Archived Prior Authorization (PA) Code Lists and Changes

Below is a list of archived PA Code Lists. View the Forms page to find the current PA Code List.

Start Date End Date PA Code List
04/01/2024  06/30/2024  Marketplace: Q2 2024 PA Code Changes - Effective 4/1/2024 to 6/30/2024 
04/01/2024  06/30/2024  Medicare and MMP: Q2 2024 PA Code Changes - Effective 4/1/2024 to 6/30/2024 
04/01/2024  06/30/2024  Medicaid: Q2 2024 PA Code Changes - Effective 4/1/2024 to 6/30/2024 
01/01/2024 03/31/2024 Marketplace: Q1 2024 PA Code Changes - Effective 1/1/2024 to 3/31/2024
01/01/2024 03/31/2024 Medicare and MMP: Q1 2024 PA Code Changes - Effective 1/1/2024 to 3/31/2024
01/01/2024 03/31/2024 Medicaid: Q1 2024 PA Code Changes - Effective 1/1/2024 to 3/31/2024
10/01/2023  12/31/2023  Prior Authorization (PA) Code List - Effective 10/01/2023 to 12/31/2023
07/01/2023  09/30/2023  Prior Authorization (PA) Code List - Effective 07/01/2023 to 09/30/2023
04/01/2023  06/30/2023  Prior Authorization (PA) Code List - Effective 04/01/2023 to 06/30/2023
01/16/2023 03/31/2023  Prior Authorization (PA) Code List - Effective 1/16/2023 to 3/31/2023
01/01/2023 01/15/2023 Prior Authorization (PA) Code List - Effective 1/1/2023 to 1/15/2023
10/01/2022  12/31/2022  Prior Authorization (PA) Code List - Effective 10/1/2022 to 12/31/2022 
07/01/2022  09/30/2022  Prior Authorization (PA) Code List - Effective 7/1/2022 to 9/30/2022 
04/01/2022  06/30/2022  Prior Authorization (PA) Code List - Effective 4/1/2022 to 6/30/2022 
03/01/2022  03/31/2022  Prior Authorization (PA) Code List - Effective 3/1/2022 to 4/30/2022 
01/01/2022  02/28/2022  Prior Authorization (PA) Code List - Effective 1/1/2022 to 2/28/2022
10/01/2021  12/31/2021  Prior Authorization (PA) Code List - Effective 10/1/2021 to 12/31/2021
09/01/2021  09/30/2021  Prior Authorization (PA) Code List - Effective 9/1/2021 to 9/30/2021
07/01/2021  08/31/2021  Prior Authorization (PA) Code List - Effective 7/1/2021 to 8/31/2021
04/01/2021 06/30/2021 Prior Authorization (PA) Code List – Effective 4/1/2021 to 6/30/2021 
02/13/2021 03/31/2021 Marketplace Prior Authorization (PA) Code List – Effective 2/13/2021 to 3/31/2021
02/13/2021
 03/31/2021 Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 2/13/2021 to 3/31/2021
02/01/2021 02/12/2021 Marketplace Prior Authorization (PA) Code List – Effective 2/1/2021 to 2/12/2021
02/01/2021
 02/12/2021 Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 2/1/2021 to 2/12/2021
02/01/2021
 03/31/2021 Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 2/1/2021 to 3/31/2021
01/01/2021 01/31/2021 Marketplace Prior Authorization (PA) Code List – Effective 1/1/2021 to 1/31/2021
01/01/2021
 01/31/2021
 Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 1/1/2021 to 1/31/2021
01/01/2021
 01/31/2021
 Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 1/1/2021 to 1/31/2021
10/01/2020 12/31/2020 Marketplace Prior Authorization (PA) Code List – Effective 10/1/2020 to 12/31/2020
10/01/2020 12/31/2020 Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 10/1/2020 to 12/31/2020
10/01/2020 12/31/2020 Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective10/1/2020 to 12/31/2020
07/01/2020 09/30/2020 Updated - Marketplace Prior Authorization (PA) Code List – Effective 7/1/2020 to 9/30/2020
07/01/2020 09/30/2020 Updated - Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 7/1/2020 to 9/30/2020
07/01/2020 09/30/2020 Updated - Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 7/1/2020 to 9/30/2020
04/01/2020 06/30/2020 COVID-19 Updates: Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 4/1/2020 to 6/30/2020
