New requirements for gastroenterology services
Last modified: March 14, 2023
Beginning June 1, 2023, you’ll be required to obtain prior authorization for gastroenterology endoscopy services for UnitedHealthcare commercial plan members, in accordance with the terms of their benefit plan. Please note that screening colonoscopy procedures are not included in this new medical necessity review requirement.
Affected procedures
The following procedures will now require prior authorizations:
- Esophagogastroduodenoscopies (EGD)
- Capsule endoscopies
- Diagnostic colonoscopies
- Surveillance colonoscopies
Submitting prior authorizations
You can submit a prior authorization request in one of the following ways:
- Online: Use the Prior Authorization and Notification tool on UHCprovider.com by following these steps:
- Sign in to the UnitedHealthcare Provider Portal using your One Healthcare ID
- Select Radiology, Cardiology, Oncology, Radiation Oncology and Gastroenterology Endoscopy Services Transactions
- Enter the required information on the submission site
- Phone: Call us at 866-889-8054 (Oxford 877-773-2884), Monday–Friday, 7a.m.–7p.m. in all time zones
Learn more
Please visit our frequently asked questions to learn more about how this change may affect you and your practice.
Review the guidelines:
Screening Colonoscopy Procedures – Commercial Medical Policy
Screening Colonoscopy Procedures – Oxford Policy
Outpatient Surgical Procedures – Commercial
Outpatient Surgical Procedures – Oxford
Gastrointestinal Colonoscopy Procedure Guidelines – Commercial
Gastrointestinal Endoscopy Procedure Guidelines – Commercial
Capsule Endoscopy Procedure Guidelines – Commercial
Oxford – Gastroenterology and Capsule Endoscopy Guidelines
Questions?
Contact Provider Services at 866-416-6594 if you have any questions.
