Important Prior Authorization Updates: Effective April 1, 2026

As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, WellCare of North Carolina 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 can be found below. These 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.

If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative.

Service Category	PA Rule	Services	Procedure Codes
DME Services	No PA Required for PAR providers	Neurostimulators	E0730
	No PA Required for PAR providers	Wheelchairs	E0950, E0956
	No PA Required if member is under 21 years old at date of service. PA Required for all other member	Nutritional Services	B4100
	PA Required beyond 200 units per calendar month	Incontinence Supplies	T4527
Physician Services	PA Required	Neurological Tests	95700, 95711, 95718, 95720, 95721, 95722, 95723, 95724, 95725, 95726
Skin Procedures	PA Required after 12 visits per calendar year	Surgery-Integumentary System	11043
Skin Procedures	PA Required if billed with diagnosis of gender dysphoria. For all others, PA Required for Non-PAR Providers only	Skin Grafts	14060, 14061, 15100, 15101, 15120
Surgery Procedures	PA Required	Rhinoplasties	30460
		Surgery-Musculoskeletal System	28296
		Surgery-Nervous System	64568
		Surgery-Respiratory System	30130, 30140, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276
	No PA Required for PAR providers	Surgery-Musculoskeletal System	29848
	No PA Required for PAR providers	Surgery-Nervous System	64721