Therapy Add-on Election, Retroactive Rate Changes, January 1 Inflation Rate
Dec 23, 2025 - Upon CMS approval, for per diem rates effective October 1, 2025 and thereafter, costs for Medicaid therapy services, including physical therapy, occupational therapy and speech-language pathology, will be considered allowable costs.
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Applied Behavior Analysis (ABA) Program Expectations and Updates
Dec 18, 2025 - Effective December 1, 2025, the Alabama Medicaid Agency (Medicaid) Mental Health Service Program Area will oversee the Applied Behavior Analysis (ABA) section of Chapter 37 in the Medicaid Provider Billing Manual.
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Additional Diagnoses Information via CPT 99499
Dec 18, 2025 - Effective January 1, 2026, physicians, nurse practitioners, physician assistants, and EPSDT screening providers can submit up to 24 additional diagnosis codes per date of service by submitting up to two claims for CPT 99499 (unlisted/unspecified) per date of service as a claim detail.
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Preferred Drug List (PDL) and Pharmacy Quarterly Update
Dec 8, 2025 - Effective January 1, 2026, the Alabama Medicaid Agency (Medicaid) will:
(1)Require prior authorization (PA) for glycerol phenylbutyrate (generic Ravicti). Brand Ravicti will not require a PA and will be billed with a Dispense as Written (DAW) Code of 9. (2) Require prior authorization for clemastine syrup (generic Tavist), conjugated estrogens tablets (generic Premarin tablets), fluticasone/vilanterol (generic Breo Ellipta), and mirabegron (generic Myrbetriq). Brand Breo Ellipta, Myrbetriq, and Premarin tablets will be preferred and will be billed with a DAW Code of 9.
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