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WellCareCommercial · Prior Auth · Provider Bulletin · TX · General Surgery, Ophthalmology, Dermatology +6 moreMedium impact

[Texas] Important Prior Authorization Updates: Effective April 1, 2026 (PDF)

Act
by Mar 31, 2026
Effective date
Apr 1, 2026
Identified
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.

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What to do

by Mar 31, 2026 · 6 steps
01Billing 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.
02Verify practice's PAR status with WellCare.
03Create 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.
04Update encounter forms and billing templates to reflect PA elimination for these codes.
05Confirm changes are live in the system by March 28, 2026 to prevent submission delays.
06Non-PAR providers must continue following existing PA requirements for these codes.

Codes mentioned

E0185L1951E0486K0738J1096812408125677002E2402L5629L563799499G300211721170001725066982669846471864719920049220192250

Original notice

[Texas] Important Prior Authorization Updates: Effective April 1, 2026 (PDF)
wellcare.com · Always check the source before changing claims.
View original ↗

Related changes

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[Georgia] Important Prior Authorization Updates: Effective April 1, 2026 (PDF)MediumEffective Apr 1, 2026 · Provider BulletinBrowse every WellCare change in the policy list

Related policy hubs

WellCare policiesTX policy changesGeneral SurgeryOphthalmologyDermatologyOrthopedicsWound CareNuclear MedicineGeneticsPhysical TherapyPM&R (Physical Medicine & Rehab)Code E0185Code L1951Code E0486Code K0738Code J1096Code 81240Code 81256Code 77002Code E2402Code L5629Code L5637Code 99499Code G3002Code 11721Code 17000Code 17250Code 66982Code 66984Code 64718Code 64719Code 92004Code 92201Code 92250

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