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Preauthorization Requirement Changes Starting April 1 and June 15, 2024

Switch to:

Preauthorization Requirement Changes Starting April 1 and June 15, 2024

Date Posted: 03/05/2024

The following two tables show the codes that will be added to and removed from the EmblemHealth Preauthorization List.

The following new code will be added to the EmblemHealth Preauthorization List starting June 15, 2024.

Codes Added to Preauthorization List Starting June 15, 2024

CPT/HCPCS Code	CPT Code Description
0037U	Targeted genomic sequence analysis, solid organ neoplasm, DNA analysis of 324 genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability and tumor mutational burden

The following codes will be removed from the EmblemHealth Preauthorization List starting April 1, 2024.

Codes Removed From Preauthorization List Starting April 1, 2024

CPT/HCPCS Code	CPT Code Description
32553	Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple
49411	Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), percutaneous, intra-abdominal, intra-pelvic (except prostate), and/or retroperitoneum, single or multiple
49412	Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), open, intra-abdominal, intrapelvic, and/or retroperitoneum, including image guidance, if performed, single or multiple (List separately in addition to code for primary procedure)
55876	Placement of interstitial device(s) for radiation therapy guidance (e.g., fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple

JP 56610 3/24

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