DraftColorado Rocky Mountain Health PlansPolicy N/A

Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico

This document lists prior authorization requirements and submission instructions for participating UnitedHealthcare Community Plan of New Mexico Turquoise Care program health care professionals for inpatient and outpatient services.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyPrior authorization requirements for UnitedHealthcare Community Plan of New Mexico

Policy CodePolicy N/A

Change TypeNo material change

Effective DateEffective May 1, 2026

Next Review DateN/A

Key ActionSubmit prior authorization requests online via UHCprovider.com or by phone at 888-702-2202.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

UHCprovider.comonline portal for prior authorization

888-702-2202phone number for prior authorization

866-889-8054radiology prior auth phone

Multipleprocedures requiring prior authorization

Prior auth requiredinjectable medications

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Coverage & Authorization Criteria

Prior authorization coverage criteria (excerpt)

Coverage stance in this excerpt: Many specified services and medications require prior authorization; some specific diagnosis codes for breast reconstruction following mastectomy are noted as prior auth NOT required.

Prior authorization is required for the services and medications listed in this section before non-emergent provision; emergency or urgent care is excluded.

Examples of services requiring prior authorization

Abortion procedures (examples: CPT 59840, 59841, 59850, 59851, 59852, 59855, 59857)
Augmentative and alternative communication devices and services (examples: CPT 92607, 92608, 92609; HCPCS E2500, E2502, E2504, A9901)
Bariatric surgery (examples: CPT 43644, 43645, 43659, 43770)
Cancer supportive care including colony-stimulating factor drugs and bone-modifying agents administered in an outpatient setting (examples: J1442, Q5110, J0897 and multiple other J/Q codes)
Behavioral health services where noted are subject to prior authorization per the Regional Behavioral Health Authority (RBHA) program

Providers should submit prior authorization requests via the UnitedHealthcare Provider Portal (UHCprovider.com) or by the phone numbers referenced in the document for the specific service category.

Cardiology prior auth criteria (summary)

Prior authorization required for participating physicians for specified outpatient and office-based cardiology procedures prior to performance.

Prior authorization is required before performance of outpatient and office-based diagnostic catheterizations, electrophysiology implants, and stress echocardiography by participating physicians.

Requests should be submitted online using the UnitedHealthcare Provider Portal (UHCprovider.com) or by phone at 866-889-8054.

Refer to the Cardiology Prior Authorization and Notification Program for the detailed CPT code list that requires prior authorization.

Prior authorization criteria

Stance on coverage and required administrative step

Participating physicians must obtain prior authorization before performing outpatient and office-based diagnostic catheterizations, electrophysiology implants, and stress echoes.

Certain HCPCS drug codes (examples cited elsewhere include J0885, J1449 and listed antiemetic codes) require prior authorization; submit requests via UHCprovider.com or by phone as instructed.

Prior authorization criteria (partial)

Prior authorization requirements and exceptions noted in this segment:

Prior authorization is required for inpatient cerebral seizure monitoring services (example CPT codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95726).

Prior authorization is required for colony-stimulating factors when administered in the outpatient setting for a cancer diagnosis (see J1442 and related J/Q codes listed in the cancer supportive care section).

Prior authorization is not required for chemotherapy when provided in an outpatient hospital or ambulatory surgical center setting (documented exception).

Continuous glucose monitor supplies and related HCPCS codes (examples: A4226, A9278, A4239, E2102, A9276, E2103, A9277) require prior authorization; obtain via UHCprovider.com or by calling 888-397-8129 as noted.

Prior authorization and diagnosis-based exceptions

Notes on prior authorization requirement and listed diagnosis codes

Providers should use UHCprovider.com or call 888-397-8129 to obtain prior authorization as instructed in this section.

Diagnosis-based exception: Prior authorization is not required when services are billed with specific ICD-10 diagnosis codes listed (examples include C43.* and C44.* series).

Prior authorization coverage criteria (partial list)

Selected services and codes require prior authorization as indicated in the lists below.

Enteral services (HCPCS examples B4034, B4100, B4102, etc.) require prior authorization.

Experimental and investigational services and associated codes (examples: G0276, G0293, S9996 and others) require prior authorization.

