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Commonwealth Care Alliance (CCA) has removed prior authorization (PA) requirements for certain ambulatory outpatient surgery procedures. This helps reduce administrative burden on our providers and extend expedient services to our members.

Effective January 1, 2023, providers are no longer required to submit a PA request or supporting documentation when these select procedures are performed by an in-network provider at an in-network facility. When a provider submits a request for a CPT code that does not require PA, a notification will be sent to inform them of this fact.

Please review the Ambulatory/Outpatient Surgery Exception List for a comprehensive list of CPT codes that no longer require a PA.

We look forward to partnering with our provider network to continuously improve the health and well-being of our members and our delivery of services.