Prior authorization requirements for various radiology, diagnostic cardiology, and cardiology procedures under Evolent’s Utilization review matrix will be removed, effective April 1, 2026. Meridian Medicaid Plan (Meridian), YouthCare HealthChoice Illinois (YouthCare), Wellcare of Illinois, and Ambetter Health will not require prior authorization for the CPT codes listed, reflecting updates in authorization policies.
Find details in the Evolent Authorization Requirements Effective April 1, 2026
The following radiology and diagnostic cardiology (RBM) codes have been removed from Evolent’s Utilization review matrix and no longer require prior authorization for Meridian and YouthCare.
|
Modality |
Impacted CPT |
|---|---|
|
CT ORBIT/EAR/FOSSA WITH O DYE |
70480, 70481, 70482 |
|
CT MAXLOFCE AREA; W/O CONTRAST MATL |
70487, 70488, 70486, 76380 |
|
DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST |
71250, 71260, 71270, 71271 |
|
CT UPPER EXTREMITY WITH O DYE |
73200, 73201, 73202 |
|
MRI UPPR EXTREMITY WITH OAND WITH DYE |
73218, 73219, 73220 |
|
CT LOWER EXTREMITY WITH O DYE |
73700, 73701, 73702 |
|
MRI FETAL SNGL/1ST GESTATION |
74712, 74713 |
|
CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST |
75557, 75559, 75561, 75563 |
|
CT HRT WITH 3D IMAGE CONGEN |
75573 |
|
MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL |
77046, 77047, 77048, 77049 |
|
CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE |
77078 |
|
MRI BONE MARROW BLOOD SUPPLY |
77084 |
|
GATED HEART PLANAR SINGLE |
78472, 78473, 78494 |
|
ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL |
93312, 93313, 93314, 93315, 93316, 93317, 93318 |
The following radiology and diagnostic cardiology (RBM) codes have been removed from Evolent’s Utilization review matrix and no longer require prior authorization for Ambetter Health.
|
Modality |
Impacted CPT |
|---|---|
|
CT ORBIT/EAR/FOSSA WITH O DYE |
70480, 70481, 70482 |
|
CT MAXLOFCE AREA; W/O CONTRAST MATL |
70487, 70488, 70486, 76380 |
|
DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST |
71250, 71260, 71270, 71271 |
|
MRI PELVIS WITH DYE |
72195, 72196, 72197 |
|
CT UPPER EXTREMITY WITH O DYE |
73200, 73201, 73202 |
|
MRI UPPR EXTREMITY WITH OAND WITH DYE |
73218, 73219, 73220 |
|
CT LOWER EXTREMITY WITH O DYE |
73700, 73701, 73702 |
|
MRI FETAL SNGL/1ST GESTATION |
74712, 74713 |
|
CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST |
75557, 75559, 75561, 75563 |
|
CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE |
77078 |
|
GATED HEART PLANAR SINGLE |
78472, 78473, 78494 |
|
ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL |
93312, 93313, 93314, 93315, 93316, 93317, 93318 |
The following radiology and diagnostic cardiology (RBM) codes have been removed from Evolent’s Utilization review matrix and no longer require prior authorization for Wellcare of Illinois.
|
Modality |
Impacted CPT |
|---|---|
|
CT ORBIT/EAR/FOSSA WITH O DYE |
70480, 70481, 70482 |
|
CT MAXLOFCE AREA; W/O CONTRAST MATL |
70487, 70488, 70486, 76380 |
|
CT SOFT TISSUE NECK WITH O DYE |
70490, 70491, 70492 |
|
MRI IMAGING BRAIN; INCLUDING BRAIN STEM; WITHOUT CONTRAST MATERIAL |
70551, 70552, 70553 |
|
MRI- SPINAL CANAL AND CONTENTS, CERVICAL; WITHOUT CONTRAST MATERIAL |
72141, 72142, 72156 |
|
MRI, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL |
72146, 72147, 72157 |
|
MRI- SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL |
72148, 72149, 72158 |
|
MRI PELVIS WITH DYE |
72195, 72196, 72197 |
|
CT UPPER EXTREMITY WITH O DYE |
73200, 73201, 73202 |
|
MRI UPPR EXTREMITY WITH OAND WITH DYE |
73218, 73219, 73220 |
|
MRI JOINT UPR EXTREM WITH O DYE |
73221, 73222, 73223 |
|
CT LOWER EXTREMITY WITH O DYE |
73700, 73701, 73702 |
|
CT ABDOMEN WITH O DYE |
74150, 74160, 74170 |
|
MRI ABDOMEN WITH O DYE |
74181, 74182, 74183, S8037 |
|
MRI FETAL SNGL/1ST GESTATION |
74712, 74713 |
|
CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST |
75557, 75559, 75561, 75563 |
|
CT HRT WITH 3D IMAGE |
75572 |
|
CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST |
75574 |
|
MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL |
77046, 77047, 77048, 77049 |
|
CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE |
77078 |
|
MRI BONE MARROW BLOOD SUPPLY |
77084 |
|
GATED HEART PLANAR SINGLE |
78472, 78473, 78494 |
|
ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL |
93312, 93313, 93314, 93315, 93316, 93317, 93318 |
The following cardiology codes have been removed from Evolent’s Utilization Review Matrix and no longer require prior authorization for Wellcare of Illinois.
