CCA has updated our Prior Authorization list and processes to improve efficiency and better support your CCA-covered patients. The details below outline these upcoming changes so you can stay informed and prepared.
2025 Prior Authorization List Updates Effective December 1,2025
Updates to the published list include a link to access the InterQual® Medical Necessity criteria transparency tool for certain medical necessity guidelines. Registration on the Interqual site is required.
Service Code Updates
- Non-Emergent Transportation via ambulance requires prior authorization except for the following specific code/modifier combinations for in-network providers:
- A0426 HH, A0426 HN
- A0428 HH, A0428 HN
- Radiology Codes that were previously omitted, and are being corrected are:
- 78491, 78492, 78815 – Positron Emission Tomography Specific Codes
- 78481, 78483 – Cardiac Imaging/Function Testing
- Retired DME supply codes:
- T4538
- T4545
New Automation: Immediate Response When PA Is Not Required
As of November 6, 2025, automated fax responses are in place. If a prior authorization request is submitted for HCPCS or CPT codes that do not require authorization, you will receive an automated fax confirming that no prior authorization is needed.
New Electronic Prior Authorization Submissions
As of January 1, 2026, CCA contracted providers who are registered on CCA’s Provider Portal will have the option of submitting new service authorization requests directly in the “Authorization Request” section of the portal.
Additional Enhancements
- The “Prior Authorization Checkpoint Tool” to easily determine if a prior authorization is required for individual procedure codes.
- Member search functionality that can support multiple data fields such as name, DOB, and CCA Member identification number.
- Provider search functions allowing multiple provider data fields such as name, NPI, and Tax Identification Number. Results will include all current, contracted service locations for selection.
- The ability to upload attachments to existing authorization requests previously submitted through the provider portal.
Accessing CCA Prior Authorization Requirements and the Provider Portal
You can access the CCA SCO and One Care Prior Authorization List by visiting our website at: CCA Provider Forms and Referrals
Access the secure Provider Portal here (registration required): CCA Provider Portal