News
Updated Evolent Requirements
Date: 01/31/26
Evolent manages prior authorizations for Centene for Radiology and Diagnostic Cardiology (RBM) and Advanced Cardiology.
Beginning on April 1st, 2026, the following procedure codes included in this bulletin have been removed from Evolent’s Utilization Review Matrix and will no longer require prior authorization through Evolent.
If you have any questions regarding this update, please contact your Provider Engagement Account Manager.
RADIOLOGY AND DIAGNOSTIC CARDIOLOGY (RBM) | |
Modality | Impacted CPT |
CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST | 75557, 75559, 75561, 75563 |
CT ABDOMEN WITH O DYE | 74150, 74160, 74170 |
CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE | 77078 |
CT HRT WITH 3D IMAGE | 75572 |
CT LOWER EXTREMITY WITH O DYE | 73700, 73701, 73702 |
CT MAXLOFCE AREA; W/O CONTRAST MATL | 70487,70488, 70486, 76380 |
CT ORBIT/EAR/FOSSA WITH O DYE | 704,807,048,170,482 |
CT SOFT TISSUE NECK WITH O DYE | 70490, 70491, 70492 |
CT UPPER EXTREMITY WITH O DYE | 73200, 73201, 73202 |
CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST | 75574 |
ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL | 93312, 93313, 93314, 93315, 93316, 93317, 93318 |
GATED HEART PLANAR SINGLE | 78472, 78473, 78494 |
MRI ABDOMEN WITH O DYE | 74181, 74182, 74183, S8037 |
MRI BONE MARROW BLOOD SUPPLY | 77084 |
MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL | 77046, 77047, 77048, 77049 |
MRI FETAL SNGL/1ST GESTATION | 74712, 74713 |
MRI IMAGING BRAIN; INCLUDING BRAIN STEM; WITHOUT CONTRAST MATERIAL | 70551, 70552, 70553 |
MRI JOINT UPR EXTREM WITH O DYE | 73221, 73222, 73223 |
MRI PELVIS WITH DYE | 72195, 72196, 72197 |
MRI- SPINAL CANAL AND CONTENTS, CERVICAL; WITHOUT CONTRAST MATERIAL | 72141, 72142, 72156 |
MRI- SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL | 72148, 72149, 72158 |
MRI UPPR EXTREMITY WITH OAND WITH DYE | 73218, 73219, 73220 |
MRI, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL | 72146, 72147, 72157 |
CARDIOLOGY | |
NCH Category | Impacted CPT |
ANGIOGRAPHY | 76937, 75736, 36253, 36254, 36218, 75580 |
BYPASS GRAFT IN-SITU VEIN | 35656, 35621, 35661, 35583, 35585, 35587, 35671, 35646, 35654, 35666, |
BYPASS GRAFT VEIN | 35556, 35558, 35566, 35571 |
CARDIAC CATHETERIZATION | 93505, 93451, 93571, 93567, 93565, 93566, 93563, 93568, C1759, 93459, 93460 |
CONGENITAL HEART DISESE SURGERY | 33820 |
CORONARY ARTERY DISEASE SURGERY | 93580 |
CORONARY ARTERY DISEASE SURGERY | C1732, C1895, 33217, 33223, 33215, 93650, 93583, 35305, 35884, 33405, 93454 |
DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION | C1722, 92960, C1882, 33224, 33225, C1760, 33271, C1785, 33226, 33222, 33218, 33286, 33202, 92961, C1900, 33236, 33220, 33234, 33235, 33275, 33233, C2621, 33227, 33229, 33228, 33274 |
DEVICE MONITORING | 93292, K0606 |
ELECTROPHYSIOLOGY STUDIES (EPS) | 93662, C1730 |
EXCISION EXPLORATION REPAIR REVISION | 35883, 35881, 35700, |
INTERRUPTION/LIGATION/STRIPPING ETC. | 37766 |
INTERRUPTION/LIGATION/STRIPPING ETC. | 37765 |
INTERVENTIONAL CARDIOLOGY | 33418, 93590, 93581, 93591, 92987, 92997, 36837, 36836 |
PULMONARY VALVE SURGERY | 33477, 33475 |
REPAIR/EXCISION FOR ANEURYSM OCCLUSIVE DISEASE ETC. | 35011, 35001, 35141, 35151 |
TAVR | 33361, 33362, 33363, 33364, 33365, 33366, 33369 |
THERAPEUTIC SERVICES | 93745 |
THROMBOENDARTERECTOMY | 35355, 35303, 35302, 35371, 35372, 35351, 35301 |
TRICUSPID VALVE SURGERY | 33465 |