Massachusetts: Prior authorization and site of service update

For dates of service on or after Jan. 1, 2022, for UnitedHealthcare commercial plans, we’re expanding our notification/prior authorization requirements to include certain surgical, screening colonoscopy, office and MR/CT imaging procedures in Massachusetts.

• We’ll conduct site of service medical necessity reviews for surgical, screening colonoscopy and MR/CT imaging procedures if the procedure is requested to be performed in an outpatient hospital setting.
• For office-based procedures, we’ll conduct site of service medical necessity reviews if the procedure is requested to be performed in an ambulatory surgical center.

We’ll use the following utilization review guidelines to facilitate these site of service medical necessity reviews:

• Outpatient Surgical Procedures – Site of Service
• Screening Colonoscopy Procedures – Site of Service
• Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service
• Office Based Procedures – Site of Service

More information is available in our Frequently Asked Questions:

• Site of Service Surgical and Screening Colonoscopy Commercial FAQ
• Site of Service MRI/CT Commercial FAQ

Questions?

Please contact Provider Services at 800-666-1353.