Notification of Revised Preauthorization Requirements by Code

Effective July 1, 2022, the following codes will be removed from the Preauthorization Requirements Code List:

Code

Description

81405 MOLECULAR PATHOLOGY PROCEDURE LEVEL 6
81406 MOLECULAR PATHOLOGY PROCEDURE LEVEL 7
81408 MOLECULAR PATHOLOGY PROCEDURE LEVEL 9
15820 Blepharoplasty, lower eyelid
15821 Blepharoplasty, lower eyelid; with extensive herniated fat pad
67901 Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia)
67902 Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia)
67903 Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach
67904 Repair of blepharoptosis; (tarso) levator resection or advancement, external approach
67906 Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia)
67908 Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type)

Codes requiring preauthorization are maintained in the Preauthorization Requirements Code List. This list can be located under "Documents, Resources, and Bulletins" on the Provider page of the Vibra Health Plan web portal.

Updated October 1, 2021
H9408_WBST22_M