | 64568 – CPT code 64568 describes the open implantation of a cranial nerve neurostimulator electrode array and pulse generator, often used for conditions like obstructive sleep apnea (OSA) with devices like Inspire, involving the vagus or hypoglossal nerve |
| Surgery – Respiratory System | PA required | 30130, 30140, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276 |
| Other Surgical Procedures | PA required | Rhinoplasty: 30460 |
Updated: