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 20 cardiology procedure codes related to endovascular revascularization (angioplasty, stent placement, and atherectomy) to its prior authorization requirements for Ambetter Health Marketplace and Wellcare Medicare plans. All affected codes will be managed by Evolent Specialty Services and require prior authorization before service delivery to avoid claim denials.
Action Required
By December 31, 2026: Billing team must update all billing software and encounter forms to require prior authorization for CPT codes 37254, 37256, 37258, 37260, 37263, 37265, 37267, 37269, 37271, 37273, 37275, 37277, 37280, 37282, 37284, 37286, 37288, and 37290 when billed to Ambetter Health Marketplace or Wellcare Medicare plans. Create internal workflows to route all cardiology revascularization cases to Evolent Specialty Services for prior authorization approval before scheduling. Notify all providers and clinical staff performing these procedures. Claims submitted without prior authorization will be denied. Contact your local Provider Engagement representative at Evolent with questions about specific codes.