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