News
Removal of Certain Service Codes Requiring Prior Authorization Effective 7/1/2023
Date: 05/31/23
This notice contains information regarding the removal of prior authorization requirements for some procedure codes that currently require prior authorization. This reduction of procedure codes that require prior authorization is applicable to all Ambetter from Superior HealthPlan’s HMO and EPO programs in Texas. Note: The same changes are not being applied for Superior HealthPlan’s Medicaid and CHIP Programs.
The table below includes the procedure codes that will no longer require prior authorization for Ambetter EPO and HMO members effective July 1, 2023.
It is the ordering provider’s responsibility to determine which specific codes require prior authorization. For the complete CPT/HCPCS code listing of services that require prior authorization, please see the online Prior Authorization Tool on our website at: https://ambetter.superiorhealthplan.com/provider-resources/manuals-and-forms/pre-auth.html.
PROCEDURE CODES FOR WHICH PRIOR AUTHORIZATION REQUIREMENTS ARE REMOVED for services rendered on and after 07/01/2023
Service Category | Service Type | Procedure Code(s) |
|---|---|---|
Behavioral Health | BH & crisis intervention | H0004, H2011, S9484 |
Behavioral Health | Substance Abuse Detox | H0005, H0007, H0014, S9475 |
Cardiovascular | Cardiac Rehab | 93797, 93798, G0422, G0423, S9472 |
DME | Infusion Pumps | B9002, E0781, K0455 |
DME | Respiratory equipment | E0550, E0565 |
DME | Wheelchair and accessories | E2611, K0001 |
Home care | Dialysis Services | 90966 |
Home care | Pregnancy Home Services | 99500 |
Home care | Home Care Services | G0179 |
Home care | Home visit post discharge | G2001, G2002, G2003, G2004, G2005, G2006, G2007, G2008, G2009, G2013, G2014, G2015 |
Home care | BPCI home visit | G9187, G9987 |
Home care | Practitioner home visit | S0270, S0271, S0272, S0273, S0274 |
Home care | Medical home program – initial and maintenance | S0280, S0281 |
Home care | Home infusion therapy | S5035, S5036, S9347 |
Home care | Home care training | S5108, S5109, S5110, S5111, S5115, S5116 |
Home care | Home visit, wound care | S9097, S9098 |
Home care | Home dialysis | S9335, S9339 |
Home care | Services to high-risk areas | S9381 |
Hospice | Counseling Services | G9473, G9474, G9475, G9476, G9477, G9478, G9479, S0255 |
Hospice | Physician Services in Hospice | G0182 |
Laboratory | Fetal genetic test | 81508 |
Laboratory | Routine venipuncture | S9529 |
Laboratory | Blood and blood products | P9010, P9011, P9016, P9021, P9022, P9051, P9054, P9056, P9057, P9058 |
Pain Management | Transversus abdominis plane (TAP) block | 64486, 64488 |
Pain Management | Destruction by neurolytic agent | 64632 |
Preventive | Developmental and behavioral screening | 96110, 96112 |
Professional Services | Remote-inpatient visit | G9978, G9979, G9980, G9981, G9982, G9983, G9984, G9985, G9986 |
Professional Services | Physician or other qualified health care professional supervision | G0068, G0069, G0070 |