Important Prior Authorization Updates Effective October 15, 2025

Date: 08/18/25

Thank you for being a participating provider with Louisiana Healthcare Connections. As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, we want to share some important updates to our PA requirements. This work is aligned with broader industry efforts, driven by commitments to regulatory agencies and America’s Health Insurance Plans (AHIP), to modernize and streamline prior authorization. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

A full list of code changes for Louisiana Healthcare Connections, including Medicaid, can be found on our website at louisianahealthconnect.com. These changes may include:

• Removing PA requirements based on criticality of review and clinical need. 
• Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.

If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative or contact Louisian Healthcare Connections]’s provider services team at 1-866-595-8133.

Service Category	PA Rule	Services	Procedure Codes
Behavioral Health	PA Required	Substance Abuse Treatment	H0004
Cardiovascular	PA Required	Cardiovascular Tests	93623
		Heart Surgery	92928, 93656
DME Services	PA Required	Incontinence Supplies	T4521, T4522, T4523, T4524
		Neurostimulators	C1767
Home Services	PA Required	Home Management	S5165
		Home Management	S9211, S9214
Hospice	PA Required	Hospice Services	Q5001, Q5002, Q5003, T2042
Laboratory	PA Required	Urinalysis	G0480, G0481
Other Medical Services	PA Required	Surgical Supplies	A4554
Skin Procedures	PA Required	Muscle Flap Procedures	15734
Surgery Procedures	PA Required	Digestive System	49505, 49650
		Female Genitalia	58662
		Integumentary System	19301, 19357
		Male Genitalia	54360
	No PA Required	Vascular	36471
Transportation Service	Pa Required	Medical Transportation	A0431, A0436