As we announced in last month’s issue of the provider newsletter, 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.
In addition, Evolent is offering training sessions for providers and office staff this month to learn more about this program and how to submit your authorization requests for these services. We encourage you and your office staff to sign up for one of the virtual sessions (see below for registration information).
Services requiring prior approval from Evolent
With this update, 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 for dates of service beginning 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.
Training sessions available
Evolent will be hosting live, virtual training sessions on the spine and interventional pain management program beginning this month. Visit this page to view dates and register.
Additional information
Point32Health currently utilizes Evolent for utilization management for a variety of services and lines of business. Refer to the Evolent page in the Vendor Programs section of the provider website for an overview of our work with Evolent and visit Evolent’s dedicated webpage for clinical guidelines, coding information, and other resources.