Effective October 1, 2025, Wellcare is notifying all participating Medicare providers that prior authorization will no longer be required for a series of computed tomography (CT) and transthoracic echocardiogram procedure codes.
A comprehensive list of procedure codes affected by this notification are provided in the following table.
|
Procedure Codes No Longer Requiring Prior Authorization Effective October 1, 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 |
Please Note:
- Non-participating providers require authorization for all HMO services, except where indicated. A complete CPT/HCPCS code list can be viewed in the online Medicare Prior Authorization Tool.
- It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.
- Please verify eligibility and benefits for all members prior to rendering services. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered.
For additional assistance, please contact your Provider Engagement Account Manager.
