December 2025 Provider News
Date: 12/29/25
In this issue:
- General Updates - Health Equity - Annual Access and Availability of Language Services Reports
- Quality - Tacoma Pierce County Opioid Awareness Toolkit, Washington launches new tools: OUD, Depression Screening, HEDIS Behavioral Health Measure Toolkit, Controlling High Blood Pressure
- Payment & Clinical Policy - Envolve Vision, Evolent Cardiology, Clinical Policy updates, Prior Authorization updates
- Wellcare - Medical Clinical Policy updates
- Apple Health Core Connections - Updated Free National Adoption Competency Mental Health Training Initiative
- Training/Education - Evolent training, Health Equity
- Pharmacy Updates - NPI Prescriber Enforcement for Pharmacy Claims; Pharmacy Clinical Policy Updates; Evolent Medical Oncology Updates
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General Updates
Health Equity- Marketplace
Standard HE 3: Access and Availability of Language Services
Element C
Language and Interpreter Resources for Ambetter Providers
This communication provides essential updates for Ambetter providers on language access services and member demographics. It includes updates on member language preferences, instructions for requesting interpreter services and translated materials, and guidance on meeting federal requirements for language access under Title VI and the Americans with Disabilities Act (ADA).
Cultural and linguistic availability of services is an important characteristic of the services Coordinated Care provides to its membership. Coordinated Care monitors, tracks, trends all available data sources and is committed to ensuring that its policies and infrastructure are attuned to the diverse needs of all members.
How to Access Interpreter Services
Language and Interpreter Services are available at no cost to Ambetter members and providers without unreasonable delay at all medical points of contact. The member has the right to file a complaint or grievance if cultural and linguistic needs are not met.
Spoken Language Interpreter
- Contact Ambetter provider services at 1-877-687-1197, TTY 711.
Sign Language Interpreter
- Providers should be prepared to meet the needs of the hearing impaired.
- For in person and American Sign Language requests, contact Ambetter Provider Services as soon as possible, or at least 5 business days before the appointment. All providers (Medical, Behavioral, Pharmacy, etc.) can request language services by calling our Provider Customer Contact Center at: 1-877-687-1197 (TTY 711).
To request translation assistance and alternate formats of documents
Language assistance services, auxiliary aids and services, larger font, written and oral translation, and other alternative formats are available to members at no cost.
The health plan fulfills these requests including, but not limited to, audio format in original language of text, interpreter recording in member’s primary and/or preferred language, an interpreter may read the material to the member, or materials in hard copy braille format.
- To request translation assistance and alternate formats of documents, contact Member Services: 1-877-687-1197 (TTY:711).
- For additional help with language resources, refer to the Language Assistance page located on the Ambetter from Coordinated Care website.
Language Services include
- Telephonic services
- Oral translation (reading of English material in a members preferred language)
- In-person non-English interpretation
- American Sign language
- Auxiliary aids including alternate formats such as large print and braille
- Written translations for materials that are critical for obtaining health insurance coverage and access to health care services in non-English prevalent languages
- Information is deemed to be critical for obtaining health insurance coverage or access to health care services if the material is required by law or regulation to provide the document to an individual.
Restrictions Related to Interpretation or Facilitation of Communication:
- Providers may not request or require an individual with limited English proficiency to provide their own interpreter.
- Providers may not rely on staff other than qualified bilingual/multilingual staff to communicate directly with individuals with limited English proficiency.
- Providers may not use an accompanying adult or minor child to interpret or facilitate communication.
Exceptions to these expectations include:
- In an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no qualified interpreter for the individual with limited English proficiency immediately available.
- Accompanying adults (minors are excluded) where the individual with limited English proficiency specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances for minimal needs.
Providers are encouraged to document in the member’s medical record any member denial of professional interpreters and the circumstances that resulted in the use of a minor or accompanying adult as an interpreter.
Common Methods to Ensure Equal Communication and Access to Information:
- Provisions for intake forms to be completed by persons who are blind or with a low visual disability with the same confidentiality afforded other members:
- Use of large print forms, electronic or online web-based forms, or in-person staff assistance in a private location.
- Provision for a presence of sign language interpreters to enable full communication with deaf or hard of hearing members who use sign language.
- Provision for making auditory information (E.G., automated messages) available via alternative means:
- Written communication or secure web-based methods may be used as possible substitutes.
- Provision for communicating with deaf or hard of hearing members by telephone:
- Use of telephone relay services (TRS), video relay services (VRS), a TDD, or use of secure electronic means.
Free Provider Training
- Access to online accredited courses offered through Centene Institute for Advanced Health Education at no cost
- Access the full catalog: centeneinstitute.com/catalog
- Visit the Log-In Page to create a free account. https://www.centeneinstitute.com/profile/create
- Please send questions about Centene Institute to Centene_Institute@centene.com
- Visit the Provider Events page for a list of upcoming training sessions: Provider Events page https://www.coordinatedcarehealth.com/providers/provider-events.html
- To request one-on-one training or a refresher session reach out to CoordinatedCareProvider@centene.com.
Available Now: Culturally Appropriate Care & Health Equity
- As part of the health plan’s Cultural Competency Program, providers agree to participate in cultural competency training annually.
- To attest to the completion of cultural competency training fill out this form: Annual Provider Check-In: Supporting Culturally Responsive Care
- Training is offered to providers/office staff: Culturally Appropriate Care & Health Equity- https://www.centeneinstitute.com/login
Objectives:
- Explores how culturally appropriate care can improve patient outcomes, safety, and experiences in healthcare.
- Examines the impact of unconscious bias on health outcomes and how it intersects with culturally appropriate care and health equity.
- Course offers practical strategies to promote inclusive and equitable care.
- Credit:
- ACPE 1.00 Credit (1 hour)
- AMA PRA Category 1 Credit(s)™ 1.00 Credit (1 hour)
- ANCC 1.00 Credit (1 hour)
- CDR 1.00 Credit (1 hour)
- CCMC 1.00 Credit (1 hour)
Request a one-on-one session for additional support
To attend an upcoming New Provider Orientation or to request a one-on-one session online or in-person, visit the Coordinated Care Corporation Provider Events page for more information.
https://www.coordinatedcarehealth.com/providers/provider-events.html
Provider & Billing Manual
To access the 2025 Provider & Billing Manual visit the Provider Resources page and click on the link to the 2025 Provider & Billing Manual.
Washington State Language Demographics
In 2020, 79.2% of Washington residents reported English as their preferred language, and 8.6% prefer Spanish, according to U.S. Census data.
The threshold languages for Washington below are provided by the Resource for Entities Covered by Section 1557 of the Affordable Care Act Estimates of at Least the Top 15 Languages Spoken by Individuals with Limited English Proficiency for the 50 States, the District of Columbia, and the U.S. Territories.
Top 15 threshold languages for Washington
Rank | Language | Estimate |
1 | Spanish | 232,748 |
2 | Chinese | 42,812 |
3 | Vietnamese | 38,432 |
4 | Korean | 27,088 |
5 | Russian | 25,421 |
6 | Tagalog | 19,128 |
7 | Ukrainian | 12,555 |
8 | Mon-Khmer, Cambodian | 9,046 |
9 | Japanese | 9,016 |
10 | Amharic | 7,590 |
11 | Cushite | 6,965 |
12 | Arabic | 6,417 |
13 | Panjabi | 6,145 |
14 | German | 3,863 |
15 | Laotian | 3,712 |
Source: Office for Civil Rights (OCR), Estimates of Limited English Proficiency (LEP) Populations by State used to determine Washington State’s threshold languages for Section 1557 compliance.
Coordinated Care Corporation Member Language Demographics
Coordinated Care at a minimum conducts a language assessment on an annual basis to determine the current population language within the service area.
Coordinated Care members speak more than 15 languages. We review the following data on a regular basis to determine the needs of our current members, future members, and the community. In 2024, 88.15% of Coordinated Care Corporation Marketplace members reported English as their preferred language, 3.66% preferred Chinese, and 2.66% preferred Spanish.
2024 Member Language Demographics
Data based on Coordinated Care’s 2024 annual language assessment conducted in accordance with NCQA requirements.
Top 10 Languages Reported by Membership | Membership (2024) | |
# of Members by Language | % of total membership | |
English | 76,284 | 88.19% |
Chinese | 3,154 | 3.65% |
Spanish | 2,289 | 2.65% |
Vietnamese | 1,827 | 2.11% |
Russian | 954 | 1.10% |
Korean | 416 | 0.48% |
Ukrainian | 308 | 0.36% |
Panjabi | 203 | 0.23% |
Portuguese | 117 | 0.14% |
Persian | 93 | 0.11% |
2024 Summary of Requests for Alternative Formats
Alternate Forms | # of Requests (2024) | % of Total (2024) |
LARGE PRINT ENGLISH | 0 | 0 |
SIGN LANGUAGES | 2 | 0.05% |
BRAILLE (ENGLISH) | 1 | .74% |
Best Practices Gathered from Providers
- Documenting a member’s refusal of professional interpreter services and noting any use of a minor or accompanying adult is a best practice supported by healthcare providers to ensure cultural preferences are respected and future visits are appropriately informed.
- If a member chooses to use a family member or friend as an interpreter, it is recommended to offer a telephonic interpreter concurrently to help ensure the accuracy and completeness of the interpretation.
Contact Your Provider Engagement Team for Support
Find out how language resources can be used to strengthen your relationship with your patients by contacting your Provider Engagement Administrator. For a list of provider engagement representatives by region, visit us here or call Customer Contact Center at 1-877-687-1197 so we can triage your call appropriately.
Providers are encouraged to review their interpreter service usage and ensure member language preferences are accurately documented. Updating this information helps improve care coordination and supports compliance with NCQA Health Equity standards.
To learn more about the language resources, visit the health equity resources page for providers on the Coordinated Care website.
To view language preferences of your members, visit the Provider Portal at coordinatedcarehealth.com/providers.
