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Effective January 1, 2023: Ambetter Clinician-Administered Drug Prior Authorization Update

Date: 11/02/22

Ambetter from Superior HealthPlan requires Prior Authorization (PA) as a condition of payment for many Clinician-Administered Drugs (CADs) provided to Ambetter members. Effective January 1, 2023, the following changes to PA requirements will take effect:

HCPCS Code

Description

Prior Authorization Requirements

A9590

IODINE I-131 IOBENGUANE 1 MCI

Pre-authorization is required for all providers

A9699

SPL RADOPHRM TX IMAG AGT NOC

Pre-authorization is required for all providers

Providers may submit a PA request by:

As a reminder, providers may determine which specific codes require PA by visiting Superior's Pre-Auth Needed Tool and selecting Ambetter.

For questions regarding this information, please contact your dedicated Account Manager or call Provider Services at 1-877-687-1196.