Changes to electrophysiology implant prior authorization

Starting Dec. 1, 2021, we’ll no longer require prior authorization and notification for electrophysiology implant procedures when performed and appropriately billed as an inpatient service for UnitedHealthcare Community Plan, Medicare Advantage^®, commercial and Exchange plan members.

We’ll continue to require prior authorization and notification for the following cardiology procedures when performed in an outpatient and office-based setting:

• Diagnostic catheterizations
• ·Electrophysiology implant procedures
• Echocardiograms
• Stress echocardiograms

These requirements do not apply to cardiology procedures provided:

• In an emergency room
• In an urgent care center
• In an observation unit
• During an inpatient stay

Questions?

• Find CPT^® codes with our Prior Authorization and Notification tool
• See cardiology protocol details in the UnitedHealthcare administrative guide

CPT^® is a registered trademark of the American Medical Association.  

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