Update to Medicaid Prior Authorization Codes

Date: 10/17/24

Effective February 1, 2025, Iowa Total Care will apply changes to prior authorization requirements. These changes are applicable to all Medicaid products.

Iowa Total Care is committed to delivering cost-effective, quality care to our members. This effort requires us to ensure that our members only receive treatment that is medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in-network utilization, where applicable.

For additional information regarding list of codes impacted by this change please refer to the Prior Authorization Code List (PDF).

It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization. 

Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. Non-par providers & facilities require authorization for all HMO services except where indicated.

For a complete CPT/HCPCS code listing, please visit our Prior Authorization Check Tool.

For questions or concerns, contact your provider relations specialist or call Provider Services at
1-833-404-1061, Monday – Friday 7:30 a.m. to 6 p.m. CT.

Thank you for your partnership in serving Iowa Total Care members.