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AmbetterExchange · Prior Auth · Prior Authorization · TX · Cardiology, Vascular SurgeryMedium impact

New Prior Authorization Requirement for Certain Procedures: Effective January 1, 2027

Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Sep 11, 2026

Summary

Starting January 1, 2027, Superior HealthPlan, Ambetter from Superior HealthPlan, Ambetter Health, and Wellcare By Superior HealthPlan Dual Align are adding prior authorization for 23 cardiac procedure codes. The codes cover endovascular revascularization of the iliac, femoral and popliteal, tibial and peroneal, and inframalleolar vascular territories, plus coronary stent placement code 92930. Prior authorization does not apply to Medicaid STAR, STAR Health, STAR Kids, and STAR+PLUS members under age 21, or to Ambetter members under age 18.

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What to do

by Jan 1, 2027 · 5 steps
01Billing team and providers must obtain prior authorization for the 23 listed codes for members of these plans, except the exempt Medicaid and Ambetter members described above.
02Evolent Specialty Services, Inc.
03processes these requests, which can be submitted through the provider portal at www1.RadMD.com, by calling 1-800-642-7554, or by fax to 1-800-784-6864.
04Review Evolent's cardiac clinical guidelines on its Cardiology webpage or at www1.RadMD.com.
05Contact your local Provider Engagement Representative with questions about specific prior authorization requirements or how these changes affect your practice.

Codes mentioned

3725437256372583726037263372653726737269372713727337275372773728037282372843728637288372903729237294372963729892930

Original notice

New Prior Authorization Requirement for Certain Procedures: Effective January 1, 2027
ambetterhealth.com · Always check the source before changing claims.
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Related changes

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Evolent Prior Authorization Updates: Effective January 1, 2027MediumEffective Jan 1, 2027 · Prior AuthorizationAmbetter of Tennessee Q3 2026 NewsletterHighEffective Oct 1, 2026 · Provider BulletinEvolent Prior Authorization Updates: Effective October 1, 2026HighEffective Oct 1, 2026 · Prior AuthorizationEvolent Prior Authorization Updates Effective October 1, 2026MediumEffective Oct 1, 2026 · Prior AuthorizationBrowse every Ambetter change in the policy list

Related policy hubs

Ambetter policiesTX policy changesCardiologyVascular SurgeryCode 37254Code 37256Code 37258Code 37260Code 37263Code 37265Code 37267Code 37269Code 37271Code 37273Code 37275Code 37277Code 37280Code 37282Code 37284Code 37286Code 37288Code 37290Code 37292Code 37294Code 37296Code 37298Code 92930

Summaries are AI-assisted. Always confirm against the original payer notice.

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