Effective January 1, 2026: Removal of Prior Authorization Requirement for Certain Procedures
Date: 12/01/25
Effective January 1, 2026, Superior HealthPlan will no longer require prior authorization for certain procedures for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), Ambetter from Superior HealthPlan and Wellcare By Allwell members.
Below are the Current Procedural Terminology (CPT) procedure codes included in this change to the prior authorization requirements.
Applicable Products: Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS)
Description | |
97032 | APPLIC MODAL 1/> AREAS; ELEC STIM EA 15 MIN |
97035 | APPLIC MODAL 1/> AREAS; ULTRASOUND EA 15 MIN |
97760 | ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15 MIN |
36471 | INJ SCLEROSING SOLUTION; MX VEINS SAME LEG |
A6216 | GAUZE NON-IMPREG NONSTERL 16 |
A6218 | GAUZE NON-IMPREG NONSTERL > 48 SQ |
Applicable Products: Ambetter from Superior HealthPlan (Marketplace)
Description | |
36476 | ENDOVEN ABLAT TX VEIN EXT RF; 2&>VNS 1 EXT EA |
36483 | ENDOVEN THER CHEM ADHES SBSQ |
66821 | AFTER CATARACT LASER SURGERY |
95980 | IO ANAL GAST N-STIM INIT |
97157 | MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP EA 15 MIN |
K0739 | REPAIR/SVC DME NON-OXYGEN EQ |
Applicable Products: Wellcare By Allwell (Medicare)
Service Category | Services | Procedure Codes |
DME Services | Equipment Accessories | E0953, K0019, K0044, K0045, K0046, K0047, K0051, K0052 |
Wheelchairs | E0954, E0956, E0957, E0973, E1028, E2209, E2210, E2365, E2366, E2367, E2603, E2604, E2615, E2616, K0733, K0739 | |
Drug Codes | Injections | J0640 |
Medications | J0897 | |
Home Services | Home Management | G0156 |
Other Medical Services | Other Services | 97010, 97012, 97024, 97033, 97035, 97150 G0283 |
Speech Therapy | 92611 | |
Sleep Medicine | Sleep Studies | 95805 |
Surgery Procedures | Vascular | 36471, 37765, 37766 |
Transportation Services | Medical Transportation | A0434 |
To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.
For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.
To review all policies, please visit Medicare Prior-Authorization Clinical Policies webpage. Prior to updates, the policies were approved for use by Medicare Quality Committee. For questions or additional information, please contact Wellcare By Allwell Provider Services at: 1-800-977-7522 (HMO) and 1-877-935-8023 (HMO DSNP).