About the Americans with Disabilities Act
Disability is any substantial limitation of one or more of a person’s daily life activities and may be present from birth or may occur during a person’s lifetime. Any individual meeting any of these conditions is an individual with a disability for purposes of coverage under the Americans with Disabilities Act.
To meet Title VI of the Civil Rights Act of 1964 and Americans with Disabilities Act (ADA) health care providers are required to assure language access.
Programmatic access to healthcare means that policies and practices that are part of the delivery of healthcare do not hinder the ability of members with disabilities to receive the same quality of care as other persons.
In accordance with Title VI of the Civil Rights Act, Prohibition against national Origin Discriminations, the President’s Executive Order 131166, section 1557 of the Patient Protection and Affordable Care Act, The Health Plan and its providers must make language assistance available to persons with Limited English Proficiency (LEP) at all points of contact during all hours of operation.
To be removed from these fax notices or to request to be added to our email list for these notices, please email: CoordinatedCareProvider@centene.com.
Health Equity- Medicaid
Standard HE 3: Access and Availability of Language Services
Element C
Language and Interpreter Resources for Medicaid Providers
This communication provides essential updates for Medicaid providers on language access services and member demographics. It includes updates on member language preferences, instructions for requesting interpreter services and translated materials, and guidance on meeting federal requirements for language access under Title VI and the Americans with Disabilities Act (ADA).
Cultural and linguistic availability of services is an important characteristic of the services Coordinated Care provides to its membership. Coordinated Care monitors, tracks, trends all available data sources and is committed to ensuring that its policies and infrastructure are attuned to the diverse needs of all members.
How to Access Language Interpreter Services
Interpreter Services are available at no cost to members, offering access to qualified spoken and sign language interpreters for Apple Health (Medicaid) clients. Providers may schedule for in-person, video, or phone appointments through the Health Care Authority - https://hcauniversal.com/ to support clear and effective communication during care.
Video or Telephonic Interpreter Services
- Request spoken language interpreters by visiting the Universal Language Service website at hcauniversal.com.
- If you’re not sure how to make a request, helpful webinars and PDF guides- https://hcauniversal.com/webinars-2/ are available to walk you through the process. Let us know if you have any questions or need support.
Sign Language Interpreter Services
- Providers should be prepared to meet the needs of the hearing impaired.
- Request for Sign Language Interpreters
Request sign language interpreters through the Department of Enterprise Services (DES) Office of Deaf and Hard of Hearing (ODHH) master contract utilizing their https://fortress.wa.gov/dshs/odhhapps/Interpreters/Service/Request.aspx
To request translation assistance and alternate formats of documents
Language assistance services, auxiliary aids and services, larger font, written and oral translation, and other alternative formats are available to members at no cost.
Coordinated Care fulfills these requests including, but not limited to, audio format in original language of text, interpreter recording in member’s primary and/or preferred language, an interpreter may read the material to the member, or materials in hard copy braille format.
- To request translation assistance and alternate formats of documents, visit the language assistance line by contacting Member Services: 1-877-644-4613 (TTY:711)
- For additional help with language resources, visit the language translation and other formats page: https://www.coordinatedcarehealth.com/members/medicaid/resources/translation-and-other-formats.html
Additional Language Resources
- ISpeak Cards
“ISpeak” cards help your members identify their preferred language when seeking care and are available to download and print from the Washington State Coalition for Language Access website at wascla.org. In addition to the ISpeak cards, you can also find a collection of materials, as well as a “Know Your Rights” flyer for help when using interpreter services in healthcare settings.
https://apps.wascla.org/library/folder.515983-WASCLA_Tools_for_Health_Resources
- For additional help with language resources, refer to the Language Assistance page.
Free Provider Training
- Access to online accredited courses offered through Centene Institute for Advanced Health Education at no cost
- Access the full catalog: centeneinstitute.com/catalog
- Visit the Log-In Page to create a free account. - https://www.centeneinstitute.com/profile/create
- Please send questions about Centene Institute to Centene_Institute@centene.com
- Visit the Provider Events page for a list of upcoming training sessions: Provider Events page
To request one-on-one training or a refresher session reach out to CoordinatedCareProvider@centene.com.
Available Now: Culturally Appropriate Care & Health Equity
- As part of the health plan’s Cultural Competency Program, providers agree to participate in cultural competency training annually.
- To attest to the completion of cultural competency training: Annual Provider Check-In: Supporting Culturally Responsive Care – Fill out form
- Training is offered to providers/office staff
Course: Culturally Appropriate Care & Health Equity
Objectives
- Explores how culturally appropriate care can improve patient outcomes, safety, and experiences in healthcare.
- Examines the impact of unconscious bias on health outcomes and how it intersects with culturally appropriate care and health equity.
- Course offers practical strategies to promote inclusive and equitable care.
Credit:
- ACPE 1.00 Credit (1 hour)
- AMA PRA Category 1 Credit(s)™ 1.00 Credit (1 hour)
- ANCC 1.00 Credit (1 hour)
- CDR 1.00 Credit (1 hour)
- CCMC 1.00 Credit (1 hour)
To access the 2025 Provider Operations Manual, visit https://www.coordinatedcarehealth.com/providers/resources/forms-resources.html and select Apple Health (Medicaid) Manual and Guides, and select Provider Manual for Medicaid Foster Care & Apple Health Expansion (PDF).
Washington State Language Demographics
In 2020, 79.2% of Washington residents reported English as their preferred language, and 8.6% prefer Spanish, according to U.S. Census data.
The threshold languages for Washington below are provided by the Resource for Entities Covered by Section 1557 of the Affordable Care Act Estimates of at Least the Top 15 Languages Spoken by Individuals with Limited English Proficiency for the 50 States, the District of Columbia, and the U.S. Territories.
Top 15 languages threshold for Washington
Rank | Language | Estimate |
1 | Spanish | 232,748 |
2 | Chinese | 42,812 |
3 | Vietnamese | 38,432 |
4 | Korean | 27,088 |
5 | Russian | 25,421 |
6 | Tagalog | 19,128 |
7 | Ukrainian | 12,555 |
8 | Mon-Khmer, Cambodian | 9,046 |
9 | Japanese | 9,016 |
10 | Amharic | 7,590 |
11 | Cushite | 6,965 |
12 | Arabic | 6,417 |
13 | Panjabi | 6,145 |
14 | German | 3,863 |
15 | Laotian | 3,712 |
Source: Office for Civil Rights (OCR), Estimates of Limited English Proficiency (LEP) Populations by State used to determine Washington State’s threshold languages for Section 1557 compliance.
Coordinated Care of Washington Member Language Demographics
Coordinated Care at a minimum conducts a language assessment on an annual basis to determine the current population language within the service area.
Coordinated Care members speak more than 15 languages. We continually looks at the following data to determine the needs of our members, future members, and the community. In 2024, 78.50% of Coordinated Care Medicaid members reported English as their preferred language and 14.60% preferred Spanish.
2024 Membership Language Demographics
Data based on Coordinated Care’s 2024 annual language assessment conducted in accordance with NCQA and HCA requirements.
Top 10 Languages Reported by Membership | Membership (2024) | |
# of Members by Language | % of total membership | |
English | 157,819 | 68.36% |
Spanish | 29,204 | 12.65% |
Russian | 2,139 | 0.93% |
Vietnamese | 1,485 | 0.64% |
Chinese | 1,410 | 0.61% |
Ukrainian | 1,394 | 0.60% |
Dari (Afghanistan) | 834 | 0.36% |
Arabic | 558 | 0.24% |
Korean | 421 | 0.18% |
Panjabi | 301 | 0.13% |
2024 Top 10 Interpreter Requests by Language and Request Type | ||||
Language of Request | Phone requests 2024 | Face-to-Face Requests 2024
| ||
f | % | f | % | |
Spanish | 8,063 | 60.42% | 2 | 33.3% |
Russian | 1,027 | 7.70% | 0 | 0.0% |
Ukrainian | 621 | 4.65% | 0 | 0.0% |
Vietnamese | 490 | 3.67% | 0 | 0.0% |
Dari (Afghanistan) | 376 | 2.82% | 0 | 0.0% |
Mandarin | 315 | 2.36% | 0 | 0.0% |
Arabic | 304 | 2.28% | 0 | 0.0% |
Amharic | 170 | 1.27% | 0 | 0.0% |
Farsi (Persian) | 123 | 0.92% | 0 | 0.0% |
Somali | 116 | 0.87% | 0 | 0.0% |
Total Requests | 13,161 |
| 2 |
|
2024 Summary of Requests for Alternative Formats
Alternate Forms | # of Requests (2024) | % of Total (2024) |
LARGE PRINT ENGLISH | 0 | 0 |
SIGN LANGUAGES | 16 | 0.12% |
BRAILLE (ENGLISH) | 3 | .25% |
Best Practices Gathered from Providers
- Documenting a member’s refusal of professional interpreter services and noting any use of a minor or accompanying adult is a best practice supported by healthcare providers to ensure cultural preferences are respected and future visits are appropriately informed.
- If a member chooses to use a family member or friend as an interpreter, it is recommended to offer a telephonic interpreter concurrently to help ensure the accuracy and completeness of the interpretation.
Contact Your Provider Engagement Team for Support
You are encouraged to reach out to your dedicated Provider Engagement Administrator to find out how this information can be used to strengthen your relationship with your patients. Your Provider Engagement team is available to help you. For a list of representatives by region visit, https://www.coordinatedcarehealth.com/providers/regional-contacts.html or call the Customer Contact Center at 1-877-644-4613 for additional support.
Providers are encouraged to review their interpreter service usage and ensure member language preferences are accurately documented. Updating this information helps improve care coordination and supports compliance with NCQA Health Equity standards.
To learn more about the language preferences of your members, visit the Provider Portal at coordinatedcarehealth.com/providers. To request a one-on-one session online or in person, visit the Coordinated Care Provider Events page for more information.
