Prior authorization requirement effective 12/1

AmeriHealth Caritas Ohio Providers,

Beginning 12/1/25, prior authorization for the HCPCS codes and services listed in the table will require prior authorization.

The items below will require prior authorization beginning on 12/1/25
Code	Description	Change
80299	Quantitation of drug, not elsewhere specified	Change to “Auth Required” on Provider Look Up Tool
92499	Unlisted ophthalmological service or procedure	Change to “Auth Required” on Provider Look Up Tool
A4335	Incontinence supply; miscellaneous	Change to “Auth Required” on Provider Look Up Tool
V5299	Hearing service, miscellaneous	Change to “Auth Required” on Provider Look Up Tool
E0465	Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)	Change to “Auth Required” on Provider Look Up Tool and in Facets

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.

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