Effective April 1, 2026: Removal of Prior Authorization Requirement for Certain Procedures
Date: 03/02/26
Effective April 1, 2026, Superior HealthPlan will no longer require prior authorization for certain procedures for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and Ambetter (Ambetter Health and Ambetter from Superior HealthPlan) members. Below are the Current Procedural Terminology (CPT) codes included in this change to the prior authorization requirements.
Applicable Products: Superior Medicaid (STAR, STAR Kids, STAR+PLUS, STAR Health)
Surgical Procedures
CPT Code | Description |
11401 | EXC BEN LES TRNK ARM/LEG;0.6-1.0 CM |
11421 | EXC H-F-NK-SP B9+MARG 0.6-1 |
Drug Testing
CPT Code | Description |
80357 | KETAMINE AND NORKETAMINE |
80362 | OPIOIDS & OPIATE ANALOGS 1/2 |
80367 | DRUG SCREENING PROPOXYPHENE |
80370 | SKEL MUSC RELAXANT 3 OR MORE |
80372 | DRUG SCREENING TAPENTADOL |
Genetic and Molecular Testing
CPT Code | Description |
81162 | BRCA1 BRCA2 GENE ALYS FULL SEQ FULL DUP/DEL ALYS |
81165 | BRCA1 GENE ANALYSIS FULL SEQUENCE ANALYSIS |
81166 | BRCA1 GENE ANALYSIS FULL DUP/DEL ANALYSIS |
81167 | BRCA2 GENE ANALYSIS FULL DUP/DEL ANALYSIS |
Applicable Products: Ambetter (Ambetter Health and Ambetter from Superior HealthPlan)
Durable Medical Equipment and Supplies
CPT Code | Description |
K0004 | HGH STRGTH LIGHTWGHT WHLCHR |
A9279 | MON FEATURE/DEVC ALONE/INTEG |
Surgical Procedures
CPT Code | Description |
66982 | CATARACT SURGERY COMPLEX |
Genetic and Molecular Testing
CPT Code | Description |
81162 | BRCA1 BRCA2 GENE ALYS FULL SEQ FULL DUP/DEL ALYS |
81167 | BRCA2 GENE ANALYSIS FULL DUP/DEL ANALYSIS |
0553U | REPRDTVE MED PGA 24CHRMSM EMBRY TE STRUX REARGMT |
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.