CommercialPrior AuthMedium impact
Important Prior Authorization Updates: Effective October 1, 2026
Ambetter·OH · Genetics, OB-GYN, Transplant Surgery +1 more·Prior Authorization
Effective date
Oct 1, 2026
We identified it
Aug 28, 2026
Summary
Ambetter from Buckeye Health Plan is removing prior authorization requirements for genetic testing, obstetrical home services, and transplant services for participating providers effective October 1, 2026. Simultaneously, prior authorization is now required for sinus surgery (CPT 31297). These changes aim to reduce administrative burden and create uniform PA requirements across markets.
Action Required
By September 30, 2026: Billing team must update prior authorization workflows in billing software and EMR systems for Ambetter from Buckeye Health Plan (Ohio). REMOVE prior authorization requirements for: genetic testing codes 86812, 86813, 86817; obstetrical home visit codes S9211, S9213, S9214; and transplant code 38208 for participating providers. ADD prior authorization requirement for sinus surgery CPT 31297. Update encounter templates and billing procedures to reflect these changes. Failure to implement correctly may result in unnecessary claim denials or inappropriate approvals. Front desk and prior authorization staff should be notified of these changes immediately. Contact local Provider Engagement representative with questions about implementation.