Archived Prior Authorization (PA) Code Lists and Changes

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
01/01/2024 03/31/2024 adobe Marketplace: Q1 2024 PA Code Changes - Effective 1/1/2024 to 3/31/2024
01/01/2024 03/31/2024 adobe Medicare and MMP: Q1 2024 PA Code Changes - Effective 1/1/2024 to 3/31/2024
01/01/2024 03/31/2024 adobe Medicaid: Q1 2024 PA Code Changes - Effective 1/1/2024 to 3/31/2024
10/01/2023  12/31/2023  adobe Prior Authorization (PA) Code List - Effective 10/01/2023 to 12/31/2023
07/01/2023  09/30/2023  adobe Prior Authorization (PA) Code List - Effective 07/01/2023 to 09/30/2023
04/01/2023  06/30/2023  adobe Prior Authorization (PA) Code List - Effective 4/1/2023 to 6/30/2023
01/16/2023 03/31/2023 adobe Prior Authorization (PA) Code List - Effective 1/16/2023 to 3/31/2023
01/01/2023 01/15/2023 adobe Prior Authorization (PA) Code List - Effective 1/1/2023 to 1/15/2023
10/01/2022  12/31/2022  adobe Prior Authorization (PA) Code List - Effective 10/1/2022 to 12/31/2022  
07/01/2022  09/30/2022  adobe Prior Authorization (PA) Code List - Effective 7/1/2022 to 9/30/2022  
04/01/2022  06/30/2022  adobe Prior Authorization (PA) Code List - Effective 4/1/2022 to 6/30/2022  
03/01/2022  03/31/2022  adobe Prior Authorization (PA) Code List - Effective 3/1/2022 to 4/30/2022  
01/01/2022  02/28/2022  adobe Prior Authorization (PA) Code List – Effective 1/1/2022 to 2/28/2022
10/01/2021  12/31/2021  adobe Prior Authorization (PA) Code List – Effective 10/1/2021 to 12/31/2021
09/01/2021  09/30/2021  adobe Prior Authorization (PA) Code List - Effective 9/1/2021 to 9/30/2021 
07/01/2021  08/31/2021  adobe Prior Authorization (PA) Code List - Effective 7/1/2021 to 8/31/2021 
04/01/2021  06/30/2021  adobe Prior Authorization (PA) Code List - Effective 4/1/2021 to 6/30/2021
02/13/2021 03/31/2021 adobe Marketplace Prior Authorization (PA) Code List – Effective 2/13/2021 to 3/31/2021
02/13/2021
 03/31/2021 adobe Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 2/13/2021 to 3/31/2021
02/01/2021 02/12/2021 adobe Marketplace Prior Authorization (PA) Code List – Effective 2/1/2021 to 2/12/2021
02/01/2021
 02/12/2021 adobe Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 2/1/2021 to 2/12/2021
02/01/2021
 03/31/2021 adobe Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 2/1/2021 to 3/31/2021
01/01/2021 01/31/2021 adobe Marketplace Prior Authorization (PA) Code List – Effective 1/1/2021 to 1/31/2021
01/01/2021
 01/31/2021
 adobe Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 1/1/2021 to 1/31/2021
01/01/2021
 01/31/2021
 adobe Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 1/1/2021 to 1/31/2021
10/01/2020 12/31/2020 adobe Marketplace Prior Authorization (PA) Code List – Effective 10/1/2020 to 12/31/2020
10/01/2020 12/31/2020 adobe Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 10/1/2020 to 12/31/2020
10/01/2020 12/31/2020 adobe Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 10/1/2020 to 12/31/2020
07/01/2020 09/30/2020 adobe Updated - Marketplace Prior Authorization (PA) Code List – Effective 7/1/2020 to 9/30/2020
07/01/2020 09/30/2020 adobe Updated - Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 7/1/2020 to 9/30/2020
07/01/2020 09/30/2020 adobe Updated - Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 7/1/2020 to 9/30/2020
04/01/2020 06/30/2020 adobe COVID-19 Updates: Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 4/1/2020 to 6/30/2020
04/01/2020 06/30/2020 adobe Marketplace Prior Authorization (PA) Code List – Effective 4/1/2020 to 6/30/2020
04/01/2020 06/30/2020 adobe Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 4/1/2020 to 6/30/2020
