CurrentColorado Rocky Mountain Health PlansPolicy N/A

Prior Authorization Requirements — RMHP Prime

Lists services and CPT/HCPCS/J-codes that require prior authorization for Colorado Rocky Mountain Health Plans (RMHP Prime) participating and non-participating providers; includes inpatient and outpatient services, submission methods, and emergency/urgent care exceptions.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyPrior Authorization Requirements — RMHP Prime

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateFeb 1, 2025

Next Review DateN/A

Key ActionSubmit prior authorization requests via the UnitedHealthcare Provider Portal, fax for non-participating providers, or through eviCore/other vendor as indicated.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

manyline-item codes listed requiring prior authorization

online,fax,phone,eviCoreaccepted submission methods

yesemergency/urgent excluded

eviCoreeviCore web/phone

multipleentries marked PA required

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

someMedicare-only items

Coverage and Prior Authorization Criteria

Benefit exceptions and diagnostic requirements (sample)

Some services are not a benefit for certain product types or require specific diagnoses for coverage.

Service is covered only when it is a benefit for the member's product; services marked 'Not a benefit for Commercial or RMHP Prime' are allowed only for Medicare when diagnosis codes B20 (HIV) AND E88.1 (lipodystrophy) are present (e.g., G0429).

Prior authorization and benefit restriction rules (excerpt)

Coverage and prior authorization notes for listed codes

Codes listed with 'Prior authorization required' must obtain authorization prior to the service or claim submission.

Durable medical equipment (DME) entries are enumerated and require prior authorization; prosthetics are explicitly not DME per this section.

Certain procedural codes include plan-specific benefit restrictions (e.g., codes marked 'Not a benefit for Commercial or RMHP Prime' are Medicare-only when Dx B20 and E88.1 are present).

Prior authorization criteria (document segment)

Coverage stance and prior authorization expectations shown for listed categories and codes in this segment.

Enteral services (B-series HCPCS) require prior authorization.

Specific HCPCS codes (C9762, C9763, S8080) require prior authorization and must be submitted through eviCore as indicated.

DME and investigational/procedural codes are listed with prior authorization context; providers should consult the category-specific entries for exact PA requirements and submission method.

Prior authorization requirements (genetic/lab services)

Prior authorization requirement notes for genetic tests/lab services and eviCore-managed codes.

Genetic tests and laboratory service codes listed in this section are marked 'Prior authorization required.'

Some genetic/molecular pathology codes are routed to eviCore for prior authorization (codes in listing annotated with '(eviCore)').

Prior Authorization Instructions

Prior authorization requirement and submission instructions for many listed CPT/HCPCS codes

When prior authorization is required, providers should submit requests online at www.evicore.com or call 800-792-8750 where indicated; some requests may be submitted via the UnitedHealthcare Provider Portal (UHCprovider.com) or by calling the portal phone number.

Prior authorization is not required for emergency or urgent care; out-of-network providers must request prior authorization for all procedures and services unless otherwise noted.

Prior authorization requirements (codes list)

Services and codes requiring prior authorization (examples shown):

Examples

Prior authorization coverage nodes

Prior authorization requirement indicators present for multiple service categories and specific CPT/HCPCS codes.

Prior authorization is required for multiple service categories including medicine services, musculoskeletal procedures, obstetrical procedures, orthognathic surgery, orthotics/prosthetics, and nerve stimulator devices as indicated in the listings.

Q-code mappings are provided for certain medicine/orthotics entries (example: Q4260 maps to 90587 and related procedure codes; Q4261 maps to 90626 and related procedure codes) and those mapped entries are subject to prior authorization where noted.

Radiology prior authorization criteria (eviCore)

Prior authorization and notification requirements for participating physicians ordering advanced outpatient imaging:

Prior authorization is required for participating physicians ordering advanced outpatient imaging procedures including certain CT, MRI, MRA, PET scans, nuclear medicine and nuclear cardiology procedures, and radiation therapy.

Care providers are responsible for providing notification prior to scheduling advanced outpatient imaging procedures as specified in the radiology prior authorization and notification guidance.

Submit prior authorization requests for radiology procedures online at www.evicore.com (or call 800-792-8750). Some radiology requests may be submitted via the UnitedHealthcare Provider Portal (UHCprovider.com) or by calling 866-889-8054 as noted.

Refer to the radiology section for the full enumerated list of CPT/HCPCS codes requiring prior authorization; example radiology codes are included in the radiology list (e.g., 70450, 70540, 78813).

Authorization coverage stance

Prior authorization is required for participating physicians for the following categories; standard radiation therapy (2D/3D) requires authorization only when associated with specified diagnosis code ranges.

