Medicare AdvantagePrior AuthMedium impact
Ambetter Health Update for HCPCS Code E0486: Effective 07/01/2026
Ambetter·NJ · 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 device for obstructive sleep apnea). Billing teams must implement prior authorization workflow changes before the effective date to avoid claim denials.
Action Required
By June 30, 2026: Billing team must update billing software and encounter forms to require prior authorization for HCPCS code E0486 (custom-fabricated mandibular advancement device). Notify providers and front desk staff of the new prior auth requirement. Establish process to submit prior authorization requests to Ambetter Health before dispensing devices. Claims submitted without prior authorization will be denied. Contact your Ambetter Health Provider Relations Representative if clarification is needed.