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Q1 2026 Provider Newsletter

Ambetter·AL · Radiology, Cardiology, Nuclear Medicine·Quality Measures
Effective date
Apr 1, 2026
We identified it
Aug 26, 2026
Days to comply

Summary

Ambetter of Alabama is removing prior authorization requirements for 29 specific imaging and diagnostic procedure codes effective on or after April 1, 2026. Billing teams must update their authorization workflows to stop requiring prior auth for these CT, MRI, echocardiography, and nuclear medicine procedures to avoid administrative delays.

Action Required

Action needed
By April 1, 2026: Billing team must remove prior authorization requirements from billing system for all 29 listed CPT codes (70480, 70481, 70482, 70487, 70488, 76380, 71250, 71260, 71270, 71271, 72195, 72196, 72197, 73200, 73201, 73202, 73218, 73219, 73220, 73700, 73701, 73702, 74712, 74713, 75557, 75559, 75561, 75563, 77078, 78472, 78473, 78494, 93312, 93313, 93314, 93315, 93316, 93317, 93318) for Ambetter of Alabama members. Update encounter forms and billing workflows to reflect that these procedures no longer require Evolent authorization. Notify clinical and administrative staff that prior auth submission for these codes is no longer needed. Failure to update system rules may result in unnecessary authorization delays and administrative burden.

Affected Billing Codes

70480
70481
70482
70487
70488
76380
71250
71260
71270
71271
72195
72196
72197
73200
73201
73202
73218
73219
73220
73700
73701
73702
74712
74713
75557
75559
75561
75563
77078
78472
78473
78494
93312
93313
93314
93315
93316
93317
93318