MedicaidPrior AuthHigh impact
Effective 10/1/26: Removal of Prior Authorization Requirement for Certain Procedures
Ambetter·TX · Genetics, Psychiatry, Sleep Medicine +4 more·Prior Authorization
Effective date
Oct 1, 2026
We identified it
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.
Action Required
By September 30, 2026: Billing 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. Update clinical decision support tools and encounter forms to reflect that these procedures no longer require prior authorization. Remove any internal PA checklists or workflows that reference these codes for these plan types. Verify changes are live in the system before October 1, 2026. Failure to implement may result in unnecessary PA requests, delayed claim processing, and provider frustration.