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Important Prior Authorization Updates  for Wellcare & Wellcare by Allwell

Date: 12/18/25

 (Effective Apr. 1, 2026) 

 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 DevicesE0486 
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 
Physician Services No PA Required for PAR providers Other Services G3002 
Skin Procedures PA Required Muscle Flap Procedures                                                   15734, 15736, 15738 
Surgery Procedures No PA Required for PAR providers Surgery-Nervous System         64718, 64719 
Vision Services No PA Required for PAR providers Vision Evaluation 92004