New codes added to the prior authorization list

Starting July 1, 2021, we’re adding additional codes to the prior authorization list for UnitedHealthcare Medicare Advantage plans and some UnitedHealthcare Community Plans (Medicaid, Long-Term Care). The codes being added are for the following services:

UnitedHealthcare Medicare Advantage plans

• Durable Medical Equipment (DME)
• Cartilage implants
• Orthopedic surgeries
• Pain management
• Cosmetic and reconstructive services
• Prostate procedures
• Neurostimulators
• Spine surgery
• Vein procedures

UnitedHealthcare Community Plans

• Cosmetic and reconstructive services
• Hysterectomy/sterilization/gender dysphoria treatment
• Vein procedures
• Medical and surgical supplies

What codes are being added?

Please refer to the 2021 Summary of Changes to Advance Notification and Prior Authorization Requirements to view:

• The impacted codes
• The list of UnitedHealthcare Community Plan states affected by this change

How to submit prior authorization and notification

Learn how to check requirements, submit new authorizations / notifications, check status, and submit updates by registering for live training or using the Prior Authorization and Notification Interactive User Guide.

PCA-1-21-00874-Corp-News