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Important Prior Authorization Updates: Effective 04/01/2026

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Wellcare wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

Code change details can be found below. These changes may include:

  • Removing PA requirements based on criticality of review and clinical need.
  • Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests. 

If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your Provider Engagement Account Manager (PEAM) or call Wellcare Provider Services at 1-855-538-0454 Monday through Friday from 8 a.m. to 8 p.m. Eastern.

Effective April 1, 2026, the following are changes to prior authorization requirements:

 Service Category  PA Rule  Services  Procedure Codes 
DME Services

No PA Required
for PAR providers

 Beds E0185
Orthotic and Prosthetic  L1951
Supplies and Devices E0486
Drug Codes No PA Required
for PAR providers		 Medications J1096
Genetic Analysis No  PA Required
for PAR providers 		 Genetic Testing 81240, 81256
Physician Services  No  PA Required
for PAR providers		 Iba Pang Mga Serbisyo G3002
Skin Procedures PA Required Muscle Flap Procedures 15734, 15736, 15738 
Surgery Procedures  No  PA Required
for PAR providers		 Surgery-Nervous System  64718, 64719

 

 

 

 

 

Questions?

Wellcare has a wealth of resources available to help answer your questions and address your concerns:

 

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Y0020_WCM_178064E_M Last Updated On: 11/10/2025