Change in Tonsillectomy and Adenoidectomy Prior Authorization Requirements
Effective June 15, 2024, the following tonsillectomy and adenoidectomy services will require prior authorization:
Code | Code Description |
|---|---|
42825 | TONSILLECTOMY PRIM/SECNDRY; UNDER AGE 12 |
42826 | TONSILLECTOMY PRIM/SECNDRY; AGE 12/OVER |
42831 | ADENOIDECTOMY PRIM; AGE 12/OVER |
42835 | ADENOIDECTOMY SECNDRY; UNDER AGE 12 |
42836 | ADENOIDECTOMY SECNDRY; AGE 12/OVER |
42820 | TONSILLECTOMY & ADENOIDECTOMY; UNDER AGE 12 |
42830 | ADENOIDECTOMY PRIM; UNDER AGE 12 |
Please reach out to your Provider Network Representative if you have additional questions or concerns, or call Provider Services at 888-773-2647.