[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-216954-en":3,"doc-seo-216954-105":30,"detail-sidebar-cat-0-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":14,"update_tm":28,"read_time":29},216954,962085564549,"Aditya","https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45",4,"Exam","Master Precertification List - For Health Care Providers - July 2026","Master Precertification List for Health Care Providers (July 2026) consolidates precertification requirements for multiple care-management levels, including Complete/PHS+, Preferred, and Basic Standard. It defines scope differences by outlining outpatient precertification categories and clarifies delegation of precertification code management to EviCore for certain clients. The list provides coding references and descriptions, along with precert effective and removal dates and ACA/IFP effective dates. Coverage indicators specify which precertification levels apply to each revenue code or procedure code.","Master Precertification List  \nFor Health Care Providers  \nJuly 2026  \nComplete/PHS+ -The most comprehensive care management model that includes all the components of our Preferred level, plus additional digital tools and the highest level of engagement and potential savings.  \nPreferred-A comprehensive care management model that includes all the components of our existing care management model, including comprehensive outpatient precertification, plus higher intensity of care coordination and more customer engagement opportunities.  \nBasic Standard-A lower touch care management model that includes many of the components of our existing care management model, such as higher intensity of care coordination and more customer engagement opportunities. Basic Standard has a limited number of outpatient precertification categories (radiation therapy, medical oncology, medical injectables, home infusion therapy and  \nprivate duty nursing), fewer than our Preferred and Complete solutions.  \n* Code may be delegated to EviCore for precertification management for certain clients.  \n\n| Code | Code Description | Precert\u003Cbr>Effective\u003Cbr>Date | Precert\u003Cbr>Removal\u003Cbr>Date | ACA/IFP\u003Cbr>Precert\u003Cbr>Effective\u003Cbr>Date | Comments | Complete/PHS+\u003Cbr>/Preferred | Basic Standard |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Revenue Code 0161 | Room & Board–Hospital at Home | 7/1/2022 |  |  |  | X |  |\n| Revenue Code 0333* | Radiology-Therapeutic and/or Chemotherapy Administration-Radiation Therapy | 2/27/2016 |  |  |  | X | X |\n| Revenue Code 0342 | Nuclear Medicine-Therapeutic | 7/1/2021 |  |  |  | X | X |\n| Revenue Code 0344 | Nuclear Medicine-Therapeutic Radiopharmaceuticals | 7/1/2021 |  |  |  | X | X |\n| Revenue Code 0870 | Cell/Gene Therapy-General Classification | 4/1/2019 |  |  |  | X | X |\n| Revenue Code 0871 | Cell/Gene Therapy-Cell Collection | 4/1/2019 |  |  |  | X | X |\n| Revenue Code 0872 | Cell/Gene Therapy-Specialized Biologic Processing And Storage-Prior To Transport | 4/1/2019 |  |  |  | X | X |\n| Revenue Code 0873 | Cell/Gene Therapy-Storage And Processing After Receipt Of Cells From Manufacturer | 4/1/2019 |  |  |  | X | X |\n| Revenue Code 0874 | Cell/Gene Therapy-Infusion Of Modified Cells | 4/1/2019 |  |  |  | X | X |\n| Revenue Code 0875 | Cell/Gene Therapy-Injection Of Modified Cells | 4/1/2019 |  |  |  | X | X |\n| Revenue Code 0890 | Pharmacy-Extension Of 025X And 063X-Reserved (Use 0250 For General Classification) | 4/1/2019 |  |  |  | X | X |\n| Revenue Code 0891 | Pharmacy-Extension Of 025X And 063X-Special Processed Drugs – FDA Approved Cell Therapy | 4/1/2019 |  |  |  | X | X |\n| Revenue Code 0892 | Special Processed Drugs-FDA Approved Gene Therapy | 4/1/2020 |  |  |  | X | X |\n| Revenue Code 0907 | Community behavioral health program (day treatment) | 8/27/2015 |  |  |  | X |  |\n| 0020M* | Oncology (central nervous system), analysis