Important Prior Authorization Updates Effective April 1, 2026

Date: 01/21/26

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Louisiana Healthcare Connections wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

Code change details can be found below. 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.

Service Category	PA Rule	Services	Procedure codes
DME Services	PA Required	Diabetic Drugs And Supplies	E0784
	PA Required	Wheelchairs	E1028, E2620, E2621
	PA Required beyond 186 units per calendar month or the benefit limitation—whichever is greater	Incontinence Supplies	T4525, T4526, T4527, T4528, T4529, T4530, T4533, T4543
	No PA Required if member is under 21 years old at date of service. PA Required for all other members.	Nutritional Services	B4100
Drug Codes	PA Required	Injections	J0878
Drug Codes	PA Required except when services are rendered by ophthalmologists	Injections	J9035
Pain Management	PA Required	Surgery-Nervous System	64628, 64629
Physician Services	PA Required	Neurological Tests	95700, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95721, 95722, 95723, 95724, 95725, 95726
Skin Procedures	PA Required	Muscle Flap Procedures	15736, 15738
Surgery Procedures	PA Required	Joint Replacement Surgery	25447
		Surgery-Cardiovascular System	37232, 37236, 37237, 37238, 37239, 37246, 37247, 37248, 37249
		Surgery-Endocrine System	60240, 60252, 60500
		Surgery-Heart	92920, 92921
		Surgery-Musculoskeletal System	28285, 28296
		Surgery-Nervous System	64582
		Surgery-Respiratory System	30130, 30140, 31254, 31255, 31256, 31257, 31259, 31267