Effective 6/1/2022, all Apple Health contracted managed care (MCO) and fee-for-service (FFS) plans have added expedited authorization (EA) criteria for contraceptives.
An EA code will be required on all claims for contraceptives. The EA code will allow pharmacies to submit a claim for contraceptives based on the following criteria.
|Product||EA code||Code criteria|
|Contraceptives||85000000131||Used as a contraceptive, dispense 1 year|
|Contraceptives||85000000132||Used as a contraceptive, dispensed less than a twelve month supply due to ONE of the following: |
|Contraceptives||85000000133||Used for other diagnosis, not related to contraception up to a 90-day supply.|