Effective for April 1, 2026 Dates of Service: Removal of Prior Authorization Requirement for Certain Interventional Cardiology and Diagnostic and Cardiac Radiology Procedures

Procedure Code

Procedure Code Description

EFFECTIVE FOR 04/01/2026 DATES OF SERVICE
Superior HealthPlan Product Applicability
No Prior Authorization (PA) Requirement

NCB - non-payable

Medicaid 

CHIP

Marketplace

Medicare

33202

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

X

X

X

X

33215

CORONARY ARTERY DISEASE SURGERY

Currently No PA

Currently No PA

Currently No PA

X

33217

CORONARY ARTERY DISEASE SURGERY

Currently No PA

Currently No PA

Currently No PA

X

33218

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

Currently No PA

Currently No PA

Currently No PA

X

33220

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

Currently No PA

Currently No PA

Currently No PA

X

33222

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

Currently No PA

Currently No PA

Currently No PA

X

33223

CORONARY ARTERY DISEASE SURGERY

Currently No PA

Currently No PA

Currently No PA

X

33224

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

Currently No PA

Currently No PA

Currently No PA

X

33225

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

X

X

X

X

33226

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

Currently No PA

Currently No PA

Currently No PA

X

33227

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

X

X

X

X

33228

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

X

X

X

X

33229

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

X

X

X

X

33233

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

X

X

X

X

33234

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

Currently No PA

Currently No PA

Currently No PA

X

33235

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

Currently No PA

Currently No PA

Currently No PA

X

33236

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

X

X

X

X

33271

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

NCB

NCB

X

X

33274

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

NCB

NCB

X

X

33275

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

NCB

NCB

X

X

33286

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

X

X

X

X

33361

TAVR

X

X

X

X

33362

TAVR

X

X

X

X

33363

TAVR

X

X

X

X

33364

TAVR

X

X

X

X

33365

TAVR

X

X

X

X

33366

TAVR

X

X

X

X

33369

TAVR

X

X

X

X

33405

CORONARY ARTERY DISEASE SURGERY

X

X

X

X

33418

INTERVENTIONAL CARDIOLOGY

NCB

NCB

X

X

33465

TRICUSPID VALVE SURGERY

X

X

X

X

33475

PULMONARY VALVE SURGERY

X

X

X

X

33477

PULMONARY VALVE SURGERY

X

X

X

X

33820

CONGENITAL HEART DISESE SURGERY

Currently No PA

Currently No PA

Currently No PA

X

35001

REPAIR/EXCISION FOR ANEURYSM OCCLUSIVE DISEASE ETC.

Currently No PA

Currently No PA

Currently No PA

X

35011

REPAIR/EXCISION FOR ANEURYSM OCCLUSIVE DISEASE ETC.

Currently No PA

Currently No PA

Currently No PA

X

35141

REPAIR/EXCISION FOR ANEURYSM OCCLUSIVE DISEASE ETC.

Currently No PA

Currently No PA

Currently No PA

X

35151

REPAIR/EXCISION FOR ANEURYSM OCCLUSIVE DISEASE ETC.

