News
Effective January 1, 2021: Ambetter Clinician-Administered Drug Prior Authorization Update
Date: 12/21/20
Effective January 1, 2021: Ambetter Clinician-Administered Drug Prior Authorization Update
Ambetter from Superior HealthPlan requires Prior Authorization (PA) as a condition of payment for many Clinician-Administered Drugs (CADs) provided to members.
Effective January 1, 2021, the following change to PA requirements will take effect:
HCPCS Code | Description | Prior Authorization Requirements |
|---|---|---|
J3240 | INJ THYROTROPIN .9 MG PROV 1.1 VIAL (THYROGEN) | No PA required for PAR providers |
As a reminder, providers may determine which specific codes require PA by visiting Ambetter’s Pre-Auth Needed Tool.
For questions regarding this information, please contact your dedicated Account Manager or call Provider Services at 1-877-391-5921.