Femoroacetabular impingement (FAI) procedures require prior authorization for the listed CPT codes (examples: 29914, 29915, 29916).

Functional endoscopic sinus surgery (FESS) procedures require prior authorization for the listed CPT codes (examples: 31240, 31253–31259, 31267, 31276, 31287–31288).

Genetic and molecular testing (multiple CPT examples including 81162, 81228, 81401 and others) require prior authorization.

Prior Authorization Required — Code Lists

Services and codes requiring prior authorization in this excerpt include:

Genetic and molecular testing codes (multiple 81xxx series and related codes) require prior authorization as listed in the genetic testing section.

Hearing evaluations and hearing aids (V50xx–V53xx series) and related services require prior authorization as indicated in the document.

Home health care services (examples: G0151–G0158, G0299) require prior authorization.

Certain hysterectomy and related surgical procedures listed in the document require prior authorization (see CPT ranges enumerated in the policy).

Injectable medications, including many J- and Q-codes and IVIG examples, require prior authorization; requests should be submitted via UHCprovider.com or by calling the numbers provided.

Authorization and submission criteria (excerpt)

Prior authorization / notification requirements and examples of services requiring it:

Notification is required for inpatient admissions; prior authorization and notification of the admission date are required for acute care hospitals and acute inpatient rehabilitation (use the Prior Authorization and Notification tool on UHCprovider.com).

Joint replacement (total hip and knee) requires prior authorization; CPT examples are provided in the joint replacement sections and requests should be submitted via the portal/Contact us page as instructed.

Non-emergent air ambulance transport requires prior authorization (HCPCS examples: A0430, A0431, A0435, A0436).

Orthognathic surgery and treatment of maxillofacial/jaw functional impairment require prior authorization with many CPT codes listed (examples given in the document).

Orthotics and prosthetics require prior authorization; numerous HCPCS L-codes are enumerated and providers should use the Prior Authorization and Notification tool on UHCprovider.com.

Extracted coverage-related criteria (partial)

Prior authorization requirements and service-specific notes appearing in this segment.

Prior authorization is required for all out-of-network services as stated in the policy.

Radiation Oncology image-guided radiation therapy (IGRT) procedures (examples: CPT 77014, 77387) require prior authorization.

Proton beam therapy and associated special/associated services (examples: CPT 77520, 77522, 77523, 77525 and 77331, 77370, 77399, 77470) are listed with prior authorization requirements and applicable ICD-10 cancer site codes for hypofractionation/conventional fractionation.

Prior Authorization / Authorization Criteria (listed services)

Services and codes requiring prior authorization or special handling include radiation oncology (including proton beam), advanced radiology imaging, certain surgical procedures, stimulators, and transplant/CAR T-cell therapies.

Advanced outpatient imaging procedures (certain CT, MRI, MRA, PET, nuclear medicine and nuclear cardiology) require prior authorization; submit requests online via UHCprovider.com or call 866-889-8054 as directed.

Listed surgical procedures (including rhinoplasty/septoplasty, shoulder surgery, sinuplasty, sleep apnea procedures, spinal surgery and other enumerated CPT codes) require prior authorization; see the document CPT lists for specifics.

Implantation of stimulators and device-related procedures require prior authorization (device HCPCS/CPT codes provided in the policy).

Transplant services, CAR T-Cell therapy and certain gene therapy products require prior authorization and clinical documentation; specific CPT/HCPCS and J/Q codes are referenced in the policy.

Special code handling

Prior authorization requirements (excerpt)

Services and codes requiring prior authorization as listed in these chunks.

CAR T-Cell therapy and related HCPCS/J codes require prior authorization; multiple J/Q codes are called out in the document.

Gene therapy products require prior authorization as listed in the gene therapy section.

Unclassified J/C codes (J3490, J3590, C9399) used for Amtagvi, Casgevy, Lantidra and Lenmeldy require prior authorization through the Optum Transplant pathway.

Vein procedures (examples: CPT 36468, 36473, 36475, 36478) require prior authorization.

