Musculoskeletal and Cardiovascular

Below are static reference lists of CPT codes that require prior authorization (PA) through EviCore Healthcare for specific service categories. 

These lists are static and will not be updated on an ongoing basis.

For the most current and complete list of codes requiring prior authorization, always refer to the SummaCare Prior Authorization Code Look Up Resource. https://priorauth.myplancentral.com/home  

Submitting requests through EviCore is required for applicable services to ensure appropriate utilization and coverage.

Available Code Lists

• Musculoskeletal (MSK) CPT Codes- Prior Authorization Required) (Excel download)
• Cardiovascular CPT Codes - Prior Authorization Required) (Excel download)

If you have questions regarding these prior authorization requirements or need assistance with the submission process, please visit the EviCore SummaCare (Apex) Provider Resource Portal at EviCore_SummaCare Resource.