Effective August 1, 2022, you’ll see new codes on the prior authorization list for cardiovascular, prostate and spinal surgery procedures. These changes impact UnitedHealthcare Community Plan of New Jersey’s Medicaid and Long-Term Care plans.
Prior authorization code lists
See the following new lists for procedure codes requiring medical necessity prior authorization.
| CPT® code | Prostate procedures description | Additional information |
|---|---|---|
| 37243 | Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedular roadmapping, and imaging guidance necessary to complete the intervention; for tumors, organ ischemia, or infarction | |
| 52441 | Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant | |
| 52442 | Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure) | |
| 53850 | Transurethral destruction of prostate tissue; by microwave thermotherapy | |
| 53852 | Transurethral destruction of prostate tissue; by radiofrequency thermotherapy | |
| 55866 | Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed | Recategorization from Experimental only; prior authorization continues |
| 55873 | Cryosurgical ablation of the prostate (includes ultrasonic guidance and monitoring) | |
| 55874 | Transperineal placement of biodegradable material, periprostatic, single or multiple injection(s), including image guidance, when performed |
| CPT code | Spine Surgery description | Additional information |
|---|---|---|
| 22510 | Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic | |
| 22511 | PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL | |
| 22512 | VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL | |
| 22513 | PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION | |
| 22514 | PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR | Recategorization from Site of Service only; clinical review will now apply to include site of service |
| 22515 | PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH |
| CPT code | Cardiovascular procedures* description | Additional information |
|---|---|---|
| 93580 | Percutaneous transcatheter closure of congenital interatrial communication (i.e., Fontan fenestration, atrialseptal defect) with implant |
* Applies to enrollees ages 18 and older
Requesting prior authorization
You can submit your prior authorization request using the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal. Learn more at UHCprovider.com/paan
Questions?
For more information, check the following online resources:
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