April 21, 2022

New Jersey: New prior authorization codes for UnitedHealthcare Community Plans (Medicaid and Long-Term Care plans)

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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PCA-1-22-01009-Clinical-News