of 30000 DNA methylation loci by methylation array, utilizing DNA extracted from tumor tissue, diagnostic algorithm reported as probability of matching a reference tumor subclass | 7/1/2024 |  |  |  | X |  |\n| 0036U* | Exome (ie, somatic mutations), paired formalin-fixed paraffin-embedded tumor tissue and normal specimen, sequence analyses | 5/14/2026 |  | 1/1/2027 |  | X |  |\n| 0037U* | Targeted genomic sequence analysis, solid organ neoplasm, DNA analysis of 324 genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability and tumor mutational burden | 5/14/2026 |  | 1/1/2027 |  | X |  |\n| 0047U* | Oncology (prostate), mRNA, gene expression profiling by real-time RTPCR of 17 genes (12 content and 5 housekeeping), utilizing formalinfixed paraffin-embedded tissue, algorithm reported as a risk score | 11/20/2025 |  | 1/1/2026 |  | X |  |\n\n| Code | Code Description | Precert\u003Cbr>Effective\u003Cbr>Date | Precert\u003Cbr>Removal\u003Cbr>Date | ACA/IFP\u003Cbr>Precert\u003Cbr>Effective\u003Cbr>Date | Comments | Complete/PHS+\u003Cbr>/Preferred | Basic Standard |\n| -","cbCaihm03nlc3OyF","https://ap.wps.com/l/cbCaihm03nlc3OyF","pdf",1851550,1,128,"English","en",105,"# Care management levels\n## Complete/PHS+\n## Preferred\n## Basic Standard\n# Precertification delegation and coding table","[{\"question\":\"What do Complete/PHS+, Preferred, and Basic Standard mean in the precertification list?\",\"answer\":\"The document defines Complete/PHS+ as the most comprehensive model, Preferred as a comprehensive model with higher-intensity coordination and engagement, and Basic Standard as a lower-touch model with a limited set of outpatient precertification categories.\"},{\"question\":\"Are any precertification codes delegated to EviCore?\",\"answer\":\"Yes. The document states that code management for certain clients may be delegated to EviCore for precertification management.\"},{\"question\":\"What information is included for each listed code?\",\"answer\":\"Each entry includes the code and description, precert effective date and removal date, ACA/IFP precert effective date, comments, and indicators showing whether it applies to Complete/PHS+/Preferred and/or Basic Standard.\"}]","Master Precertification List - For Health Care Providers - July 2026 | PDF",1788828617,323,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":86,"head_meta":88,"extra_data":90,"updated_unix":28},"master-precertification-list-for-health-care-providers-july-2026","",{"@graph":36,"@context":85},[37,53,68],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/document/","Document",2,{"item":49,"name":12,"@type":43,"position":50},"https://docshare.wps.com/document/exam/",3,{"item":52,"name":13,"@type":43,"position":11},"https://docshare.wps.com/document/master-precertification-list-for-health-care-providers-july-2026/216954/",{"url":52,"name":13,"@type":54,"author":55,"headline":13,"publisher":57,"fileFormat":60,"inLanguage":23,"description":14,"dateModified":61,"datePublished":62,"encodingFormat":60,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":56},"Person",{"url":41,"name":58,"@type":59},"DocShare","Organization","application/pdf","2026-09-09","2026-09-08",true,{"@type":65,"interactionType":66,"userInteractionCount":20},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81],{"name":72,"@type":73,"acceptedAnswer":74},"What do Complete/PHS+, Preferred, and Basic Standard mean in the precertification list?","Question",{"text":75,"@type":76},"The document defines Complete/PHS+ as the most comprehensive model, Preferred as a comprehensive model with higher-intensity coordination and engagement, and Basic Standard as a lower-touch model with a limited set of outpatient precertification categories.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"Are any precertification codes delegated to EviCore?",{"text":80,"@type":76},"Yes. 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