Procedure code billing statuses and prior authorization guidance (code list)
This list maps CPT and HCPCS codes to plan operational labels (MP Criteria, Unlisted, EIU, Non Covered), notes codes that may require prior authorization or recommended clinical review, and records code-specific add/retire effective dates (most codes effective on or before 2023-01-01 unless noted).
Multiple Category III and other procedure/drug codes were added with specified effective dates (examples: many codes added effective 06/15/2023, 07/01/2023, 08/01/2023, 09/01/2023, 10/01/2023, 11/15/2023, 12/01/2023, and some with future dates such as 03/01/2024).
Several codes include retire effective dates (commonly 08/31/2023, 09/30/2023, 10/14/2023, 10/31/2023, 11/16/2023, 01/31/2024 or 02/01/2024) and some source rows contain typographical date errors or placeholder dates (e.g., 11/0/52023 or 12/31/2999).
Some codes were reclassified between 'MP Criteria' (requires recommended clinical review and may need PA) and 'EIU' (excluded/not reimbursed) across specified date ranges (examples: 0807T/0808T, various wound matrix/Q-code series).
Several monoclonal antibody–related codes (notably M0240–M0246 and Q0240–Q0245) were added effective 06/01/2023 and are marked EIU or Non Covered in the listing.
Coverage classification changes were applied to multiple wound matrix/skin substitute codes, with transitions from MP Criteria to EIU or Non Covered and add/retire effective dates (examples: Q4280–Q4284 series showing retire/add actions and reclassifications).
Coverage classifications and operational labels
Operational designations per code
Operational designations applied at the plan (policy) level. These labels indicate how procedure and supply codes are classified for review, coverage, and reimbursement workflows. Except as otherwise noted in the date column, codes listed are effective on or before January 1, 2023. Some codes include specific effective/retirement dates indicated in the per-code mapping.
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