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Medicaid Prior Authorization Changes Effective 7/1/2025

Date: 05/30/25

Medicaid Prior Authorization Changes Effective July 1, 2025

Arizona Complete Health-Complete Care Plan requires prior authorization (PA) as a condition of payment for certain services. This communication outlines PA changes effective for dates of service 7/1/2025 and after.

NON-PARTICIPATING PROVIDERS & FACILITIES REQUIRE PA FOR ALL SERVICES UNLESS SPECIFICALLY OTHERWISE INDICATED.

Benefits are separate from PA requirements. If the service is a covered benefit, we then follow the PA requirements. In addition, payment, regardless of PA requirements, is contingent on the member’s eligibility at the time service is rendered. As a result, please verify eligibility and benefits prior to rendering services to members.

To confirm if a CPT/HCPCS code requires PA, please use the Pre-Auth Check Tool on our website www.arizonacompletehealth.com > For Providers > Pre-Auth Check. Please Note: This tool displays the PA requirements at the time of the look-up.  It does not display future changes to PA requirements.

If you have questions, please contact your Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us: AzCHProviderEngagement@azcompletehealth.com.

Code

Description

PA Requirement Effective 7/1/2025

37229

Revascularization, endovascular

Open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy

PA Required for all providers

31276

Nasal/sinus endoscopy

Surgical, with frontal sinus exploration, including removal of tissue from frontal sinus

PA Required for all providers

31295

Nasal/sinus endoscopy

Surgical, with dilation; maxillary sinus ostium, transnasal or via canine fossa

PA Required for all providers

31298

Nasal/sinus endoscopy

Surgical, with dilation; frontal and sphenoid sinus ostia

PA Required for all providers

31296

Nasal/sinus endoscopy

Surgical, with dilation; frontal sinus ostium

PA Required for all providers

E0466

Home ventilator, any type, used with noninvasive interface

PA Required for all providers

L0650

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panel(s)

PA Required for all providers

 

Code

Description

PA Requirement Effective 7/1/2025

E1012

Wheelchair accessory

Addition to power seating system, center mount power elevating leg rest/platform

PA Required for all providers

L0637

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid anterior and posterior frame/panels

PA Required for all providers

L0464

Thoracic-lumbar-sacral orthosis (TLSO), triplanar control, modular segmented spinal system

PA Required for all providers

L1844

Knee orthosis (KO), single upright, thigh and calf

Adjustable flexion and extension joint

PA Required for all providers

20939

Bone marrow aspiration for bone grafting, spine surgery only

No PA for PAR Providers

95806

Sleep study, unattended

No PA for PAR Providers

A4253

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips

No PA for PAR Providers

A4259

Lancets, per box of 100

No PA for PAR Providers

A4450

Tape, nonwaterproof, per 18 sq in

No PA for PAR Providers

A4604

Tubing with integrated heating element for use with positive airway pressure device

No PA for PAR Providers

A5120

Skin barrier, wipes or swabs, each

No PA for PAR Providers

A6216

Gauze, nonimpregnated, nonsterile

No PA for PAR Providers

A6402

Gauze, nonimpregnated, sterile

No PA for PAR Providers

A6446

Conforming bandage, nonelastic, knitted/woven, sterile

No PA for PAR Providers

A7000

Canister, disposable, used with suction pump, each

No PA for PAR Providers

A7005

Administration set, with small volume nonfiltered pneumatic nebulizer, nondisposable

No PA for PAR Providers

A7013

Filter, disposable, used with aerosol compressor or ultrasonic generator

No PA for PAR Providers

A7031

Face mask interface, replacement for full face mask, each

No PA for PAR Providers

A7032

Cushion for use on nasal mask interface, replacement only, each

No PA for PAR Providers

A7033

Pillow for use on nasal cannula type interface, replacement only, pair

No PA for PAR Providers

A7034

Nasal interface used with positive airway pressure device

No PA for PAR Providers

A7035

Headgear used with positive airway pressure device

No PA for PAR Providers

A7036

Chinstrap used with positive airway pressure device

No PA for PAR Providers

A7037

Tubing used with positive airway pressure device

No PA for PAR Providers

 

Code

Description

PA Requirement Effective 7/1/2025

A7038

Filter, disposable, used with positive airway pressure device

No PA for PAR Providers

A7039

Filter, nondisposable, used with positive airway pressure device

No PA for PAR Providers

A7046

Water chamber for humidifier, used with positive airway pressure device, replacement, each

No PA for PAR Providers

E0100

Cane, includes canes of all materials, adjustable or fixed, with tip

No PA for PAR Providers

E0105

Cane, quad or three-prong, includes canes of all materials, adjustable or fixed, with tips

No PA for PAR Providers

E0143

Walker, folding, wheeled, adjustable or fixed height

No PA for PAR Providers

E0156

Seat attachment, walker

No PA for PAR Providers

E0163

Commode chair, mobile or stationary, with fixed arms

No PA for PAR Providers

E0431

Portable gaseous oxygen system, rental

No PA for PAR Providers

E0443

Portable oxygen contents, gaseous, 1 month's supply = 1 unit

No PA for PAR Providers

E0562

Humidifier, heated, used with positive airway pressure device

No PA for PAR Providers

E0570

Nebulizer, with compressor

No PA for PAR Providers

E0601

Continuous positive airway pressure (CPAP) device

No PA for PAR Providers

E0971

Manual wheelchair accessory, antitipping device, each

No PA for PAR Providers

E0978

Wheelchair accessory, positioning belt/safety belt/pelvic strap, each

No PA for PAR Providers

E1392

Portable oxygen concentrator, rental

No PA for PAR Providers

E2601

General use wheelchair seat cushion, width less than 22 in, any depth

No PA for PAR Providers

K0001

Standard wheelchair

No PA for PAR Providers

K0195

Elevating legrests, pair (for use with capped rental wheelchair base)

No PA for PAR Providers

K0738

Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders

No PA for PAR Providers

L3908

Wrist-hand orthosis (WHO), wrist extension control cock-up

No PA for PAR Providers

L8470

Prosthetic sock, single ply, fitting, below knee (BK), each

No PA for PAR Providers

E1038

Transport chair, adult size, patient weight capacity up to and including 300 pounds

No PA for PAR Providers