News
Important Prior Authorization Updates (10/15/2025)
Date: 09/23/25
Effective 10/15/2025
As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Wellcare wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.
A full list of code changes for Wellcare can be found below. These changes may include:
- Removing PA requirements based on criticality of review and clinical need.
- Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.
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 or contact Wellcare’s provider services team at 1-800-977-7522 (Non-Duals/C-SNP) or 1-844-796-6811 (Duals/D-SNP).
EFFECTIVE 10/15/2025
| Service Category | PA Rule | Services | Procedure Codes |
|---|---|---|---|
| DME Services | No PA Required | EquipmentAccessories | E0953, K0019, K0044, K0045, K0046, K0047, K0051, K0052 |
| Wheelchairs | E0954, E0956, E0957, E0973, E1028, E2209, E2210, E2365, E2366, E2367, E2603, E2604, E2615, E2616, K0733, K0739 | ||
| Home Services | No PA Required | Home Management | G0156 |
| Surgery Procedures | No PA Required | Vascular | 36471 |
| Transportation Services | PA Required | Medical Transportation | A0431, A0436 |
| Skin Substitutes & Wound Dressings | PA Required | Skin Substitutes & Wound Dressings | C9358, C9360, C9363, Q4111, Q4115, Q4117, Q4118, Q4125, Q4134, Q4135, Q4136, Q4139, Q4145, Q4162, Q4165, Q4166, Q4167, Q4168, Q4170, Q4171, Q4174, Q4176, Q4177, Q4179, Q4180, Q4181, Q4182, Q4205, Q4206, Q4208, Q4209, Q4211, Q4212, Q4214, Q4216, Q4217, Q4218, Q4219, Q4220, Q4221, Q4222, Q4226, Q4227, Q4229, Q4230, Q4232, Q4233, Q4234, Q4235, Q4237, Q4238, Q4239, Q4240, Q4241, Q4242, Q4244, Q4245, Q4246, Q4247, Q4248, Q4251,Q4252,Q4253 |
EFFECTIVE 10/1/2025
| Service Category | PA Rule | Services | Procedure Codes |
|---|---|---|---|
| Durable Medical Equipment | No PA Reuired | Equipment and Accessories | A5500, A6530, A9279, E0184 |
| Incontinence Supplies | A4335, T4521, T4535 | ||
| Neurostimulators | E0720, E0730 | ||
| Nutritional Services | B4034 | ||
| Orthotics and Prosthetics | E0849 | ||
| Supplies and Devices | A9900 | ||
| Wheelchairs | E0961, E0951, E0955, E0990, E1016, E2359, E2361, E2363, E2606, E2607, E2624, K0040 K0043, K0077 | ||
| Physical Medicine | No PA Required | Orthotics and Prosthetics | L5926, L5685 L2820, L5617 |
| Other Medical Services | No PA Required | Other Services | L5926, L5685 L2820, L5617 |
| Surgical Supplies | A4557 | ||
| Wound Care | A6010 |