Medicare AdvantagePrior AuthHigh impact
Evolent Prior Authorization Updates Effective October 1, 2026
Ambetter·LA · 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 for vascular revascularization to the prior authorization requirement for Ambetter Louisiana Marketplace and Wellcare Medicare plans. All procedures involving iliac, femoral, popliteal, and tibial/peroneal vascular territories with angioplasty, stent placement, or atherectomy now require prior authorization through Evolent Specialty Services.
Action Required
By September 30, 2026: Billing team must update billing system and prior authorization workflows to require prior authorization through Evolent Specialty Services for CPT codes 37254, 37256, 37258, 37260, 37263, 37265, 37267, 37269, 37271, 37273, 37275, 37277, 37280, 37282, 37284, 37286, 37288, and 37290 for all Ambetter Louisiana Marketplace and Wellcare Medicare plan patients. Update encounter templates and provider alerts to flag these codes as requiring prior auth. Contact your local Provider Engagement representative for Evolent Specialty Services contact information and submission procedures. Claims submitted without prior authorization for these codes will be denied for Ambetter Louisiana and Wellcare members effective October 1, 2026.