Oklahoma Complete Health Prior Authorization Requirements For Tonsillectomy and Adenoidectomy, Effective May 2nd, 2026

Date: 03/05/26

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Oklahoma Complete Health wants to share some important updates to our PA requirements. 

Code change details can be found below. These changes include:   Creating a more uniform set of prior authorization requirements for all SoonerSelect Contracted Entities to simplify processes, reduce confusion for providers, and support future efforts. These changes are effective for the SoonerSelect and SoonerSelect Children’s Specialty Program health plans.

If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative or contact Provider Services at 1-833-752-1664. 

Service Type	PA Rule	Services	Procedure Code
Tonsillectomy and Adenoidectomy (T&A)	PA Required	Tonsillectomy and adenoidectomy, underage 12	42820
Tonsillectomy and Adenoidectomy (T&A)	PA Required	Tonsillectomy and adenoidectomy, age 12 or over	42821

Posted: 3/5/26

Oklahoma Complete Health is committed to delivering cost-effective, quality care to our members. This requires us to ensure that our members only receive treatments that are 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. It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.  

Please verify every member’s eligibility and benefits prior to rendering services to them. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. 

Non-Par Providers and facilities require authorization for all services except where indicated.  The codes listed in this document represent the national, standard code sets. Inclusion or exclusion of a code does not constitute or imply subscriber coverage or provider reimbursement. Please refer to your contract with Oklahoma Complete Health to determine all contracted/covered codes for each membership group. Please refer to the Medicaid Fee Schedule and the Billing and Procedure Coding Guide for a list of approved modifier codes.  For a complete list of CPT/HCPCS codes, please use the Pre-Auth Check Tool.

Questions? 

If you have any questions, please call Oklahoma Complete Health Provider Services at 1-833-752-1664 or visit the Find Your Provider Engagement Administrator tool to confirm the individual supporting your specialty and region. We encourage you stay up to date on Oklahoma Complete Health provider notices by reviewing and bookmarking Provider News.