Cohere Health’s 2025 Scope of Management:
Prior Authorization List for Oak Street Health (Aetna)
Effective July 1, 2025
Overview
Beginning July 1, 2025, Oak Street Health providers can begin submitting prior authorization requests for select outpatient and inpatient services through Cohere.
Please note, in addition to the procedure codes, other request criteria may impact submission requirements.
Impacted Plans and Geographies
Impacted plans and geographies will include Oak Street Health Medicare, for all eligible members.
Clinical Scope
Practices must use Cohere when requesting preauthorizations for any of the procedure codes or services listed in the table below.
Service | Code |
Abdominoplasty | 15847 |
Blepharoplasty | 67908, 67906, 67904, 67903, 67902, 67901, 67900, 15823, 15822, 15821, 15820 |
Breast Cancer Biopsy (excisional) | 19120 |
Cardiac Ablation/ Electrophysiology Study and Ablation for Bone, Liver, Kidney and Prostate cancer | 93656, 93653 |
Cardiac Catheterizations | 93597, 93596, 93595, 93594, 93593, 93461, 93460, 93459, 93458, 93457, 93456, 93455, 93454, 93453, 93452, 93451 |
Cardiac implantable devices [e.g., pacemakers, leadless pacemaker, left atrial appendage closure (LAAC), defibrillators (implantable and subcutaneous) and cardiac resynchronization therapy] | 33340, 33289, 33275, 33274, 33273, 33272, 33271, 33270, 33264, 33263, 33262, 33249, 33240, 33231, 33230, 33229, 33228, 33227, 33225, 33224, 33221, 33214, 33213, 33212, 33208, 33207, 33206, 0614T, 0520T, 0519T, 0517T, 0516T, 0515T |
Clinical Review Required (Unlisted) | 49999, 43999, 43659 |
Cochlear and Auditory Brainstem Implants | L8619, L8614, 69930 |
Computed Tomography (CT) Scan | S8092, 76380, 75635, 75574, 75573, 75572, 74263, 74262, 74261, 74178, 74177, 74176, 74175, 74174, 74170, 74160, 74150, 73706, 73702, 73701, 73700, 73206, 73202, 73201, 73200, 72194, 72193, 72192, 72191, 72133, 72132, 72131, 72130, 72129, 72128, 72127, 72126, 72125, 71275, 71271, 71270, 71260, 71250, 70498, 70496, 70492, 70491, 70490, 70488, 70487, 70486, 70482, 70481, 70480, 70470, 70460, 70450, 0638T, 0637T, 0636T, 0635T, 0634T, 0633T, 0042T |
Dental | 21249, 21248, 21246, 21245 |
Epidural Injections (Outpatient Only) | 64484, 64483, 64480, 64479, 62323, 62322, 62321, 62320 |
Facet Injections | 64636, 64635, 64634, 64633, 64495, 64494, 64493, 64492, 64491, 64490, 0218T, 0217T, 0216T, 0215T, 0214T, 0213T |
Facility-based Sleep Studies (PSG) | 95811, 95810, 95808, 95807, 95805, 95783, 95782 |
Hemodialysis | 90999, 90935, 90937 |
Home Health/Home Infusion | T1031, T1030, T1000, S9124, S9123, G0496, G0495, G0494, G0493, G0300, G0299, G0162, G0161, G0160, G0159, G0158, G0157, G0156, G0155, G0153, G0152, G0151 |
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) | 96547, 96548 |
Laminotomy with decompression of nerve root(s) | 63032 |
Loop Recorders | 33285 |
