Effective June 1, 2023: Update to Prior Authorization Requirements for Certain Enteral Nutrition and Incontinence Supplies
Date: 05/25/23
Effective June 1, 2023, Superior HealthPlan will no longer require prior authorization for certain enteral supplies and will increase the unit limitation for certain enteral and incontinence supplies for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP. The following Current Procedural Terminology (CPT) codes included in this change to the prior authorization requirements are noted below.
CPT Codes for Prior Authorization removal | Description |
|---|---|
B4088 | GASTRO/JEJUNO TUBE LOW-PRO |
B9998 all modifiers | NOC ENTERAL SUPPLIES |
CPT Codes | Description | Unit Limitation Increase |
|---|---|---|
B9998-modifier U2 | NONOBTURATED GASTROSTOMY OR JEJUNOSTOMY TUBE WITH INSERTION SUPPLIES AND EXTENSIONS | 6 units every rolling year |
A4927 | GLOVES NON-STERILE PER 100 | 2 units per month |
A6250 | SKIN SEALANTS PROTECT MOISTURIZER ANY TYPE/SIZE | 4units per month |
To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.
For questions or additional information, contact Superior HealthPlan Prior Authorization department at 1-800-218-7508.