News
Radiology & Diagnostic Cardiology & Cardiology Prior Authorization Updates
Date: 03/13/26
Vendor, Evolent, Prior Authorization Updates Effective April 1,2026
Effective April 1, 2026, Sunflower Health Plan will remove certain prior authorization (PA) requirements that are managed through Evolent Specialty Services.
As part of our ongoing work to improve the prior authorization process for providers and members, Sunflower is removing PA requirements for select Radiology & Diagnostic Cardiology & Cardiology codes.
These updates will create a more uniform set of PA requirements across all health plan offerings, simplify processes, reduce provider confusion, and support future efforts to expand real-time responses to requests. Each of the affected codes in this communication is managed on behalf of Sunflower by Evolent Specialty Services, our utilization management partner.
As of April 1, 2026, the following codes for RBM will no longer require PA and will be removed from the Evolent utilization review matrix.
Modality | Allowable Billing Group | CPT |
|---|---|---|
CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST | 75557, 75559, 75561, 75563 | 75557 |
CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE | 77078 | 77078 |
CT LOWER EXTREMITY WITH O DYE | 73700, 73701, 73702 | 73700 |
CT MAXLOFCE AREA; W/O CONTRAST MATL | 70487,70488, 70486, 76380 | 70486 |
CT ORBIT/EAR/FOSSA WITH O DYE | 70480,70481,70482 | 70480 |
CT UPPER EXTREMITY WITH O DYE | 73200, 73201, 73202 | 73200 |
DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST | 71250, 71260, 71270, 71271 | 71250 |
ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL | 93312, 93313, 93314, 93315, 93316, 93317, 93318 | 93312 |
GATED HEART PLANAR SINGLE | 78472, 78473, 78494 | 78472 |
MRI FETAL SNGL/1ST GESTATION | 74712, 74713 | 74712 |
MRI PELVIS WITH DYE | 72195, 72196, 72197 | 72196 |
MRI UPPR EXTREMITY WITH OAND WITH DYE | 73218, 73219, 73220 | 73220 |
If you have questions about this bulletin or other provider resources, please contact your Provider Relations Representative or call Provider Services at 1-844-518-9505 (TTY 711).
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