About the Americans with Disabilities Act
Disability is any substantial limitation of one or more of a person’s daily life activities and may be present from birth or may occur during a person’s lifetime. Any individual meeting any of these conditions is an individual with a disability for purposes of coverage under the Americans with Disabilities Act. https://www.ada.gov/
To meet Title VI of the Civil Rights Act of 1964 and Americans with Disabilities Act (ADA) health care providers are required to assure language access.
Programmatic access to healthcare means that policies and practices that are part of the delivery of healthcare do not hinder the ability of members with disabilities to receive the same quality of care as other persons.
In accordance with Title VI of the Civil Rights Act, Prohibition against national Origin Discriminations, the President’s Executive Order 131166, section 1557 of the Patient Protection and Affordable Care Act, The Health Plan and its providers must make language assistance available to persons with Limited English Proficiency (LEP) at all points of contact during all hours of operation.
To be removed from these fax/email notices or to request to be added to our email list for these notices, please email: CoordinatedCareProvider@centene.com.
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Quality
Medicaid Quality
The Tacoma Pierce County Health Department has developed a free, downloadable Opioid Awareness Toolkit
“Whether you’re a youth advocate, community leader, or first responder, this toolkit provides the resources you need to help make healthier choices and save lives in your community.”
“Together, we can prevent overdose, support recovery, and create a culture of care.”
Learn more about this great resource:
https://fentanylfacts.org/opioid-awareness-toolkit/
Washington launches new tools to help medical professionals deliver life-saving medications for opioid use disorder (OUD).
The Washington State Health Care Authority (HCA) and Department of Health (DOH) just released a new resource library to help health care providers and emergency medical services (EMS) personnel build knowledge and confidence to prescribe and administer medications for opioid use disorder (MOUD).
The Importance of Depression Screening
Depression is one of the leading causes of disability across the world. 1 The earlier depression is detected, the earlier it can be treated. Research shows when collaboration occurs between primary, OB/GYN and behavioral health care to screen for depression, monitor symptoms, and provide or refer for treatment, patient outcomes improve. Perinatal depression refers to minor and major depression episodes during pregnancy and/or the first 12 months after childbirth and is a common condition that affects functional outcomes both for affected women and for their families.
Measures
- Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
- Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
- Depression Remission or Response for Adolescents and Adults (DRR-E)
- Prenatal and Postpartum Depression Screening and Follow-Up (PND-E and PDS-E)
HEDIS Behavioral Health Measure Toolkit
Measurement Year 2025
Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
This measure assesses the percentage of members 18 years of age and older who were screened for unhealthy alcohol use using a standardized instrument and, if screened positive, received appropriate follow-up dare.
- Unhealthy Alcohol Use Screening: The percentage of members who had a systemic screening for unhealthy alcohol use.
- Follow-up Care on Positive Screen: The percentage of members receiving brief counseling or other follow-up care within 60 days (2 months) of screening positive for unhealthy alcohol use.
Use of Imaging Studies for Low Back Pain
Use of Imaging Studies for Low Back Pain (LBP) - NCQA
Approximately 4.3 million ED visits in the U.S. each year are due to a low back pain-related disorder1. An estimated 75%–85% of all Americans will experience back pain at some point in their lives, and approximately 39% of American adults will experience at least one day of back pain during any three-month period2 3.
Appropriate Treatment for Upper Respiratory Infection (URI)
Appropriate Treatment for Upper Respiratory Infection (URI) - NCQA
Clinical practice guidelines do not recommend antibiotics for a majority of upper respiratory tract infections because of the viral etiology of these infections, including the common cold. A performance measure of antibiotic use for URI sheds light on the prevalence of inappropriate antibiotic prescribing in clinical practice and raises awareness of the importance of reducing inappropriate antibiotic use to combat antibiotic resistance in the community.
Use of Opioids at High Dosage (HDO)
Use of Opioids at High Dosage (HDO) - NCQA
The percentage of persons 18 years of age and older who received prescription opioids at a high dosage (average morphine milligram equivalent dose [MME] ≥90) for ≥15 days during the measurement period
Oral Health Training for Healthcare Professionals
Smiles for Life Oral Health is a comprehensive oral health curriculum for healthcare professionals and health educators. This American Dental Association endorsed curriculum is designed to enhance the role of primary care clinicians in the promotion of oral health for all age groups. This curriculum includes oral health training for all ages and offers free CME to healthcare providers. Resource: https://www.smilesforlifeoralhealth.org/
Wellcare Quality
Controlling High Blood Pressure (CBP)- HEDIS Measure
Controlling High Blood Pressure (CBP) - NCQA
The percentage of persons 18–85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90 mm Hg) during the measurement period.
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Envolve Vision has announced annual updates to their policies. These changes are effective for Apple Health and Ambetter on January 1, 2026. You will find the policies on their website. You can find a link to Envolve Vision’s website on our Prior Authorization page.
The following policies are updated as of the listed Effective Date.
Policies are posted on the Coordinated Care of Washington Policy webpage. Evolent policies are available at https://www.radmd.com/solutions and will be accessible via the Evolent landing page found on the Coordinated Care Prior Authorization webpage effective 1/1/26.
New to List? | Policy # | Policy Title | Line of Business | Change Type | Effective Date |
CG.CC.PP.01 | Concert Lab Payment Policy | Apple Health, Ambetter | Revised | 1/1/2026 | |
CG.CP.MP.01 | Infection Disease: Respiratory Lab Testing | Apple Health, Ambetter | Revised | 1/1/2026 | |
CG.CP.MP.02 | Infectious Disease: Multisystems Lab Testing | Apple Health, Ambetter | Revised | 1/1/2026 | |
CG.CP.MP.03 | Infectious Dz Dermatologic Lab Testing | Apple Health, Ambetter | Revised | 1/1/2026 | |
CG.CP.MP.04 | Infectious Dz Gastroenterologic Lab Testing | Apple Health, Ambetter | Revised | 1/1/2026 | |
CG.CP.MP.05 | ID Primary Care Preventive Lab Testing | Apple Health, Ambetter | Revised | 1/1/2026 | |
CG.CP.MP.06 | ID Vector-Borne and Tropical Dz Lab Testing | Apple Health, Ambetter | Revised | 1/1/2026 | |
CG.PP.551A | Concert Genetic and Molecular Testing Payment Policy | Apple Health, Ambetter | Revised | 1/1/2026 | |
X | CP.MP.144 | Mechanical Stretching Devices | Ambetter | Revised | 1/1/2026 |
X | CP.MP.145 | Electric Tumor Treating Fields | Ambetter | Revised | 1/1/2026 |
X | CP.MP.22 | Stereotactic Body Radiation Therapy | Ambetter | Revised | 1/1/2026 |
X | CP.MP.61 | IV Moderate Sedation, IV Deep Sedation and General Anesthesia for Dental Procedures | Ambetter | Revised | 1/1/2026 |
CP.MP.93 | Bone-anchored hearing aid | Apple Health, Ambetter | Revised | 1/1/2026 | |
X | CP.PP.073 | Sepsis Diagnosis | Apple Health, Ambetter | Revised | 1/1/2026 |
X | WA.CP.BH.528 | Intensive Behavioral Supportive Supervision | Apple Health | Revised | 1/1/2026 |
X | WA.CP.BH.529 | Community Behavioral Health Support: Supportive Supervision | Apple Health | Revised | 1/1/2026 |
X | WA.CP.MP.22 | Stereotactic Body Radiation Therapy | Apple Health | Revised | 1/1/2026 |
X | WA.CP.MP.37 | Bariatric Surgery | Apple Health | Revised | 1/1/2026 |
WA.CP.MP.527 | Vitamin D Testing | Apple Health, Ambetter | Revised | 1/1/2026 | |
X | WA.CP.MP.54 | Hospice Services | Apple Health | Revised | 1/1/2026 |
CP.MP.107 | DME | Apple Health, Ambetter | Revised | 2/1/2026 | |
CP.MP.202 | Orthognathic Surgery | Apple Health, Ambetter | Revised | 2/1/2026 | |
X | CP.MP.185 | Skin Substitutes for Chronic Wounds | Ambetter | Revised | 4/1/2026 |
X | CP.MP.188 | Pediatric Oral Function Therapy | Apple Health, Ambetter | Revised | 4/1/2026 |
X | CP.MP.247 | Transplant Service Documentation Requirements | Apple Health, Ambetter | Revised | 4/1/2026 |
X | CP.MP.248 | Facility Based Sleep Studies for Obstructive Sleep Apnea | Ambetter | Revised | 4/1/2026 |
ECG_7252 | Evolent - Ambulatory Rhythm Monitoring | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7254 | Evolent - Coronary Artery Bypass Graft | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7255 | Evolent - Aortic Valve Replacement | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7258 | Evolent - Device Interrogation and Programming | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7261 | Evolent - Device (AICD, CRT and/or Pacemaker) Battery Replacement | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7262 | Evolent - Diagnostic Electrophysiologic Testing | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7263 | Evolent - Cardiac Resynchronization Therapy | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7264 | Evolent - Renal Angiography and Intervention | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7266 | Evolent - Carotid Artery Stenting | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7268 | Evolent - Carotid Endarterectomy | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7269 | Evolent - Catheter Based Carotid, Brachiocephalic Arteriography, Venography, Intervention | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7282 | Evolent - Atrial Fibrillation Ablation | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7283 | Evolent - Abdominal Aortography w Bilateral Iliofemoral Lower Extremity Runoff | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7284 | Evolent - Catheter Ablation of Reentrant or Focal Tachydysrhythmias | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7286 | Evolent - Endomyocardial Biopsy | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7287 | Evolent - Endovascular Femoropopliteal Interventions | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7288 | Evolent - Endovascular Aortoiliac Interventions | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7289 | Evolent - Endovascular Infrapopliteal (Tibioperoneal) Interventions | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7290 | Evolent - Treatment of Varicose Veins | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7292 | Evolent - Infra-inguinal Open Arterial Vascular Surgery | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7295 | Evolent - Hearth Catheterization | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7299 | Evolent - Hemodialysis Access Creation | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7301 | Evolent - Implantable Cardioverter Defibrillator | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7302 | Evolent - Percutaneous Coronary Interventions | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7303 | Evolent - Interventions for Adults with Congenital Heart Defects | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7305 | Evolent - Introduction of Inferior Vena Cava Filter Device | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7310 | Evolent - Mitral Valve Surgery | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7315 | Evolent - Pacemaker Insertion | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7319 | Evolent - Percutaneous Iliocaval Interventions | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7320 | Evolent - Percutaneous Left Atrial Appendage Closure | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7327 | Evolent - Standalone Right Heart Catheterization | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7334 | Evolent - Transcatheter Aortic Valve Replacement (TAVR) | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7335 | Evolent - Transcatheter Edge to Edge Repair (TEER) of Mitral Valve | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7338 | Evolent - Tricuspid Valve Surgery | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7339 | Evolent - Ultrasound-Guided Vascular Access | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7341 | Evolent - Venogram Invasive Vein Mapping | Apple Health, Ambetter | New | 1/1/2026 | |
ECG_7345 | Evolent - Wireless Pulmonary Artery Pressure Device Placement and Monitoring | Apple Health, Ambetter | New | 1/1/2026 | |
X | WA.CP.MP.536 | HCA HTCC Clinical Policy Alignment | Apple Health | New | 1/1/2026 |
CC.PP.018 | Inpatient Only Procedures | Apple Health | Archived | 12/31/2025 | |
MP.PP.018 | Inpatient Only Procedures | Ambetter | Archived | 12/31/2025 | |
WA.CP.MP.516 | Carotid Artery Stenting | Apple Health, Ambetter | Archived | 12/31/2025 | |
WA.CP.MP.522 | Varicose Vein Treatment | Apple Health, Ambetter | Archived | 12/31/2025 | |
WA.CP.MP.525 | Catheter Ablation for SVTA | Apple Health, Ambetter | Archived | 12/31/2025 | |
WA.HIM.CP.MP.92 | Acupuncture | Ambetter | Archived | 12/31/2025 | |
WA.CP.MP.513 | Cardiac Stents | Apple Health, Ambetter | Archived | 12/31/25 |
The following codes will require Pre-Authorization as of the listed Effective Date
Future changes to Pre-Authorization requirements are noted below. Utilize our Pre-Auth Check tool for real time response to pre authorization requirements.
