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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)

CPT Codes

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)

CPT Codes

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).