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Ambetter from Absolute Total Care Prior Authorization Update

Date: 07/30/21

Ambetter from Absolute Total Care requires prior authorization as a condition of payment for many services. This effort requires us to ensure that our members receive only treatments that are medically necessary according to current standards of practice.

Effective October 1, 2021, prior authorization will be required for the services listed below.

Procedure Code

Procedure Description 

 54401

INSRT PENILE PROSTH; INFLATABLE

54405

INSRT INFLATBL PENILE PROSTH W/PLCMT PUMP/CYLIND

61885

INCS & SUBQ PLCMT CRANIAL NEUROSTIM GEN/RECEIVER

61886

IMPLANT NEUROSTIM ARRAYS

64568

INC FOR VAGUS N ELECT IMPL

69714

IMPLANT TEMPLE BONE W/STIMUL

77371

SRS MULTISOURCE

If you have any questions regarding this information, you may contact Provider Services at 1-833-270-5443 or contact your dedicated Provider Relations Specialist.