News

Important Prior Authorization Updates

Date: 08/06/26

(Effective October 1, 2026)

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.

Code change details are noted in the table below. The 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.

For questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.

Service Category	PA Rule	Services	Procedure codes
Behavioral Health	No PA Required	Behavioral Assessment	96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146
DME and Supplies	No PA Required	Equipment and Accessories	E0656, E0657
		Orthotic and Prosthetic	L0457, L0650, L1932, L1940, L1960, L2330, L3030
		Respiratory Devices and Supplies	E0470, E0471, E0562
		Supplies and Devices	E0935
		Wheelchairs	E1226, E2310, E2374, E2607, E2608, E2613, E2614, E2622, E2623, E2624, E2625
DME Services	No PA Required	Wheelchairs	E1032, E1033, E1034
Genetic Analysis	No PA Required	Genetic Testing	88271, 88275, 88280
Home Services	No PA Required	Infusion Services	99601, 99602, S9500
Other Medical Services	PA Required	Wound Care	97605, 97606
Pain Management	No PA Required	Surgery – Nervous System	64566
Physician Services	No PA Required	Diagnostic Testing	91110, 91111, 91112, 91113
Physician Services	No PA Required	Home Visit	99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350
Surgery Procedures	No PA Required	Integumentary Services	14000, 14040, 14041, 15100
		Rhinoplasties	30520
		Musculoskeletal System	29848
		Sinuses	31256, 31267
Transportation Services	PA Required	Medical Transportation	A0100