UnitedHealthcare Maryland Changes in Advance Notification and Prior Authorization Requirements

July 2019 ~

Effective for dates of service on or after October 1, UnitedHealthcare (UHC) Community Plan of Maryland will implement changes to advance notification and prior authorization requirements for certain plans.

Code Additions to Prior Authorization

The following procedure codes will require prior authorization for UHC Plan of Maryland (Medicaid Plan), effective October 1, 2019:

Cochlear and Other Auditory Implants – L8627, L8628, L8693, L8694

Hearing Aid Services – V5171, V5172, V5181, V5211, V5212, V5213, V5214, V5215, V5221, V5267

Code Removals from Existing Prior Authorization

The following codes will not require prior authorization for UHC Community Plan of Maryland (Medicaid), effective October 1, 2019:

Hearing Aid Services – V5170, V5180, V5210, V5220

 UHC notes that although prior authorization requirements are being removed for certain codes, post-service determinations may still be applicable based on criteria published in medical policies, local/national coverage determination criteria and/or state fee schedule coverage.

Source(s): UnitedHealthcare Network Bulletin July 2019;