eviCore Cardiology - Diagnostic and Implants prior authorization requirements (2026)
What eviCore generally requires to approve Cardiology - Diagnostic and Implants (CPT 33206, 33207, 33208, 33212, 33213, 33214, 33221, 33224, 33225, 33227, 33228, 33229, 33230, 33231, 33240, 33249, 33262, 33263, 33264, 33270, 33274, 93306, 93307, 93308, 93319, 93350, 93351, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 0571T, 0614T, 0795T, 0796T, 0801T, 0802T, 0803T, 0823T, 0825T), for Commercial plans. Yes. eviCore generally requires prior authorization for Cardiology - Diagnostic and Implants (CPT 33206, 33207, 33208, 33212, 33213, 33214, 33221, 33224, 33225, 33227, 33228, 33229, 33230, 33231, 33240, 33249, 33262, 33263, 33264, 33270, 33274, 93306, 93307, 93308, 93319, 93350, 93351, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 0571T, 0614T, 0795T, 0796T, 0801T, 0802T, 0803T, 0823T, 0825T).
Medical-necessity criteria eviCore generally applies
For cardiac implants (pacemakers, ICDs, CRT devices): (1) Diagnosis confirmed by clinical evaluation and appropriate prior testing (ECG, Holter, stress test, echocardiogram); (2) Meets ACC/AHA guideline-based criteria for specific device (e.g., EF ≤35% for ICD, complete heart block for pacemaker); (3) Optimized medical therapy where applicable. For advanced cardiac imaging (echo, stress echo, nuclear): (1) Appropriate clinical indication; (2) Not duplicative of recent testing without clinical change
Commonly required documentation
- ECG, Holter monitor records, echocardiogram results with EF documentation
- electrophysiology study results where applicable
- cardiologist evaluation
- records of medical therapy and optimization
- relevant prior imaging results
How to submit
- Portal: eviCore Connect
- Typical turnaround: about 3 days
Source
eviCore manages cardiac imaging and device PAs for many plans. Device PAs (pacemakers, ICDs) must cite specific ACC/AHA guideline indication. Advanced imaging (cardiac CT, PET) requires clinical indication beyond routine screening.
Frequently asked questions
Does eviCore require prior authorization for Cardiology - Diagnostic and Implants?
Yes. eviCore generally requires prior authorization for Cardiology - Diagnostic and Implants (CPT 33206, 33207, 33208, 33212, 33213, 33214, 33221, 33224, 33225, 33227, 33228, 33229, 33230, 33231, 33240, 33249, 33262, 33263, 33264, 33270, 33274, 93306, 93307, 93308, 93319, 93350, 93351, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 0571T, 0614T, 0795T, 0796T, 0801T, 0802T, 0803T, 0823T, 0825T).
What does eviCore require to approve Cardiology - Diagnostic and Implants?
For cardiac implants (pacemakers, ICDs, CRT devices): (1) Diagnosis confirmed by clinical evaluation and appropriate prior testing (ECG, Holter, stress test, echocardiogram); (2) Meets ACC/AHA guideline-based criteria for specific device (e.g., EF ≤35% for ICD, complete heart block for pacemaker); (3) Optimized medical therapy where applicable. For advanced cardiac imaging (echo, stress echo, nucl… Always confirm against the current eviCore policy.
How long does a eviCore prior authorization take?
eviCore typically decides Cardiology - Diagnostic and Implants requests in about 3 days. Timeframes vary; check the payer portal.
Submitting Cardiology - Diagnostic and Implants to eviCore?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.