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.
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 |