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New Prior Authorization Requirements & Updates from United Healthcare for Radiology

Claims with a date of service on or after November 1, 2020 containing the following PET CPT codes will be added to the Radiology Notification Prior Authorization list:  78429, 78430, 78431, 78432 and 78433. This applies to United Healthcare (UHC) Commercial, UHC Community Plan and Medicare Advantage plans.   

Click here to view United Healthcare’s Network Bulletin appendix and click here to see the October, 2020 Network Bulletin, page 12 for additional details.

UHC has published their 2021 list of changes to their Advance Notification and Prior Authorization Requirements.  Click here for a listing of those changes, broken out by plan type with applicable state, action, category, codes, and effective dates. The above mentioned radiology updates can be found on page 9.  Additional Radiology and/or Interventional Radiology updates can be found on pages 20, 22, 28, 29, 46 and 49.  

Effective November 1, 2020 radiology providers can make urgent prior authorization requests for UHC Commercial, Medicare Advantage and Medicaid plans during normal business hours either online or by phone.  

•    Online: Go to UHCprovider.com/radiology and select the Prior Authorization and Notification tool
•    Phone: Call 866-889-8054

Click here for more details on page 13.

Lastly, United Healthcare has made updates to their genetic testing for hereditary breast and ovarian cancer (BRCA1/BRCA2) coverage rationale.  Please click here for more details.

APS looks to provide ongoing support to our clients to help identify new carrier prior authorization requirement policies to help educate referring providers as well as their internal staffs. 

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