Medicare and DSNP: Prior authorization and site of service expansion

Starting May 1, 2022, for UnitedHealthcare Medicare Advantage plans, we’re expanding our prior authorization requirements and site of service medical necessity reviews for certain surgical procedures.

  • We’ll now require prior authorization and conduct site of service medical necessity reviews for 50 additional surgical procedure/CPT® codes if the service is planned to be performed in an outpatient hospital setting
  • Please note the following:
    • At this time, providers in the following states are excluded from these updates: Arkansas, Hawaii, Kentucky, Massachusetts, Utah and Wisconsin

Utilization review guidelines
You can access the revised UnitedHealthcare Outpatient Surgical Procedures – Site of Service Utilization Review Guideline (URG) on or after May 1, 2022, by visiting UHCprovider.com > Policies and Protocols > Commercial Policies > Medical & Drug Policies and Coverage Determination Guidelines.

Questions?
See our frequently asked questions.

PCA-1-21-03221-VC-News