Priority Health’s Medical Affairs Committee (MAC), comprised of network practitioners contracted with Priority Health, meets quarterly to review a set of medical policies. The policy changes outlined below were approved by MAC at the May meeting and – unless otherwise noted – are effective May 2023.

New prior authorization requirements:

In tandem with the policy changes, the following prior authorization requirements will go into effect on July 24, 2023:

• Panniculectomy / Abdominoplasty:
  • Abdominoplasty (CPT 15847) will require prior authorization.
  • Unless abdominal wall laxity interferes with activities of daily living and causes a functional impairment, abdominoplasty is considered cosmetic and not medically necessary.
  • Procedure was previously allowed if prior authorization was approved for the primary procedure, Panniculectomy.
• Thyroid-Related Procedures
  • Thyroid molecular diagnostic tests (CPT codes 81546, 0026U, 0245U, 0204U, 0018U, 0287U and 81210) will require prior authorization.

Click here to learn more and read the full announcement on the Priority Health website.