4/1/26: Important Wellcare Prior Authorization Updates

Date: 12/23/25

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Wellcare wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

Code change details can be found below. These changes may include:

Removing PA requirements based on criticality of review and clinical need.
Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.

If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.

Service Category	PA Rule	Services	Procedure codes
DME Services	No PA Required for PAR providers	Beds	E0185
		Orthotic & Prosthetic	L1951
		Supplies and Devices	E0486, K0738
Drug Codes	No PA Required for PAR providers	Medications	J1096
Genetic Analysis	No PA Required for PAR providers	Genetic Testing	81240, 81256
Imaging Services	No PA Required for PAR providers	Nuclear Medicine	77002
Other Medical Services	No PA Required for PAR providers	Wound Care	E2402
Physical Medicine	No PA Required for PAR providers	Orthotic & Prosthetic	L5629, L5637
Physician Services	No PA Required for PAR providers	Other Services	99499, G3002
Skin Procedures	No PA Required for PAR providers	Surgery-Integumentary System	11721, 17000, 17250
Surgery Procedures	No PA Required for PAR providers	Surgery-Eye and Ocular Adnexa	66982, 66984
Surgery Procedures	No PA Required for PAR providers	Surgery-Nervous System	64718, 64719
Vision Services	No PA Required for PAR providers	Vision Evaluation	92004, 92201, 92250