CommercialPrior AuthMedium impact
[Texas] Important Prior Authorization Updates: Effective April 1, 2026 (PDF)
WellCare·TX · General Surgery, Ophthalmology, Dermatology +6 more·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 2, 2026
Summary
Effective April 1, 2026, WellCare is removing prior authorization requirements for 20 specific procedure codes across multiple service categories (DME, medications, genetic testing, imaging, wound care, surgery, and vision services) for PAR (participating) providers in Texas. This change simplifies the PA process and reduces administrative burden while maintaining clinical oversight for non-PAR providers.
Action Required
By March 31, 2026: Billing team must update the billing system and prior authorization workflows to remove PA requirements for the 23 listed CPT and HCPCS codes when billing WellCare for PAR providers in Texas. Verify practice's PAR status with WellCare. Create internal communication to providers (especially orthopedic, general surgery, ophthalmology, and dermatology specialists) informing them that prior authorization is no longer required for these specific codes effective April 1, 2026. Update encounter forms and billing templates to reflect PA elimination for these codes. Confirm changes are live in the system by March 28, 2026 to prevent submission delays. Non-PAR providers must continue following existing PA requirements for these codes.