Prior Authorization Updates - Effective April 1, 2026
Date: 12/18/25
Prior Authorization Updates - Effective Apr. 1, 2026
Arizona Complete Health is updating prior authorization (PA) requirements to make the process simpler for providers and members. Our goals are to reduce administrative burden, streamline submissions and approvals, and ensure timely access to quality care.
Key changes include:
- Some PA requirements will be removed based on clinical need and review urgency
- We are working to standardize PA requirements across all markets and lines of business. This may include adding or changing certain requirements to simplify processes, reduce confusion, and support future real-time response capabilities
Details by line of business (Arizona Complete Health – Complete Care Plan [Medicaid], Ambetter from Arizona Complete Health [Marketplace] and Wellcare [Medicare]) are outlined in the tables below.
Questions?
Contact your Provider Engagement Account Manager
Or email AzCHProviderEngagement@azcompletehealth.com
Arizona Complete Care- Complete Care Plan (Medicaid) Updates Effective April 1, 2026:
Service Category | PA Rule | Service | Procedure Code |
DME Services
| No PA required for PAR providers
| Neurostimulators | E0730 |
Orthotic & Prosthetic | L2330 | ||
Supplies and Devices | A4322, E0600 | ||
Wheelchairs | E0950, E0956 | ||
Genetic Analysis | PA required for all providers | Genetic Testing | 81455 |
Physical Medicine | No PA required for PAR providers | Orthotic & Prosthetic | L8420, L8430, L8440, L8470, L8480, L8485 |
Physician Services | PA required for all providers | Neurological Tests | 95700, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95721, 95722, 95723, 95724, 95725, 95726 |
Skin Procedures | PA required if billed with diagnosis of gender dysphoria. For all other dx, PA required for Non-PAR providers only | Skin Grafts | 14061 |
Service Category | PA Rule | Service | Procedure Code |
Surgery Procedures
| PA Required for all providers
| Surgery-Cardiovascular System | 37232, 37236, 37237, 37238, 37239, 37246, 37247, 37248, 37249 |
Surgery-Endocrine System | 60240, 60252, 60500 | ||
Surgery-Heart | 92920, 92921 | ||
Surgery-Nervous System | 64568, 64582 | ||
Surgery-Respiratory System | 30130, 31253, 31254, 31255, 31256, 31257, 31259, 31267 | ||
No PA required for PAR providers
| Surgery-Digestive System | 43238 | |
Surgery-Eye and Ocular Adnexa | 68815 | ||
Surgery-Integumentary System | 13132 | ||
Surgery-Musculoskeletal System | 29848 | ||
Surgery-Nervous System | 64721 | ||
Surgery-Urinary System | 52000, 52005, 52204, 52351 |
Ambetter from Arizona Complete Health Updates Effective April 1, 2026:
Service Category | PA Rule | Service | Procedure Code |
DME Services
| PA required for all providers | Diabetic Drugs And Supplies | A9276 |
No PA required for PAR providers
| Diabetic Drugs And Supplies | A9279 | |
Wheelchairs | K0004 | ||
Drug Codes | PA required for all providers | Injections | J0887 |
Genetic Analysis | No PA required for PAR providers | Genetic Testing | 81252 |
Physical Medicine | No PA required for PAR providers | Orthotic & Prosthetic | L5652 |
Surgery Procedures
| PA required for all providers | Surgery-Musculoskeletal System | 25111 |
No PA Required for PAR providers | Surgery-Eye and Ocular Adnexa | 66982 |
Wellcare (Medicare) Updates Effective April 1, 2026:
Service Category | PA Rule | Service | Procedure Code |
DME Services
| No PA required for PAR providers
| Beds | E0185 |
Orthotic & Prosthetic | L1951 | ||
Supplies and Devices | E0486 | ||
Drug Codes | No PA required for PAR providers | Medications | J1096 |
Genetic Analysis | No PA required for PAR providers | Genetic Testing | 81240, 81256 |
Imaging Services | No PA required for PAR providers | Nuclear Medicine | 77002 |
Physician Services | No PA required for PAR providers | Other Services | G3002 |
Skin Procedures | PA required for all providers | Muscle Flap Procedures | 15734, 15736, 15738 |
Surgery Procedures | No PA required for PAR providers | Surgery-Nervous System | 64718, 64719 |
Vision Services | No PA required for PAR providers | Vision Evaluation | 92201 |