Gastroenterology Endoscopy Prior Authorization and Notification

As of June 1, 2023, prior authorizations for gastroenterology endoscopy services are required for UnitedHealthcare commercial plan members. Please note screening colonoscopy procedures are not included in this new medical necessity review requirement. 

Affected states

  • All states, except Rhode Island and Kentucky
  • Iowa effective: Aug. 1, 2023
  • U.S. territories (U.S. Virgin Islands, Guam and Puerto Rico) are excluded

Affected plans

This requirement pertains to patients with UnitedHealthcare commercial plans, including:

  • UnitedHealthcare Plan of the River Valley
  • Neighborhood Health Partnership
  • UnitedHealthcare Level Funded
  • Oxford Health Plans

Additional information 

Currently, some gastroenterology endoscopy procedures may require prior authorization and site of service medical necessity review if the procedure is planned in an outpatient hospital. Beginning June 1, 2023, we’ll require prior authorization for these procedures regardless of the outpatient location in which you plan to perform the procedure.

Screening colonoscopy procedures only require prior authorization for site of service medical necessity review if the service is planned at an outpatient hospital.

Specific gastroenterology programs

All commercial plans

Oxford plans

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