Advanced imaging modalities (CT, MRI, MRA, PET), nuclear medicine, nuclear cardiology and radiation therapy require prior authorization for participating physicians as listed in the radiology prior authorization guidance.

Standard radiation therapy (2D/3D) requires prior authorization only when performed with diagnosis codes within specified oncologic diagnosis ranges (examples provided in the document: C34.00–C34.92, C50.011–C50.929, C61, etc.).

Prior authorization required — code listings (partial)

Procedures and codes requiring prior authorization (partial list):

Unlisted and surgery examples

Vein procedures prior authorization

Prior authorization requirement for vein procedures

Prior authorization required for the listed CPT/HCPCS codes for vein procedures. Examples include: 55880; endovenous and ablation/removal codes such as 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 36522, 37501; saphenous/extremity vein codes including 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37788, 37790; and other listed codes (e.g., 61630, 61635).

CPT / HCPCS / Code Groups

Arthroplasty CPT codes (sample)CPTCovered

23472	Arthroplasty service code listed for prior authorization
23473	Arthroplasty service code listed for prior authorization
23474	Arthroplasty service code listed for prior authorization

Bariatric surgery CPT codes (sample)CPTCovered

43644	Bariatric surgery CPT code listed for prior authorization
43645	Bariatric surgery CPT code listed for prior authorization

Chemotherapy and injectable drug codesHCPCSCovered

J9000-J9999	Injectable chemotherapy drugs range requiring prior authorization
J0640	Leucovorin
J0897	Bone modifying agent

Sample DME HCPCS E-codes (many more listed)HCPCS

E0170
E0194
E0250
E0744
E0783

Selected CPT/procedure codesCPT

41120
43206
67900
G0429	Medicare-only with Dx B20 and E88.1

Representative listed codesHCPCSCovered

K0863	DME-related HCPCS code listed for prior authorization
B4149	Enteral services HCPCS code
B4150	Enteral services HCPCS code
C9762	Code requiring prior authorization (special note)
C9763	Code requiring prior authorization (special note)

Gender dysphoria / related surgical codesCPTCovered

15769	Surgical codes listed under gender dysphoria treatment/surgical sections
15833	Gender dysphoria treatment CPT code
57296	Additional surgical/procedural code listed

Selected genetic/test codesCPT | HCPCS | mixedCovered

81435	Genetic test / molecular pathology code listed
81162	Genetic test code listed
81201	Genetic test code listed

Additional CPT codes (genetics/lab)CPT | mixedCovered

81298	Listed CPT code
81300	Listed CPT code
81400	Listed CPT code

Genetic/molecular pathology codes (partial list in this chunk)CPTCovered

81413	Molecular pathology
81414	Molecular pathology
81415	Molecular pathology
81416	Molecular pathology
81417	Molecular pathology
81419	Molecular pathology
81422	Molecular pathology
81425	Molecular pathology
81426	Molecular pathology
81427	Molecular pathology

1–10 of 53

1/6

Miscellaneous T-codes and CPT/HCPCS codesCPT

0479T	Listed HCPCS/CPT code (part of sequence)
0480T	Listed HCPCS/CPT code (part of sequence)
0481T	Listed HCPCS/CPT code (part of sequence)

Q-code mappingsHCPCS

Q4118	Q-code group with mapped subcodes (see mapping list)
Q4135	Q-code group with mapped subcodes

Examples of CPT/HCPCS mappings with PAmixedCovered

90587	Listed as mapping for Q4260 (medicine services/procedure)
90626	Listed as mapping for Q4261 (medicine services/procedure)
L1499	Orthotics/prosthetics — requires prior authorization (Q4260 mapping)

Orthotics/prosthetics HCPCS examplesHCPCSCovered

L5100	Prosthetics — listed with prior authorization
L5610	Orthotics/prosthetics — listed
L5703	Orthotics/prosthetics — listed

Radiology CPT/HCPCS codes requiring prior authorization (partial list)CPTCovered

70450	CT scan (example included in list)
70540	MRI (example included in list)
78813	Nuclear medicine (example included in list)

IGRT codesCPT | HCPCSCovered

77014	IGRT
77387	IGRT
G6001	IGRT
G6002	IGRT

IMRT codesCPT | HCPCSCovered

77385	IMRT
77386	IMRT
G6015	IMRT
G6016	IMRT
G6017	IMRT

Proton beam codesCPTCovered

77520	Proton beam therapy
77522	Proton beam therapy
77523	Proton beam therapy
77525	Proton beam therapy

Special/associated and SRS/SBRT codesCPTCovered

77331	Special/associated services
77370	Special/associated services
77399	Special/associated services
77470	Special/associated services
77371	SRS/SBRT
77372	SRS/SBRT
77373	SRS/SBRT

