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AmbetterExchange · Prior Auth · Prior Authorization · TX · Genetics, OB-GYN, Psychiatry +6 moreHigh impact

Effective October 1, 2026: Removal of Prior Authorization Requirement for Certain Procedures

Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
Aug 28, 2026

Summary

Effective October 1, 2026, Superior HealthPlan (Ambetter Health, Medicaid, CHIP) is removing prior authorization requirements for specific procedures across multiple service categories including genetic analysis, home services, transplant services, behavioral health, sleep medicine, durable medical equipment, and hearing services. Billing teams must update systems to stop requesting prior authorization for the listed procedure codes to avoid unnecessary delays and claim processing issues.

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What to do

by Sep 15, 2026 · 6 steps
01Billing team must update billing software to REMOVE prior authorization requirements for all 13 listed procedure codes (86812, 86813, 86817, 38208, S9211, S9213, S9214, 90792, 96121, 95805, E2607, E2608, L8624) for Ambetter Health, Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), and CHIP members.
02Remove prior auth workflows and encounter form prompts for these codes in the billing system.
03Verify that claims for these procedures will process without authorization holds starting October 1, 2026.
04Communicate change to clinical staff and providers.
05Failure to update systems may result in unnecessary prior auth requests and potential claim processing delays.
06Reference Superior HealthPlan Prior Authorization webpage or contact 1-800-218-7508 for verification.

Codes mentioned

86812868138681738208S9211S9213S9214907929612195805E2607E2608L8624

Original notice

Effective October 1, 2026: Removal of Prior Authorization Requirement for Certain Procedures
ambetterhealth.com · Always check the source before changing claims.
View original ↗

Related changes

See all Ambetter changes →
Effective 10/1/26: Removal of Prior Authorization Requirement for Certain ProceduresHighEffective Oct 1, 2026 · Prior AuthorizationImportant Prior Authorization Updates: Effective October 1, 2026MediumEffective Oct 1, 2026 · Prior AuthorizationAmbetter of Tennessee Q3 2026 NewsletterHighEffective Oct 1, 2026 · Provider BulletinImportant Prior Authorization UpdatesMediumEffective Oct 1, 2026 · Prior AuthorizationBrowse every Ambetter change in the policy list

Related policy hubs

Ambetter policiesTX policy changesGeneticsOB-GYNPsychiatrySleep MedicineOccupational TherapyAudiologyTransplant SurgeryPhysical TherapyWound CareCode 86812Code 86813Code 86817Code 38208Code S9211Code S9213Code S9214Code 90792Code 96121Code 95805Code E2607Code E2608Code L8624

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