Prior authorization requirement changes effective May 1, 2024

Effective May 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Wellpoint for Medicaid and CHIP members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions take precedence over these PA rules and must be considered first when determining coverage.

Non-compliance with new requirements may result in denied claims.

Prior authorization requirements will be added for the following code(s):

To request PA, you may use one of the following methods:

• Web: Log in to Availity Essentials at Availity.com.
• Fax: 800-964-3627
• Phone: 833-731-2162

Not all PA requirements are listed here. Detailed PA requirements are available to providers on provider.wellpoint.com/tx on the Resources tab or by accessing Availity.com. Providers may also call Provider Services at 833-731-2162 for assistance with PA requirements.