|
Modality |
Impacted CPT |
|---|---|
|
CORONARY ARTERY DISEASE SURGERY |
93580 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
C1722 |
|
CARDIAC CATHETERIZATION |
93505 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
92960 |
|
CARDIAC CATHETERIZATION |
93451 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
C1882 |
|
CORONARY ARTERY DISEASE SURGERY |
C1732 |
|
INTERRUPTION/LIGATION/STRIPPING ETC. |
37766 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33224 |
|
ANGIOGRAPHY |
76937 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33225 |
|
ANGIOGRAPHY |
75736 |
|
CORONARY ARTERY DISEASE SURGERY |
C1895 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
C1760 |
|
ELECTROPHYSIOLOGY STUDIES (EPS) |
93662 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33271 |
|
INTERRUPTION/LIGATION/STRIPPING ETC. |
37765 |
|
CARDIAC CATHETERIZATION |
93571 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
C1785 |
|
CORONARY ARTERY DISEASE SURGERY |
33217 |
|
ANGIOGRAPHY |
93580 |
|
CORONARY ARTERY DISEASE SURGERY |
33223 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33226 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33222 |
|
CARDIAC CATHETERIZATION |
93567 |
|
INTERVENTIONAL CARDIOLOGY |
33418 |
|
EXCISION EXPLORATION REPAIR REVISION |
35883 |
|
BYPASS GRAFT IN-SITU VEIN |
35656 |
|
ELECTROPHYSIOLOGY STUDIES (EPS) |
C1730 |
|
CORONARY ARTERY DISEASE SURGERY |
33215 |
|
BYPASS GRAFT IN-SITU VEIN |
35621 |
|
THROMBOENDARTERECTOMY |
35355 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33218 |
|
REPAIR/EXCISION FOR ANEURYSM OCCLUSIVE DISEASE ETC. |
35011 |
|
DEVICE MONITORING |
93292 |
|
CORONARY ARTERY DISEASE SURGERY |
93650 |
|
PULMONARY VALVE SURGERY |
33477 |
|
ANGIOGRAPHY |
36254 |
|
BYPASS GRAFT IN-SITU VEIN |
35661 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33286 |
|
THROMBOENDARTERECTOMY |
35302 |
|
EXCISION EXPLORATION REPAIR REVISION |
35881 |
|
THROMBOENDARTERECTOMY |
35302 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33202 |
|
INTERVENTIONAL CARDIOLOGY |
93590 |
|
TAVR |
33361 |
|
BYPASS GRAFT VEIN |
35556 |
|
ANGIOGRAPHY |
36218 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
92961 |
|
THROMBOENDARTERECTOMY |
35371 |
|
CORONARY ARTERY DISEASE SURGERY |
93583 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
C1900 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33236 |
|
TAVR |
33362 |
|
TAVR |
33363 |
|
TAVR |
33364 |
|
TAVR |
33365 |
|
TAVR |
33366 |
|
TAVR |
33369 |
|
PULMONARY VALVE SURGERY |
33475 |
|
CONGENITAL HEART DISESE SURGERY |
33820 |
|
REPAIR/EXCISION FOR ANEURYSM OCCLUSIVE DISEASE ETC. |
35001 |
|
REPAIR/EXCISION FOR ANEURYSM OCCLUSIVE DISEASE ETC. |
35141 |
|
REPAIR/EXCISION FOR ANEURYSM OCCLUSIVE DISEASE ETC. |
35151 |
|
CORONARY ARTERY DISEASE SURGERY |
35305 |
|
THROMBOENDARTERECTOMY |
35372 |
|
BYPASS GRAFT VEIN |
35558 |
|
BYPASS GRAFT VEIN |
35566 |
|
BYPASS GRAFT VEIN |
35571 |
|
BYPASS GRAFT IN-SITU VEIN |
35583 |
|
BYPASS GRAFT IN-SITU VEIN |
35585 |
|
BYPASS GRAFT IN-SITU VEIN |
35587 |
|
BYPASS GRAFT IN-SITU VEIN |
35671 |
|
EXCISION EXPLORATION REPAIR REVISION |
35700 |
|
CORONARY ARTERY DISEASE SURGERY |
35884 |
|
INTERVENTIONAL CARDIOLOGY |
93581 |
|
THERAPEUTIC SERVICES |
93745 |
|
DEVICE MONITORING |
K0606 |
|
CARDIAC CATHETERIZATION |
93565 |
|
BYPASS GRAFT IN-SITU VEIN |
35646 |
|
TRICUSPID VALVE SURGERY |
33465 |
|
CARDIAC CATHETERIZATION |
93566 |
|
BYPASS GRAFT IN-SITU VEIN |
35654 |
|
BYPASS GRAFT IN-SITU VEIN |
35666 |
|
THROMBOENDARTERECTOMY |
35351 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33220 |
|
CARDIAC CATHETERIZATION |
93563 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33234 |
|
CORONARY ARTERY DISEASE SURGERY |
33405 |
|
CARDIAC CATHETERIZATION |
93568 |
|
THROMBOENDARTERECTOMY |
35301 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33235 |
|
INTERVENTIONAL CARDIOLOGY |
93591 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33275 |
|
INTERVENTIONAL CARDIOLOGY |
92987 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33233 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
C2621 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33227 |
|
CARDIAC CATHETERIZATION |
C1759 |
|
INTERVENTIONAL CARDIOLOGY |
92997 |
|
INTERVENTIONAL RADIOLOGY |
36837 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33229 |
|
ANGIOGRAPHY |
75580 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33228 |
|
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION |
33274 |
|
INTERVENTIONAL RADIOLOGY |
36836 |
|
CORONARY ARTERY DISEASE SURGERY |
93454 |
|
CARDIAC CATHETERIZATION |
93459 |
|
CARDIAC CATHETERIZATION |
93460 |
