Medicaid Prior Authorization Updates, eff 10/1/2026

Date: 07/01/26

Important Prior Authorization Updates (Effective October 1, 2026)

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Arizona Complete Health-Complete Care Plan wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

Code change details are noted in the table below. The changes may include:

• Removing PA requirements based on criticality of review and clinical need.
• Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.                                                               

Service Category	PA Rule	Services	Procedure codes
Behavioral Health	PA Required	Treatment Services	97157
	No PA Required	Behavioral Assessment	96121
Diagnostic Services	PA Required	Therapy Services	92526
DME and Supplies	No PA Required	Wheelchairs	E2607, E2622, E2623, E2624
		Orthotic and Prosthetic	L5000, L5704
Genetic Analysis	PA Required	Genetic Testing	81519
	No PA Required	Genetic Testing	81161, 81200, 81206, 81207, 81219, 81240, 81241, 81242, 81243, 81251, 81255, 81256, 81260, 81279, 81297, 81304, 81319, 81338, 81339, 81381, 81382, 81400, 81401
Home Services	No PA Required	Home Visit	S9213
Physical Medicine	PA Required	Therapy Services	92507
Physician Services	No PA Required	Diagnostic Testing	91113
Sleep Medicine	No PA Required	Sleep Studies	95805
Surgery Procedures	No PA Required	Eye and Ocular Adnexa	67904
Transportation Services	PA Required	Medical Transportation	A0130

 

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

📧  AzCHProviderEngagement@azcompletehealth.com.

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