MedicaidPrior AuthHigh impact
Evolent Prior Authorization Updates: Effective October 1, 2026
Ambetter·IA · Cardiology, Vascular Surgery·Prior Authorization
Effective date
Oct 1, 2026
We identified it
Aug 26, 2026
Summary
Effective October 1, 2026, Evolent is adding 24 cardiology procedure codes related to endovascular revascularization procedures (angioplasty, stent placement, and atherectomy) across iliac, femoral, popliteal, and tibial/peroneal vascular territories to its prior authorization requirements. These codes will now require prior authorization through Evolent Specialty Services for Iowa Total Care Medicaid and Ambetter Health Marketplace plans.
Action Required
By September 15, 2026: Billing team must update billing system and prior authorization workflows to require prior authorization for all 18 cardiology CPT codes (37254, 37256, 37258, 37260, 37263, 37265, 37267, 37269, 37271, 37273, 37275, 37277, 37280, 37282, 37284, 37286, 37288, 37290) when billed to Iowa Total Care Medicaid and Ambetter Health Marketplace plans. Update billing software to automatically flag these codes for Evolent Specialty Services prior authorization requests before claim submission. Notify providers and clinical staff that endovascular revascularization procedures in the iliac, femoral, popliteal, and tibial/peroneal territories now require prior authorization. Claims submitted without prior authorization for these codes to affected plans will be denied. Contact your local Provider Engagement representative at Evolent with questions about specific codes.