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.
Adding prior authorization medical necessity, effective June 1, 2022, for listed states.
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
Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant
Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure)
Transurethral destruction of prostate tissue; by microwave thermotherapy
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
Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring)
Transperineal placement of biodegradable material, periprostatic, single or multiple injection(s), including image guidance, when performed