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  Medicaid: Q4 2025 PA Code Changes 
10/01/2025  12/31/2025  Medicare and MMP: Q4 2025 PA Code Changes 
10/01/2025  12/31/2025  Marketplace: Q4 2025 PA Code Changes 
09/01/2025  09/30/2025  Medicaid: Q3 2025 PA Code Changes Evolent Codes 
07/01/2025  09/30/2025  Medicaid: Q3 2025 PA Code Changes 
07/01/2025  09/30/2025  Medicare and MMP: Q3 2025 PA Code Changes 
07/01/2025  09/30/2025  Marketplace: Q3 2025 PA Code Changes 
04/01/2025  06/30/2025  Medicaid: Q2 2025 PA Code Changes 
04/01/2025  06/30/2025  Medicare and MMP: Q2 2025 PA Code Changes 
04/01/2025  06/30/2025  Marketplace: Q2 2025 PA Code Changes 
01/01/2025  03/31/2025  Medicaid: Q1 2025 PA Code Changes 
01/01/2025  03/31/2025 Medicare and MMP: Q1 2025 PA Code Changes 
01/01/2025  03/31/2025  Marketplace: Q1 2025 PA Code Changes 
12/01/2024  12/31/2024  Medicaid and Marketplace: Updated Q4 2024 PA Code Change with 12/1 Evolent Codes Impacted 
10/01/2024  11/30/2024  Medicaid: Q4 2024 PA Code Changes 
10/01/2024  12/31/2024  Medicare and MMP: Q4 2024 PA Code Changes 
10/01/2024  11/30/2024  Marketplace: Q4 2024 PA Code Changes 
09/01/2024  09/30/2024  Medicaid: Updated Q3 2024 PA Code Change with 9/1 Evolent Codes 
09/01/2024  09/30/2024  Marketplace: Updated Q3 2024 PA Code Change with 9/1 Evolent Codes 
07/01/2024  08/31/2024  Medicaid: Q3 2024 PA Code Changes  
07/01/2024  09/30/2024  Medicare and MMP: Q3 2024 PA Code Changes  
07/01/2024  08/31/2024  Marketplace: Q3 2024 PA Code Changes  
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