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. |
For additional questions, email: [email protected] or call Community Health Plan Customer Service at 1-800-440-1561 Monday through Friday 8:00 am to 5:00 pm.
