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UHC to require prior authorization for select outpatient surgical procedures

August 04, 2016
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement Practice Management 


As indicated in its July 2015 Network Bulletin, United Healthcare (UHC) will begin requiring prior authorization for certain surgical procedures done in a hospital outpatient setting effective October 1, 2016. The new prior authorization requirement includes procedure codes in cardiovascular, cosmetic and reconstruction, ophthalmology, and ENT (ear, nose and throat) specialties. 


Prior authorization will not be required to perform the identified procedures if done in an in-network ambulatory surgery center.


For a complete listing of procedures requiring prior authorization, physicians can access the Prior Authorization for Outpatient Surgical Procedures FAQ on the UHC website.


Practices may submit prior authorization requests to UHC via the www.UnitedHealthcareOnline.com website, by calling (877) 842-3210 or by faxing the request to (866) 756-9733.


For questions or concerns regarding this process, physician practices should contact UHC Network Management at (866) 574-6088.

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