AmeriHealth Caritas Ohio Providers,

Prior authorization for the HCPCS codes and services listed in Table 1 do not require prior authorization as of 10/1.

Table 1 Prior authorization is NOT required as of 10/1/25
CPT/HCPCS Codes
A4288	A9612	A9616
C1740	C1741	C1742
C8006	J0163	J0164
J0462	J0525	J0582
J0668	J0759	J1370
J1612	J1807	J1834
J2151	J2291	J3290
M0235	M0236	M0237
M0238	Q0235

Table 2 Prior authorization IS required as of 10/1/25
CPT/HCPCS Codes
0575U	0576U	0577U
0578U	0579U	0580U
0581U	0582U	0583U
0584U	0585U	0586U
0587U	0588U	0589U
0590U	0591U	0592U
0593U	0594U	0595U
0596U	0597U	0598U
0599U	A2036	A2037
A2038	A2039	C9305
C9306	E0150	E0658
E0659	J0458	J0614
J0675	J0681	J0738
J0752	J1809	J3402
J3403	J7173	J7174
J9011	L1007	L1007
L5657	L6034	L6035
L6036	L6038	L6039
Q0237	Q4383	Q4384
Q4385	Q4386	Q4387
Q4388	Q4389	Q4390
Q4391	Q4392	Q4393
Q4394	Q4395	Q4396
Q4397	Q5154	Q5155
Q5156	Q5157	Q5158
Q5159

Removal/addition of the prior authorization and medical necessity review for these services is part of AmeriHealth Caritas Ohio’s continued dedication to supporting providers in our shared commitment to high quality healthcare for our participants.

 

As a reminder, when you do need to verify whether a service requires prior authorization, use the Prior Authorization Lookup Tool on the provider website at: https://www.amerihealthcaritasoh.com/provider/resources/prior-auth-lookup-tool.

Questions? Please contact your Provider Account Executive or call Provider Services at 

1-833-644-6001.