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Medicare AdvantagePrior AuthHigh impact

Reminder: Expansion of vendor program and training sessions

Harvard Pilgrim Health Care·Pain Management, Neurosurgery, Orthopedics +1 more·Prior Authorization
Effective date
Oct 1, 2025
We identified it
Jun 26, 2026
Days to comply

Summary

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.

Action Required

Action needed
By September 30, 2025: Billing team must (1) Update authorization routing in billing software to direct spine and interventional pain management prior authorization requests for Tufts Medicare Preferred members to Evolent (phone: 866-642-9703, fax: 800-784-6864, online: www.radmd.com) instead of Tufts Health Plan; (2) Create or update internal documentation identifying which codes no longer require prior authorization (22800, 22802, 22808, 22810, 22812) and remove authorization requirements for these in billing system rules; (3) Configure system to require prior authorization for newly mandated codes including 62320, 62322, 64490-64495, 63075-63076, 63005, 63012, 63017, 63042, 62380, 63030, 27279, and add-on codes +22614, +22534, +22585, +22632, +22634, +63052, +63053; (4) Establish process for rendering providers to verify authorization numbers through Evolent website (www.radmd.com) or Tufts Health Plan secure portal before service delivery; (5) Notify ordering and rendering providers and clinical staff of contact information and new authorization workflow; (6) Document that existing approved authorizations from Tufts Health Plan remain valid and do not require re-authorization. Failure to obtain prior authorization through Evolent for required services will result in claim denials. Recommend staff attend Evolent training sessions this month (registration via provider website).

Affected Billing Codes

62320
62322
62321
62323
64479
64480
64483
64484
22800
22802
22808
22810
22812
22614
22548
22551
22552
22554
22590
22595
22600
22534
22585
22632
22634
63052
63053
22533
22558
22612
22630
22633
64490
64491
64492
64633
64634
64493
64494
64495
63075
63076
63005
63012
63017
63042
63044
63047
63048
63056
63057
62380
63030
63035
27279
22858