Example other codesCPT | HCPCS

78799

Unlisted nuclear medicine/procedure code shown

Unlisted surgery codes (examples)CPTCovered

15999	Unlisted surgery — prior authorization required
17999	Unlisted surgery — prior authorization required
19499	Unlisted surgery — prior authorization required

Vascular / vein procedure codes (selected)CPTCovered

36465	Vein procedures — prior authorization required
36466	Vein procedures — prior authorization required
37700	Procedures on main trunks — listed with prior authorization instruction

Transplant and related codes (selected)mixedCovered

32850	Transplant-related code — prior authorization required
38205	Transplant / hematopoietic cell code — prior authorization required
G0341	HCPCS/G-code entries listed for prior authorization

Vein procedure CPT/HCPCS codesCPTCovered

55880	Listed vein procedure requiring prior authorization (document excerpt)
36465	Vein procedure code listed
36466	Vein procedure code listed
36468	Vein procedure code listed
36470	Vein procedure code listed
36471	Vein procedure code listed
36473	Vein procedure code listed
36474	Vein procedure code listed
36475	Vein procedure code listed
36476	Vein procedure code listed

1–10 of 30

1/3

How Providers Obtain Prior Authorization

Prior Authorization

How to request prior authorization

This list contains prior authorization requirements and submission instructions for Colorado Rocky Mountain Health Plans participating providers. Submit requests via the methods below. Prior authorization is not required for emergency or urgent care. Out-of-network providers must request prior authorization for all procedures and services.

Online: UnitedHealthcare Provider Portal — sign in at UHCprovider.com (One Healthcare ID) and use the Prior Authorization and Notification tool.
eviCore healthcare (for specialty services and many genetic/radiology reviews): www.evicore.com or call 800-792-8750.
Non-participating providers may fax requests and documentation to 800-262-2567 or 970-255-5681.
Behavioral health (mental health and substance use disorder): call 888-282-8801.
Notification by admitting facility: phone 800-416-2157, option 4 or 970-248-5197.

Prior Authorization

eviCore submission for specialty services

Certain specialty and advanced services are managed by eviCore. Providers must submit those prior authorization requests directly to eviCore via their web portal or phone number.

Definitions and Notes

Prior authorization required except for emergency or urgent care; out-of-network providers must request prior authorization for all procedures.

General rulePrior authorization is required for listed services except for emergency or urgent care; out-of-network physicians, facilities and other health care professionals must request prior authorization for all procedures and services.

Submission channelsOnline via UnitedHealthcare Provider Portal (Prior Authorization & Notification tool), fax for non-participating providers (800-262-2567 or 970-255-5681), eviCore (www.evicore.com, 800-792-8750), phone numbers for behavioral health (888-282-8801) and admitting facility notification (800-416-2157 option 4 or 970-248-5197)

Emergency/Urgent carePrior authorization is not required for emergency or urgent care.

Out-of-network requirementOut-of-network providers must request prior authorization for all procedures and services.

prosthetics vs DME

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyPrior Authorization Requirements — RMHP Prime

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateFeb 1, 2025

Next Review DateN/A

Key ActionSubmit prior authorization requests via the UnitedHealthcare Provider Portal, fax for non-participating providers, or through eviCore/other vendor as indicated.

SourceLink

On This Page

Submit eviCore requests online at www.evicore.com or call 800-792-8750.
Advanced outpatient imaging (CT, MRI, MRA, PET), many genetic tests/lab services, and other designated specialty procedures are routed to eviCore — see specific code lists and eviCore submission note.
For radiology prior authorization details and full CPT lists, see Radiology Prior Authorization and Notification guidance referenced by the plan.

Prior Authorization

Procedure codes with Medicare-only restrictions / prior auth instructions

The following codes are noted in source material as having Medicare-only benefit limitations or special prior authorization instructions. Providers should confirm member benefit (Commercial vs Medicare) before billing and follow the stated prior authorization path.

G0429 — Not a benefit for Commercial or RMHP Prime. Allowed for Medicare only with diagnosis B20 (HIV) AND E88.1.
When codes are marked with an asterisk or note in the plan lists (e.g., C9762, C9763, S8080), confirm whether they require prior authorization and whether they are limited to Medicare.
If a code is Medicare-only per the plan list, obtain prior authorization according to Medicare-specific instructions or do not bill Commercial/RMHP if not a benefit.

Prior Authorization

Genetic tests/lab services - prior authorization

Genetic tests and many molecular pathology codes require prior authorization. Some of these reviews are managed by eviCore — submit requests to eviCore when indicated.

