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.