Medicare AdvantagePrior AuthHigh impact
Evolent Prior Authorization Updates Effective January 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 22 cardiology procedure codes related to endovascular revascularization (angioplasty, stent placement, and atherectomy) across iliac, femoral, popliteal, tibial, and peroneal vascular territories to prior authorization requirements for Ambetter Health Marketplace and Wellcare Medicare plans. All affected codes must now be managed through Evolent Specialty Services before procedures are performed.
Action Required
By December 15, 2026: Billing team must update billing system and EMR encounter forms to require prior authorization through Evolent Specialty Services for all 18 cardiology codes (37254, 37256, 37258, 37260, 37263, 37265, 37267, 37269, 37271, 37273, 37275, 37277, 37280, 37282, 37284, 37286, 37288, 37290). Providers must submit prior authorization requests to Evolent Specialty Services before performing any procedures using these codes for Ambetter Health Marketplace and Wellcare Medicare plan members. Front desk staff should flag all scheduled cardiology vascular procedures for these plan types to ensure prior auth is obtained before the January 1, 2027 effective date. Update billing workflows to deny claims processed without prior authorization documentation. Contact your local Provider Engagement representative with questions about specific prior authorization requirements.