Important Prior Authorization Updates

Date: 12/17/25

Effective April 1, 2026

As part of our ongoing work to improve the prior authorization (PA) process for providers and members, Meridian Medicaid Plan (Meridian) and YouthCare HealthChoice (YouthCare) are sharing important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

Code change details are noted in the table below. The changes may include:

Removing PA requirements based on criticality of review and clinical need
Creating a more uniform set of PA requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.

For questions about specific prior authorization codes or how these changes may affect your practice, please reach out to your Provider Engagement representative.

Service Category	PA Rule	Services	Procedure codes
Behavioral Health	PA Required	Treatment Services	H2012
Behavioral Health	No PA Required for all providers for the first 8 combined hours per member per calendar year for codes 96130, 96131, 96132, 96133, 96136 and 96137 billed with behavioral health diagnoses. For all other diagnosis types and, or requests beyond 8 hours, PA is Required.	Treatment Services	96130, 96131, 96132, 96133, 96136, 96137
Cardiovascular	No PA Required for PAR providers	Cardiovascular Tests	93307
DME Services	PA Required	Beds	E0277
		Diabetic Drugs And Supplies	A9276, A9277, A9278
		Nutritional Services	B4102, B4103, B4104
		Orthotic & Prosthetic	L0460, L0462, L0464, L1832
		Wheelchairs	E2621
	PA Required beyond 186 units per calendar month or the benefit limitation—whichever is greater	Incontinence Supplies	T4525, T4526, T4527, T4528, T4529, T4530, T4533, T4543
	PA Required after plan benefit limitation	Nutritional Services	B4149, B4150, B4152, B4153, B4154, B4155, B9998
	No PA Required for PAR providers	Neurostimulators	E0730
	No PA Required if member is under 21 years old at date of service. PA Required for all other members	Nutritional Services	B4100
	No PA Required for PAR providers	Supplies and Devices	E0600
Genetic Analysis	PA Required	Genetic Testing	81307, 81308, 88271, 88275
Home Services	PA Required	Home Therapy	S5120, S5121
Home Services	PA Required	Nursing Services	S9123
Laboratory	No PA Required for PAR providers	Drug Tests	80362
Other Medical Services	PA Required	Hyperbaric Oxygen Therapy	99183
Pain Management	PA Required	Surgery-Nervous System	64628, 64629
Physician Services	PA Required	Neurological Tests	95700, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95721, 95722, 95723, 95724, 95725, 95726
Physician Services	PA Required	Other Treatments	99199
Skin Procedures	PA Required	Muscle Flap Procedures	15736, 15738
Skin Procedures	PA Required	Skin Grafts	15274, 15276
Surgery Procedures	PA Required	Facial, Cranial & TMJ Procedures	21235
		Hysterectomies	58545
		Joint Replacement Surgery	25447
		Rhinoplasties	30460, 30462
		Spinal Surgery	63200
		Surgery-Cardiovascular System	37236, 37237, 37238, 37239, 37246, 37247, 37248, 37249
		Surgery-Digestive System	43659
		Surgery-Heart	92920, 92921
		Surgery-Nervous System	64568, 64582
		Surgery-Respiratory System	30130