Payer Policy Updates

UnitedHealthcare individual exchange plan prior authorization cuts by category

UnitedHealthcare is cutting 20 percent of its prior authorizations in two waves. The first cuts take effect Sept. 1 and the second phase goes into effect Nov. 1.

By: Andrew Cass

Monday, August 28th, 2023

Here are the cuts UnitedHealthcare is making to its individual exchange plan prior authorization requirements, broken down by category. See the individual codes being eliminated here.

Effective Sept. 1

Arthroplasty: 2

Breast reconstruction (non-mastectomy): 1

Durable medical equipment: 4

Hysterectomy: 2

Orthopedics/prosthetics: 2

Genetic testing: 208

Spine surgery: 4

Site of service: 99

Effective Nov. 1

Unlisted: 4

Radiology: 66

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