Medicare AdvantagePrior AuthHigh impact
Evolent Prior Authorization Updates: Effective October 1, 2026
Ambetter·MS · 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 in iliac, femoral, popliteal, and tibial/peroneal vascular territories) to prior authorization requirements for Ambetter from Magnolia Health Marketplace and Wellcare Medicare health plans. These procedures will now require prior authorization through Evolent Specialty Services before billing.
Action Required
By September 30, 2026: Billing team must update all billing system workflows 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 for Ambetter from Magnolia Health and Wellcare Medicare plans. Update encounter templates and provider documentation requirements to remind physicians that these endovascular revascularization procedures require prior authorization submission to Evolent Specialty Services before scheduling or performing the procedure. Train billing staff to submit prior authorization requests immediately upon procedure scheduling. Claims submitted without prior authorization will be denied. Contact local Provider Engagement representative with questions about specific codes or practice impact.