All PlansPrior AuthMedium impact
Ambetter Health Update for HCPCS Code E0486: Effective 07/01/2026
Ambetter·Sleep Medicine, Pulmonology·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Aug 26, 2026
Summary
Effective July 1, 2026, Ambetter Health will require prior authorization for HCPCS code E0486 (custom-fabricated mandibular advancement devices for obstructive sleep apnea). Billing teams must implement prior authorization requirements in their systems and workflows before this date to avoid claim denials.
Action Required
By June 30, 2026: Billing team must update billing software and prior authorization workflows to require prior authorization for HCPCS code E0486 when billing to Ambetter Health plans. Update claim submission procedures to obtain prior authorization before submitting claims for custom-fabricated mandibular advancement devices. Notify providers and sleep medicine staff of the new requirement. Claims submitted without prior authorization will be denied by Ambetter Health.