April 01, 2022

Medicaid: Effective June 1, new prior authorization codes added in more states

Effective June 1, 2022, we’re adding new codes to the prior authorization list for cardiovascular procedures, prostate procedures, spine surgery and cosmetic surgery procedures. These changes impact UnitedHealthcare Community Plans in Indiana, Louisiana and Nebraska. This is an update to the list of new prior authorization codes, effective April 1, 2022, announced on Jan. 1, 2022, in Network News.

View the following list for new procedure codes requiring prior authorization and their applicable states. 

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Adding prior authorization medical necessity, effective June 1, 2022, for listed states.

CPT® code Description States impacted

37243

Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction

Louisiana

52441

Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant

Indiana, Louisiana

52442

Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure)

Indiana, Louisiana

53850

Transurethral destruction of prostate tissue; by microwave thermotherapy

Louisiana

55866

Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed

Recategorization only from Experimental Services to Prostate Procedures; prior authorization requirement continues in Indiana, Louisiana

55873

Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring)

Louisiana

55874

Transperineal placement of biodegradable material, periprostatic, single or multiple injection(s), including image guidance, when performed

Louisiana

Adding prior authorization medical necessity, effective June 1, 2022, for listed states.

CPT code Description States impacted

22510

PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC

Louisiana

22511

PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL

Louisiana

22512

VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL

Louisiana

22513

PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION

Louisiana

22514

PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR

Louisiana

22515

PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH

Louisiana

Adding prior authorization medical necessity, effective June 1, 2022, for states listed. This applies to enrollees ages 18 and older.

CPT code Description States impacted

93580

Percutaneous transcatheter closure of congenital interatrial communication (i.e., Fontan fenestration, atrial septal defect) with implant

Louisiana

Adding prior authorization medical necessity, effective June 1, 2022, for states listed.

CPT code Description States impacted

15878

Suction assisted lipectomy; upper extremity

Nebraska

15879

Suction assisted lipectomy; lower extremity

Nebraska

PCA-22-00143-Clinical-News