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AmbetterExchange · Prior Auth · Prior Authorization · NE · Cardiology, Vascular SurgeryHigh impact

Evolent Prior Authorization Updates Effective January 1, 2027

Effective date
Jan 1, 2027
Identified
Aug 26, 2026

Summary

Evolent Specialty Services will require prior authorization for 23 cardiology codes covering angioplasty, stent placement and atherectomy in the iliac, femoral and popliteal, tibial and peroneal, and inframalleolar arteries, plus code 92930 for placement of intracoronary stents. The requirement begins January 1, 2027 for members of the Ambetter Health Marketplace and Wellcare Medicare health plans.

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What to do

Action · 2 steps
01Starting January 1, 2027: Billing team, get prior authorization through Evolent Specialty Services for codes 37254, 37256, 37258, 37260, 37263, 37265, 37267, 37269, 37271, 37273, 37275, 37277, 37280, 37282, 37284, 37286, 37288, 37290, 37292, 37294, 37296, 37298 and 92930 for members of the Ambetter Health Marketplace and Wellcare Medicare health plans.
02Contact your local Provider Engagement representative with questions about specific prior authorization codes or how these changes affect your practice.

Codes mentioned

3725437256372583726037263372653726737269372713727337275372773728037282372843728637288372903729237294372963729892930

Original notice

Evolent Prior Authorization Updates Effective January 1, 2027
ambetterhealth.com · Always check the source before changing claims.
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Related changes

See all Ambetter changes →
Evolent Prior Authorization Updates: Effective January 1, 2027MediumEffective Jan 1, 2027 · Prior AuthorizationAmbetter of Tennessee Q3 2026 NewsletterHighEffective Oct 1, 2026 · Provider BulletinNew Prior Authorization Requirement for Certain Procedures: Effective January 1, 2027MediumEffective Jan 1, 2027 · Prior AuthorizationEvolent Prior Authorization Updates: Effective October 1, 2026HighEffective Oct 1, 2026 · Prior AuthorizationBrowse every Ambetter change in the policy list

Related policy hubs

Ambetter policiesNE policy changesCardiologyVascular SurgeryCode 37254Code 37256Code 37258Code 37260Code 37263Code 37265Code 37267Code 37269Code 37271Code 37273Code 37275Code 37277Code 37280Code 37282Code 37284Code 37286Code 37288Code 37290Code 37292Code 37294Code 37296Code 37298Code 92930

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