Code | Description | Line of Business | Effective Date |
69714 | Implantation, osseo-integrated implant, skull; with percutaneous attachment to external speech processor | Apple Health | 1/1/2026 |
69729 | Implantation, osseo-integrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex | Apple Health | 1/1/2026 |
15734 | MUSCLE-SKIN GRAFT TRUNK | Apple Health | 2/1/2026 |
19301 | PARTIAL MASTECTOMY | Apple Health | 2/1/2026 |
19357 | TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION | Apple Health | 2/1/2026 |
37243 | VASC EMBOLIZE/OCCLUDE ORGAN | Apple Health | 2/1/2026 |
43281 | LAP PARAESOPHAG HERN REPAIR | Ambetter | 2/1/2026 |
43282 | LAP PARAESOPH HER RPR W/MESH | Ambetter | 2/1/2026 |
49505 | PRP I/HERN INIT REDUC >5 YR | Apple Health | 2/1/2026 |
49591 | RPR AA HERNIA 1ST < 3 CM REDUCIBLE | Apple Health | 2/1/2026 |
49593 | RPR AA HERNIA 1ST 3-10 CM REDUCIBLE | Apple Health | 2/1/2026 |
49595 | RPR AA HERNIA 1ST > 10 CM REDUCIBLE | Apple Health | 2/1/2026 |
49650 | LAP ING HERNIA REPAIR INIT | Apple Health | 2/1/2026 |
54360 | PENIS PLASTIC SURGERY | Apple Health | 2/1/2026 |
55866 | LAPARO RADICAL PROSTATECTOMY | Ambetter | 2/1/2026 |
58541 | LSH UTERUS 250 G OR LESS | Apple Health | 2/1/2026 |
58573 | TLH W/T/O UTERUS OVER 250 G | Apple Health | 2/1/2026 |
58661 | LAPAROSCOPY REMOVE ADNEXA | Apple Health | 2/1/2026 |
58662 | LAPAROSCOPY EXCISE LESIONS | Apple Health | 2/1/2026 |
64999 | NERVOUS SYSTEM SURGERY | Apple Health | 2/1/2026 |
97155 | ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN | Apple Health | 2/1/2026 |
0340U | ONC PAN CANCER ANALYSIS MRD FROM PLASMA | Apple Health | 2/1/2026 |
C1767 | GENERATOR NEUROSTIM NONRECHARGEABLE | Apple Health | 2/1/2026 |
H2022 | CMTY-BASED WRAP-AROUND SRVC DIEM | Apple Health | 2/1/2026 |
J2426 | INJECTION PP LAI EXT RLS INVEGA SUSTENNA 1 MG | Apple Health | 2/1/2026 |
L1833 | KNEE ORTHOSIS ADJUST JNT RIGD SUPP | Apple Health | 2/1/2026 |
Q4101 | APLIGRAF PER SQ CM | Apple Health | 2/1/2026 |
Q4121 | THERASKIN PER SQ CM | Apple Health | 2/1/2026 |
Q4160 | NUSHIELD 1 SQUARE CM | Apple Health | 2/1/2026 |
Q4195 | PURAPLY PER SQ CM | Apple Health | 2/1/2026 |
Q4196 | PURAPLY AM PER SQ CM | Apple Health | 2/1/2026 |
Q5001 | HOSPICE/HOME HLTH CARE PT HOME/RES | Apple Health | 2/1/2026 |
Q5002 | HOSPICE/HHC PROV ASSTD LIVING FACL | Apple Health | 2/1/2026 |
Q5003 | HOSPICE CARE PRVO LTC/NON-SKILL NF | Apple Health | 2/1/2026 |
With the implementation of the Evolent Interventional Cardiology program for both Ambetter and Apple Health on January 1, 2026, the following services will require prior authorization from Evolent as of January 1:
Code | Description | Line of Business | Effective Date |
33202 | Insertion of epicardial electrode(s); open incision (eg, thoracotomy, median sternotomy, subxiphoid approach) | Apple Health, | 1/1/2026 |
33203 | Insertion of epicardial electrode(s); endoscopic approach (eg, thoracoscopy, pericardioscopy) | Apple Health, | 1/1/2026 |
33206 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial | Apple Health, | 1/1/2026 |
33207 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular | Apple Health, | 1/1/2026 |
33208 | Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular | Apple Health, | 1/1/2026 |
33210 | Insertion or replacement of temporary transvenous single chamber cardiac electrode or pacemaker catheter (separate procedure) | Apple Health, | 1/1/2026 |
33211 | Insertion or replacement of temporary transvenous dual chamber pacing electrodes (separate procedure) | Apple Health, | 1/1/2026 |
33212 | Insertion of Pacemaker Pulse Generator Only; with Existing single Lead | Apple Health, | 1/1/2026 |
33213 | Insertion of Pacemaker Pulse Generator Only; with Existing Dual Leads | Apple Health, | 1/1/2026 |
33214 | Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new pulse generator) | Apple Health, | 1/1/2026 |
33215 | Repositioning of previously implanted transvenous pacemaker or implantable defibrillator (right atrial or right ventricular) electrode | Apple Health, | 1/1/2026 |
33216 | Insertion of a single transvenous electrode, permanent pacemaker or implantable defibrillator | Apple Health, | 1/1/2026 |
33217 | Insertion of 2 transvenous electrodes, permanent pacemaker or implantable defibrillator | Apple Health, | 1/1/2026 |
33218 | Repair of single transvenous electrode, permanent pacemaker or implantable defibrillator | Apple Health, | 1/1/2026 |
33220 | Repair of 2 transvenous electrodes for permanent pacemaker or implantable defibrillator | Apple Health, | 1/1/2026 |
33221 | Insertion of Pacemaker Pulse Generator Only; with Existing Multiple Leads | Apple Health, | 1/1/2026 |
33222 | Relocation of Skin Pocket for Pacemaker | Apple Health, | 1/1/2026 |
33223 | Relocation of skin pocket for implantable defibrillator | Apple Health, | 1/1/2026 |
33224 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) | Apple Health, | 1/1/2026 |
33225 | Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33226 | Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of existing generator) | Apple Health, | 1/1/2026 |
33227 | Removal of Permanent Pacemaker Pulse Generator with Replacement of Pacemaker Pulse Generator; single Lead System | Apple Health, | 1/1/2026 |
33228 | Removal of Permanent Pacemaker Pulse Generator with Replacement of Pacemaker Pulse Generator; Dual Lead System | Apple Health, | 1/1/2026 |
33229 | Removal of Permanent Pacemaker Pulse Generator with Replacement of Pacemaker Pulse Generator; Multiple Lead System | Apple Health, | 1/1/2026 |
33230 | Insertion of implantable defibrillator pulse generator only; with existing dual leads | Apple Health, | 1/1/2026 |
33231 | Insertion of implantable defibrillator pulse generator only; with existing multiple leads | Apple Health, | 1/1/2026 |
33233 | Removal of permanent pacemaker pulse generator only | Apple Health, | 1/1/2026 |
33234 | Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular | Apple Health, | 1/1/2026 |
33235 | Removal of transvenous pacemaker electrode(s); dual lead system | Apple Health, | 1/1/2026 |
33236 | Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single lead system, atrial or ventricular | Apple Health, | 1/1/2026 |
33237 | Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual lead system | Apple Health, | 1/1/2026 |
33240 | Insertion of implantable defibrillator pulse generator only; with existing single lead | Apple Health, | 1/1/2026 |
33241 | Removal of implantable defibrillator pulse generator only | Apple Health, | 1/1/2026 |
33243 | Removal of single or dual chamber implantable defibrillator electrode(s); by thoracotomy | Apple Health, | 1/1/2026 |
33244 | Removal of single or dual chamber implantable defibrillator electrode(s); by transvenous extraction | Apple Health, | 1/1/2026 |
33249 | Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber | Apple Health, | 1/1/2026 |
33262 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; single lead system | Apple Health, | 1/1/2026 |
33263 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system | Apple Health, | 1/1/2026 |
33264 | Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system | Apple Health, | 1/1/2026 |
33270 | Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed | Apple Health, | 1/1/2026 |
33271 | Insertion of subcutaneous implantable defibrillator electrode | Apple Health, | 1/1/2026 |
33272 | Removal of subcutaneous implantable defibrillator electrode | Apple Health, | 1/1/2026 |
33273 | Repositioning of previously implanted subcutaneous implantable defibrillator electrode | Apple Health, | 1/1/2026 |
33274 | Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed | Apple Health, | 1/1/2026 |
33275 | Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed | Apple Health, | 1/1/2026 |
33285 | Insertion, subcutaneous cardiac rhythm monitor, including programming | Apple Health, | 1/1/2026 |
33286 | Removal, subcutaneous cardiac rhythm monitor | Apple Health, | 1/1/2026 |
33361 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach | Apple Health, | 1/1/2026 |
33362 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach | Apple Health, | 1/1/2026 |
33363 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach | Apple Health, | 1/1/2026 |
33364 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open iliac artery approach | Apple Health, | 1/1/2026 |
33365 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy) | Apple Health, | 1/1/2026 |
33366 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transapical exposure (eg, left thoracotomy) | Apple Health, | 1/1/2026 |
33367 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with percutaneous peripheral arterial and venous cannulation (eg, femoral vessels) (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33368 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with open peripheral arterial and venous cannulation (eg, femoral, iliac, axillary vessels) (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33369 | Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; cardiopulmonary bypass support with central arterial and venous cannulation (eg, aorta, right atrium, pulmonary artery) (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33405 | Replacement, aortic valve, open, with cardiopulmonary bypass; with prosthetic valve other than homograft or stentless valve | Apple Health, | 1/1/2026 |
33406 | Replacement, aortic valve, open, with cardiopulmonary bypass; with allograft valve (freehand) | Apple Health, | 1/1/2026 |
33410 | Replacement, aortic valve, open, with cardiopulmonary bypass; with stentless tissue valve | Apple Health, | 1/1/2026 |
33411 | Replacement, aortic valve; with aortic annulus enlargement, noncoronary sinus | Apple Health, | 1/1/2026 |
33412 | Replacement, aortic valve; with transventricular aortic annulus enlargement (Konno procedure) | Apple Health, | 1/1/2026 |
33413 | Replacement, aortic valve; by translocation of autologous pulmonary valve with allograft replacement of pulmonary valve (Ross procedure) | Apple Health, | 1/1/2026 |
33418 | Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis | Apple Health, | 1/1/2026 |
33419 | Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33425 | Valvuloplasty, mitral valve, with cardiopulmonary bypass; | Apple Health, | 1/1/2026 |
33426 | Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring | Apple Health, | 1/1/2026 |
33427 | Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction, with or without ring | Apple Health, | 1/1/2026 |
33430 | Replacement, Mitral Valve, with Cardiopulmonary Bypass | Apple Health, | 1/1/2026 |
33440 | Replacement, aortic valve; by translocation of autologous pulmonary valve and transventricular aortic annulus enlargement of the left ventricular outflow tract with valved conduit replacement of pulmonary valve (Ross-Konno procedure) | Apple Health, | 1/1/2026 |
33465 | Replacement, Tricuspid Valve, with Cardiopulmonary Bypass | Apple Health, | 1/1/2026 |
33475 | Replacement, Pulmonary Valve | Apple Health, | 1/1/2026 |
33477 | Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed | Apple Health, | 1/1/2026 |
