Evolent Cardiology Solution Program Codes

Prior Authorization for medical necessity and appropriate length of stay (when applicable) has been delegated to Evolent (formerly New Century Health) and will be required for the following procedures (and codes listed below) in both inpatient and outpatient settings:

Cardiovascular Services

Cardiac Catheterization and Intervention
Cardiac Surgery
Electrophysiology
Vascular Radiology and Intervention
Vascular Surgery

Cardiac CPT and HCPCS Coding
33202	33244	33427	33924	35671	37221	76989	93460	93621	C1895
33203	33249	33430	35001	35700	37224	92920	93461	93622	C1896
33206	33262	33440	35011	35881	37225	92921	93462	93623	C1898
33207	33263	33465	35141	35883	37226	92924	93463	93650	C1899
33208	33264	33475	35151	35884	37227	92925	93464	93653	C1900
33210	33270	33477	35301	36005	37228	92928	93505	93654	C2617
33211	33271	33510	35302	36140	37229	92929	93563	93655	C2619
33212	33272	33511	35303	36200	37230	92933	93564	93656	C2620
33213	33273	33512	35304	36215	37231	92934	93565	93657	C2621
33214	33274	33513	35305	36216	37232	92937	93566	93662	C2623
33215	33275	33514	35306	36217	37233	92938	93567	93745	C2624
33216	33285	33516	35351	36218	37234	92943	93568	0572T	C2630
33217	33286	33517	35355	36221	37235	92944	93569	0573T	C9600
33218	33289	33518	35371	36245	37236	92960	93571	0574T	C9601
33220	33340	33519	35372	36246	37237	92961	93572	0580T	C9602
33221	33361	33521	35390	36247	37238	92972	93573	4110F	C9603
33222	33362	33522	35400	36251	37239	92973	93574	C1721	C9604
33223	33363	33523	35500	36252	37246	92974	93575	C1722	C9605
33224	33364	33530	35556	36253	37247	92978	93580	C1730	C9606
33225	33365	33533	35558	36254	37248	92979	93581	C1731	C9607
33226	33366	33534	35566	36465	37249	92986	93582	C1732	C9608
33227	33367	33535	35571	36466	37765	92987	93583	C1733	E0616
33228	33368	33536	35572	36473	37766	92997	93584	C1753	G0278
33229	33369	33572	35583	36474	75580	92998	93585	C1759	G0448
33230	33405	33641	35585	36475	75625	93292	93586	C1760	K0606
33231	33406	33768	35587	36476	75630	93451	93587	C1764	K0607
33233	33410	33820	35600	36478	75710	93452	93588	C1768	K0608
33234	33411	33840	35621	36479	75716	93453	93590	C1777	K0609
33235	33412	33900	35646	36482	75726	93454	93591	C1779	S2205
33236	33413	33901	35654	36483	75736	93455	93592	C1785	S2206
33237	33418	33902	35656	36836	76937	93456	93609	C1786	S2207
33240	33419	33903	35661	36837	76984	93457	93613	C1876	S2208
33241	33425	33904	35665	37215	76987	93458	93619	C1877	S2209
33243	33426	33917	35666	37220	76988	93459	93620	C1882

This program applies to Managed Medical Assistance (MMA), Child Welfare (CW), Serious Mental Illness (SMI) and HIV/AIDS specialty plan members ages 21 years and over.

NOTE: The coding sets identified above are subject to quarterly additions/deletions per the Centers for Medicare & Medicaid Services (CMS) guidelines. To account for these changes, or any inadvertent omissions directly related to the procedures on the TurningPoint Clinical Scope of Services, codes may be added or deleted throughout the term of the program.

Evolent Questions?

Online: Evolent CarePro Provider Portal
Phone: 1-888-999-7713, select option 1 for cardiology
- Evolent staff is available Monday through Saturday from 8 a.m. to 8 p.m. Eastern

Sunshine Health Questions?

Provider Services: 1-844-477-8313
Provider Engagement: Visit the Find Your Account Manager tool to find who supports your specialty and region.