News
Prior Authorization for Radiology and Diagnostic Cardiology (RBM) and Advanced Cardiology
Date: 01/29/26
Evolent manages prior authorizations for Centene for Radiology and Diagnostic Cardiology (RBM) and Advanced Cardiology.
Beginning on April 1st, 2026, the following procedure codes included in this bulletin have been removed from Evolent’s Utilization Review Matrix and will no longer require prior authorization through Evolent.
If you have any questions regarding this update, please contact your Provider Engagement Account Manager.
RADIOLOGY AND DIAGNOSTIC CARDIOLOGY (RBM) | |
|---|---|
Modality | Impacted CPT |
CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST | 75557, 75559, 75561, 75563 |
CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE | 77078 |
CT LOWER EXTREMITY WITH O DYE | 73700, 73701, 73702 |
CT MAXLOFCE AREA; W/O CONTRAST MATL | 70487,70488, 70486, 76380 |
CT ORBIT/EAR/FOSSA WITH O DYE | 704,807,048,170,482 |
CT UPPER EXTREMITY WITH O DYE | 73200, 73201, 73202 |
DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST | 71250, 71260, 71270, 71271 |
ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL | 93312, 93313, 93314, 93315, 93316, 93317, 93318 |
GATED HEART PLANAR SINGLE | 78472, 78473, 78494 |
MRI FETAL SNGL/1ST GESTATION | 74712, 74713 |
MRI PELVIS WITH DYE | 72195, 72196, 72197 |
MRI UPPR EXTREMITY WITH OAND WITH DYE | 73218, 73219, 73220 |
CARDIOLOGY | |
|---|---|
NCH Category | Impacted CPT |
ANGIOGRAPHY | 76937, 75736, 36253, 36254, 36218, 75580 |
BYPASS GRAFT IN-SITU VEIN | 35656, 35621,35661, 35583, 35585, 35587, 35671, 35646, 35654, 35666, |
BYPASS GRAFT VEIN | 35556, 35558, 35566, 35571 |
CARDIAC CATHETERIZATION | 93505, 93451, 93571, 93567, 93565, 93566, 93563, 93568, C1759 |
CONGENITAL HEART DISESE SURGERY | 33820 |
CORONARY ARTERY DISEASE SURGERY | 93580, C1732, C1895, 33217, 33223, 33215, 93650, 93583, 35305, 35884, 33405 |
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION | C1722, 92960, C1882, 3322, 33225, C1760, 33271, C1785, 33226, 33222, 33218, 33286, 33202, 92961, C1900, 33236, 33220, 33234, 33235, 33275, 33233, C2621, 33227, 33229, 33228, 33274 |
DEVICE MONITORING | 93292, K0606 |
ELECTROPHYSIOLOGY STUDIES (EPS) | 93662, C1730 |
EXCISION EXPLORATION REPAIR REVISION | 35883, 35881, 35700 |
INTERRUPTION/LIGATION/STRIPPING ETC. | 37766, 37765 |
INTERVENTIONAL CARDIOLOGY | 33418, 93590, 93581, 92987, 92997, 36836 |
PULMONARY VALVE SURGERY | 33477, 33475 |
REPAIR/EXCISION FOR ANEURYSM OCCLUSIVE DISEASE ETC. | 35011, 35001, 35141, 35151 |
TAVR | 33361, 33362, 33363, 33364, 33365, 33366, 33369 |
THERAPEUTIC SERVICES | 93745 |
THROMBOENDARTERECTOMY | 35355, 35303, 35302, 35371, 35372, 35351, 35301 |
TRICUSPID VALVE SURGERY | 33465 |