To earlier identify AmeriHealth Caritas Ohio members facing potential solid organ or bone marrow transplant, the transplant evaluation is being added as a prior authorization requirement. The transplant inpatient procedure itself remains a requirement because all inpatient admissions require prior authorization. However, the actual transplant procedure codes will be added to the prior authorization look-up tool for clarity.

 

The following codes will appear as “Yes, Prior Authorization Required” on the Prior Auth Look Up Tool, effective date 10/15/25.

(As stated above, this change will not impact UM in practice as these are all inpatient procedures that currently require Prior Authorization. This is strictly to decrease confusion among end users of the Prior Auth Look Up Tool.)