As part of our annual review process, EmblemHealth is removing 303 services and codes from the EmblemHealth Preauthorization List.
In addition, we are adding five new codes, expanding some existing preauthorization requirements to additional members. Also, as shared in EmblemHealth Site of Service Rules for Certain Surgeries Start Aug. 1 and in our Notable Changes, starting Aug. 1, 2025, some codes will require preauthorization when performed in an outpatient hospital setting, places of service (POS) 19 and 22 for members under 75 years of age.
EmblemHealth Preauthorization List: See list for code changes and applicable effective dates.
See revision histories for the updates to the following lists:
- GHI PPO City of New York Preauthorization List.
- ConnectiCare Commercial Preauthorization List.
- ConnectiCare Medicare Preauthorization List.
- EmblemHealth/ConnectiCare: Home Infusion Therapy Drug Preauthorization List.
- The Pharmacy Medical Preauthorization Lists for EmblemHealth and ConnectiCare.
Quarterly Code Updates
EmblemHealth and ConnectiCare update their claims processing systems based on code updates received from American Medical Association (AMA), CPT, and Centers for Medicare & Medicaid Services (CMS). Both the AMA and CMS release quarterly updates to their respective code sets. Below are links to the latest preauthorization lists.
We strive to load and configure each code update within 60 days of the update’s effective date. The current process will hold the entire claim if it contains a new code while it is being configured. To avoid delaying critical payments to our providers, we adjudicate the claim for all services except for the new code(s) that need configuration. Once the new CPT and/or HCPCS codes have been loaded into our claims processing system, we will reprocess the claims to ensure proper adjudication of the claim.
