Medical Prior Authorization - Arkansas January 1, 2026 - Breast Reconstruction and Acquired Brain Injury CPT/ICD-10 Prior Authorization Requirements

Sep 17, 2026

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Medical Prior Authorization requirements for Arkansas members effective January 1, 2026, outlining which Fully Insured plan types and exchange/group categories require prior authorization for specified services. The page lists covered service categories including breast reconstruction and acquired brain injury-related rehabilitation, with explicit notes that prior authorization is required when certain CPT codes are billed alongside listed ICD-10 diagnosis codes. It provides CPT code mappings, descriptions, and effective dates.

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Medical Prior Authorization Requirements

Eligible plans and applicability

Covered services requiring prior authorization

Breast reconstruction CPT code table

Acquired brain injury ICD-10 and CPT prior authorization criteria

Medical Prior Authorization | Arkansas January 1, 2026 Blue Cross and Blue Shield, BlueAdvantage Administrators of Arkansas, Health Advantage, and Octave Blue Cross and Blue Shield Fully Insured The following services require prior authorization and will apply to members that have the following plans: Arkansas Blue Cross Blue Shield and Health Advantage Fully Insured plans, Exchange, AR Home, Health advantage Exchange and Octave groups and Farm Bureau plans. ¡ Breast Reconstruction The following services require prior authorization and will apply to Arkansas Blue Cross Blue Shield members that have the following plans (PA required for CPT codes if billed with the listed ICD-10 codes): ACA Individual Exchange, both On and Off Exchange Plans and Standalone Off Exchange Plans for Arkansas Blue Cross Blue Shield, Health Advantage, and Octave Members. ¡ Bariatric Surgery and Weight Loss Services ¡ Craniofacial-related surgeries/services ¡ Inpatient Neuro-Rehabilitation Facility (Acquired Brain Injury) ¡ Outpatient Cognitive Rehabilitation (Acquired Brain Injury) ¡ PANS-PANDAS Coverage ¡ Reproductive services specific to RESTORE Act– Arkansas Blue Cross Blue Shield Exchange only Arkansas Blue Cross Blue Shield Small Group Metallic Plan and Arkansas Blue Cross Blue Shield Individual Plans, Complete and Complete Plus Only: DOES NOT INCLUDE Comp Blue I or III, Blue Cares PPO, Short-term Blue, Farm Bureau, Blue Solution, or Blue Choice ¡ Bariatric Surgery and Weight Loss Services ¡ Inpatient Neuro-Rehabilitation Facility (Acquired Brain Injury) ¡ Outpatient Cognitive Rehabilitation (Acquired Brain Injury) Breast Reconstruction | CPT Code | Description | Effective
Date | End Prior
Approval Date | | --- | --- | --- | --- | | 11920 | Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less | 1/1/2026 | | | CPT Code | Description | Effective
Date | End Prior
Approval Date | | --- | --- | --- | --- | | 11921 | Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm | 1/1/2026 | | | 11970 | Replacement of tissue expander with permanent implant | 1/1/2026 | | | 15271 | Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area | 1/1/2026 | | | 15272 | Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure) | 1/1/2026 | | | 15771 | Grafting of autologous fat, harvested via liposuction, to the trunk, breasts, scalp, arms, and/or legs, with 50 cc or less injectate. | 1/1/2026 | | | 15777 | Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) | 1/1/2026 | | | 19316 | Mastopexy | 1/1/2026 | | | 19318 | Breast Reduction | 1/1/2026 | | | 19325 | Breast augmentation with implant | 1/1/2026 | | | 19340 | Insertion of breast implant on same day of mastectomy (ie, immediate) | 1/1/2026 | | | 19342 | Insertion or replacement of breast implant on separate day from mastectomy | 1/1/2026 | | | 19350 | Nipple/areola reconstruction | 1/1/2026 | | | 19357 | Tissue expander placement in breast reconstruction, including subsequent expansion(s) | 1/1/2026 | | | 19361 | Breast reconstruction; with latissimus dorsi flap | 1/1/2026 | | | 19364 | Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap) | 1/1/2026 | | | 19367 | Breast reconstruction; with single-pedicled transverserectus abdominis myocutaneous (TRAM) flap | 1/1/2026 | | | 19368 | Breast reconstruction; with single-pedicled transverserectus abdominis myocutaneous (TRAM) flap, requirin

FAQs

Which Arkansas plans are subject to prior authorization requirements starting January 1, 2026?

The document states the requirements apply to Arkansas Blue Cross Blue Shield and Health Advantage Fully Insured plans, as well as Exchange, AR Home, Health Advantage Exchange and Octave groups and Farm Bureau plans, with additional exclusions noted for certain plan types.

For breast reconstruction, what information does the prior authorization list provide?

It lists CPT codes with descriptions and the effective date (January 1, 2026), including end prior approval date fields where applicable.

For acquired brain injury services, when is prior authorization required?

Prior authorization is required for the specified CPT codes when billed with the listed ICD-10 diagnosis codes, and the page provides an ICD-10 table to define those qualifying diagnoses.

Sep 17, 2026

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