Ventricular assist devices (VAD) and associated CPT/HCPCS codes (examples: 33927, 33928, 33929, 33975, 33976, Q0507–Q0509) require prior authorization; providers are instructed to call the notification number on the member's ID card.

Relevant CPT / HCPCS / ICD-10 Codes

Covered HCPCS / J-codes (injectable & CAR-T related)HCPCSCovered

J3387	Trastuzumab and related - specified HCPCS (example)
J3389	Unclassified antineoplastic drug (used for select therapies)
J3391	Unclassified biologic/oncology drug
J3392	Unclassified biologic/oncology drug
J9999	Not otherwise classified drug or biological

Covered HCPCS / Q-codes (cellular therapies / CAR-T related)HCPCSCovered

Q2041	CAR-T related Q-code range start
Q2042	CAR-T related Q-code
Q2043	CAR-T related Q-code
Q2044	CAR-T related Q-code
Q2045	CAR-T related Q-code
Q2046	CAR-T related Q-code
Q2047	CAR-T related Q-code
Q2048	CAR-T related Q-code
Q2049	CAR-T related Q-code
Q2050	CAR-T related Q-code

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Cardiology CPT / HCPCS (neutral)CPT

93580

Right heart catheterization and related services (example)

Example HCPCS drug codes requiring prior authorizationHCPCSCovered

J3387	Listed injectable drug HCPCS (requires prior authorization)
J3389	Unclassified oncology/biologic HCPCS (requires prior authorization)

Antiemetic HCPCS / J-codes (covered)HCPCSCovered

J3389	Unclassified antineoplastic/antiemetic (listed when used)
J3391	Unclassified biologic/antiemetic (listed when used)

Cardiovascular / peripheral vascular ICD-10 (neutral)ICD-10

C50.*	Malignant neoplasm of breast — all C50 series (see proton beam and radiation oncology sections)
D05.*	Carcinoma in situ of breast — all D05 series (includes D05.00-D05.92)
C61	Malignant neoplasm of prostate
M86.051	Osteomyelitis codes (example)
M86.052	Osteomyelitis codes (example)
M86.059	Osteomyelitis codes (example)
I70.221	Atherosclerosis related codes (example)

Osteomyelitis ICD-10 (neutral)ICD-10

M86.051	Osteomyelitis of right shoulder
M86.052	Osteomyelitis of left shoulder
M86.059	Osteomyelitis, unspecified site

Sample ICD-10 diagnosis codes (neutral)ICD-10

C50.*	All C50 breast cancer diagnosis codes (consolidated listing)
D05.*	All D05 carcinoma in situ of breast codes (consolidated)
C61	Prostate cancer (C61)

Sample ICD-10 diagnosis codes (C44 series) (neutral)ICD-10

C44.01	Squamous cell carcinoma of lip (example)
C44.02	Basal cell carcinoma of skin (example)

ICD-10 diagnosis codes referenced (neutral)ICD-10

D05.01	Carcinoma in situ of nipple and areola
D05.02	Carcinoma in situ of other specified part of breast
D05.90	Carcinoma in situ of breast, unspecified
C50.521	Malignant neoplasm of upper-outer quadrant of right female breast

How Providers Obtain Prior Authorization

Prior Authorization

How to obtain prior authorization

Submit prior authorization requests online using the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal (UHCprovider.com — sign in with One Healthcare ID). You may also call the numbers listed for service-specific requests. Prior authorization is required for many services and drugs (see items). Emergency and urgent care do not require prior authorization. Out-of-network services require prior authorization and must be requested by a network care provider.

Online: Sign in at UHCprovider.com and select the Prior Authorization and Notification tab on your dashboard.
Phone: Use the service-specific phone numbers shown throughout (examples below include 888-397-8129 and 866-889-8054).
Pre-determination is highly recommended for new-to-market medications (see Review at Launch section).

Prior Authorization

Drug prior authorization (antiemetics and colony‑stimulating factors)

Certain antiemetics, colony-stimulating factors and other supportive oncology drugs require prior authorization when administered in outpatient settings. Submit requests via the UnitedHealthcare Provider Portal or call 888-397-8129 where shown.

