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Archived Prior Authorization (PA) Code Lists

Below is a list of archived PA Code Lists. View the Forms page to find the current PA Code List.

Start Date End Date PA Code List
04/01/2017 06/30/2017 PA Code List – Effective 04/01/2017
02/01/2017 03/31/2017 PA Code List – Effective 02/01/2017
07/01/2016 09/30/2016 PA Code List  Effective 07/01/2016
04/01/2016 06/30/2016 PA Code List – Effective 04/01/2016
01/01/2016 03/31/2016 PA Code List – Effective 01/01/2016
08/01/2015 12/31/2015 PA Code List – Effective 08/01/2015
04/01/2015 07/31/2015 PA Code List – Effective 04/01/2015
01/01/2015 03/31/2015 PA Code List – Effective 01/01/2015
10/01/2014 12/31/2015 PA Code List – Effective 10/01/2014
10/01/2014 12/31/2014 Behavioral Health PA Code List - Effective 10/01/2014
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