Kentucky: Prior authorization and site of service update

Starting Aug. 1, 2021, for UnitedHealthcare commercial plans, we’re expanding our prior authorization requirements to include Kentucky for certain surgical, screening colonoscopy, office and MRI/CT imaging procedures.

• We’ll conduct site of service medical necessity reviews for surgical, screening colonoscopy and MRI/CT imaging procedures if the procedure is planned 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 planned to be performed in an outpatient hospital setting or 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
•  Site of Service Office Commercial FAQ

Questions?

Call Provider Services at 800-666-1353.

PCA-21-01093-VC-LTR