Medicare AdvantagePrior AuthHigh impact
Evolent Prior Authorization Programs' Code Updates for Medicare Advantage Members
Florida Blue·FL · Cardiology, Oncology, Hematology +1 more·Prior Authorization
Effective date
Aug 25, 2025
We identified it
Jun 16, 2026
Summary
Florida Blue Medicare updated prior authorization code lists for Cardiovascular Services, Oncology and Hematology, and Radiation Oncology services through their Evolent program, effective August 25, 2025. All billed codes must exactly match the authorized codes or claims will be denied.
Action Required
By August 25, 2025: Billing team must access updated prior authorization code lists at evolent.com for Cardiovascular, Oncology/Hematology, and Radiation Oncology services. Ensure all claims use exact HCPCS/CPT codes that match Evolent authorizations - any code mismatch will result in claim denial. Update billing system edits to verify code matching for these specialties.