Key Terms & Definitions

Prior authorization — definition

DefinitionAn approval process for certain non-emergency services where providers must request authorization via the UnitedHealthcare Provider Portal (UHCprovider.com) or by phone before services are provided.

Not required for emergenciesPrior authorization is not required for emergency or urgent care.

Submission methodsSubmit requests online using the Prior Authorization and Notification tool on UHCprovider.com or by phone (see contact entries).

Cardiology prior authorization — definition

ScopePrior authorization is required for participating physicians for specified outpatient and office-based cardiology procedures before performance (including diagnostic catheterizations, electrophysiology implants, and stress echoes).

Where to submit

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyPrior authorization requirements for UnitedHealthcare Community Plan of New Mexico

Policy CodePolicy N/A

Change TypeNo material change

Effective DateEffective May 1, 2026

Next Review DateN/A

Key ActionSubmit prior authorization requests online via UHCprovider.com or by phone at 888-702-2202.

SourceLink

On This Page

For new-to-market injectable medications, refer to the Review at Launch guidance and pre-determination is recommended; submit requests via UHCprovider.com or call 888-397-8129.

Code 38232 requires prior authorization only when billed with an oncology diagnosis.

Unclassified codes J3490, J3590 and C9399 for specific high-cost therapies (Amtagvi, Casgevy, Lantidra, Lenmeldy) require prior authorization through Optum Transplant.

Wound vacuum devices (example HCPCS E2402) require prior authorization.

Colony-stimulating factor drugs requiring prior authorization include (examples): J1442 (filgrastim), Q5110 (filgrastim-aafi), Q5125 (filgrastim-ayow), Q5101 (filgrastim-sndz), J1449.
Other injectable oncology/supportive agents listed (examples): J0185, J1453, J1454, J1627, J1456, J1434, J2468, J0885.
Requests for these drugs should be submitted online at UHCprovider.com or by calling the number provided for injectable medications (888-397-8129).

Prior Authorization

Cosmetic/reconstructive and related procedures prior authorization

Many cosmetic, reconstructive and related procedures require prior authorization. Providers must submit prior authorization via the UnitedHealthcare Provider Portal or call 888-397-8129. Prior authorization may not be required when services are billed with certain diagnosis codes — check the specific code guidance.

Examples of CPT codes requiring prior authorization include: 11960; 14020*, 14021*, 14041, 14061*; 15823, 15830, 15847; 17106–17108; 17999; 21137–21139, 21172, 21175, 21179–21180; 67917–67966; 11971; 17106 series may be subject to diagnosis exceptions.
Sign in at UHCprovider.com to submit requests or call 888-397-8129 for assistance.
If a service is billed with an allowed diagnosis code listed elsewhere in this document, prior authorization may not be required — verify the code-level notes before submission.

Note

Review at Launch / Submission instructions

For medications newly approved by the FDA, consult the "Review at Launch for New to Market Medications" policy and the Review at Launch Medication List before submission. Pre-determination is highly recommended for drugs on that list.

Check the Review at Launch policy and Medication List for up-to-date coverage and submission guidance.
Pre-determination (prior authorization) is recommended for new-to-market medications; submit via UHCprovider.com or call 888-397-8129.

Prior Authorization

How to obtain prior authorization (reference)

Reference for submitting prior authorization requests: sign in at UHCprovider.com and use the Prior Authorization and Notification tool. When applicable, use the service-specific phone numbers shown in this policy (for example, 888-397-8129 for many injectable medications and 866-889-8054 for certain radiology requests).

Use Prior Authorization and Notification tab on UnitedHealthcare Provider Portal (UHCprovider.com).
Injectable medications: submit online or call 888-397-8129.
Radiology (advanced outpatient imaging) requests: submit via UHCprovider.com or call 866-889-8054.

Prior Authorization

Out-of-network / service‑level prior authorization notes

Out-of-network services require prior authorization for all services. Requests for out-of-network care must be submitted by a network care provider and follow the same submission methods (portal or phone).

Prior authorization is required for all out-of-network services.
Out-of-network prior authorization requests must be made by a network care provider using the Prior Authorization and Notification tool on UHCprovider.com.

