April 23, 2026

We’re changing prior authorization requirements that may apply to some HealthSpring Medicare Advantage members.

Changes are based on updates from utilization management prior authorization assessment, Current Procedural Terminology (CPT^®) code changes released by the American Medical Association or Healthcare Common Procedure Coding System code changes from the Centers for Medicare & Medicaid Services.

For some services and members, prior authorization may be required through HealthSpring or EviCore healthcare.

These changes begin July 1, 2026:

• Updates to the Part B Step Therapy Program
• Addition of orthotic codes to be reviewed by HealthSpring
• Addition of new Medicare Advantage Prescription Drug plan codes to be reviewed by HealthSpring
• Removal of cardiology codes previously reviewed by EviCore
• Removal of miscellaneous codes previously reviewed by HealthSpring

For more information, refer to prior authorization requirements.

Always check eligibility and benefits first through Availity^® Essentials or your preferred vendor prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.

Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s evidence of coverage. If you have any questions, call the number on the member's ID card.

Services performed without required prior authorization or that do not meet medical necessity criteria may be denied for payment, and the rendering provider may not seek reimbursement from the member.