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AmbetterExchange · Prior Auth · Prior Authorization · TX · Genetics, Psychiatry, Sleep Medicine +4 moreHigh impact

Effective 10/1/26: Removal of Prior Authorization Requirement for Certain Procedures

Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Sep 3, 2026

Summary

Effective October 1, 2026, Superior HealthPlan will remove prior authorization requirements for 13 specific procedure codes across Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, and Ambetter Health plans. Billing teams must update their prior authorization workflows to stop requiring PA for these codes to avoid unnecessary delays and claim processing issues.

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What to do

by Sep 30, 2026 · 4 steps
01Billing team must update prior authorization rules in billing software to remove PA requirements for the 13 affected codes (86812, 86813, 86817, S9211, S9213, S9214, 38208, 90792, 96121, 95805, E2607, E2608, L8624) for Superior HealthPlan Medicaid, CHIP, and Ambetter Health members.
02Update clinical decision support tools and encounter forms to reflect that these procedures no longer require prior authorization.
03Remove any internal PA checklists or workflows that reference these codes for these plan types.
04Verify changes are live in the system before October 1, 2026.
If missed: Failure to implement may result in unnecessary PA requests, delayed claim processing, and provider frustration.

Codes mentioned

868128681386817S9211S9213S921438208907929612195805E2607E2608L8624

Original notice

Effective 10/1/26: 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 October 1, 2026: 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 changesGeneticsPsychiatrySleep MedicineOccupational TherapyAudiologyTransplant SurgeryOB-GYNCode 86812Code 86813Code 86817Code S9211Code S9213Code S9214Code 38208Code 90792Code 96121Code 95805Code E2607Code E2608Code L8624

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