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[Texas] Evolent Prior Authorization Updates Effective January 1, 2027 (PDF)
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
[Texas] Evolent Prior Authorization Updates Effective January 1, 2027 (PDF)
wellcare.com · Always check the source before changing claims.