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
10/01/2025  12/31/2025  adobe Medicaid: Q4 2025 PA Code Changes
10/01/2025  12/31/2025  adobe Medicare and MMP: Q4 2025 PA Code Changes
10/01/2025  12/31/2025  adobe Marketplace: Q4 2025 PA Code Changes
09/01/2025  09/30/2025  adobe Medicaid: Q3 2025 PA Code Changes Evolent Codes
07/01/2025  09/30/2025  adobe Medicaid: Q3 2025 PA Code Changes
07/01/2025  09/30/2025  adobe Medicare and MMP: Q3 2025 PA Code Changes
07/01/2025  09/30/2025  adobe Marketplace: Q3 2025 PA Code Changes
04/01/2025  06/30/2025  adobe Medicaid: Q2 2025 PA Code Changes
04/01/2025  06/30/2025  adobe Medicare and MMP: Q2 2025 PA Code Changes
04/01/2025  06/30/2025  adobe Marketplace: Q2 2025 PA Code Changes
01/01/2025  03/31/2025  adobe Medicaid: Q1 2025 PA Code Changes
01/01/2025  03/31/2025  adobe Medicare and MMP: Q1 2025 PA Code Changes
01/01/2025  03/31/2025  adobe Marketplace: Q1 2025 PA Code Changes  
12/01/2024  12/31/2024  adobe Medicaid and Marketplace: Updated Q4 2024 PA Code Change with 12/1 Evolent Codes Impacted
10/01/2024  11/30/2024  adobe Medicaid: Q4 2024 PA Code Changes
10/01/2024  12/31/2024  adobe Medicare and MMP: Q4 2024 PA Code Changes
10/01/2024  11/30/2024  adobe Marketplace: Q4 2024 PA Code Changes  
07/01/2024  09/30/2024  adobe Medicaid: Q3 2024 PA Code Changes
07/01/2024  09/30/2024  adobe Medicare and MMP: Q3 2024 PA Code Changes
07/01/2024 09/30/2024  adobe Marketplace: Q3 2024 PA Code Changes
04/01/2024  06/30/2024  adobe Marketplace: Q2 2024 PA Code Changes - Effective 4/1/2024 to 6/30/2024 
04/01/2024  06/30/2024  adobe Medicare and MMP: Q2 2024 PA Code Changes - Effective 4/1/2024 to 6/30/2024
04/01/2024  06/30/2024  adobe Medicaid: Q2 2024 PA Code Changes - Effective 4/1/2024 to 6/30/2024
01/01/2024 03/31/2024 adobe Marketplace: Q1 2024 PA Code Changes - Effective 1/1/2024 to 3/31/2024
01/01/2024 03/31/2024 adobe Medicare and MMP: Q1 2024 PA Code Changes - Effective 1/1/2024 to 3/31/2024
01/01/2024 03/31/2024 adobe Medicaid: Q1 2024 PA Code Changes - Effective 1/1/2024 to 3/31/2024
10/01/2023  12/31/2023  adobe Prior Authorization (PA) Code List - Effective 10/01/2023 to 12/31/2023
07/01/2023  09/30/2023  adobe Prior Authorization (PA) Code List - Effective 07/01/2023 to 09/30/2023
04/01/2023  06/30/2023  adobe Prior Authorization (PA) Code List - Effective 4/1/2023 to 6/30/2023
01/16/2023 03/31/2023 adobe Prior Authorization (PA) Code List - Effective 1/16/2023 to 3/31/2023
01/01/2023 01/15/2023 adobe Prior Authorization (PA) Code List - Effective 1/1/2023 to 1/15/2023