Magnetic Resonance Angiogram (MRA) | C8936, C8935, C8934, C8933, C8932, C8931, C8920, C8919, C8918, C8914, C8913, C8912, C8911, C8910, C8909, C8902, C8901, C8900, 74185, 73725, 73225, 72198, 72159, 71555, 70549, 70548, 70547, 70546, 70545, 70544 |
Magnetic Resonance Imaging (MRI) | S8042, S8037, C9763, C9762, C8908, C8906, C8905, C8903, 77084, 77049, 77048, 77047, 77046, 77022, 77021, 76390, 75571, 75565, 75563, 75561, 75559, 75557, 74713, 74712, 74183, 74182, 74181, 73723, 73722, 73721, 73720, 73719, 73718, 73223, 73222, 73221, 73220, 73219, 73218, 72197, 72196, 72195, 72158, 72157, 72156, 72149, 72148, 72147, 72146, 72142, 72141, 71552, 71551, 71550, 70555, 70554, 70553, 70552, 70551, 70543, 70542, 70540, 70336, 0612T, 0611T, 0610T, 0609T |
Molecular Diagnostic/Genetic Testing | 81432, 81417, 81416, 81415, 81217, 81216, 81215, 81212, 81165, 81163, 81162, 81425, 81426, 81427, 0094U, 0214U, 0215U, 0335U, 0336U, 0425U, 0426U |
Myocardial Perfusion Imaging Single Photon Emission Computed Tomography (MPI-SPECT) | 0742T |
Neurostimulators | 64595, 64590, 64585, 64584, 64583, 64582, 64581, 64580, 64575, 64569, 64568, 64561, 64555, 64553 |
Nuclear Stress Test | 93351, 93350, 78496, 78494, 78483, 78481, 78473, 78472, 78469, 78468, 78466, 78454, 78453, 78452, 78451 |
Obesity Surgeries | 43888, 43887, 43886, 43848, 43847, 43846, 43845, 43843, 43842, 43775, 43774, 43773, 43772, 43771, 43770, 43645, 43644, 43634, 43633, 43632, 43631 |
Oral, Orthognathic, Temporomandibular Joint (TMJ) Surgeries | 29804, 29800, 21497, 21490, 21485, 21480, 21255, 21247, 21244, 21243, 21242, 21240, 21215, 21206, 21199, 21198, 21196, 21195, 21194, 21193, 21159, 21154, 21151, 21150, 21147, 21146, 21145, 21143, 21142, 21141, 21073, 21070, 21060, 21050, 21010 |
Orthopedic Surgeries: Hip, Knee and Shoulder Arthroscopy | 29804, 29800, 21497, 21490, 21485S2118, 27488, 27487, 27486, 27447, 27446, 27445, 27443, 27442, 27441, 27440, 27438, 27437, 27138, 27137, 27134, 27132, 27130, 27125, 23474, 23473, 23472, 23470, S2112, J7330, 29916, 29915, 29914, 29883, 29882, 29881, 29880, 29863, 29862, 29861, 29860, 27412, 29875, 29876, 29877, 29879 |
Other Breast Procedures (Excludes breast reconstruction following medically necessary mastectomies for breast cancer.) | S2068, S2067, S2066, 19396, 19380, 19371, 19370, 19364, 19357, 19355, 19330, 19328 |
Other Durable Medical Equipment (DME) | E0766 |
Pain Infusion Pump | 62327, 62326, 62325, 62324 |
Percutaneous Lumbar Intravertebral Disc Injection | 0630T, 0629T, 0628T, 0627T |
Peripheral Revascularization (Atherectomy, Angioplasty) | 37235, 37234, 37233, 37232, 37231, 37230, 37229, 37228, 37227, 37226, 37225, 37224, 37223, 37222, 37221, 37220, 0238T |
Plastics/Reconstructive Procedures | 30520, 14301, 14060, 14040, 13132, 13101 |
Positron Emission Tomography (PET) Scan | 78816, 78815, 78814, 78813, 78812, 78811, 78609, 78608, 78492, 78491, 78459, 78434, 78433, 78432, 78431, 78430, 78429 |
