All PlansPrior AuthMedium impact
Important Prior Authorization Updates
Ambetter·MS · Genetics, ENT (Ear, Nose & Throat), Transplant Surgery +1 more·Prior Authorization
Effective date
Oct 1, 2026
We identified it
Sep 3, 2026
Summary
Ambetter from Magnolia Health is updating prior authorization requirements effective October 1, 2026. Genetic testing (CPT 81378-81383, 86812-86813, 86817), home services (S9211, S9213, S9214), and transplant services (CPT 38208) no longer require prior authorization, while sinus surgery (CPT 31297) now requires prior authorization. These changes standardize PA requirements across markets and lines of business.
Action Required
By September 30, 2026: Billing team must update the billing system and prior authorization workflows to reflect the following changes: (1) Remove prior authorization requirements for genetic testing codes (81378, 81379, 81380, 81381, 81382, 81383, 86812, 86813, 86817) and home services codes (S9211, S9213, S9214) and transplant code (38208); (2) Add prior authorization requirement for sinus surgery code (31297). Update encounter forms, billing software rules, and provider education materials to reflect these changes. Billing team should coordinate with providers and front desk staff to ensure claims are submitted correctly without unnecessary prior auth requests. Failure to implement these changes may result in claim processing delays or unnecessary denials/appeals. Contact your local Ambetter from Magnolia Health Provider Engagement representative with questions about specific codes.