04/01/2020 06/30/2020 adobe Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 4/1/2020 to 6/30/2020
01/01/2020 03/31/2020 adobe Marketplace Prior Authorization (PA) Code List – Effective 1/1/2020 to 3/31/2020
01/01/2020 03/31/2020 adobe Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 1/1/2020 to 3/31/2020
01/01/2020 03/31/2020 adobe Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 1/1/2020 to 3/31/2020
11/01/2019 12/31/2019 adobe Marketplace Prior Authorization (PA) Code List – Effective 11/1/2019 to 12/31/2019
11/01/2019 12/31/2019 adobe Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 11/1/2019 to 12/31/2019
10/01/2019 12/31/2019 adobe Updated - Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 10/1/2019 to 12/31/2019
10/01/2019 10/31/2019 adobe Updated - Medicaid/MMP Medicaid Prior Authorization (PA) Code List – Effective 10/1/2019 to 10/31/2019
10/01/2019 10/31/2019 adobe Updated - Marketplace Prior Authorization (PA) Code List – Effective 10/1/2019 to 10/31/2019
07/01/2019 09/30/2019 adobe Updated - Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 7/1/2019 to 09/30/2019
07/01/2019 09/30/2019 adobe Updated - Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 7/1/2019 to 09/30/2019
06/01/2019 06/30/2019 adobe Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 6/1/2019 to 06/30/2019
06/01/2019 06/30/2019 adobe Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 6/1/2019 to 06/30/2019
04/01/2019 05/31/2019 adobe Updated - Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 4/1/2019 to 5/31/2019
04/01/2019 05/31/2019 adobe Updated - Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 4/1/2019 to 5/31/2019
01/01/2019 03/31/2019 adobe Updated - Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 1/1/2019 to 3/31/2019
01/01/2019 03/31/2019 adobe Updated - Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 1/1/2019 to 3/31/2019
10/01/2018 12/31/2018 adobe Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 10/1/2018 to 12/31/2018
10/01/2018 12/31/2018 adobe Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 10/1/2018 to 12/31/2018
06/01/2018 09/30/2018 adobe Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 6/1/2018 to 9/30/2018
06/01/2018 09/30/2018 adobe Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 6/1/2018 to 9/30/2018
02/01/2018 05/31/2018 adobe Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – Effective 2/1/2018 to 5/31/2018
02/01/2018 05/31/2018 adobe Medicare/MMP Medicare Prior Authorization (PA) Code List – Effective 2/1/2018 to 5/31/2018
10/01/2017 01/31/2018 adobe Medicaid/MMP Medicaid/Marketplace Prior Authorization (PA) Code List – 10/1/2017 to 1/31/2018
10/01/2017 01/31/2018 adobe Medicare/MMP Medicare Prior Authorization (PA) Code List – 10/1/2017 to 1/31/2018
07/01/2017 09/30/2017 adobe PA Medicaid/MMP Medicaid/Marketplace PA Code List – Effective 07/01/2017
07/01/2017 09/30/2017 adobe PA Medicare/MMP Medicare PA Code List – Effective 07/01/2017
04/01/2017 06/30/2017 adobe PA Code List – Effective 04/01/2017
02/01/2017 03/31/2017 adobe PA Code List – Effective 02/01/2017
10/01/2016 01/31/2017 adobe PA Code List – Effective 10/01/2016
07/01/2016 09/30/2016 adobe PA Code List – Effective 07/01/2016
04/01/2016 06/30/2016 adobe PA Code List – Effective 04/01/2016
01/01/2016 03/31/2016 adobe PA Code List – Effective 01/01/2016
08/01/2015 12/31/2015 adobe PA Code List – Effective 08/01/2015
04/01/2015 07/31/2015 adobe PA Code List – Effective 04/01/2015
01/01/2015 03/31/2015 adobe PA Code List – Effective 01/01/2015
10/01/2014 12/31/2015 adobe PA Code List – Effective 10/01/2014
10/01/2014 12/31/2014 adobe Behavioral Health PA Code List - Effective 10/01/2014