Evolent Cardiology Solution Program

Prior Authorization for medical necessity and appropriate length of stay (when applicable) has been delegated to Evolent (formerly New Century Health) and will be required for the following procedures (and codes listed below) in both inpatient and outpatient settings:

Cardiovascular Services

• Cardiac Catheterization and Intervention
• Cardiac Surgery
• Electrophysiology
• Vascular Radiology and Intervention
•  Vascular Surgery

This program applies to Managed Medical Assistance (MMA), Child Welfare (CW), Serious Mental Illness (SMI) and HIV/AIDS specialty plan members ages 21 years and over and all Ambetter Health products for members ages 19 years and over.

• Evolent Cardiology Prior Authorization Codes for Medicaid
• Evolent Cardiology Prior Authorization Codes for Ambetter