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Arizona Complete Health-Complete Care Plan & Ambetter Prior Authorization Updates Effective October 1, 2021

Arizona Complete Health-Complete Care Plan & Ambetter Prior Authorization Updates Effective October 1, 2021

Arizona Complete Health is committed to delivering cost-effective quality care to our members.  This effort requires all of us to make certain members receive treatment that is medically necessary according to current standards of practice.  We use prior authorization to review the medical necessity of a particular treatment in advance.

We are making updates to our prior authorization requirements for Arizona Complete Health-Complete Care Plan (Medicaid) and Ambetter effective October 1, 2021.

Please use the Pre-Auth Check Tool on our website to confirm if a specific code(s) requires prior authorization. When checking Medicaid prior authorization requirements please select the Medicaid tool and when checking Ambetter prior authorization requirements please select the Ambetter tool as prior authorization requirements vary based on the line of business. Pre-Auth Check tool location: https://www.azcompletehealth.com/providers/preauth-check.html

The tables below outline the changes effective October 1, 2021:

Arizona Complete Health-Complete Care Plan (Medicaid)
Procedure CodeDescriptionRule
58611G/TRANSECT FALLOPIAN TUBE-W/C SECT/INTRA-ABDNo auth required for PAR providers
58670LAPAROSCOPY WITH FULGURATION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, RIN)No auth required for PAR providers
58671LAPAROSCOPY W/OCCLUSION OF OVIDUCTSNo auth required for PAR providers
53854TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPYNo auth required for PAR providers
A5514DIAB ONLY MX DEN INSRT DIRECT CARV CUSTOM FAB EANo Auth required for PAR providers
E0601CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICENo Auth required for PAR providers
E0470RSPRTRY DVCE/BI-LVL PRESS CPLTY/WOUT BCKP RATE FTRE/W NNINVSV INTRFCNo Auth required for PAR providers
E0471RSPRTRY DVCE/BI-LVL PRESS CPLTY/W BCKP RATE FTRE/W NNINVSV INTRFCNo Auth required for PAR providers
81443GENETIC TESTING FOR SEVERE INHERITED CONDITIONsAuth Required for all providers
Ambetter
Procedure CodeDescriptionRule
54401Insertion of penile prosthesis; inflatable (self-contained)Auth required for all providers
54405Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoirAuth required for all providers
61885Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode arrayAuth required for all providers
61886Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to 2 or more electrode arraysAuth required for all providers
64568Incision for implantation of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generatorAuth required for all providers
69714Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomyAuth required for all providers
77371Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 basedAuth required for all providers

If you have questions regarding the information contained in this update, please contact our Provider Customer Service center at (866) 796-0542 or your Provider Engagement Specialist.  If you need contact information for your assigned Provider Engagement Specialist, please email AzCHProviderEngagement@azcompletehealth.com.

Best Regards,

Arizona Complete Health 

Provider Communications

“Transforming the health of the community, one person at a time.”

1870 W. Rio Salado Parkway Suite 2A Tempe, AZ 85281

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