Important Wellcare Prior Authorization Updates
Date: 08/05/26
Effective October 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 are noted in the table below. The 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.
| Service Category | PA Rule | Services | Procedure Codes |
|---|---|---|---|
| Behavioral Health | No PA Required | Behavioral Assessment | 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146 |
| DME and Supplies | No PA Required | Equipment and Accessories | E0656, E0657 |
| Orthotic and Prosthetic | L0457, L0650, L1932, L1940, L1960, L2330, L3030 | ||
| Respiratory Devices and Supplies | E0470, E0471, E0562 | ||
| Supplies and Devices | E0935 | ||
| Wheelchairs | E1226, E2310, E2374, E2607, E2608, E2613, E2614, E2622, E2623, E2624, E2625 | ||
| DME Services | No PA Required | Wheelchairs | E1032, E1033, E1034 |
| Genetic Analysis | No PA Required | Genetic Testing | 88271, 88275, 88280 |
| Home Services | No PA Required | Infusion Services | 99601, 99602, S9500 |
| Other Medical Services | PA Required | Wound Care | 97605, 97606 |
| Pain Management | No PA Required | Surgery - Nervous System | 64566 |
| Physician Services | No PA Required | Diagnostic Testing | 91110, 91111, 91112, 91113 |
| Home Visit | 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350 | ||
| Surgery Procedures | No PA Required | Integumentary Services | 14000, 14040, 14041, 15100 |
| Rhinoplasties | 30520 | ||
| Musculoskeletal System | 29848 | ||
| Sinuses | 31256, 31267 | ||
| Transportation Services | PA Required | Medical Transporation | A0100 |
For questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.