04/01/2020 06/30/2020 Marketplace Prior Authorization (PA) Code List – Effective 4/1/2020 to 6/30/2020
04/01/2020 06/30/2020 Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 4/1/2020 to 6/30/2020
04/01/2020 06/30/2020 Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 4/1/2020 to 6/30/2020
01/01/2020 03/31/2020 Marketplace Prior Authorization (PA) Code List – Effective 1/1/2020 to 3/31/2020
01/01/2020 03/31/2020 Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 1/1/2020 to 3/31/2020
01/01/2020 03/31/2020 Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 1/1/2020 to 3/31/2020
11/01/2019 12/31/2019 Marketplace Prior Authorization (PA) Code List – Effective 11/1/2019 to 12/31/2019
11/01/2019 12/31/2019 Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 11/1/2019 to 12/31/2019
10/01/2019 12/31/2019 Updated - Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 10/1/2019 to 12/31/2019
10/01/2019 10/31/2019 Updated - Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 10/1/2019 to 10/31/2019
10/01/2019 10/31/2019 Updated - Marketplace Prior Authorization (PA) Code List – Effective 10/1/2019 to 10/31/2019
07/01/2019 09/30/2019 Updated - Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 7/1/2019 to 09/30/2019
07/01/2019 09/30/2019 Updated - Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 7/1/2019 to 09/30/2019
06/01/2019 06/30/2019 Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 6/1/2019 to 06/30/2019
06/01/2019 06/30/2019 Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 6/1/2019 to 06/30/2019
04/01/2019 05/31/2019 Updated - Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 4/1/2019 to 5/31/2019
04/01/2019 05/31/2019 Updated - Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 4/1/2019 to 5/31/2019
01/01/2019 03/31/2019 Updated - Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 1/1/2019 to 3/31/2019
01/01/2019 03/31/2019 Updated - Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 1/1/2019 to 3/31/2019
10/01/2018 12/31/2018 Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 10/1/2018 to 12/31/2018
10/01/2018 12/31/2018 Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 10/1/2018 to 12/31/2018
06/01/2018 09/30/2018 Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 6/1/2018 to 9/30/2018
06/01/2018 09/30/2018 Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 6/1/2018 to 9/30/2018
02/01/2018 05/31/2018 Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 2/1/2018 to 5/31/2018
02/01/2018 05/31/2018 Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 2/1/2018 to 5/31/2018
10/01/2017 01/31/2018 Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – 10/1/2017 to 1/31/2018
10/01/2017 01/31/2018 Medicare/MMP Medicare Prior Authorization (PA) Code List – 10/1/2017 to 1/31/2018
07/01/2017 09/30/2017 PA Medicaid/MMP Medicaid/Marketplace PA Code List – Effective 07/01/2017
07/01/2017 09/30/2017 PA Medicare/MMP Medicare PA Code List – Effective 07/01/2017
04/01/2017 06/30/2017 PA Code List – Effective 04/01/2017
02/01/2017 03/31/2017 PA Code List – Effective 02/01/2017
10/01/2016 01/31/2017 PA Code List – Effective 10/01/2016
07/01/2016 09/30/2016 PA Code List – Effective 07/01/2016
04/01/2016 06/30/2016 PA Code List – Effective 04/01/2016
01/01/2016 03/31/2016 PA Code List – Effective 01/01/2016
08/01/2015 12/31/2015 PA Code List – Effective 08/01/2015
04/01/2015 07/31/2015 PA Code List – Effective 04/01/2015
01/01/2015 03/31/2015 PA Code List – Effective 01/01/2015
10/01/2014 12/31/2015 PA Code List – Effective 10/01/2014
10/01/2014 12/31/2014 Behavioral Health PA Code List - Effective 10/01/2014