All PlansPrior AuthHigh impact
New Prior Authorization Requirements for CPT Codes Effective April 2025
Healthfirst·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
New prior authorization requirements will be implemented for specific CPT codes starting April 2025. Medical billing teams must identify which codes are affected and update their systems to require prior authorization before services are performed to avoid claim denials.
Action Required
By April 1, 2025: Billing team must access the full list of affected CPT codes at https://hfproviders.org/whatsnew/new-prior-authorization-requirements-for-cpt-codes-effective-april-2025 and update billing software to require prior authorization for all listed codes. Update encounter forms and notify providers of new requirements. Claims submitted without prior authorization will be denied.