Relaxation of Prior Authorization Requirements for Certain DME, Orthotic/Prosthetics, Enteral/Parenteral Nutrition and Medical Supplies

Date: 02/16/23

Superior HealthPlan has implemented a relaxation of prior authorization requirements for covered Durable Medical Equipment (DME), Prosthetics, Orthotics, Enteral/Parenteral Nutrition and Medical Supplies for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members.

As a reminder, Superior previously implemented a temporary relaxation through June 2022. That relaxation has now been made permanent. No changes have been made to the clinical criteria for the applicable service/categories that continue to require prior authorization.

Prior authorization for certain items and supplies are waived for Medicaid and CHIP members 0- 20 years of age only. Superior encourages providers to review the listing of items and supplies that do not require prior authorization during this time, before a supply or item is fabricated and/or dispensed.

Please review the listing of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes that DO NOT REQUIRE PRIOR AUTHORIZATION: Prior Authorization CPT/HCPC Codes (PDF)

For any questions on this notice, or to confirm if an item or supply requires prior authorization, please contact the Utilization Review department at 1-800-218-7508.