Evolent Prior Authorization Updates, Effective May 1, 2026

Date: 04/07/26

As part of Oklahoma Complete Health’s collaboration with Evolent Specialty Services to administer utilization management, certain prior authorization (PA) requirements will be removed from the Evolent Specialty Services PA process effective May 1, 2026.

To further enhance the PA experience for providers and members, Evolent Specialty Services will discontinue PA requirements for select Radiology & Diagnostic Cardiology (RBM) codes beginning May 1, 2026.

These changes are designed to create greater consistency in PA requirements across the health plan, streamline administrative workflows, minimize provider confusion, and support future efforts to expand real-time decision capabilities. The codes referenced in this
communication are currently managed by Evolent Specialty Services and will transition from our utilization management partner to Oklahoma Complete Health.

If you have questions regarding specific PA codes or how these updates may impact your practice, please contact your local Provider Engagement representative.

Effective May 1, 2026, the Radiology & Diagnostic Cardiology (RBM) codes listed below will no longer require prior authorization under the Evolent Specialty Services Utilization Review Matrix. 

Modality	Allowable Billing Group	CPT
CT ORBIT/EAR/FOSSA WITH O DYE	70480, 70481, 70482	70480
CT MAXLOFCE AREA; W/O CONTRAST MATL	70487, 70488, 70486, 76380	70486
DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST	71250, 71260, 71270, 71271	71250
CT UPPER EXTREMITY WITH O DYE	73200, 73201, 73202	73200
MRI UPPR EXTREMITY WITH OAND WITH DYE	73218, 73219, 73220	73220
CT LOWER EXTREMITY WITH O DYE	73700, 73701, 73702	73700
MRI FETAL SNGL/1ST GESTATION	74712, 74713	74712
CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST	75557, 75559, 75561, 75563	75557
CT HRT WITH 3D IMAGE CONGEN	75573	75573
MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL	77046, 77047, 77048, 77049	77046
CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE	77078	77078
MRI BONE MARROW BLOOD SUPPLY	77084	77084
GATED HEART PLANAR SINGLE	78472, 78473, 78494	78472
ECHOCRDGRPHY RL TM W/2D W/WO M-MODE, TRANSESOPHAGEAL	93312, 93313, 93314, 93315, 93316, 93317, 93318	93312

Posted: 4/7/26

Oklahoma Complete Health is committed to delivering cost-effective, quality care to our members. This requires us to ensure that our members only receive treatments that are medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable. It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.  

Please verify every member’s eligibility and benefits prior to rendering services to them. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. 

Non-Par Providers and facilities require authorization for all services except where indicated.  The codes listed in this document represent the national, standard code sets. Inclusion or exclusion of a code does not constitute or imply subscriber coverage or provider reimbursement. Please refer to your contract with Oklahoma Complete Health to determine all contracted/covered codes for each membership group. Please refer to the Medicaid Fee Schedule and the Billing and Procedure Coding Guide for a list of approved modifier codes.  For a complete list of CPT/HCPCS codes, please use the Pre-Auth Check Tool.

Questions? 

If you have any questions, please call Oklahoma Complete Health Provider Services at 1-833-752-1664 or visit the Find Your Provider Engagement Administrator tool to confirm the individual supporting your specialty and region. We encourage you stay up to date on Oklahoma Complete Health provider notices by reviewing and bookmarking Provider News.