UnitedHealthcare – Changes in Advance Notification and Prior Authorization Requirements

January 2018 ~

Effective for dates of service on or after April 1st, several new codes will be added to UHC’s prior authorization list as a result of the American Medical Association (AMA) 2018 annual CPT® update. These changes are as follows:

  • Functional Endoscopic Sinus Surgery (FESS) – 31253, 31257, 31259
  • Sinuplasty – 31298
  • Arthroplasty – 24370
  • Injectable Medications – J7320, J7322
  • Non-Emergent Air Ambulance Transport – A0430, A0431, A0435, A0436
  • Circumcision – 54161 (Code requires prior authorization based on site of service today. Effective April 1st, this will require prior authorization in all places of service.)
  • Enteral Services – B9004, B9006, E0791
  • Home Health Care – S5170 (limit is 14 meals in 7 days upon member discharge from a facility into the community)
  • Injectable Medications – J0178, J0490, J0585, J0586, J0587, J0588, J0596, J0597, J0598, J0881, J0882, J0885, J0887, J0888, J0890, J1290, J1726, J1729, J2503, J2778, J3358, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J9035(for non-oncology indication only), J9310(for non-oncology indication only)
  • Injectable Medications – 90378, J0490, J0585, J0586, J0587, J0588, J0596, J0597, J0598, J1290, J1726, J1729, J3358, J7320, J7321, J7322, J7324, J7326, J7327, J7328, J9035(for oncology indications only), J9310(for non-oncology indication only)




Source(s): UnitedHealthcare Network Bulletin;