MedicaidPrior AuthMedium impact
Prior Authorization Requirements Effective:1/1/2025
Molina Healthcare·NY·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Molina Healthcare of New York is removing prior authorization requirements for specific DME codes (A4238, A4239, A9276, A9277, A9278, E2102, E2103) effective January 1, 2025, but only for in-network providers. Out-of-network providers will still need prior authorization for these codes.
Action Required
By January 1, 2025: Billing team must update prior authorization workflows to remove PA requirements for DME codes A4238, A4239, A9276, A9277, A9278, E2102, E2103 when billing as in-network providers for Molina Healthcare of New York. Ensure billing system still flags these codes for PA when submitting as out-of-network. Verify updated Codification Matrix on Molina's website.