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首頁 | Fidelis Care医疗保健经纪人

Welcome, Brokers!

Fidelis Care serves more than 1.7 million children and adults of all ages, making us one of the largest health insurance plans in New York State. We were founded on the belief that all New Yorkers should have access to quality, affordable health insurance, and our mission to help others informs everything that we do. 

Latest News


Important Prior Authorization Updates Effective October 1, 2026
2026/8/31 • 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. 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 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. 

 

For 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

Behavioral Health

No PA Required for participating providers

 

Neurobehavioral Status Exam

 

96116, 96121

DME and Supplies

No PA Required for participating providers

Mobility Services

E0630

Respiratory Devices and Supplies

E0443

Wheelchairs

E0954, E0955, E2607, E2608, E2622, E2623, E2624, E2625

Orthotic and Prosthetic

L1932, L2630, L5000, L5620, L5629, L5631, L5637, L5704, L5920, L5950

Drug Codes

No PA Required CHP members only

Diabetic Drugs and Supplies

A4238

Genetic Analysis

No PA Required for participating providers

Genetic Testing

81161, 81200, 81206, 81207, 81240, 81241, 81242, 81243, 81250, 81251, 81255, 81260, 81279, 81297, 81304, 81319, 81338, 81339, 81400, 81401

Hearing Services

No PA Required for participating providers

Implants and Supplies

L8624

Hearing Aids

V5130, V5160, V5140

Home Services

No PA Required for participating providers

Home Visit

S9211, T1028

Nursing Services

T1001

Other Medical Services

PA Required

Other Services

T1999

No PA Required for participating providers

Wound Care

97597

Dental Care

G0330

Waiver Services

T2023

Incontinence Supplies

T4541

Physician Services

PA Required

Diagnostic Testing

91299

No PA Required for participating providers

Diagnostic Testing

91110, 91111, 91112

Sleep Medicine

No PA Required for participating providers

Sleep Studies

95800, 95805, 95806

Surgery Procedures

No PA Required for participating providers

Eye and Ocular Adnexa

67904

 

 

Ambetter From Fidelis Care

Service Category

PA Rule

Services

Procedure codes

Anesthesia

PA Required

Anesthesia Services

00170

Genetic Analysis

PA Required

Genetic Testing

0211U, 0345U

No PA Required for participating providers

Genetic Testing

86813, 86817

Home Services

No PA Required for participating providers

Home Visit

S9211, S9213, S9214

Surgery Procedures

PA Required

Tonsil and Adenoid Procedures

42835

Transplant Services

No PA Required for participating providers

Transplant

38208

 

 

Medicare

Service Category

PA Rule

Services

Procedure codes

Testing

No PA Required

Psychological Testing/Neuropsychological Testing

96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146

DME and Supplies

No PA Required

Equipment and Accessories

E0656, E0657

Orthotic and Prosthetic

L0457, L0650, L1932, L1940, L1960, L2330, L3030

Respiratory Devices and Supplies

E0470, E0471, E0562

Supplies and Devices

E0935

Wheelchairs

E1226, E2310, E2374, E2607, E2608, E2613, E2614, E2615, E2622, E2623, E2624, E2625

DME Services

No PA Required

Wheelchairs

E1032, E1033, E1034

Genetic Analysis

No PA Required

Genetic Testing

88271, 88275, 88280

Home Services

No PA Required

Infusion Services

99601, 99602, S9500

Other Medical Services

PA Required

Wound Care

97605, 97606

Pain Management

No PA Required

Surgery – Nervous System

64566

Physician Services

No PA Required

Diagnostic Testing

91110, 91111, 91112, 91113

Home Visit

99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350

Surgery Procedures

No PA Required

Integumentary Services

14000, 14001, 14020, 14021, 14040, 14041, 14060, 14061, 15100

Musculoskeletal System

29848

Transportation Services

PA Required

Medical Transportation

A0100

 

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