MedicaidPrior AuthMedium impact
Medical Code 64451 Change - Effective June 1, 2026
Sentara Health Plans·VA · Pain Management, Orthopedics, Anesthesiology·Coding
Effective date
Jun 1, 2026
We identified it
May 12, 2026
Summary
Effective June 1, 2026, Sentara Health Plans will no longer require prior authorization for CPT 64451 (sacroiliac joint nerve injections with image guidance) for Medicaid products in Virginia, up to a limit of 4 dates of service per rolling 12-month period. Claims with dates of service on or after June 1, 2026 will be automatically reprocessed.
Action Required
By May 31, 2026: Billing team must update prior authorization requirements in the billing system to remove the authorization requirement for CPT 64451 for Sentara Medicaid plans in Virginia. However, implement a tracking mechanism to monitor dates of service to ensure the 4-visit limit in a rolling 12-month period is enforced—claims exceeding this limit will require prior authorization. Update internal billing guidelines and provider communications. Beginning June 1, 2026, do not request prior authorization for CPT 64451 for Sentara Medicaid beneficiaries unless the patient has already exceeded 4 dates of service in the preceding 12 months. Failure to comply may result in unnecessary claim delays or denials.