Fidelis Care Authorization Grids Effective September 1, 2026
2026/7/28
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Posted by Provider Relations
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Provider News
The following section of the Fidelis Care authorization grids has been updated effective September 1, 2026.
The following section of the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and requires prior authorization:
III. Outpatient surgery: The following services require prior authorization:
D. Skin surgery and other dermatological procedures: Q4110, Q4111
The following codes have been added to the Medicaid, CHP, Essential Plan, Ambetter Metal-Level Plans, and Medicare Authorization Grids and require prior authorization:
J0528 fosfomycin disodium
J2374 apraclonidine hcl
J7176 fibrinogen-chmt (Fesilty)
Visit: Authorization Grids