Point32Health currently utilizes Evolent for utilization management for a variety of services and lines of business, and we are expanding this program (refer to the Evolent page in the Vendor Programs section of the provider website for details on existing utilization management vendor programs). For dates of service beginning Oct. 1, 2025, Evolent will be conducting utilization management for spine and interventional pain management services for Tufts Medicare Preferred members.
With this change, some spine and interventional services currently requiring prior authorization through Tufts Health Plan will be managed by Evolent, some prior authorization requirements will be removed, and some services will newly require prior authorization. Changes include those noted below.
| For Members of Tufts Medicare Preferred | |
| Services currently requiring prior authorization (currently through Tufts Health Plan and will move to Evolent review) | Coding updates as of Oct. 1, 2025 |
Epidural Steroid Injections for Pain Management
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Cervical Fusion
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| Lumbar Fusion — Single Level and Multi-Level |
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| Interventional Pain Management services newly requiring prior authorization | Codes requiring prior authorization as of Oct. 1, 2025 |
| Cervical/ Thoracic Facet Joint Block | 64490, + 64491, +64492, 0213T, +0214T, +0215T |
| Cervical/ Thoracic Facet Joint Radiofrequency Neurolysis | 64633, +64634 |
| Lumbar/ Sacral Facet Joint Block | 64493, +64494, +64495, 0216T, +0217T, +0218T |
| Lumbar/ Sacral Facet Joint Radiofrequency Neurolysis | 64633, +64634 |
| Spine procedures newly requiring prior authorization | Codes requiring prior authorization as of Oct. 1, 2025 |
| Cervical Anterior Decompression without Fusion | 63075, +63076 |
| Cervical Artificial Disc Replacement – Single Level | 22548, 22551, 22554 |
| Cervical Artificial Disc Replacement – Two Levels | +22858, +0098T, +0095T |
| Cervical Posterior Decompression without Fusion | 22595, +22614 |
| Lumbar Decompression | 63005, 63012, 63017, 63042, +63044, 63047, +63048, 63056, +63057 |
| Lumbar Microdiscectomy | 62380, 63030, +63035 |
| Sacroiliac Joint Fusion | 27279 |
Requesting authorization
For dates of service beginning Oct. 1, 2025, providers should request prior authorization for these services through Evolent in one of the following ways:
- Online: www.radmd.com
- Fax: 800-784-6864
- Telephone: 866-642-9703
Current approved authorizations for these services (obtained directly through Tufts Health Plan) will continue to be valid and a new authorization isn’t required in these instances.
While the ordering provider is responsible for obtaining prior authorization, rendering providers must confirm that authorization has been obtained and have the required authorization number before a service is performed. Status and transaction numbers can be accessed through Evolent’s website at www.radmd.com. You can also verify authorizations through the Tufts Health Plan secure portal.
For complete details refer to Evolent’s dedicated webpage for clinical guidelines, coding information, and other resources.