Medicaid Prior Authorization Updates Effective 1/1/2026

Date: 12/04/25

Medicaid Prior Authorization Updates - Effective January 1, 2026

Arizona Complete Health-Complete Care Plan is updating Medicaid prior authorization (PA) requirements.

Key updates include:

• Adding PA requirements across lines of business to simplify processes, reduce confusion, and support future real-time response capabilities.
• Revision of PA requirements to reflect AHCCCS directives regarding covered and non-covered benefits.

The table below includes select changes to Medicaid PA requirements. For the most accurate and up-to-date information, please use the Pre-Auth Check tool before delivering services: Our website → For Providers → Pre Auth Check. Please note: The Pre-Auth Check tool reflects PA requirements as of the time of your search. It does not show future updates or changes.

Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE PA FOR ALL SERVICES EXCEPT WHERE SPECIFICALLY OTHERWISE INDICATED.

Questions? Contact your Provider Engagement Account Manager. Need their contact information? Email us at: AzCHProviderEngagement@azcompletehealth.com.

Service Category	PA Rule	Procedure Code
Skin Substitutes	PA required for all providers	A2019, A2021, Q4128, Q4166, Q4197
Skin Substitutes	Procedure code is not covered	A2001, A2002, A2005, A2024, Q4100, Q4102, Q4103, Q4104, Q4108, Q4111, Q4112, Q4114, Q4115, Q4116, Q4117, Q4118, Q4122, Q4123, Q4124, Q4126, Q4127, Q4130, Q4132, Q4134, Q4135, Q4136, Q4138, Q4139, Q4140, Q4141, Q4142, Q4143, Q4145, Q4146, Q4147, Q4148, Q4149, Q4150, Q4152, Q4153, Q4154, Q4155, Q4156, Q4159, Q4160, Q4161, Q4162, Q4163, Q4164, Q4165, Q4179, Q4181, Q4185, Q4186, Q4189, Q4192, Q4198, Q4200, Q4202, Q4205, Q4206, Q4208, Q4209, Q4210, Q4211, Q4212, Q4214, Q4215, Q4216, Q4217, Q4218, Q4220, Q4221, Q4222, Q4226, Q4230, Q4231, Q4233, Q4236, Q4240, Q4241, Q4242, Q4244, Q4245, Q4246, Q4259, Q4261, Q4273, Q4275, Q4284, Q4285, Q4287, Q4288, Q4289, Q4305, Q4306, Q4307, Q4308
Wound Care	PA required for all providers for wound care that extends beyond the initial 12 visits per calendar year	11046, 11047