Sanford Health Plan is implementing broad reductions in prior authorization requirements across multiple service areas, including surgical, ENT, diagnostic and specialty therapy services, to improve provider experience, reduce administrative burden and support more efficient patient care.
 
These updates, effective Jan. 1, 2026, primarily apply to commercial products, with select changes also extending to Medicare Advantage. New lists with code level details will be available on the website and provider portal by Jan. 1, 2026. In the meantime, here are the key prior authorization reductions to note: 

• Ablation procedures (Prostate)
• Anti-Müllerian Hormone (AMH) testing
• Apheresis
• Applied behavioral analysis (PA for over age 12 only)
• Artificial urinary sphincter
• Biofeedback (when diagnosis-specific)
• Bone Anchored Hearing Aids (BAHA)
• Caffeine Halothane Contracture Test
• Chelation therapy
• Cleft lip/palate repair
• Cochlear implants
• Facet Neurotomy
• Functional endoscopic sinus surgery
• Gastrectomy (non-bariatric)
• Glossectomy
• Hearing aids (Commercial only)
• Home health care (for benefit-limited plans and ISNP; PA retained for MA and select markets)
• Hyoid suspension (expanded no-PA scenarios)
• Hypoglossal nerve stimulation
• Inpatient and post-acute admissions – No PA required for Great Plains Medicare Advantage; All other plans will continue to require prior authorization
• Interdental wire fixation
• Laser interstitial thermal therapy (for select diagnoses)
• Nasolabial fistula repair
• Palate lengthening
• Pediatric feeding disorder program
• Platelet-rich plasma (PRP) – allowed for osteoarthritis of the knee; all other diagnoses remain experimental/investigational
• Prophylactic surgery
• Prosthetics for cleft lip/palate (when diagnosis-specific)
• Suprachoroidal space injection
• TMJ surgery
• Trabeculoplasty / trabeculectomy
• Transcatheter Atrial Septostomy (TAS) and Transcatheter Intracardiac Shunt (TIS) 
• Transcervical Ablation of Uterine Fibroids 
• Turbinate resection
• Vestibuloplasty
• Vitrectomy with injection

 Please reach out to the provider experience team with questions.