33510 | Coronary artery bypass, vein only; single coronary venous graft | Apple Health, | 1/1/2026 |
33511 | Coronary artery bypass, vein only; 2 coronary venous grafts | Apple Health, | 1/1/2026 |
33512 | Coronary artery bypass, vein only; 3 coronary venous grafts | Apple Health, | 1/1/2026 |
33513 | Coronary artery bypass, vein only; 4 coronary venous grafts | Apple Health, | 1/1/2026 |
33514 | Coronary artery bypass, vein only; 5 coronary venous grafts | Apple Health, | 1/1/2026 |
33516 | Coronary artery bypass, vein only; 6 or more coronary venous grafts | Apple Health, | 1/1/2026 |
33517 | Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33518 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 2 venous grafts (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33519 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 3 venous grafts (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33521 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 4 venous grafts (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33522 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 5 venous grafts (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33523 | Coronary artery bypass, using venous graft(s) and arterial graft(s); 6 or more venous grafts (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33530 | Reoperation, coronary artery bypass procedure or valve procedure, more than 1 month after original operation (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33533 | Coronary Artery Bypass, Using Arterial Graft(S); single Arterial Graft | Apple Health, | 1/1/2026 |
33534 | Coronary Artery Bypass, Using Arterial Graft(S); 2 Coronary Arterial Grafts | Apple Health, | 1/1/2026 |
33535 | Coronary Artery Bypass, Using Arterial Graft(S); 3 Coronary Arterial Grafts | Apple Health, | 1/1/2026 |
33536 | Coronary artery bypass, using arterial graft(s); 4 or more coronary arterial grafts | Apple Health, | 1/1/2026 |
33572 | Coronary endarterectomy, open, any method, of left anterior descending, circumflex, or right coronary artery performed in conjunction with coronary artery bypass graft procedure, each vessel (List separately in addition to primary procedure) | Apple Health, | 1/1/2026 |
33641 | Repair atrial Septal Defect, Secundum, with Cardiopulmonary Bypass, with or without Patch | Apple Health, | 1/1/2026 |
33768 | Anastomosis, cavopulmonary, second superior vena cava (List separately in addition to primary procedure) | Apple Health, | 1/1/2026 |
33820 | Repair of patent ductus arteriosus; by ligation | Apple Health, | 1/1/2026 |
33840 | Excision of coarctation of aorta, with or without associated patent ductus arteriosus; with direct anastomosis | Apple Health, | 1/1/2026 |
33900 | Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, unilateral | Apple Health, | 1/1/2026 |
33901 | Percutaneous pulmonary artery revascularization by stent placement, initial; normal native connections, bilateral | Apple Health, | 1/1/2026 |
33902 | Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, unilateral | Apple Health, | 1/1/2026 |
33903 | Percutaneous pulmonary artery revascularization by stent placement, initial; abnormal connections, bilateral | Apple Health, | 1/1/2026 |
33904 | Percutaneous pulmonary artery revascularization by stent placement, each additional vessel or separate lesion, normal or abnormal connections (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
33917 | Repair of pulmonary artery stenosis by reconstruction with patch or graft | Apple Health, | 1/1/2026 |
33924 | Ligation and takedown of a systemic-to-pulmonary artery shunt, performed in conjunction with a congenital heart procedure (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
35001 | Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, carotid, subclavian artery, by neck incision | Apple Health, | 1/1/2026 |
35011 | Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm and associated occlusive disease, axillary-brachial artery, by arm incision | Apple Health, | 1/1/2026 |
35141 | Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, common femoral artery (profunda femoris, superficial femoral) | Apple Health, | 1/1/2026 |
35151 | Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, popliteal artery | Apple Health, | 1/1/2026 |
35301 | Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision | Apple Health, | 1/1/2026 |
35302 | Thromboendarterectomy, including patch graft, if performed; superficial femoral artery | Apple Health, | 1/1/2026 |
35303 | Thromboendarterectomy, including patch graft, if performed; popliteal artery | Apple Health, | 1/1/2026 |
35304 | Thromboendarterectomy, including patch graft, if performed; tibioperoneal trunk artery | Apple Health, | 1/1/2026 |
35305 | Thromboendarterectomy, including patch graft, if performed; tibial or peroneal artery, initial vessel | Apple Health, | 1/1/2026 |
35306 | Thromboendarterectomy, including patch graft, if performed; each additional tibial or peroneal artery (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
35351 | Thromboendarterectomy, including Patch Graft, If Performed; Iliac | Apple Health, | 1/1/2026 |
35355 | Thromboendarterectomy, including Patch Graft, If Performed; Iliofemoral | Apple Health, | 1/1/2026 |
35371 | Thromboendarterectomy, including Patch Graft, If Performed; Common Femoral | Apple Health, | 1/1/2026 |
35372 | Thromboendarterectomy, including Patch Graft, If Performed; Deep (Profunda) Femoral | Apple Health, | 1/1/2026 |
35390 | Reoperation, carotid, thromboendarterectomy, more than 1 month after original operation (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
35400 | Angioscopy (noncoronary vessels or grafts) during therapeutic intervention (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
35500 | Harvest of upper extremity vein, 1 segment, for lower extremity or coronary artery bypass procedure (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
35556 | Bypass Graft, with Vein; Femoral-Popliteal | Apple Health, | 1/1/2026 |
35558 | Bypass Graft, with Vein; Femoral-Femoral | Apple Health, | 1/1/2026 |
35566 | Bypass graft, with vein; femoral-anterior tibial, posterior tibial, peroneal artery or other distal vessels | Apple Health, | 1/1/2026 |
35571 | Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels | Apple Health, | 1/1/2026 |
35572 | Harvest of femoropopliteal vein, 1 segment, for vascular reconstruction procedure (eg, aortic, vena caval, coronary, peripheral artery) (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
35583 | In-situ vein bypass; femoral-popliteal | Apple Health, | 1/1/2026 |
35585 | In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery | Apple Health, | 1/1/2026 |
35587 | In-situ vein bypass; popliteal-tibial, peroneal | Apple Health, | 1/1/2026 |
35600 | Harvest of upper extremity artery, 1 segment, for coronary artery bypass procedure, open | Apple Health, | 1/1/2026 |
35621 | Bypass Graft, with Other than Vein; Axillary-Femoral | Apple Health, | 1/1/2026 |
35646 | Bypass Graft, with Other than Vein; Aortobifemoral | Apple Health, | 1/1/2026 |
35654 | Bypass Graft, with Other than Vein; Axillary-Femoral-Femoral | Apple Health, | 1/1/2026 |
35656 | Bypass Graft, with Other than Vein; Femoral-Popliteal | Apple Health, | 1/1/2026 |
35661 | Bypass graft, with other than vein; femoral-femoral | Apple Health, | 1/1/2026 |
35665 | Bypass Graft, with Other than Vein; Iliofemoral | Apple Health, | 1/1/2026 |
35666 | Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or peroneal artery | Apple Health, | 1/1/2026 |
35671 | Bypass graft, with other than vein; popliteal-tibial or -peroneal artery | Apple Health, | 1/1/2026 |
35700 | Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior tibial, peroneal artery, or other distal vessels, more than 1 month after original operation (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
35881 | Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition | Apple Health, | 1/1/2026 |
35883 | Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, Dacron, ePTFE, bovine pericardium) | Apple Health, | 1/1/2026 |
35884 | Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with autogenous vein patch graft | Apple Health, | 1/1/2026 |
36005 | Injection procedure for extremity venography (including introduction of needle or intracatheter) | Apple Health, | 1/1/2026 |
36140 | Introduction of needle or intracatheter, upper or lower extremity artery | Apple Health, | 1/1/2026 |
36200 | Introduction of Catheter, Aorta | Apple Health, | 1/1/2026 |
36215 | Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family | Apple Health, | 1/1/2026 |
36216 | Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family | Apple Health, | 1/1/2026 |
36217 | Selective Catheter Placement, Arterial System; initial Third order or More Selective Thoracic or Brachiocephalic Branch, within A Vascular Family | Apple Health, | 1/1/2026 |
36218 | Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate) | Apple Health, | 1/1/2026 |
36221 | Non-selective catheter placement, thoracic aorta, with angiography of the extracranial carotid, vertebral, and/or intracranial vessels, unilateral or bilateral, and all associated radiological supervision and interpretation, includes angiography of the cervicocerebral arch, when performed | Apple Health, | 1/1/2026 |
36245 | Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family | Apple Health, | 1/1/2026 |
36246 | Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family | Apple Health, | 1/1/2026 |
36247 | Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family | Apple Health, | 1/1/2026 |
36251 | Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral | Apple Health, | 1/1/2026 |
36252 | Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral | Apple Health, | 1/1/2026 |
36253 | Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral | Apple Health, | 1/1/2026 |
36254 | Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; bilateral | Apple Health, | 1/1/2026 |
36465 | Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) | Apple Health, | 1/1/2026 |
36466 | Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg | Apple Health, | 1/1/2026 |
36473 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated | Apple Health, | 1/1/2026 |
36474 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
36475 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated | Apple Health, | 1/1/2026 |
36476 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
36478 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated | Apple Health, | 1/1/2026 |
36479 | Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
36482 | Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated | Apple Health, | 1/1/2026 |
36483 | Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
36836 | Percutaneous arteriovenous fistula creation, upper extremity, single access of both the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation | Apple Health, | 1/1/2026 |
