Medicare AdvantagePrior AuthHigh impact
Authorization Updates - Effective January 1, 2026
Sentara Health Plans·VA · Physical Therapy, Speech Therapy, OB-GYN +2 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Oct 24, 2025
Summary
Sentara Health Plans is removing prior authorization requirements for 67 specific medical codes effective January 1, 2026, across Medicaid, Medicare, and Commercial products in Virginia. This eliminates pre-certification barriers for common physical therapy, speech-language pathology, gynecological procedures, and other services. Billing teams must update their authorization workflows to reflect these codes no longer require prior auth submission.
Action Required
By December 15, 2025: Billing team must update authorization rules in billing software to remove prior authorization requirements for all 67 affected codes. Create three separate rule sets: (1) Medicaid/Medicare codes effective Jan 1, 2026 (codes 57106-57288 through 97763); (2) Medicare-only codes (58150-58575); (3) Commercial-only codes (58150-58292). Remove these codes from all prior authorization request workflows and templates. Update provider communication materials and encounter forms to indicate these services no longer require precertification. Audit claims submitted for these codes after January 1, 2026 to ensure no unnecessary prior auth denials occur. Failure to update rules will result in unnecessary authorization delays and potential claim processing errors.