July 01, 2022

Procedures added to prior authorization requirement effective Oct. 1

Effective Oct. 1, 2022, prior authorization will be required for a number of procedures across various service areas, including:

  • Prosthetic Procedures
  • Miscellaneous Diagnostics & Therapeutic Services
  • Miscellaneous Drugs
  • Home Health Care
  • GI Motility Disorders
  • Chromosome Microarray Testing
  • Chelation Therapy
  • Cardiac Event Monitoring

The updated requirement applies to UnitedHealthcare Individual and Family Plan members in select states as outlined in the tables below.

Submitting prior authorization requests
Submit your prior authorization request on the UnitedHealthcare Provider Portal using your One Healthcare ID and the Prior Authorization and Notification tool.

Prosthetic Procedures

CPT code Description Applicable states
L8685 Implantable neurostimulator pulse generator, single array, rechargeable, includes extension Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA
L8686 Implantable neurostimulator pulse generator, single array, nonrechargeable, includes extension Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA
L8687 Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA
L8688 Implantable neurostimulator pulse generator, dual array, nonrechargeable, includes extension Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA

Miscellaneous Diagnostics & Therapeutic Services

CPT code Description Applicable states
G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes Add Prior Authorization AZ, TN
G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes Add Prior Authorization AZ, TN

Miscellaneous Drugs

CPT code Description Applicable states
J7330 Autologous cultured chondrocytes, implant Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA

Home Health Care

CPT code Description Applicable states
S9129 Occupational therapy, in the home, per diem Add Prior Authorization AZ, OK, TN
S9131 Physical therapy; in the home, per diem Add Prior Authorization AZ, OK, TN

GI Motility Disorders

CPT code Description Applicable states
43647 Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA
43881 Implantation or replacement of gastric neurostimulator electrodes, antrum, open Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA

Chromosome Microarray Testing

CPT code Description Applicable states
81349 Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number and loss-of-heterozygosity variants, low-pass sequencing analysis Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA

Chelation Therapy

CPT code Description Applicable states
M0300 IV chelation therapy (chemical endarterectomy) Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA
S9355 Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA

Cardiac Event Monitoring

CPT code Description Applicable states
93228 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days: review and interpretation with report by a physician or other qualified health care professional Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA
93229 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional Add Prior Authorization AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX VA, WA

Questions?
Call Provider Services at 800-666-1353.

PCA-22-01632-E&INews