Currently No PA

Currently No PA

Currently No PA

X

35301

THROMBOENDARTERECTOMY

Currently No PA

Currently No PA

Currently No PA

X

35302

THROMBOENDARTERECTOMY

X

X

X

X

35303

THROMBOENDARTERECTOMY

X

X

X

X

35305

CORONARY ARTERY DISEASE SURGERY

X

X

X

X

35351

THROMBOENDARTERECTOMY

Currently No PA

Currently No PA

Currently No PA

X

35355

THROMBOENDARTERECTOMY

Currently No PA

Currently No PA

Currently No PA

X

35371

THROMBOENDARTERECTOMY

X

X

X

X

35372

THROMBOENDARTERECTOMY

X

X

X

X

35556

BYPASS GRAFT VEIN

X

X

X

X

35558

BYPASS GRAFT VEIN

X

X

X

X

35566

BYPASS GRAFT VEIN

X

X

X

X

35571

BYPASS GRAFT VEIN

X

X

X

X

35583

BYPASS GRAFT IN-SITU VEIN

X

X

X

X

35585

BYPASS GRAFT IN-SITU VEIN

X

X

X

X

35587

BYPASS GRAFT IN-SITU VEIN

X

X

X

X

35621

BYPASS GRAFT IN-SITU VEIN

Currently No PA

Currently No PA

Currently No PA

X

35646

BYPASS GRAFT IN-SITU VEIN

Currently No PA

Currently No PA

Currently No PA

X

35654

BYPASS GRAFT IN-SITU VEIN

Currently No PA

Currently No PA

Currently No PA

X

35656

BYPASS GRAFT IN-SITU VEIN

X

X

X

X

35661

BYPASS GRAFT IN-SITU VEIN

X

X

X

X

35666

BYPASS GRAFT IN-SITU VEIN

X

X

X

X

35671

BYPASS GRAFT IN-SITU VEIN

X

X

X

X

35700

EXCISION EXPLORATION REPAIR REVISION

X

X

X

X

35881

EXCISION EXPLORATION REPAIR REVISION

X

X

X

X

35883

EXCISION EXPLORATION REPAIR REVISION

X

X

X

X

35884

CORONARY ARTERY DISEASE SURGERY

X

X

X

X

36218

ANGIOGRAPHY

X

X

X

X

36253

ANGIOGRAPHY

Currently No PA

Currently No PA

Currently No PA

X

36254

ANGIOGRAPHY

Currently No PA

Currently No PA

Currently No PA

X

36836

INTERVENTIONAL RADIOLOGY

Currently No PA

Currently No PA

X

X

36837

INTERVENTIONAL RADIOLOGY

Currently No PA

Currently No PA

X

X

37765

INTERRUPTION/LIGATION/STRIPPING ETC.

X

X

X

Currently No PA

37766

INTERRUPTION/LIGATION/STRIPPING ETC.

X

X

X

Currently No PA

70480

CT ORBIT/EAR/FOSSA WITH O DYE

X

X

X

X

70481

CT ORBIT/EAR/FOSSA WITH O DYE

X

X

X

X

70482

CT ORBIT/EAR/FOSSA WITH O DYE

X

X

X

X

70486

CT MAXLOFCE AREA; W/O CONTRAST MATL

X

X

X

X

70487

CT MAXLOFCE AREA; W/O CONTRAST MATL

X

X

X

X

70488

CT MAXLOFCE AREA; W/O CONTRAST MATL

X

X

X

X

70490

CT SOFT TISSUE NECK WITH O DYE

PA Required

PA Required

PA Required

X

70491

CT SOFT TISSUE NECK WITH O DYE

PA Required

PA Required

PA Required

X

70492

CT SOFT TISSUE NECK WITH O DYE

PA Required

PA Required

PA Required

X

70551

MRI IMAGING BRAIN; INCLUDING BRAIN STEM; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

70552

MRI IMAGING BRAIN; INCLUDING BRAIN STEM; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

70553

MRI IMAGING BRAIN; INCLUDING BRAIN STEM; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

71250

DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST

PA Required

PA Required

X

Currently No PA

71260

DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST

PA Required

PA Required

X

Currently No PA

71270

DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST

PA Required

PA Required

X

Currently No PA

71271

DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST

PA Required

PA Required

X

Currently No PA

72141

MRI- SPINAL CANAL AND CONTENTS, CERVICAL; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

72142

MRI- SPINAL CANAL AND CONTENTS, CERVICAL; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

72146

MRI, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

72147

MRI, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

72148

MRI- SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

72149

MRI- SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

72156

MRI- SPINAL CANAL AND CONTENTS, CERVICAL; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

