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AmbetterExchange · Prior Auth · Prior Authorization · MS · Genetics, ENT (Ear, Nose & Throat), Transplant Surgery +1 moreMedium impact

Important Prior Authorization Updates

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

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What to do

by Sep 30, 2026 · 7 steps
01Billing team must update the billing system and prior authorization workflows to reflect the following changes.
02Remove 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).
03Add prior authorization requirement for sinus surgery code (31297).
04Update encounter forms, billing software rules, and provider education materials to reflect these changes.
05Billing team should coordinate with providers and front desk staff to ensure claims are submitted correctly without unnecessary prior auth requests.
06Failure to implement these changes may result in claim processing delays or unnecessary denials/appeals.
07Contact your local Ambetter from Magnolia Health Provider Engagement representative with questions about specific codes.

Codes mentioned

813788137981380813818138281383868128681386817S9211S9213S92143129738208

Original notice

Important Prior Authorization Updates
ambetterhealth.com · Always check the source before changing claims.
View original ↗

Related changes

See all Ambetter changes →
Q3 2026 Provider NewsletterHighEffective Oct 1, 2026 · Provider BulletinImportant Prior Authorization Updates: Effective October 1, 2026MediumEffective Oct 1, 2026 · Prior AuthorizationAmbetter of Tennessee Q3 2026 NewsletterHighEffective Oct 1, 2026 · Provider BulletinAugust Provider NewsletterHighEffective Jan 1, 2027 · Provider BulletinBrowse every Ambetter change in the policy list

Related policy hubs

Ambetter policiesMS policy changesGeneticsENT (Ear, Nose & Throat)Transplant SurgeryGeneral SurgeryCode 81378Code 81379Code 81380Code 81381Code 81382Code 81383Code 86812Code 86813Code 86817Code S9211Code S9213Code S9214Code 31297Code 38208

Summaries are AI-assisted. Always confirm against the original payer notice.

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