Prior authorization reductions for members under 18

As part of our continued commitment to reduce administrative burden, on Dec. 1, 2026, we’ll remove prior authorization requirements for select codes for all patients under the age of 18.

We’ll announce in-scope codes before the program begins. Once implemented, these codes will be able to be verified within the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal. These codes will vary by state and UnitedHealthcare plan. 

Applicable plans

The following plans are included in the program:

• UnitedHealthcare commercial plans
• UnitedHealthcare Individual Exchange Plans
• Select UnitedHealthcare Community Plans 

Pending plans

UnitedHealthcare Community Plan of Nebraska, New Jersey and Tennessee are pending state approval.

Excluded plans

The following plans are excluded from the program:

• UMR plans not following the UMR prior authorization list 
• Health Plan of Nevada Medicaid
• Dual Eligible Special Needs Plans (D-SNP)
• UnitedHealthcare Medicare Advantage Plans