Medicaid: Prior authorization required for heart valve procedures

Due to recent medical policy changes, beginning July 1, 2026, we’ll require prior authorization for the following 2 transcatheter heart valve procedure codes for select UnitedHealthcare Community Plans: 

• 0569T
• 0570T

Reason for the change

These codes were previously classified as unproven. Based on recent updates to clinical evidence, the services are now considered proven in certain clinical circumstances and will require a medical necessity review to determine whether criteria are met. Refer to the UnitedHealthcare Community Plan Medical Policy for details. 

Affected plans

This change applies to the following UnitedHealthcare Community Plans:

How to submit and manage a prior authorization

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
  • If you don’t have a One Healthcare ID, register now
• From the left-hand tabs, select Prior Authorizations & Notifications