[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-288606-105":3,"detail-sidebar-cat-1-en-105":80,"doc-detail-288606-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","prior-authorization-update-for-evolent","Prior Authorization Update for Evolent","","Prior Authorization Update for Evolent explains that Evolent (formerly New Century Health) manages prior authorizations for Centene across medical oncology, radiation oncology, pediatric and dose optimization, and cardiology. Effective July 1, 2026, listed procedure codes must obtain prior authorization through Evolent for all Centene Ambetter (Marketplace) and Medicare products. Affected code lists include cancer treatments and numerous injectable and oral medications.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/letters/","Letters",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/prior-authorization-update-for-evolent/288606/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/prior-authorization-update-for-evolent/288606.png","ImageObject",442,249,{"name":42,"@type":43},"Aurora","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-21","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":22},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"Who manages prior authorizations mentioned in this bulletin?","Question",{"text":62,"@type":63},"Evolent (formerly New Century Health) manages prior authorizations for Centene for the listed specialties.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"When does the prior authorization requirement take effect?",{"text":67,"@type":63},"Beginning July 1, 2026, procedure codes included in the bulletin require prior authorization through Evolent.",{"name":69,"@type":60,"acceptedAnswer":70},"Which Centene products are impacted by the change?",{"text":71,"@type":63},"The update applies to all Ambetter (Marketplace) and Medicare products offered by Centene.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},288606,1790023744,{"code":4,"msg":81,"data":82},"success",[83,88,93,98,103,108,113,117,122],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},11,"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":110,"show_sort_weight":111,"slug":112},17,"Forms",40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":115,"slug":116},18,30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":81,"data":127},{"doc_id":78,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":114,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":33,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":135,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":140,"read_time":30},4810365810221,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Prior Authorization Update for Evolent  \nEvolent (formerly New Century Health) manages prior authorizations for Centene for Medical Oncology, Radiation Oncology, Pediatric and Dose Optimization, and Cardiology.  \nBeginning on July 1, 2026 the procedure codes included in this bulletin will require prior authorization through Evolent. This change applies to all Ambetter (Marketplace) and Medicare products offered by Centene.  \nIf you have any questions regarding this update please contact your Provider Engagement representative.  \n\n| Codes Requiring Prior Authorization Effective July 1, 2026 |  |  |\n| --- | --- | --- |\n| CODE | MEDICATION | DOSE |\n|  | CANCER TREATMENT |  |\n| A9513 | LUTETIUM LU 177 DOTATATE THERAPEUTIC | 1 MCI |\n| C9155 | INJECTION EPCORITAMAB-BYSP | 0.16\u003Cbr>MG |\n| C9163 | INJECTION TALQUETAMAB-TGVS | 0.25\u003Cbr>MG |\n| C9165 | INJECTION ELRANATAMAB-BCMM | 1 MG |\n| J0202 | INJECTION ALEMTUZUMAB | 1 MG |\n| J0594 | INJECTION BUSULFAN | 1 MG |\n| J0640 | INJ LEUCOVORIN CALCIUM PER | 50 MG |\n| J0641 | INJECTION LEVOLEUCOVORIN NOS | 0.5 MG |\n| J0642 | INJECTION, LEVOLEUCOVORIN (KHAPZORY) | 0.5 mg |\n| J0791 | INJECTION CRIZANLIZUMAB-TMCA | 5 MG |\n| J0893 | INJECTION DECITABINE NOT THR EQUIV TO J0894 | 1 MG |\n| J0894 | INJECTION DECITABINE | 1 MG |\n| J1050 | MEDROXYPROGESTERONE ACETATE |  |\n| J1246 | INJECTION DINUTUXIMAB | 0.1 MG |\n| J1950 | INJ LEUPROLIDE ACETATE PER | 3.75\u003Cbr>MG |\n| J1952 | LEUPROLIDE INJECTABLE CAMCEVI, | 1 MG |\n| J1954 | INJECTION LA FOR DEPOT SUSPENSION | 7.5 MG |\n| J2860 | INJECTION SILTUXIMAB | 10 MG |\n| J3240 | INJ THYROTROPIN PROV 1.1 VIAL | .9 MG |\n| J3315 | INJ TRIPTORELIN PAMOATE | 3.75\u003Cbr>MG |\n| J3316 | INJECTION TRIPTORELIN EXTENDED-RELEASE | 3.75\u003Cbr>MG |\n| J7308 | AMINOLEVULINIC ACID HCI FOR TICL ADMIN, 20%/1UNIT DOSAGE FORM | 354MG |\n| J7502 | CYCLOSPORINE, ORAL, SOL |  |\n| J7504 | LYMPHOCYTE IMMUNE/ANTITHYMOCYTE GLOBULIN | 5ML EA |\n| J7512 | PDN IMMED RLSE/DELAY RLSE ORAL | 1 MG |\n| J7520 | SIROLIMUS ORAL | 1 MG |\n| J7527 | ORAL EVEROLIMUS |  |\n\n4597262_NA5PCADCARMKTWEBE Internal Approved 09122026  \n\n| Codes Requiring Prior Authorization Effective July 1, 2026 |  |  |\n| --- | --- | --- |\n| CODE | MEDICATION | DOSE |\n| J8510 | BUSULFAN, ORAL | 2 MG |\n| J8520 | CAPECITABINE, ORAL | 150 MG |\n| J8521 | CAPECITABINE, ORAL | 500 MG |\n| J8530 | CYCLOPHOSPHAMIDE ORAL | 25 MG |\n| J8560 | ETOPOSIDE ORAL | 50 MG |\n| J8565 | GEFITINIB ORAL | 250 mg |\n| J8600 | MELPHALAN ORAL | 2 MG |\n| J8610 | METHOTREXATE ORAL | 2.5 MG |\n| J8700 | TEMOZOLOMIDE ORAL | 5 MG |\n| J8705 | TOPOTECAN, ORAL | 0.25\u003Cbr>MG |\n| J8999 | PRESCRIPTION DRUG-ORAL-CHEMOTHERAPEUTIC-NOS |  |\n| J9000 | INJECTION DOXORUBICIN HCL | 10 MG |\n| J9015 | ALDESLEUKIN INJECTION |  |\n| J9017 | INJECTION ARSENIC TRIOXIDE | 1 MG |\n| J9019 | ERWINAZE INJECTION |  |\n| J9021 | INJECT ASPARAGINASE RECOMBINANT (RYLAZE) | 0.1 MG |\n| J9022 | INJECTION ATEZOLIZUMAB | 10 MG |\n| J9023 | INJECTION AVELUMAB | 10 MG |\n| J9025 | INJECTION AZACITIDINE | 1 MG |\n| J9027 | INJECTION CLOFARABINE | 1 MG |\n| J9029 | IVES INSTAL NADOFARAGN FIRADENOVC-VNCG PER THR D |  |\n| J9030 | BCG LIVE INTRAVESICAL INSTILLATION | 1 MG |\n| J9032 | INJECTION BELINOSTAT | 10 MG |\n| J9033 | INJECTION BENDAMUSTINE HCL | 1 MG |\n| J9034 | INJ. BENDEKA | 1 MG |\n| J9035 | INJECTION BEVACIZUMAB | 10 MG |\n| J9036 | INJECTION BENDAMUSTINE HYDROCHLORIDE | 1 MG |\n| J9037 | INJECTION, BELANTAMAB MAFODOTIN-BLMF | 0.5 MG |\n| J9039 | INJECTION BLINATUMOMAB | 1 MCG |\n| J9040 | BLEOMYCIN SULFATE INJECTION |  |\n| J9041 | INJECTION BORTEZOMIB | 0.1 MG |\n| J9042 | BRENTUXIMAB VEDOTIN INJ |  |\n| J9043 | CABAZITAXEL INJECTION |  |\n| J9044 | INJECTION BORTEZOMIB NOS | 0.1 MG |\n| J9045 | INJECTION CARBOPLATIN | 50 MG |\n| J9046 | INJ BORTEZOMIB NOT THER EQUIV TO J9041 | 0.1 MG |\n| J9047 | INJECTION, CARFILZOMIB, | 1 MG |\n| J9048 | INJ BTZ FRESENIUS KABI NOT TX EQV TO J9041 | 0.1MG |\n| J9049 | INJ BORTEZOMB HOSPIRA NOT TX EQV TO J9041 | 0.1 MG |\n| J9050 | INJECTION CARMUSTINE | 100 MG |\n| J9051 | INJECTION, BORT","cbCain1emqNTPtoE","https://ap.wps.com/l/cbCain1emqNTPtoE","pdf",404640,7,"English","# Prior authorization scope\n## Effective date and affected products\n# Code lists requiring prior authorization\n## Cancer treatment and injectable/oral medications","[{\"question\":\"Who manages prior authorizations mentioned in this bulletin?\",\"answer\":\"Evolent (formerly New Century Health) manages prior authorizations for Centene for the listed specialties.\"},{\"question\":\"When does the prior authorization requirement take effect?\",\"answer\":\"Beginning July 1, 2026, procedure codes included in the bulletin require prior authorization through Evolent.\"},{\"question\":\"Which Centene products are impacted by the change?\",\"answer\":\"The update applies to all Ambetter (Marketplace) and Medicare products offered by Centene.\"}]","Prior Authorization Update for Evolent | PDF",1789633690]