36837 | Percutaneous arteriovenous fistula creation, upper extremity, separate access sites of the peripheral artery and peripheral vein, including fistula maturation procedures (eg, transluminal balloon angioplasty, coil embolization) when performed, including all vascular access, imaging guidance and radiologic supervision and interpretation | Apple Health, | 1/1/2026 |
37215 | Transcatheter placement of intravascular stent(s), cervical carotid artery, open or percutaneous, including angioplasty, when performed, and radiological supervision and interpretation; with distal embolic protection | Apple Health, | 1/1/2026 |
37236 | Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; initial artery | Apple Health, | 1/1/2026 |
37237 | Transcatheter placement of an intravascular stent(s) (except lower extremity artery(s) for occlusive disease, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or percutaneous, including radiological supervision and interpretation and including all angioplasty within the same vessel, when performed; each additional artery (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37238 | Transcatheter Placement of An Intravascular Stent(S), Open or Percutaneous, including Radiological Supervision and Interpretation and including Angioplasty within the Same Vessel, when Performed; initial Vein | Apple Health, | 1/1/2026 |
37239 | Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; each additional vein (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37246 | Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery | Apple Health, | 1/1/2026 |
37247 | Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37248 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein | Apple Health, | 1/1/2026 |
37249 | Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37254 | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37255 | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37256 | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37257 | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37258 | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37259 | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37260 | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37261 | Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37263 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37264 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37265 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37266 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37267 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37268 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37269 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37270 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37271 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37272 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37273 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37274 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37275 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37276 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37277 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37278 | Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37280 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37281 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37282 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37283 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37284 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37285 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37286 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37287 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37288 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37289 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37290 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37291 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the atherectomy and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37292 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37293 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37294 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37295 | Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the stent placement, atherectomy, and angioplasty when performed, within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37296 | Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, initial vessel | Apple Health, | 1/1/2026 |
37297 | Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; straightforward lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37298 | Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, initial vessel | Apple Health, | 1/1/2026 |
37299 | Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidance and radiological supervision and interpretation necessary to perform the angioplasty within the same artery, unilateral; complex lesion, each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
37765 | Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions | Apple Health, | 1/1/2026 |
37766 | Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions | Apple Health, | 1/1/2026 |
75580 | Noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified health care professional | Apple Health, | 1/1/2026 |
75625 | Aortography, abdominal, by serialography, radiological supervision and interpretation | Apple Health, | 1/1/2026 |
75630 | Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation | Apple Health, | 1/1/2026 |
75710 | Angiography, extremity, unilateral, radiological supervision and interpretation | Apple Health, | 1/1/2026 |
75716 | Angiography, extremity, bilateral, radiological supervision and interpretation | Apple Health, | 1/1/2026 |
75726 | Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation | Apple Health, | 1/1/2026 |
75736 | Angiography, pelvic, selective or supraselective, radiological supervision and interpretation | Apple Health, | 1/1/2026 |
76937 | Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
76984 | Ultrasound, intraoperative thoracic aorta (eg, epiaortic), diagnostic | Apple Health, | 1/1/2026 |
76987 | Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; including placement and manipulation of transducer, image acquisition, interpretation and report | Apple Health, | 1/1/2026 |
76988 | Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; placement, manipulation of transducer, and image acquisition only | Apple Health, | 1/1/2026 |
76989 | Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; interpretation and report only | Apple Health, | 1/1/2026 |
92920 | Percutaneous Transluminal Coronary Angioplasty; single Major Coronary Artery or Branch | Apple Health, | 1/1/2026 |
92924 | Percutaneous Transluminal Coronary atherectomy, with Coronary Angioplasty when Performed; single Major Coronary Artery or Branch | Apple Health, | 1/1/2026 |
92928 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch | Apple Health, | 1/1/2026 |
92930 | Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, single major coronary artery and/or its branch(es); 2 or more distinct coronary lesions with 2 or more coronary stents deployed in 2 or more coronary segments, or a bifurcation lesion requiring angioplasty and/or stenting in both the main artery and the side branch | Apple Health, | 1/1/2026 |
92933 | Percutaneous Transluminal Coronary atherectomy, with Intracoronary Stent, with Coronary Angioplasty when Performed; single Major Coronary Artery or Branch | Apple Health, | 1/1/2026 |
92937 | Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel | Apple Health, | 1/1/2026 |
92943 | Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel | Apple Health, | 1/1/2026 |
92960 | Cardioversion, elective, electrical conversion of arrhythmia; external | Apple Health, | 1/1/2026 |
92961 | Cardioversion, elective, electrical conversion of arrhythmia; internal (separate procedure) | Apple Health, | 1/1/2026 |
92972 | Percutaneous transluminal coronary lithotripsy (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
92973 | Percutaneous transluminal coronary thrombectomy mechanical (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
92974 | Transcatheter placement of radiation delivery device for subsequent coronary intravascular brachytherapy (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
92978 | Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
92979 | Endoluminal imaging of coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
92986 | Percutaneous balloon valvuloplasty; aortic valve | Apple Health, | 1/1/2026 |
92987 | Percutaneous balloon valvuloplasty; mitral valve | Apple Health, | 1/1/2026 |
92997 | Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel | Apple Health, | 1/1/2026 |
92998 | Percutaneous transluminal pulmonary artery balloon angioplasty; each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93292 | Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; wearable defibrillator system | Apple Health, | 1/1/2026 |
93451 | Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed | Apple Health, | 1/1/2026 |
93452 | Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed | Apple Health, | 1/1/2026 |
93453 | Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed | Apple Health, | 1/1/2026 |
93454 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; | Apple Health, | 1/1/2026 |
93455 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography | Apple Health, | 1/1/2026 |
93456 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization | Apple Health, | 1/1/2026 |
93457 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization | Apple Health, | 1/1/2026 |
93458 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed | Apple Health, | 1/1/2026 |
93459 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography | Apple Health, | 1/1/2026 |
93460 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed | Apple Health, | 1/1/2026 |
93461 | Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography | Apple Health, | 1/1/2026 |
93462 | Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93463 | Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when performed (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93464 | Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93505 | Endomyocardial Biopsy | Apple Health, | 1/1/2026 |
