Issued: April 13, 2026
Partners Health Management (Partners) is issuing this provider alert to notify Physical Health providers of updated prior authorization (PA) requirements for certain radiology and diagnostic cardiology services. The changes were effective April 1, 2026, and apply to services rendered on or after that date.
What is happening?
Effective April 1, 2026, the following RADIOLOGY AND DIAGNOSTIC CARDIOLOGY (RBM) procedures will be removed from Evolent’s Utilization Review Matrix and no longer require prior authorization for in-network providers (Prior Authorization is still required for out-of-network).
| Procedure | CPT |
| CT Orbit/Ear/Fossa with contrast dye | 70480, 70481, 70482 |
| CT Maxillofacial area; with and without contrast | 70487, 70488, 70486, 76380 |
| Diagnostic CT thorax without contrast | 71250, 71260, 71270, 71271 |
| CT upper extremity with contrast dye | 73200, 73201, 73202 |
| MRI upper extremity with and without contrast dye | 73218, 73219, 73220 |
| CT lower extremity with contrast dye | 73700, 73701, 73702 |
| Cardiac MRI morphology & function without contrast dye | 75557, 75561 |
| CT heart with 3D image, congenital | 75573 |
| MRI breast without contrast material, unilateral | 77046, 77047, 77048, 77049 |
| CT bone mineral density study 1/> sites axial skeleton | 77078 |
| MRI bone marrow blood supply | 77084 |
| Gated heart planar single | 78472, 78473, 78494 |
| Echocardiography transesophageal, with or without M‑mode | 93312, 93313, 93314, 93315, 93316, 93317, 93318 |
What do providers need to do?
- Providers should review the updated requirements outlined in this communication and in the table above.
- Providers should continue to verify authorization needs prior to rendering services.
- Utilize the pre‑authorization check tool to confirm whether authorization is required prior to rendering services.
- Review applicable clinical coverage policies issued by NC Medicaid and Carolina Complete Health to ensure documentation and medical necessity requirements are met.
- Ensure claims are submitted accurately and align with approved prior authorizations to avoid denials.
What do providers need to know?
- Authorization determinations are based on procedure codes, clinical criteria, and benefit coverage.
These requirements are reflected in the pre‑authorization check tool.
Who can providers contact if they have questions?
- Physical Health Utilization Management: phumquestions@partnersbhm.org.
- Claims: ClaimsDepartment@PartnersBHM.org.
- Provider Network Relations: PNRelations@PartnersBHM.org or call the Provider Services Line at 1-877-398-4145 for questions other than rates or claims.