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UHC to require prior authorization for additional outpatient surgical procedures

September 12, 2019
Area(s) of Interest: Payor Issues and Reimbursement Practice Management 


As indicated in its September 2019 Network Bulletin, United Healthcare (UHC) will expand the list of surgical procedures that will require prior authorization when done in the hospital outpatient setting effective December 1, 2019.  UHC will add additional procedures/CPT codes to the existing list of services already subject to review for determining whether the outpatient hospital site of service is medical necessary for the service requested. 

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

United Healthcare (UHC) began requiring prior authorization for certain surgical procedures done in a hospital outpatient setting effective October 1, 2016. The prior authorization requirement included procedure codes in cardiovascular, cosmetic and reconstruction, ophthalmology, and ENT (ear, nose and throat) specialties. 

For a complete listing of procedures requiring prior authorization, physicians can access the Prior Authorization Requirements for UnitedHealthcare 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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