REVISION to 11/3/2025 Alert: Prior Authorization Updates

Date: 11/10/25

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Iowa Total Care wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes andfacilitate timely access to appropriate, high-quality care. 

Code changes will be effective on February 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 across our markets and lines of businesses, including adding and changing some PA 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
Behavioral Health	Participating providers allow the first 24 visits, then prior authorization is required.	Psychotherapy	90847 90853
	Non-participating providers require an authorization.
	PA Required	Substance Abuse Treatment	H0004
DME Services	PA Required	Neurostimulators	C1767
		Nutritional Services	B4158 B4159 B4160 B4161
		Supplies and Devices	E2512
Drug Codes	PA Required	Injections	J1944 Q4081
Genetic Analysis	No PA Required	Genetic Testing	81244 81331
Home Services	PA Required	Nursing Services	T1002
Laboratory	PA Required	Urine Drug Testing	G0480 G0481
Physical Medicine	PA Required	Orthotic and Prosthetic	Q4195
Maternal Health	No PA Required	Prenatal, At-Risk Enhance Service Package	H1005
Surgery Procedures	PA Required	Female Genitalia	58662
		Integumentary System	19357
		Male Genitalia	54360
	No PA Required	Vascular	36471
Transportation Services	PA Required	Medical Transportation	A0428 A0431 A0436

For questions or concerns, contact your provider engagement account manager in your area or call Provider Services at 1-833-404-1061, Monday – Friday 7:30 a.m. to 6 p.m. CT.

Thank you for your partnership in serving Iowa Total Care members.