Changes to electrophysiology implant prior authorization

Starting Dec. 1, 2021, we’ll no longer require prior authorization and notification for electrophysiology implant procedures subject to the UnitedHealthcare outpatient cardiology notification/prior authorization protocol 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

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PCA-1-21-03419-VC-News_10082021