MedicaidPrior AuthHigh impact
Evolent Prior Authorization Updates: Effective October 1, 2026
Ambetter·Cardiology, Vascular Surgery·Prior Authorization
Effective date
Oct 1, 2026
We identified it
Aug 28, 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 across Absolute Total Care Medicaid, Ambetter from Absolute Total Care Marketplace, and Wellcare Medicare plans. All affected codes will be managed by Evolent Specialty Services and require prior authorization before procedures are performed.
Action Required
By September 30, 2026: Billing team must update all billing and EMR systems to require prior authorization from Evolent Specialty Services before submitting claims for CPT codes 37254, 37256, 37258, 37260, 37263, 37265, 37267, 37269, 37271, 37273, 37275, 37277, 37280, 37282, 37284, 37286, 37288, and 37290. Update provider order entry forms and encounter templates with prior authorization reminders for all cardiology endovascular revascularization procedures. Contact Evolent Specialty Services and your local Provider Engagement representative to establish submission protocols. Ensure front desk and clinical staff notify cardiology providers of the new requirement. Claims submitted without prior authorization for these codes on Absolute Total Care Medicaid, Ambetter Marketplace, or Wellcare Medicare plans will be denied.