Issued: February 19, 2026

Effective Feb. 1, 2026

Partners Health Management is providing a reminder and an update to providers regarding updates to physical health prior authorization (PA) requirements that took effect on Feb. 1, 2026. Carolina Complete Health (CCH) administers Physical Health utilization management on behalf of Partners.

These updates reflect ongoing efforts to improve consistency, reduce unnecessary administrative burden, and ensure members receive timely access to medically necessary care.

What is happening?

Effective Feb.  1, 2026, prior authorization requirements across several Physical Health service categories have been revised. Key objectives of these updates include:

• Eliminating certain prior authorization requirements when the urgency of review or the clinical nature of the service supports timely access without additional review.
• Improving consistency of prior authorization requirements across markets and lines of business by aligning, adding, or modifying select requirements to simplify processes, reduce provider confusion, and support future enhancements such as expanded real-time authorization responses.

What do providers need to do?

• Providers should review the updated requirements in the chart at the end of this communication.
• Providers should continue to verify authorization needs prior to rendering services.

What do providers need to know?

• Authorization determinations are based on procedure codes, clinical criteria, and benefit coverage.

Who can providers contact if they have questions?

• Utilization Management: phumquestions@PartnersBHM.org

Prior Authorization Requirements by Service Category

Effective February 1, 2026

Service Category	Procedure Codes	Prior Authorization Required	Prior Authorization Not Required
DME Services	PA Required:  L1833, E2512 No PA Required: E1392, E2231, K0195, E0960, E0973, E0978, E2366, K0739	Select orthotic/prosthetic, supplies and devices	Equipment and accessories, wheelchairs
Home Services	PA Required: T1002	Nursing services	N/A
Laboratory Services	G0480, G0481 (PA required after 12 tests per calendar year)	Urinalysis	Routine labs within allowable limits
Other Medical Services	No PA Required: A6549	Other medical services	Wound care services (A6549)
Skin Procedures	PA Required: 15734	Muscle flap procedures	N/A
Surgical Procedures	PA Required: 49505, 49591, 49593, 49595, 49650, 58662 No PA required: 36471	Digestive system and female genitalia procedures	Select vascular procedures
Transportation Services	PA Required: A0431, A0436	Medical transportation services	Emergencies