Wellcare is notifying all participating Medicare providers that prior authorization will no longer be required for service dates on or after October 1, 2025. This impacts 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 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 |
Please Note:
- Non-participating providers require authorization for all Medicare 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 request prior authorization for specific codes that require prior authorization as communicated by Wellcare.
- 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 Representative.
