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Renueve antes del 15 de diciembre para tener cobertura el 1 de enero. Mantén tu cobertura con Ambetter Health.

Renueve antes del 15 de diciembre para tener cobertura el 1 de enero. Mantén tu cobertura con Ambetter Health.

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Skin and Soft Tissue Substitute Prior Authorization Updates

Fecha: 15/09/25

Ambetter from Meridian is notifying providers of an update to the policy regarding prior authorizations of Skin and Soft Tissue Substitutes. Effective November 15, 2025, the codes below will be updated to require a prior authorization.

Code

Code Description

Upcoming Change

Q4173

PALINGEN OR PALINGEN XPLUS

Authorization required for all providers.

Q4204

XWRAP PER SQ CM

Authorization required for all providers.

Q4250

AMNIOAMP-MP PER SQ CM

Authorization required for all providers.

Q4248

DERMACYTE AMNIOTIC MEMBRANE ALLOGRAFT PER SQ CM

Authorization required for all providers.

Q4234

XCELLERATE PER SQ CM

Authorization required for all providers.

All policies and procedures are regularly reviewed as part of our commitment to delivering quality, cost-effective care for Ambetter from Meridian members. Please contact the Ambetter from Meridian provider engagement team for additional information and questions related to this policy update. To check if an authorization is needed, please utilize our Pre-Auth Check Tool.