Medicare AdvantagePrior AuthHigh impact
Authorization Updates - Effective May 1, 2026
Sentara Health Plans·VA · Radiology, Cardiology, Nuclear Medicine·Prior Authorization
Effective date
May 1, 2026
We identified it
Apr 21, 2026
Summary
Effective May 1, 2026, Sentara Health Plans is removing prior authorization requirements for 41 diagnostic imaging and cardiac procedure codes that were previously managed by Evolent. These codes across CT, MRI, and echocardiography will no longer require prior authorization or precertification for Medicaid, Medicare, and Commercial products in Virginia. Claims with service dates on or after May 1, 2026 will be automatically reprocessed.
Action Required
By April 30, 2026: Billing team must update billing system rules to REMOVE prior authorization requirements for all 46 listed CPT and HCPCS codes when billed to Sentara Health Plans Medicaid, Medicare, or Commercial products in Virginia. Update internal workflows and provider education materials to reflect that these imaging and cardiac codes no longer require precertification. Audit billing software to ensure prior auth logic is disabled for these codes to prevent unnecessary authorization requests. Claims with service dates on or after May 1, 2026 will be automatically reprocessed by the payer; monitor for successful reprocessing and verify no claim denials occur due to missing prior authorizations. Remove these codes from any prior authorization tracking lists or encounter templates that currently flag them for authorization.