Starting October 1, 2025, Evolent will no longer require prior authorization will for the following CT and transthoracic echocardiogram procedure codes for Medicare members:
Procedure Codes No Longer Requiring Prior Authorization from Evolent
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Procedure Codes No Longer Requiring Prior Authorization Effective 10/01/2025 |
|
|
Procedure |
Procedure Codes |
|
Chest CT |
71250, 71260, 71270, 0722T |
|
CT for Low Dose Lung Cancer Screening |
71271 |
|
CT of the Pelvis and Abdomen |
74176, 74177, 74178, 0722T |
|
Transthoracic Echocardiogram |
93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93356 |
Important Notes:
- Non-participating providers still require prior authorization for all HMO services unless otherwise specified.
- Wellcare (PPO): A complete CPT/HCPCS code list can be viewed in the online Medicare Prior Authorization Tool
- Wellcare by Allwell (HMO): Review the Pre-Auth Check Tool on our website www.azcompletehealth.com > For Providers> Pre-Auth Check to confirm if a CPT/HCPCS code requires prior authorization
- The ordering/prescribing provider is responsible for verifying which codes require prior authorization.
- Always verify member eligibility and benefits before providing service. Payment, regardless of prior authorization, is contingent on the member’s eligibility at the time service is rendered.
Questions?
Contact your Provider Engagement Account Manager. Need their contact information? Email us at: AzCHProviderEngagement@azcompletehealth.com
