October 01, 2022

New Jersey: Prior authorization and site of service expansion

UnitedHealthcare Community Plan outpatient surgical procedures and sleep studies updates

Effective Nov. 1, 2022, we’re expanding our prior authorization requirements and site of service medical necessity reviews for certain outpatient surgical procedures and sleep studies. This will affect UnitedHealthcare Community Plan of New Jersey members.

Outpatient surgical procedures

We’re adding 150 CPT® codes for surgical procedures that take place in an outpatient hospital setting.

Utilization review guidelines

We’ll use our Outpatient Surgical Procedures – Site of Service (for New Jersey Only) – Community Plan Utilization Review Guideline to facilitate these reviews.

More information

Outpatient sleep studies

The following 5 new CPT® codes will require prior authorization/notification and medical necessity reviews:

  • 95805
  • 95807
  • 95808
  • 95810
  • 95811

If you have questions, please see our Community Plan of New Jersey page.

CPT® is a registered trademark of the American Medical Association.
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