Provider Quick Alert

February 16, 2026

Updated Evolent Authorization Requirements Effective April 1, 2026

Effective April 1, 2026, the following Radiology and Diagnostic Cardiology (RBM) codes have been removed from the Evolent’s Utilization Review Matrix and no longer require prior authorization for QualChoice. 

Modality

Impacted CPT®

CT ORBIT/EAR/FOSSA WITH O DYE

70480, 70481, 70482

CT MAXLOFCE AREA; W/O CONTRAST MATL

70487,70488, 70486, 76380

DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST

71250, 71260, 71270, 71271

CT UPPER EXTREMITY WITH O DYE

73200, 73201, 73202

MRI UPPR EXTREMITY WITH O AND WITH DYE

73218, 73219, 73220

CT LOWER EXTREMITY WITH O DYE

73700, 73701, 73702

MRI FETAL SNGL/1ST GESTATION

74712, 74713

CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST

75557, 75559, 75561, 75563

CT HRT WITH 3D IMAGE

75572

CT HRT WITH 3D IMAGE CONGEN

75573

MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL

77046, 77047, 77048, 77049

CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE

77078

MRI BONE MARROW BLOOD SUPPLY

77084

GATED HEART PLANAR SINGLE

78472, 78473, 78494

ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL

93312, 93313, 93314, 93315, 93316, 93317, 93318

Thank you for trusting QualChoice as your healthcare partner. If you have any questions or concerns, please call us at 501-228-7111 or 1-800-235-7111 (TTY: 711). We are available Monday through Friday from 8 a.m. to 5 p.m. CT. 

QCA26-AR-H-028