As part of Iowa Total Care’s ongoing work to improve the prior authorization (PA) process for both providers and members, they are sharing some important updates to their PA requirements. Their goal is to reduce administrative burden, simplify submission and approval processes and facilitate timely access to appropriate, high-quality care.
Code changes will be effective on April 1, 2026. Code changes 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 to simplify processes, reduce confusion for providers and support future efforts to expand real-time responses to requests.
| Service category | PA rule | Services | Procedure codes |
|---|---|---|---|
| DME services | PA required | Beds | E0277 |
| Diabetic drugs and supplies | A9276, A9277, A9278, E0784 | ||
| Neurostimulators | E0745 | ||
| Orthotic and prosthetic | L0460, L0462, L0464, L1832, L1940, L1970 | ||
| Oxygen supplies and devices | E0445, E1390 | ||
| Wheelchair accessories | E1028, E2620, E2621 | ||
| PA required after plan benefit limitation | Nutritional services | B9998 | |
| Drug codes | PA required | Injection medications | J0878, Q5129 |
| Genetic analysis | PA required | Genetic testing | 81308, 88262, 88271, 88275 |
| Other medical services | PA required | Hyperbaric oxygen therapy | 99183 |
| Wound care | E2402 | ||
| No PA required for PAR providers | Wound care | 97606 | |
| Pain management | PA required | Surgery-nervous system | 64628, 64629 |
| Physical medicine | PA required | Orthotic and prosthetic | L5673 |
| 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 |
| PA required if billed with diagnosis of gender dysphoria for all others, PA required for non-PAR providers only | Skin grafts | 14060, 14061 | |
| Surgery procedures | PA required | Hysterectomies | 58545 |
| Joint replacement surgery | 25447 | ||
| Surgery – ENT system | 30460, 30462, 30520 | ||
| Surgery – endocrine system | 602240, 60252, 60500 | ||
| Surgery – musculoskeletal system | 28285, 28296 | ||
| Surgery – nervous system | 64582 | ||
| Surgery – respiratory system | 30130, 30140, 31253, 31254, 31255, 31256, 31257, 31259, 31267 |
For questions or concerns, contact the provider engagement account manager in your area or call Provider Services at 1-833-404-1061, Monday – Friday 7:30 a.m. to 6:00 p.m. CT.
View the complete Iowa Total Care Provider Alert here.