Issued: January 14, 2026
Partners Health Management is providing a reminder to providers regarding updates to prior authorization (PA) requirements for physical health that will take effect on Feb. 1, 2026. Carolina Complete Health (CCH) administers Physical Health utilization management on behalf of Partners.
These updates reflect ongoing efforts to enhance consistency, minimize unnecessary administrative burdens and ensure that members receive timely access to medically necessary care.
What is happening?
Prior authorization requirements across several Physical Health service categories have been revised, effective Feb. 1, 2026. Key objectives of these updates include:
- Eliminating certain prior authorization requirements when the urgency of review or the clinical nature of the service supports timely access without additional review.
- Improving consistency of prior authorization requirements across markets and lines of business by aligning, adding or modifying select requirements to simplify processes, reduce provider confusion and support future enhancements such as expanded real-time authorization responses.
What do providers need to know?
- Providers should continue to confirm prior authorization requirements before delivering services.
- Authorization determinations are based on procedure codes, clinical criteria and benefit coverage.
- Providers should review the updated requirements in the chart below and continue to verify authorization needs before rendering services.
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 Effective Feb. 1, 2026
| Service Category | Procedure Codes | Prior Authorization Required | Prior Authorization Not Required |
| DME Services | PA Required: T4521, T4522, T4523, T4524, B4158, B4159, B4160, B4161, L1833, E2512
No PA Required: E1392, E2231, K0195, E0960, E0973, E0978, E2366, K0739 |
Incontinence supplies, nutritional services, select orthotic/prosthetic, supplies and devices | Equipment and accessories, wheelchairs |
| Home Services | T1002 | Nursing services | N/A |
| Laboratory Services | G0480, G0481 (after 12 tests per calendar year) | Urinalysis | Routine labs within allowable limits |
| Other Medical Services | A4554 | Other medical services | Wound care services (A6549) |
| Skin Procedures | 15734 | Muscle flap procedures | N/A |
| Surgical Procedures | PA Required: 49505, 49591, 49593, 49595, 49650, 58662
No PA required: 36471 |
Digestive system and female genitalia procedures | Select vascular procedures |
| Transportation Services | A0431, A0436 | Medical transportation services | N/A |