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MedicaidPrior AuthMedium impact

Prior Authorization Requests Effective 10/1/25

Molina Healthcare·NY · General Surgery, Plastic Surgery, Oncology +3 more·Prior Authorization
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Days to comply

Summary

Molina Healthcare of New York is implementing new prior authorization requirements for transplant/gene therapy drugs and skin substitutes effective October 1, 2025, while removing prior auth requirements for certain ASC procedures (33904) unless performed out-of-network.

Action Required

Action needed
By October 1, 2025: Billing team must update system to require prior authorization for new transplant/gene therapy codes J3403 and J3402, skin substitute codes C9250, Q4102, Q4103, Q4108, A4100, Q4110, Q4111, and healthcare administered drug codes J9011, J0614, Q5159, Q5158, Q5157, J0458, Q5154, Q5155, Q5156, Q0235, J7173, J7174, J0681, J1809. Remove prior auth requirement for CPT 33904 ASC procedures for in-network providers only. Update encounter forms and notify providers. Contact Molina UM at 1-877-872-4716 with questions.

Affected Billing Codes

J3403
J3402
C9250
Q4102
Q4103
Q4108
A4100
Q4110
Q4111
J9011
J0614
C9174
C9175
Q5159
Q5158
Q5157
J0458
Q5154
Q5155
Q5156
Q0235
J7173
J7174
J0681
J1809
33904