Commonwealth Care Alliance Massachusetts (CCA) and CCA Health Rhode Island no longer require Prior Authorization (PA) requirements for certain ambulatory outpatient surgery procedures. This helps reduce administrative burden on our providers and extends expedient services to our members.
Effective April 1, 2023, providers will no longer be required to submit a PA or supporting documentation for the following procedures when they are performed by an in-network provider at an in-network facility:
|12036||Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 30.0 cm|
|12037||Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cm|
|36576||Repair of central venous access device, with subcutaneous port or pump, central or peripheral insertion site|
|36597||Repositioning of previously placed central venous catheter under fluoroscopic guidance|
|37788||Penile revascularization, artery, with or without vein graft|
|46260||Hemorrhoidectomy, internal and external, 2 or more columns/groups|
|46261||Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy|
|50700||Ureteroplasty, plastic operation on ureter (e.g., stricture)|
|54112||Excision of penile plaque (Peyronie disease); with graft greater than 5 cm in length|
|54401||Insertion of penile prosthesis; inflatable (self-contained)|
|54405||Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir|
|54411||Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue|
|54417||Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue|
|57452||Colposcopy of the cervix including upper/adjacent vagina|
|66984||Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation|
|95909||Nerve conduction studies; 5-6 studies|
CCA and CCA Health Rhode Island will work with relevant stakeholders to review ambulatory and outpatient procedures and provide relevant updates to the PA program on a quarterly basis.
For more information on the CPT codes that no longer require a PA, please review the PA Ambulatory / Outpatient Surgery Exception List:
- Massachusetts: PA Ambulatory / Outpatient Surgery Exception List
- Rhode Island: PA Ambulatory / Outpatient Surgery Exception List
We look forward to partnering with our provider network to continuously improve the health and wellbeing of our members and our delivery of services.