72157

MRI, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

72158

MRI- SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL

PA Required

PA Required

PA Required

X

72195

MRI PELVIS WITH DYE

PA Required

PA Required

X

X

72196

MRI PELVIS WITH DYE

PA Required

PA Required

X

X

72197

MRI PELVIS WITH DYE

PA Required

PA Required

X

X

73200

CT UPPER EXTREMITY WITH O DYE

X

X

X

X

73201

CT UPPER EXTREMITY WITH O DYE

X

X

X

X

73202

CT UPPER EXTREMITY WITH O DYE

X

X

X

X

73218

MRI UPPR EXTREMITY WITH OAND WITH DYE

X

X

X

X

73219

MRI UPPR EXTREMITY WITH OAND WITH DYE

X

X

X

X

73220

MRI UPPR EXTREMITY WITH OAND WITH DYE

X

X

X

X

73221

MRI JOINT UPR EXTREM WITH O DYE

PA Required

PA Required

PA Required

X

73222

MRI JOINT UPR EXTREM WITH O DYE

PA Required

PA Required

PA Required

X

73223

MRI JOINT UPR EXTREM WITH O DYE

PA Required

PA Required

PA Required

X

73700

CT LOWER EXTREMITY WITH O DYE

X

X

X

X

73701

CT LOWER EXTREMITY WITH O DYE

X

X

X

X

73702

CT LOWER EXTREMITY WITH O DYE

X

X

X

X

74150

CT ABDOMEN WITH O DYE

PA Required

PA Required

PA Required

X

74160

CT ABDOMEN WITH O DYE

PA Required

PA Required

PA Required

X

74170

CT ABDOMEN WITH O DYE

PA Required

PA Required

PA Required

X

74181

MRI ABDOMEN WITH O DYE

PA Required

PA Required

PA Required

X

74182

MRI ABDOMEN WITH O DYE

PA Required

PA Required

PA Required

X

74183

MRI ABDOMEN WITH O DYE

PA Required

PA Required

PA Required

X

74712

MRI FETAL SNGL/1ST GESTATION

X

X

X

X

74713

MRI FETAL SNGL/1ST GESTATION

X

X

X*

X

75557

CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

X

X

X

X

75559

CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

X

X

X

X

75561

CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

X

X

X

X

75563

CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

X

X

X

X

75572

CT HRT WITH 3D IMAGE

PA Required

PA Required

PA Required

X

75573

CT HRT WITH 3D IMAGE CONGEN

X

X

PA Required

X

75574

CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST

PA Required

PA Required

PA Required

X

75580

ANGIOGRAPHY

Currently No PA

Currently No PA

Currently No PA

X

75736

ANGIOGRAPHY

Currently No PA

Currently No PA

Currently No PA

X

76380

CT MAXLOFCE AREA; W/O CONTRAST MATL

Currently No PA

Currently No PA

Currently No PA

X

76937

ANGIOGRAPHY

Currently No PA

Currently No PA

Currently No PA

X

77046

MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL

X

X

PA Required

X

77047

MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL

X

X

PA Required

X

77048

MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL

X

X

PA Required

X

77049

MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL

X

X

PA Required

X

77078

CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE

X

X

X

X

77084

MRI BONE MARROW BLOOD SUPPLY

X

X

PA Required

X

78472

GATED HEART PLANAR SINGLE

X

X

X

Currently No PA

78473

GATED HEART PLANAR SINGLE

X

X

X

Currently No PA

78494

GATED HEART PLANAR SINGLE

X

X

X

Currently No PA

92960

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

Currently No PA

Currently No PA

Currently No PA

X

92961

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

Currently No PA

Currently No PA

Currently No PA

X

92987

INTERVENTIONAL CARDIOLOGY

Currently No PA

Currently No PA

Currently No PA

X

92997

INTERVENTIONAL CARDIOLOGY

Currently No PA

Currently No PA

Currently No PA

X

93292

DEVICE MONITORING

Currently No PA

Currently No PA

X

X

93312

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

X

X

X

X

93313

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

X

X

X

X

93314

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

X

X

X

X

93315

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

X

X

X

X

93316

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

X

X

X

X

93317

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

X

X

X

X

93318

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

X

X

X

X

93451

CARDIAC CATHETERIZATION

Currently No PA

Currently No PA

Currently No PA

X

93452

CORONARY ARTERY DISEASE SURGERY

Currently No PA

Currently No PA

Currently No PA

PA Required

93454

CORONARY ARTERY DISEASE SURGERY

X

X

X

X

93459

CARDIAC CATHETERIZATION

X

X

X

X

93460

CARDIAC CATHETERIZATION

X

X

X

X

93505

CARDIAC CATHETERIZATION

Currently No PA

Currently No PA

Currently No PA

X

93563

CARDIAC CATHETERIZATION

Currently No PA

Currently No PA

Currently No PA

X

93565

CARDIAC CATHETERIZATION

Currently No PA

Currently No PA

Currently No PA

X

93566

CARDIAC CATHETERIZATION

Currently No PA

Currently No PA

Currently No PA

X

93567

CARDIAC CATHETERIZATION

Currently No PA

Currently No PA

Currently No PA

X

93568

CARDIAC CATHETERIZATION

Currently No PA

Currently No PA

Currently No PA

X

93571

CARDIAC CATHETERIZATION

Currently No PA

Currently No PA

Currently No PA

X

93580

CORONARY ARTERY DISEASE SURGERY

Currently No PA

Currently No PA

Currently No PA

X

93581

INTERVENTIONAL CARDIOLOGY

Currently No PA

Currently No PA

Currently No PA

X

93583

CORONARY ARTERY DISEASE SURGERY

Currently No PA

Currently No PA

Currently No PA

X

93590

INTERVENTIONAL CARDIOLOGY

Currently No PA

Currently No PA

Currently No PA

X

93591

INTERVENTIONAL CARDIOLOGY

Currently   No PA

Currently No PA

Currently No PA

X

93650

CORONARY ARTERY DISEASE SURGERY

Currently No PA

Currently No PA

Currently No PA

X

93662

ELECTROPHYSIOLOGY STUDIES (EPS)

Currently No PA

Currently No PA

Currently No PA

X

93745

THERAPEUTIC SERVICES

Currently No PA

Currently No PA

Currently No PA

X

C1722

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

NCB

NCB

X

X

C1730

ELECTROPHYSIOLOGY STUDIES (EPS)

NCB

NCB

X

X

C1732

CORONARY ARTERY DISEASE SURGERY

NCB

NCB

X

X

C1759

CARDIAC CATHETERIZATION

NCB

NCB

X

X

C1760

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

NCB

NCB

X

X

C1785

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

NCB

NCB

X

X

C1882

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

NCB

NCB

X

X

C1895

CORONARY ARTERY DISEASE SURGERY

NCB

NCB

X

X

C1900

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

NCB

NCB

X

X

C2621

DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION

NCB

NCB

X

X

K0606

DEVICE MONITORING

X

X

X

X