26-255 Evolent Removes Prior Authorization for Select Radiology and Cardiology Services
Date: 02/27/26
Streamlined access to imaging services begins May 1, 2026
Effective May 1, 2026, several radiology and diagnostic cardiology CPT codes have been removed from Evolent’s Utilization Review Matrix. These services no longer require prior authorization, reducing administrative steps for physicians, practitioners and other providers and supporting more timely delivery of care for patients.
Services that no longer require prior authorization
Modality | Codes |
|---|---|
CT orbit | 70480, 70481, 70482 |
CT maxillofacial/sinus | 70487, 70488, 70486, 76380 |
CT chest | 71250, 71260, 71270, 71271 |
MRI pelvis with dye | 72195, 72196, 72197 |
CT upper extremity | 73200, 73201, 73202 |
MRI upper extremity, other than joint | 73218, 73219, 73220 |
CT lower extremity | 73700, 73701, 73702 |
Fetal MRI | 74712, 74713 |
MRI heart | 75557, 75559, 75561, 75563 |
CT bone density studies | 77078 |
Gated heart planar single | 78472, 78473, 78494 |
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If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center.
Provider Services
Line of business | Phone number | |
|---|---|---|
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO | ||
Medi-Cal (including CS and ECM providers) | N/A |
This information applies to Physicians, Practitioners and Hospitals.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.