Medicare AdvantagePrior AuthHigh impact
Evolent Prior Authorization Updates Effective Jan 1, 2027
Ambetter·Cardiology, Vascular Surgery·Prior Authorization
Effective date
Jan 1, 2027
We identified it
Aug 26, 2026
Summary
Effective January 1, 2027, Evolent is adding 24 vascular revascularization procedure codes to prior authorization requirements across Meridian Medicaid, Ambetter from Meridian Marketplace, and Wellcare Medicare plans. All affected codes will be managed through Evolent Specialty Services and require prior authorization before procedures are performed to avoid claim denials.
Action Required
By December 1, 2026: Billing and clinical teams must update prior authorization workflow to require pre-approval for all 18 vascular revascularization codes (37254, 37256, 37258, 37260, 37263, 37265, 37267, 37269, 37271, 37273, 37275, 37277, 37280, 37282, 37284, 37286, 37288, 37290) for patients on Meridian Medicaid, Ambetter from Meridian Marketplace, or Wellcare Medicare plans. Update billing system rules and provider encounter templates to flag these codes for mandatory prior authorization submission to Evolent Specialty Services before scheduling or performing procedures. Train clinical staff and providers on new requirements. Contact local Provider Engagement representative for specific plan guidance. Failure to obtain prior authorization will result in claim denials.