Prior Authorization and Site of Service Reviews

In the June edition of the Network Bulletin, we informed you that for dates of service on or after Sept. 1, 2020 for UnitedHealthcare Medicare Advantage plans (Oct. 1, 2020 for Iowa and Illinois), we’re expanding our prior authorization requirements and site of service medical necessity reviews to include certain surgical procedures/CPT® codes.

Please note procedures/CPT® codes 66982 and 66984 will not be subject to prior authorization requirements or site of service medical necessity review on these dates. The Outpatient Surgical Procedures – Site of Service Utilization Review Guideline we will use to facilitate site of service medical necessity reviews will be updated to reflect the removal of these two codes.

As of Sept. 1, 2020, the revised Utilization Review Guideline can be accessed at > Policies and Protocols > Commercial Policies > Medical & Drug Policies and Coverage Determination Guidelines. Until then, you can view the update to the Utilization Review Guideline in the August edition of our UnitedHealthcare Commercial Medical Policy Update Bulletin.