MedicaidPrior AuthHigh impact
Effective October 1, 2026: Removal of Prior Authorization Requirement for Certain Procedures
Ambetter·TX · Genetics, OB-GYN, Psychiatry +6 more·Prior Authorization
Effective date
Oct 1, 2026
We identified it
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.
Action Required
By September 15, 2026: Billing 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. Remove prior auth workflows and encounter form prompts for these codes in the billing system. Verify that claims for these procedures will process without authorization holds starting October 1, 2026. Communicate change to clinical staff and providers. Failure to update systems may result in unnecessary prior auth requests and potential claim processing delays. Reference Superior HealthPlan Prior Authorization webpage or contact 1-800-218-7508 for verification.