Effective January 1, 2026, select advanced imaging, IPM procedures, MSK surgeries and oncology-related infused chemotherapeutic drugs, supportive agents, symptom management medications, and radiation oncology services being administered in provider office, ambulatory center, outpatient hospital and *inpatient hospital settings (*CAR T-cell therapy and MSK surgery) will require Evolent preauthorization for the members below.
The Evolent advanced imaging, IPM and MSK programs will apply to all ordering provider specialties for the following non-emergent services for Blue Shield Medicare Advantage PPO plan members:
Interventional Pain Management (IPM)
- Sacroiliac joint injections
Spinal epidural injections Paravertebral facet joint injections or blocks Paravertebral facet joint denervation (radiofrequency (RF) neurolysis)
Musculoskeletal and Spine Surgery (MSK)
Advanced Imaging
The Evolent oncology program will apply to all ordering provider specialties for members of all ages who have one of the following plans: Blue Shield Group Medicare Advantage PPO, Commercial PPO, ASO and Shared Advantage, Trio HMO (those with virtual primary care physician plans), or direct contract HMO plans (check member benefits at blueshieldca.com/provider) for the following primary diagnosis codes:
Cancer Diagnosis Range: C00-D09.0, D37.01-D49.9, D61.810, D61.82, D63.0, D64.0-64.81, D70.1, D72.822, D75.81, E34.0, D3A.8 Providers may begin contacting Evolent on January 1, 2026, to secure prior authorization for services scheduled on or after January 1, 2026, for the Blue Shield members included in this program. Prior authorization requests can be submitted to Evolent:
Advanced Imaging, IPM and MSK:
Oncology:
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