Updated Evolent Authorization Requirements Effective June 1, 2025
5/16/2025
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Posted by Provider Relations
The following codes on the Evolent/Fidelis Care authorization grid have been updated effective June 1, 2025.
The following codes have been removed from the Evolent Radiology Cardiology Utilization Review Matrix and no longer require prior authorization for Wellcare by Fidelis Care, Medicaid, Essential Plans, and Ambetter Metal-Level Products:
- Transthoracic Echocardiogram - 93307, 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93356
- Chest CT - 71250, 71260, 71270, 0722T
- CT for Low Dose Lung Cancer Screening - 71271
Visit: Authorization Requests