Prior Authorization

Radiation Oncology — IGRT codes

Radiation oncology image‑guided radiation therapy (IGRT) requires prior authorization. Examples of IGRT-related CPT codes include 77014 and 77387. Submit radiology and radiation oncology prior authorization requests via the UnitedHealthcare Provider Portal or call 866-889-8054.

IGRT example codes: 77014, 77387.
Submit radiation oncology and advanced imaging prior authorization requests using UHCprovider.com Prior Authorization and Notification tool or call 866-889-8054.

Prior Authorization

Biologics / Gene / CAR T therapies prior authorization

Biologics, gene therapies and CAR T‑cell therapies require prior authorization. Transplant and CAR T‑Cell therapy services (including specified CAR T products) require clinical documentation and route-specific prior authorization — some unclassified J/C codes and select products require submission through Optum Transplant. Follow the portal submission process or the transplant pathway instructions when applicable.

CAR T and gene therapy related codes referenced include J3389, J9999, Q2041–Q2042, Q2053–Q2057 (examples) — clinical documentation is required.
Unclassified codes (e.g., J3490, J3590, C9399) for products such as Amtagvi, Casgevy, Lantidra, Lenmeldy require Prior Authorization through Optum Transplant.
For transplant and CAR T‑Cell therapy authorization, submit via the Prior Authorization and Notification tool or follow the Optum Transplant submission instructions; contact information is provided in the transplant section of this policy.

Submit requests online via UHCprovider.com or call the cardiology phone line cited in the cardiology section (866-889-8054).

ReferenceSee Cardiology Prior Authorization and Notification Program for full CPT lists that require prior authorization.

Prior authorization required — diagnostic catheterizations / electrophysiology / stress echo

Procedures includedOutpatient diagnostic catheterizations, electrophysiology implants, and stress echocardiography require prior authorization prior to performance.

SubmissionPlease submit requests online using the UnitedHealthcare Provider Portal (UHCprovider.com) or call 866-889-8054.

Further detailsFor more details and the specific CPT codes that require prior authorization, visit the Cardiology Prior Authorization and Notification Program.

Prior authorization — general requirement

General statementPrior authorization is required for many specified services and listed CPT/HCPCS codes as noted throughout this document.

Common submission routeUse UHCprovider.com to sign in to the Prior Authorization and Notification tool or call the phone numbers provided in-section.

Example servicesExamples across the document include durable medical equipment, enteral services, genetic testing, device implants, and select surgeries.

Chemotherapy outpatient authorization exception

ExceptionPrior authorization is not required for chemotherapy services when billed as outpatient hospital or ambulatory surgical center (ASC) chemotherapy.

ContextThis exception applies to outpatient hospital or ASC settings as noted in the chemotherapy/monitoring section.

Related codesChemotherapy monitoring codes are listed elsewhere, but outpatient hospital/ASC chemotherapy generally does not require prior authorization.

Prior authorization exception — diagnosis-based

Diagnosis-based exceptionPrior authorization is not required when services are billed with specified ICD-10 diagnosis codes (examples include listed C43.* and C44.* codes).

How notedThe document explicitly lists ICD-10 codes for which prior authorization is not required when billed with the service.

Where to find codesSee the diagnosis code listings in the cosmetic/reconstructive and skin cancer sections for specific ICD-10 examples (e.g., C44.529, C44.591, C44.599).

Prior authorization contact

Primary contactSign in at UHCprovider.com and use the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal.

Phone alternativesCall 888-397-8129 (document repeats this number in multiple sections) or other department-specific numbers where indicated (e.g., 888-702-2202 or 866-889-8054 for some services).

Portal access detailsLog in using your One Healthcare ID and password; if you do not have an ID, visit UHCprovider.com/access to get started.

How to obtain prior authorization — contact methods

Portal submissionSubmit prior authorization requests using the Prior Authorization and Notification tool on UHCprovider.com (sign in with One Healthcare ID).

Phone submissionCall the appropriate phone number for the service area if unable to submit online (examples in document: 888-702-2202, 888-397-8129, 866-889-8054).

Emergency care noteDo not submit prior authorization requests for emergency or urgent care—prior authorization is not required for those services.

