Prior authorization updates effective January 15, 2025

Simply and CHA are transitioning to the Availity Essentials platform to obtain prior authorizations.
As of January 15, 2025, the following CPT^® codes require preapproval.

CPT code(s)	Description
S9128	Speech therapy, in the home
S9129	Occupational therapy, in the home
S9131	Physical therapy in the home, per diem
T1021	Home health aide or certified nurse assistant, per visit. Authorization required for > 2 visits/day
43236	Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance

Standard preapproval requests for Simply, CHA, and FHK can be submitted via:

• Availity Essentials: https://Availity.com
• Phone: 844-405-4296
• Fax: 800-964-3627
• Fax: Long-term care benefit authorizations: 844-285-1169

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative or call Provider Services at 844-405-4296.