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HomeAbout usHealth EquityHealth Equity Alt

Health Equity

At Fidelis Care, we believe everyone should have the opportunity to live a healthy life. It’s our mission to ensure New Yorkers have access to high-quality healthcare, so they can get the care they need when they need it.

But many other factors contribute to an individual’s health and wellness beyond access to healthcare. Socioeconomic conditions can influence health risks and outcomes. Poverty, food insecurity, housing instability, education, employment, access to transportation and other circumstances contribute to health disparities among underserved and vulnerable populations.

Fidelis Care is committed to removing those barriers to health to improve access, quality, and affordability. It is an ongoing process that requires working together with our members, providers, and community-based organizations to support fair and just opportunities to equal access to healthcare.

Learn more about our different approaches to improve health equity:


Key partnerships

Wellness commitment to Buffalo Urban League

To nurture social entrepreneurship, facilitate wellness, and strengthen organizations focused on Black, Indigenous and People of Color in Buffalo’s East Side, Fidelis Care and the Centene Foundation donated $1.1 million to the Buffalo Urban League (BUL) to help establish its new headquarters and develop a Wellness and Entrepreneurial Center.

In addition, Fidelis Care partners with BUL through community programs and at events held in the city focused on health, family support and stabilization services, foster care, adoption, education, job training, employment, scholarships, and more.

Buffalo-Urban-League

Mental health alliance with The Jed Foundation

As part of our behavioral health efforts, Fidelis Care and the Centene Foundation awarded $1.1 million to The Jed Foundation (JED) to protect the mental health of New York State’s youth.

Through the funding, JED will expand its current services, providing at least five youth-serving community-based organizations (CBOs) with consultation or strategic planning services, including expert guidance, educational workshops, and training programs, equipping young people with life skills and connecting them to mental healthcare when they are in distress.

Fidelis-JED-Social


More Health Equity News


Important Prior Authorization Updates Effective April 1, 2026
2/27/2026 • Posted by Provider Relations in Provider News

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Fidelis Care wants to share some important updates to our PA requirements for Medicaid, Ambetter From Fidelis Care and Medicare lines of business. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care. 

 

 Code change details for each line of business can be found below. These changes may include:   

·         Removing PA requirements based on criticality of review and clinical need. 

·         Creating a more uniform set of prior authorization 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. 

 

If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.

Medicaid

Service Category

PA Rule

Services

Procedure codes

Breast Services

No PA Required if billed with breast cancer diagnosis. PA Required if billed with any other diagnosis

 

Breast Reconstruction

19350, 19364

Surgery-Integumentary System                                           

19303

DME Services

PA Required

 

 

 

Neurostimulators                                                       

E0745

Orthotic & Prosthetic                             

L0460, L0462

Supplies and Devices

E1390

Wheelchairs

E1028, K0826, K0836, K0837, K0838, K0839, K0841, K0843, K0850, K0857, K0858, K0863, K0884

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

 

 

Neurostimulators                                                       

E0730

Orthotic & Prosthetic                             

L2330

Supplies and Devices

E0600

Wheelchairs

E0950, E0956

Drug Codes

PA Required

 

Injections

J0485, J0878, J1437, J3240, Q0138, Q0139, Q4081, Q5105

Medications

J0604

Genetic Analysis

PA Required

Genetic Testing

81201, 81292, 81329, 88262, 88271, 88275

Other Medical Services

No PA Required for PAR providers

Wound Care

97605, 97606, 97607, 97608

Pain Management                                                

 

PA Required

Surgery-Nervous System                                                  

62350, 62362

PA Required

Surgery-Nervous System                                                  

64445

Physician Services

PA Required

Neurological Tests

95700, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95721, 95722, 95723, 95724, 95725, 95726

Skin Procedures

PA Required

 

Muscle Flap Procedures                                                 

15736, 15738

Skin Grafts

15271, 15274, 15275, 15276

No PA Required for PAR providers

Skin Grafts

14060, 14061, 15100, 15101, 15120

PA Required after 12 visits per calendar year

Surgery-Integumentary System                                           

11043

Surgery Procedures

PA Required

Bariatric Surgery

43644, 43645

Hysterectomies                                                         

58545

Joint Replacement Surgery                                              

25447, 27702

Spinal Surgery                                                         

22830, 63200

Surgery-Heart

92920

Surgery-Musculoskeletal System                                         

28285, 28296

No PA Required for PAR providers

Hysterectomies                                                         

58260, 58262, 58550, 58552, 58553, 58554

Surgery-Male Genitalia                                                  

54520

 

Ambetter From Fidelis Care

Service Category

PA Rule

Services

Procedure codes

Breast Services

No PA Required if billed with breast cancer diagnosis. PA Required if billed with any other diagnosis

Surgery-Integumentary System                                           

19303

DME Services

No PA Required for PAR providers

Wheelchairs

K0004

Drug Codes

PA Required

Injections

J3240, Q0138, Q0139, Q5105

Genetic Analysis

 

PA Required

Genetic Testing

0037U

No PA Required for PAR providers

Genetic Testing

81252

Physical Medicine

No PA Required for PAR providers

Orthotic & Prosthetic                             

L5652

Skin Procedures

PA Required

Muscle Flap Procedures                                                 

15734, 15736, 15738

Surgery Procedures

PA Required

Surgery-Musculoskeletal System                                         

25111, 29848

 

 

Medicare

Service Category

PA Rule

Services

Procedure codes

DME Services

No PA Required for PAR providers

Beds

E0185

Orthotic & Prosthetic

L1951

Supplies and Devices

E0486, K0738

Drug Codes

No PA Required for PAR providers

Medications

J1096

Genetic Analysis

No PA Required

for PAR providers

Genetic Testing

81240, 81256

Other Medical Services

No PA Required for PAR providers

Wound Care

E2402

Physical Medicine

No PA Required for PAR providers

Orthotic & Prosthetic

L5629, L5637

Physician Services

No PA Required for PAR providers

Other Services

99499, G3002

Skin Procedures

PA Required

Muscle Flap Procedures

15734, 15736, 15738

No PA Required for PAR providers

Surgery-Integumentary System

11721, 17000, 17250

Surgery Procedures

No PA Required for PAR providers

Surgery-Nervous System

64718, 64719

Vision Services

No PA Required for PAR providers

Vision Evaluation

92004, 92201, 92250