64494 Insurance Policy Changes

Reminder: Expansion of vendor program and training sessions

Effective October 1, 2025, Evolent will assume utilization management (prior authorization) for spine and interventional pain management services for Tufts Medicare Preferred members. Prior authorization requirements are changing for specific CPT codes—some codes will have authorization requirements removed, others newly require authorization, and some will continue through Evolent instead of Tufts Health Plan. Billing teams must update systems to route authorization requests to Evolent and track code-specific authorization requirements.