93563 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective coronary angiography during congenital heart catheterization (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93564 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective opacification of aortocoronary venous or arterial bypass graft(s) (eg, aortocoronary saphenous vein, free radial artery, or free mammary artery graft) to one or more coronary arteries and in situ arterial conduits (eg, internal mammary), whether native or used for bypass to one or more coronary arteries during congenital heart catheterization, when performed (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93565 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective left ventricular or left atrial angiography (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93566 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective right ventricular or right atrial angiography (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93567 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for supravalvular aortography (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93568 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for pulmonary angiography (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93569 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, unilateral (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93571 | Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; initial vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93572 | Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement (coronary vessel or graft) during coronary angiography including pharmacologically induced stress; each additional vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93573 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary arterial angiography, bilateral (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93574 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary venous angiography of each distinct pulmonary vein during cardiac catheterization (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93575 | Injection procedure during cardiac catheterization including imaging supervision, interpretation, and report; for selective pulmonary angiography of major aortopulmonary collateral arteries (MAPCAs) arising off the aorta or its systemic branches, during cardiac catheterization for congenital heart defects, each distinct vessel (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93580 | Percutaneous transcatheter closure of congenital interatrial communication (ie, Fontan fenestration, atrial septal defect) with implant | Apple Health, | 1/1/2026 |
93581 | Percutaneous transcatheter closure of a congenital ventricular septal defect with implant | Apple Health, | 1/1/2026 |
93582 | Percutaneous transcatheter closure of patent ductus arteriosus | Apple Health, | 1/1/2026 |
93583 | Percutaneous Transcatheter Septal Reduction therapy (Eg, Alcohol Septal Ablation) including Temporary Pacemaker Insertion when Performed | Apple Health, | 1/1/2026 |
93584 | Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; anomalous or persistent superior vena cava when it exists as a second contralateral superior vena cava, with native drainage to heart (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93585 | Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; azygos/hemiazygos venous system (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93586 | Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; coronary sinus (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93587 | Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; venovenous collaterals originating at or above the heart (eg, from innominate vein) (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93588 | Venography for congenital heart defect(s), including catheter placement, and radiological supervision and interpretation; venovenous collaterals originating below the heart (eg, from the inferior vena cava) (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93590 | Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, mitral valve | Apple Health, | 1/1/2026 |
93591 | Percutaneous transcatheter closure of paravalvular leak; initial occlusion device, aortic valve | Apple Health, | 1/1/2026 |
93592 | Percutaneous transcatheter closure of paravalvular leak; each additional occlusion device (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93609 | Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter manipulation to record from multiple sites to identify origin of tachycardia (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93613 | Intracardiac electrophysiologic 3-dimensional mapping (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93619 | Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia | Apple Health, | 1/1/2026 |
93620 | Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording | Apple Health, | 1/1/2026 |
93621 | Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left atrial pacing and recording from coronary sinus or left atrium (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93622 | Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with left ventricular pacing and recording (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93623 | Programmed stimulation and pacing after intravenous drug infusion (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93650 | Intracardiac catheter ablation of atrioventricular node function, atrioventricular conduction for creation of complete heart block, with or without temporary pacemaker placement | Apple Health, | 1/1/2026 |
93653 | Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry | Apple Health, | 1/1/2026 |
93654 | Comprehensive electrophysiologic evaluation with insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia with right atrial pacing and recording and catheter ablation of arrhythmogenic focus, including intracardiac electrophysiologic 3-dimensional mapping, right ventricular pacing and recording, left atrial pacing and recording from coronary sinus or left atrium, and His bundle recording, when performed; with treatment of ventricular tachycardia or focus of ventricular ectopy including left ventricular pacing and recording, when performed | Apple Health, | 1/1/2026 |
93655 | Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93656 | Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia including left or right atrial pacing/recording, and intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation, including intracardiac electrophysiologic 3-dimensional mapping, intracardiac echocardiography with imaging supervision and interpretation, right ventricular pacing/recording, and His bundle recording, when performed | Apple Health, | 1/1/2026 |
93657 | Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93662 | Intracardiac echocardiography during therapeutic/diagnostic intervention, including imaging supervision and interpretation (List separately in addition to code for primary procedure) | Apple Health, | 1/1/2026 |
93745 | Initial set-up and programming by a physician or other qualified health care professional of wearable cardioverter-defibrillator includes initial programming of system, establishing baseline electronic ECG, transmission of data to data repository, patient instruction in wearing system and patient reporting of problems or events | Apple Health, | 1/1/2026 |
C1721 | CARDIOVERT-DEFIBRILLATOR DUAL CHAMB | Apple Health, | 1/1/2026 |
C1722 | CARDIOVERT-DEFIB SINGLE CHAMB | Apple Health, | 1/1/2026 |
C1730 | CATH EP DX OTH THAN 3D MAP 19/< | Apple Health, | 1/1/2026 |
C1731 | CATH EP DX OTH THAN 3D MAP 20/> | Apple Health, | 1/1/2026 |
C1732 | CATH EP DX/ABLAT 3D/VECTOR MAP | Apple Health, | 1/1/2026 |
C1733 | CATH EP DX/ABLAT NOT MAP/COOL-TIP | Apple Health, | 1/1/2026 |
C1753 | CATHETER INTRAVASCULAR ULTRASOUND | Apple Health, | 1/1/2026 |
C1759 | CATHETER INTRACARD ECHOCARDIOGRAPHY | Apple Health, | 1/1/2026 |
C1760 | CLOSURE DEVICE VASCULAR | Apple Health, | 1/1/2026 |
C1764 | EVENT RECORDER CARDIAC | Apple Health, | 1/1/2026 |
C1768 | GRAFT VASCULAR | Apple Health, | 1/1/2026 |
C1777 | LEAD CARDIOVRT-DFIB ENDOCARD 1 COIL | Apple Health, | 1/1/2026 |
C1779 | LEAD PACEMKR TRNS VDD SINGLE PASS | Apple Health, | 1/1/2026 |
C1785 | PACEMKR DUAL CHAMB RATE-RESPONSIVE | Apple Health, | 1/1/2026 |
C1786 | PACEMKR 1 CHAMB RATE-RESPONSIVE | Apple Health, | 1/1/2026 |
C1876 | STNT NON-COATED/NON-COVR DELIV SYS | Apple Health, | 1/1/2026 |
C1877 | STNT NON-COAT/NON-COVR W/O DEL SYS | Apple Health, | 1/1/2026 |
C1882 | CARDIOVRT-DFIB OTH THAN 1/DUL CHAMB | Apple Health, | 1/1/2026 |
C1895 | LEAD CARDIOVRT-DFIB ENDOCARD DUL | Apple Health, | 1/1/2026 |
C1896 | LEAD CARDIOVRT-DFIB NOT ENDOCARD | Apple Health, | 1/1/2026 |
C1898 | LEAD PACEMKR NOT TRNS VDD 1 PASS | Apple Health, | 1/1/2026 |
C1899 | LEAD PACEMKR/CARDIOVERT-DEFIB COMB | Apple Health, | 1/1/2026 |
C1900 | LEAD LT VENTRICULAR CORON VENUS SYS | Apple Health, | 1/1/2026 |
C2617 | STENT NON-COR TEMP W/O DELIV SYSTEM | Apple Health, | 1/1/2026 |
C2619 | PACEMKR DUL CHAMB NON RATE-RESPONS | Apple Health, | 1/1/2026 |
C2620 | PACEMKR 1 CHAMB NON RATE-RESPONSIVE | Apple Health, | 1/1/2026 |
C2621 | PACEMKR OTH THAN SINGLE/DUAL CHAMB | Apple Health, | 1/1/2026 |
C2623 | CATHETER TA DRUG-COATED NON-LASER | Apple Health, | 1/1/2026 |
C2630 | CATH EP DX/ABLAT NOT MAP COOL-TIP | Apple Health, | 1/1/2026 |
C9600 | PERQ TRANSCATH PLCMT; 1 MAJ CA/BR | Apple Health, | 1/1/2026 |
C9601 | PC TRNSCATH PLCMT; EA ADD BR MAJ CA | Apple Health, | 1/1/2026 |
C9602 | PERQ TL CORONARY ATHERECT; 1 MCA/BR | Apple Health, | 1/1/2026 |
C9603 | PERQ TL COR ATHERECT;EA ADD BR MCA | Apple Health, | 1/1/2026 |
C9604 | PERQ TL REVISION OF/THRU CABG;1 VES | Apple Health, | 1/1/2026 |
C9605 | PERQ TL REV OF/THRU CABG;EA ADD BR | Apple Health, | 1/1/2026 |
C9606 | PC TL REV AC TOT/SUBTOT OCCL 1 VES | Apple Health, | 1/1/2026 |
C9607 | PERQ TL REV CHRN TOT OCCL; 1 VESSEL | Apple Health, | 1/1/2026 |
C9608 | PC TL REV CHRN TOT OCCL; EA ADD BR | Apple Health, | 1/1/2026 |
E0616 | Implantable cardiac event recorder with memory, activator, and programmer | Apple Health, | 1/1/2026 |
G0278 | Iliac and/or Femoral Angiography at Time of Cath | Apple Health, | 1/1/2026 |
K0606 | Automatic external defibrillator, with integrated electrocardiogram analysis, garment type | Apple Health, | 1/1/2026 |
K0607 | Replacement battery for automated external defibrillator, garment type only, each | Apple Health, | 1/1/2026 |
K0608 | Replacement garment for use with automated external defibrillator, each | Apple Health, | 1/1/2026 |
K0609 | Replacement electrodes for use with automated external defibrillator, garment type only, each | Apple Health, | 1/1/2026 |
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Please see the Wellcare Website for the latest upcoming policy changes going into effect February 9th. https://www.wellcare.com/providers/medicare-bulletins/medical-clinical-policy-updates
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FREE Adoption Competency Training! The Center for Adoption Support and Education has updated its National Adoption Competency Mental Health Training Initiative. NTI is state-of-the-art, web-based training to enhance the capacity of child welfare and mental health professionals to effectively address the complex mental health needs of children in foster care, moving to permanency through adoption or guardianship or living with their adoptive or guardianship families.
NTI Training for Mental Health Professionals (26.5 hours) was designed for behavioral/mental health professionals in public and private agency, community-based, or residential settings, as well as private practitioners. NTI provides foundational knowledge to more effectively address the unique adoption-related issues that arise throughout the lifespan of the adoptive or guardianship/ kinship family. This includes work with children and youth in foster care, adoptees, birth families, adoptive/kinship families.
