Effective June 1, 2022, we’re adding new codes to the prior authorization list for cardiovascular procedures, prostate procedures, spine surgery and cosmetic surgery procedures. These changes impact UnitedHealthcare Community Plans in Indiana, Louisiana and Nebraska. This is an update to the list of new prior authorization codes, effective April 1, 2022, announced on Jan. 1, 2022, in Network News.
View the following list for new procedure codes requiring prior authorization and their applicable states.
Adding prior authorization medical necessity, effective June 1, 2022, for listed states.
CPT® code | Description | States impacted |
---|---|---|
37243 |
Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction |
Louisiana |
52441 |
Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant |
Indiana, Louisiana |
52442 |
Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure) |
Indiana, Louisiana |
53850 |
Transurethral destruction of prostate tissue; by microwave thermotherapy |
Louisiana |
55866 |
Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed |
Recategorization only from Experimental Services to Prostate Procedures; prior authorization requirement continues in Indiana, Louisiana |
55873 |
Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring) |
Louisiana |
55874 |
Transperineal placement of biodegradable material, periprostatic, single or multiple injection(s), including image guidance, when performed |
Louisiana |
Adding prior authorization medical necessity, effective June 1, 2022, for listed states.
CPT code | Description | States impacted |
---|---|---|
22510 |
PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC |
Louisiana |
22511 |
PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL |
Louisiana |
22512 |
VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL |
Louisiana |
22513 |
PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION |
Louisiana |
22514 |
PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR |
Louisiana |
22515 |
PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH |
Louisiana |
Adding prior authorization medical necessity, effective June 1, 2022, for states listed. This applies to enrollees ages 18 and older.
CPT code | Description | States impacted |
---|---|---|
93580 |
Percutaneous transcatheter closure of congenital interatrial communication (i.e., Fontan fenestration, atrial septal defect) with implant |
Louisiana |
Adding prior authorization medical necessity, effective June 1, 2022, for states listed.
CPT code | Description | States impacted |
---|---|---|
15878 |
Suction assisted lipectomy; upper extremity |
Nebraska |
15879 |
Suction assisted lipectomy; lower extremity |
Nebraska |
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