Prior Authorization (PA) Optimization Outpatient Updates
Effective October 1, 2025, the following codes will require prior authorization to be submitted to 'Ohana Health Plan:
31295 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa |
64450 | Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch |
31276 | Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed |
31296 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium |
31298 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal and sphenoid sinus ostia |
The following codes will no longer require prior authorization:
97606 | Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeter |
97605 | Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters |
20553 | Injection(s); single or multiple trigger point(s), 3 or more muscles |
20552 | Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) |
If you have questions, please contact Provider Services.