News
Effective November 1, 2026: New Prior Authorization Requirement for Certain Procedures
Date: 07/14/26
Superior HealthPlan will require prior authorization for certain procedures for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP and Ambetter Health members. Superior ensures medical necessity review criteria is current and appropriate for members and the scope of services provided.
As a result, the following procedure code update is effective on November 1, 2026, according to the products listed below.
Medicaid and CHIP Members:
Service Category | Procedure Code | Description | Criteria |
Genitourinary Procedures | 55899 | GENITAL SURGERY PROCEDURE | Change Healthcare’s InterQual criteria, proprietary, but available upon request. |
Physician Services | 91299 | GASTROENTEROLOGY PROCEDURE |
Medicaid, CHIP and Ambetter Health: Members of all ages
Service Category | Procedure Code | Description | Criteria |
Sleep Medicine | 95811 | POLYSOM 6/>YRS CPAP 4/> PARM | Change Healthcare’s InterQual criteria, proprietary, but available upon request. |
Ambetter Health- Members of All Ages
Service Category | Procedure Code | Description | Criteria |
Sleep Medicine | 95810 | POLYSOM 6/> YRS 4/> PARAM | Change Healthcare’s InterQual criteria, proprietary, but available upon request. |
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.