News
Evolent Prior Authorization Updates, Effective April 1, 2026
Date: 03/02/26
As part of NH Healthy Families’ partnership with Evolent Specialty Services to manage utilization management, certain prior authorization requirements will be removed effective April 1, 2026.
As part of our ongoing work to improve the prior authorization (PA) process for providers and members, NH Healthy Families is removing PA requirements for select Radiology and Diagnostic Cardiology codes effective April 1, 2026.
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 provided in this communication is managed on behalf of NH Healthy Families by Evolent Specialty Services, our utilization management partner.
If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.
As of April 1, 2026, the following codes for Radiology and Diagnostic Cardiology (RBM) for Medicaidwill no longer require PA and will be removed from the Evolent Utilization Review Matrix.
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 |
As of April 1, 2026, the following codes for Radiology and Diagnostic Cardiology (RBM) for Marketplacewill no longer require PA and will be removed from the Evolent Utilization Review Matrix.
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 |