Procedure - Musculoskeletal - Other | 64520, 64510, 27702, 27091, 23430 |
Prostate Surgeries (Prostatectomy) | 55880 |
Prosthetics | L8693, L8692, L8691, L8690, L5999, L5987, L5980, L5969, L5968, L5926, L5859, L5858, L5857, L5856, L5782, L5781, 69716, 69714, 27415, L5973 |
Radiation Therapy | G6017, G6016, G6015, G6014, G6013, G6012, G6011, G6010, G6009, G6008, G6007, G6006, G6005, G6004, G6003, G6002, G6001, G0340, G0339, A9590, A9543, A9513, 79403, 79101, 79005, 77778, 77772, 77771, 77770, 77768, 77767, 77763, 77762, 77761, 77750, 77620, 77615, 77610, 77605, 77600, 77525, 77523, 77522, 77520, 77425, 77424, 77423, 77412, 77407, 77402, 77401, 77387, 77386, 77385, 77373, 77372, 77371, 77014, 0747T, 0395T, 0394T |
Radiology- Other | S8035, 75580, 0713T, 0712T, 0711T, 0710T |
SI Joint Injections | G0260, G0259, 27096 |
Spinal Cord Stimulators | 63688, 63685, 63664, 63663, 63655, 63650 |
Spinal Fusion, Decompression, Kyphoplasty and Vertebroplasty | C1821, 63267, 63266, 63265, 63200, 63190, 63185, 63091, 63090, 63086, 63085, 63082, 63081, 63078, 63077, 63076, 63075, 63066, 63064, 63057, 63056, 63055, 63053, 63052, 63051, 63050, 63048, 63047, 63046, 63045, 63044, 63043, 63042, 63040, 63035, 63030, 63020, 63017, 63016, 63015, 63012, 63011, 63005, 63003, 63001, 27280, 27279, 27278, 22865, 22862, 22861, 22860, 22859, 22858, 22857, 22856, 22855, 22854, 22853, 22852, 22850, 22849, 22848, 22847, 22846, 22845, 22844, 22843, 22842, 22841, 22840, 22838, 22837, 22836, 22830, 22819, 22818, 22812, 22810, 22808, 22804, 22802, 22800, 22634, 22633, 22632, 22630, 22614, 22612, 22610, 22600, 22595, 22590, 22585, 22558, 22556, 22554, 22552, 22551, 22548, 22534, 22533, 22532, 22515, 22514, 22513, 22512, 22511, 22510, 22226, 22224, 22222, 22220, 22216, 22214, 22212, 22210, 0790T, 0657T, 0656T, 61343 |
Surgery for Obstructive Sleep Apnea | S2080, 42299, 42145, 42140 |
Surgery Other | 30140 |
Surgical Nasal/Sinus Endoscopic Procedures and Balloon Sinuplasty (Excludes diagnostic nasal/sinus endoscopies) | 31298, 31297, 31296, 31295, 31288, 31287, 31276, 31267, 31259, 31257, 31256, 31255, 31254, 31253 |
Urology | 53445, 52000 |
Varicose Vein: Surgical Treatment and Sclerotherapy | 37785, 37780, 37761, 37760, 37735, 37722, 37718, 37700, 37500, 36479, 36478, 36476, 36475, 0524T |
Ventricular Assist Devices (VADs) | 92970, 33993, 33992, 33991, 33990, 33981, 33979, 33978, 33975 |
Wheelchairs/Scooters | K0899, K0898, K0891, K0890, K0886, K0885, K0884, K0880, K0879, K0878, K0877, K0871, K0870, K0869, K0868, K0864, K0863, K0862, K0861, K0860, K0859, K0858, K0857, K0856, K0855, K0854, K0853, K0852, K0851, K0850, K0849, K0848, K0843, K0842, K0841, K0840, K0839, K0838, K0837, K0836, K0835, K0831, K0830, K0829, K0828, K0827, K0826, K0825, K0824, K0823, K0822, K0821, K0820, K0816, K0815, K0814, K0813, K0812, K0808, K0807, K0806, K0802, K0801, K0800, K0014, K0013, K0012, K0011, K0010, E1007, E0984, E0983 |