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Ambetter HCPCs Code E0486 Prior Auth

Date: 04/13/26

Prior Authorization Update for HCPCS Code E0486 Effective 7/1/2026

Effective 7/1/2026, Ambetter from Arizona Complete Health will require prior authorization for HCPCS code E0486, a custom-fabricated mandibular advancement device (MAD) for obstructive sleep apnea.

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

📧  AzCHProviderEngagement@azcompletehealth.com.