Enteral services — definition and scope

Definition / scopeEnteral services include enteral nutrition products and related HCPCS codes (examples listed: B4034, B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4155, B4158).

Authorization requirementPrior authorization is required for enteral services and the listed codes.

Where to submitUse the Prior Authorization and Notification tool on UHCprovider.com to submit requests for enteral services.

Experimental and investigational — definition and scope

Definition / scopeExperimental and investigational services are procedures and services identified with specific CPT/HCPCS codes (examples: G0276, G0293, S9996) that require prior authorization.

Authorization requirementPrior authorization is required for experimental and investigational services and the listed codes.

ExamplesThe document lists multiple investigational procedure codes and device/drug entries in this category—submit requests via UHCprovider.com.

Genetic testing — definition and scope

Definition / scopeGenetic and molecular testing includes a range of CPT codes (examples listed: 81162, 81228, 81401, 81410 and many 81xxx series codes) for which prior authorization is required.

SubmissionRequests for genetic and molecular testing must be submitted via the UnitedHealthcare Provider Portal (UHCprovider.com) or by phone as instructed.

BRCA testingBRCA gene testing codes (e.g., 81401–81408) are included and require prior authorization per the genetic testing section.

Prior authorization required — submission channels

Submission requirementPrior authorization requests must be submitted via the UnitedHealthcare Provider Portal (UHCprovider.com) or by phone when permitted.

Portal recommendedThe Provider Portal is the preferred route (Prior Authorization and Notification tool) for most requests including injectable medications.

Phone supportPhone numbers provided for submission assistance include 888-397-8129 and other service-specific lines noted in the document.

Review at Launch — new-to-market medications

Review at LaunchPlease check the 'Review at Launch for New to Market Medications' policy for up-to-date information on newly approved drugs; pre-determination is highly recommended for drugs on that list.

SubmissionSubmit requests for new-to-market medications online via UHCprovider.com or call 888-397-8129.

PurposeThis process helps ensure timely review for medications newly approved by the FDA.

Prior authorization and notification — inpatient / post-acute

Notification requirementNotification of the admission date is required for inpatient admissions and post-acute services; use the Prior Authorization and Notification tool on UHCprovider.com.

Facilities coveredThis requirement applies to acute care hospitals and acute inpatient rehabilitation facilities as listed.

How to submitUse UHCprovider.com dashboard Prior Authorization and Notification tool or the Contact Us page for 24/7 support.

Proton Beam — definition

DefinitionProton Beam therapy is focused radiation therapy that uses beams of protons (tiny particles with a positive charge).

Codes listedRepresentative CPT codes for proton beam therapy include 77520, 77522, 77523, 77525 and associated special/associated service codes (e.g., 77331, 77370).

Authorization notePrior authorization is required for radiation oncology services as listed in the document; submit via the portal or the designated radiology phone line where applicable.

Proton Beam — focused radiation therapy

Therapy definitionFocused radiation therapy that uses beams of protons (tiny particles with a positive charge).

Representative codesIncludes proton beam CPT codes 77520, 77522, 77523, 77525 and related radiation oncology service codes.

Clinical contextApplicable ICD-10 cancer site codes and hypofractionation/conventional fractionation details are provided in the radiation oncology section.

Optum Transplant prior authorization pathway

PathwayCertain unclassified J/C codes and select transplant therapies require prior authorization through Optum Transplant; submit per Optum Transplant instructions.

ExamplesUnclassified codes J3490, J3590, and C9399 for products such as Amtagvi, Casgevy, Lantidra, Lenmeldy require Optum Transplant prior authorization.

Clinical documentationTransplant services routed through Optum Transplant will require clinical documentation as part of the authorization process.

Ventricular Assist Device (VAD) — definition

DefinitionVentricular Assist Device (VAD) — a mechanical pump that takes over the function of a damaged ventricle; VAD-related services require prior authorization.

Provider actionFor VADs, providers are instructed to call the notification number on the back of the member's health plan ID card for authorization instructions.

Codes referencedMultiple VAD-related CPT/HCPCS codes are listed in the document (examples in coding sections include 33927, 33928, 33975, Q0507–Q0509).