This training is approved by the National Association of Social Workers (NASW) and National Board of Certified Counselors (NBCC) for 26.5 continuing education credits for individuals who enroll through C.A.S.E. on the C.A.S.E. LMS (Use Enrollment Key: NTIMHP2021) and pass the module post-tests at 80%.
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Evolent training sessions
Evolent training sessions will be scheduled for several dates beginning in December. For additional program details and to register for training, please visit the Evolent resource page. For program changes effective January 1. https://go.evolent.com/coordinated-care-program-changes-january-1-2026
Full link: https://go.evolent.com/coordinated-care-program-changes-january-1-2026
Cultural Care & Connections: Supporting Native American Tribal Families and Youth This training explores the importance of honoring cultural differences when caring for Native American children and youth, particularly those placed outside of their tribal communities. Participants will gain insight of tribal communities, as well as the impact of historical and intergenerational trauma. The training also helps caregivers identify potential cultural barriers— including in areas of personal care—and provides strategies for offering respectful, inclusive support. Emphasis is placed on the vital need to keep Native children connected to their tribal heritage, extended family, and community in alignment with the Indian Child Welfare Act (ICWA) and tribal sovereignty. Jan 6, 2026, 11:00 AM https://centene.zoom.us/meeting/register/cgvsP2DZTSuVmwULd07QdA
Trauma 101 What is Trauma? This training answers this question by defining trauma, how trauma affects children, and what caregivers can do to assist children. The presentation will heighten the caregiver’s awareness of children’s cues so they will know what to expect and how to respond when a child experiences trauma triggers. Jan 7, 2026, 01:00 PM https://centene.zoom.us/meeting/register/z3vems5pSkaevRMEoRoS1A
Childhood Development & The Impact of Trauma This training provides information on key areas of childhood development; social, cognitive, and physical development are all explored. The training focuses on how complex trauma effects development in infants and toddlers, school aged children, and adolescents. Jan 14, 2026 12:00 PM Pacific https://centene.zoom.us/j/96686731324?pwd=lb3N9rmBoyxDy0dCbGAR9t06ByjEFg.1
Suicide Prevention in Youth: Provides an overview of the topic of suicide, signs and symptoms in youth, and how professionals and caregivers should respond in times of crisis. The training will dive into the rates of youth suicide, risk factors, and proactive steps to take for prevention. Will include a discussion on self-harm and social media. This training has many resources to utilize, as well as being useful for concerns of suicidal ideation in adults as well. Jan 7, 2026 06:00 - 08:00pm https://centene.zoom.us/meeting/register/3hcXpz-lRMO6sg6MMEuuuw
Attachment: Beyond Infancy: Attachment is the foundation of all relationships, and when caring for children with a history of trauma and trust issues, it does not always occur easily. Lack of bonding is often a core reason why caretakers and children have challenges in placement and/or disrupt from the home. This training addresses the need for Attachment-Focused care, including some practical tips on how to strengthen connections to children. This training can help caregivers and professionals understand the basics of how attachment issues are extremely common in children who have experienced complex trauma, and what behaviors may come from that history. Jan 15, 2026 06:00 -08:00pm
https://centene.zoom.us/meeting/register/mQMh1YGVS2aCbD0_QcpObg
ACE's (Adverse Childhood Experiences): This training explains the Adverse Childhood Experiences (ACEs) study and identifies all 10 ACEs. All childhood experiences, especially traumatic events, have an impact on people as they mature. This training explores the long term effects that adverse childhood experiences have on physical and mental health. Preventative measures, resiliency, and how to address the needs of children with a high ACEs score are all discussed. Personal ACE's test provided. Jan 28,2026 06:00 - 08:00pm https://centene.zoom.us/meeting/register/65nzbI9bRpa0ssqoJU1jnw
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NPI Prescriber Enforcement for Pharmacy Claims- Medicaid
Action Required: In accordance with 42 CFR 438.602(b), all prescribers must be registered with the Health Care Authority (HCA). Effective April 1, 2026, any prescription submitted by a prescriber not recognized by the HCA will be rejected at pharmacy point of sale, some exceptions may apply. Please visit Enroll as a provider | Washington State Health Care Authority for more information on how to enroll as a provider with the HCA.
https://www.hca.wa.gov/billers-providers-partners/become-apple-health-provider/enroll-provider
Pharmacy Clinical Policy Updates- Medicaid & Ambetter
The following pharmacy policies have been updated and will be posted on the policy site, including a description of revisions at https://www.coordinatedcarehealth.com/providers/resources/clinical-payment-policies.html.
Policy Number | Policy Title | Effective Date | Line of Business |
WA.PHAR.49.AB | IL4 IL 13 Inhibitors | 01/01/2026 | Medicaid |
WA.PHAR.49.AH | CAM-JAK Inhibitors | 01/01/2026 | Medicaid |
WA.PHAR.81 | Proton Pump Inhibitors (PPI) | 01/01/2026 | Medicaid |
WA.PHAR.28 | Androgenic Agents- Testosterone Replacement Therapy (TRT) | 01/01/2026 | Medicaid |
CP.PHAR.103 | Immune Globulins | 01/01/2026 | Medicaid |
CP.PMN.154 | Isavuconazonium (Cresemba) | 01/01/2026 | Medicaid & Ambetter |
CP.PHAR.759 | Nerandomilast (Jascayd) | 01/01/2026 | Medicaid & Ambetter |
CP.PMN.156 | Perampanel (Fycompa) | 01/01/2026 | Medicaid & Ambetter |
CP.PMN.33 | Pregabalin (Lyrica, Lyrica CR) | 01/01/2026 | Medicaid & Ambetter |
CP.PHAR.725 | Tiopronin Delayed-Release (Thiola EC) | 01/01/2026 | Medicaid & Ambetter |
Evolent Medical Oncology Update- Ambetter
Prior Authorization requests for the following HCPCS codes need to be verified by Evolent.
HCPCS | Generic Name | Brand Name | Medical PA | Pharmacy PA | Impact Description |
C9399 | CARBOPLATIN INJECTION | KYXATA | Yes | Yes | · FDA new release/approval 8/8/25 · Centene PA effective date 4/1/26 |
J9999 | CARBOPLATIN INJECTION | KYXATA | Yes | Yes | · FDA new release/approval 8/8/25 · Centene PA effective date 4/1/26 |
J9999 | PEMBROLIZUMAB AND | KEYTRUDA QLEX | Yes | Yes | · FDA new release/approval 9/19/25 · Centene PA effective date 4/1/26 |
J3590 | DENOSUMAB-QBDE ENOBY INJECTION | ENOBY | Yes | Yes | · FDA new release/ approval 9/26/25 · Centene PA effective date 4/1/26 |
J3590 | DENOSUMAB-QBDE XTRENBO | XTRENBO | Yes | Yes | · FDA new release/approval 9/26/25 · Centene PA effective date 4/1/26 |
J9999 | LEUPROLIDE INJECTION | CAMCEVI ETM | Yes | Yes | · FDA new release/approval 8/28/25 · Centene PA effective date 4/1/26 |
C9307 | LINVOSELTAMAB-GCPT INJECTION | LYNOZYFIC | Yes | Yes | · New code, CMS effective date 1/1/26 · Centene PA effective 4/1/26 |
C9308 | CARBOPLATIN (AVYXA) INJECTION | KYXATA | Yes | Yes | · New code, CMS effective date 1/1/26 · Centene PA effective 4/1/26 |
J0162 | EPINEPHRINE [FRESNIUS KABI) | EPINEPHRINE | No | No | · New code, CMS effective date 1/1/26 · Centene PA effective 4/1/26 |
J9184 | GEMCITABINE (AVGEMSI) | AVGEMSI | Yes | Yes | · New code, CMS effective date 1/1/26 · Replace J9999 · Centene PA effective 4/1/26 |
J9282 | MITOMYCIN SOLUTION | ZUSDURI | Yes | Yes | · New code, CMS effective date 1/1/26 · Replace J9999 · Centene PA effective 4/1/26 |
J9326 | TELISOTUZUMAB VEDOTIN-TLLV | EMRELIS | Yes | Yes | · New code, CMS effective date 1/1/26 · Replace J9999 & C9306 · Centene PA effective 4/1/26 |
Q5160 | BEVACIZUMAB-NWGD | JOBEVNE | Yes | Yes | · New code, CMS effective date 1/1/26 · Replace J9999 · Centene PA effective 4/1/26 |
J3590 | DENOSUMAB-DESU JUBEREQ | JUBEREQ | Yes | Yes | · FDA new release approval 11/20/25 · Biosimilar to Xgeva-has PA · Centene PA effective 4/1/26 |
J3590 | DENOSUMAB-DESU OSVYRTI | OSVYRTI | Yes | Yes | · FDA new release approval 11/20/25 · Biosimilar to Prolia-has PA · Centene PA effective 4/1/26 |
J8999 | SEVABERTINIB ORAL | HYRNUO | Yes | Yes | · FDA new release approval 11/19/25 · Centene PA effective 4/1/26 |
J8999 | ZIFTOMENIB ORAL | KOMZIFTI | Yes | Yes | · FDA new release approval 11/13/25 · Centene PA effective 4/1/26 |
J9217 | LEUPROLIDE ACETATE SUSPENSION | VABRINTY | Yes | Yes | · Added to Evolent review scope 12/15/25 · Centene PA effective 4/1/26 |
J9999 | BELANTAMAB MAFODOTIN-BLMF | BLENREP | Yes | Yes | · FDA new release approval 10/23/25 · Centene PA effective 4/1/26 |
J9999 | PERTUZUMAB-DPZB INJECTION | POHERDY | Yes | Yes | · FDA new release approval 11/13/25 · Biosimilar to Perjeta-has PA · Centene PA effective 4/1/26 |