Evolent Descope CPT Codes

Date: 02/24/26

Evolent Prior Authorization Updates, Effective April 1, 2026

As part of Wellcare’s 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, Wellcare is removing PA requirements for select Radiology, Diagnostic Cardiology and 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 Wellcare 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 Medicaid will no longer require PA and will be removed from the Evolent Utilization Review Matrix.

As of April 1, 2026, the following codes for Radiology and Diagnostic Cardiology (RBM) for Medicare will no longer require PA and will be removed from the Evolent Utilization Review Matrix.

As of April 1, 2026, the following codes for Radiology and Diagnostic Cardiology (RBM) for Marketplace will no longer require PA and will be removed from the Evolent Utilization Review Matrix.

As of April 1, 2026, the following codes for Cardio for Medicare will no longer require PA and will be removed from the Evolent Utilization Review Matrix.

As of April 1, 2026, the following codes for Cardio for Marketplace will no longer require PA and will be removed from the Evolent Utilization Review Matrix.