Prior authorization required for genetic tests/lab services. Example codes include (non-exhaustive): 0001U, 0004M, 0005U, 0006M, 0007M, 0011M, 0012M, 0013M, 0016M, 0017M, 0018U, 0019U, 0021U, 0022U, 0026U, 0029U, 0030U–0037U, 0045U, and many others listed in the plan's genetic test code list.
eviCore-managed genetic tests: when the code list indicates (eviCore), submit via www.evicore.com or call 800-792-8750.
Additional molecular and laboratory CPT/HCPCS codes (0701T–0713T, 81506, 81560, 82523, 82542, 82726, 82777, 83006, 83698, 83700, 83704, 83876, 83883, 83951, 83987, 84431, 86001, 86152/53, 86305, 86343, 86849, etc.) may also require prior authorization — confirm on the plan list.

Prior Authorization

Additional code/PA notes

Notes and clarifications about unclassified, injectable, and miscellaneous codes requiring prior authorization or special handling.

Unclassified drug codes (J3490, J3590, C9399) and certain unlisted reimbursement codes require prior authorization. For specific listed therapies (e.g., Amtagvi, Lenmeldy, Tecelra) using J3490/J3590/C9399, prior authorization is required through Optum Transplant when indicated.
Some HCPCS/J-codes require plan prior authorization or have special billing instructions (examples from source: C9399*, J3490*, J3590* — verify plan notes).
For injectable chemotherapy drugs administered outpatient, prior authorization is required (J9000–J9999 and selected add-on codes such as J0640/J0641/J0642/J1950 and others specified in chemotherapy section).

Prior Authorization

Prior authorization vendor and required codes (eviCore)

When eviCore is the designated prior authorization vendor for a code or service, providers must submit via eviCore per the plan instructions.

eviCore web portal: www.evicore.com — sign in to submit requests.
eviCore phone: 800-792-8750 for telephonic submissions and inquiries.
Codes and services annotated in the plan as 'Through eviCore' or marked with eviCore should not be submitted via the UnitedHealthcare Provider Portal; follow the eviCore path.

Prior Authorization

Additional vein procedures prior authorization list (part)

Vein procedures require prior authorization. The plan lists multiple CPT codes for ablation, removal, and treatment of saphenous and other venous trunks — obtain prior authorization before performing these services.

Examples of vein procedure codes requiring prior authorization: 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 36522, 37501, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37788, 37790.
Removal and ablation codes for main trunks and saphenous veins are included — consult the full vein procedures list in the plan to ensure all applicable CPT codes are authorized.
Follow the plan's prior authorization submission route (UnitedHealthcare Provider Portal or eviCore) as indicated for venous procedures.

Prior Authorization

Authorization requirement summary / Additional code/PA notes

If a specific code in the plan lists is marked with an asterisk or a vendor note, follow that note for submission (e.g., eviCore, Optum Transplant) and verify member benefit applicability prior to service.

Codes C9762, C9763, S8080 are identified in the source as requiring prior authorization — follow the vendor instructions provided.
For advanced outpatient imaging codes and many radiology CPTs, submit through eviCore per the radiology prior authorization guidance.
Always verify member plan (Commercial vs Medicare) and any diagnosis-specific limitations prior to scheduling and billing.

DefinitionProsthetics are explicitly not considered Durable Medical Equipment (DME) in this section.

DME examplesThis section enumerates many HCPCS E-codes (e.g., E0170, E0194, E0250) as DME entries that require prior authorization.

Related noteSee the DME code listings for specific prior authorization instructions and the separate orthotics/prosthetics entries for prosthetic devices.

Medicare-only benefit restriction

Medicare-only restrictionCertain items (example: G0429) are not a benefit for Commercial or RMHP Prime and are allowed for Medicare only when diagnosis codes B20 (HIV) AND E88.1 (lipodystrophy) are present.

How to obtain PAWhen Medicare-only allowance applies, follow the referenced prior authorization mechanism in the code entry.

Impacted codesSee code listings in this section (e.g., G0429) for other items with the same restriction.

external prior authorization vendor used for submitting prior authorization requests online

Primary external vendoreviCore is the external prior authorization vendor noted for many specialty requests; submit requests online at www.evicore.com or call 800-792-8750.

Codes routed to eviCoreCertain codes (e.g., C9762, C9763, S8080 and many radiology CPTs) require submission through eviCore as indicated in code entries.

Alternate routing noteSome codes marked with an asterisk indicate eviCore submission; other items may use UnitedHealthcare portal per specific instructions.

nutrition support services billed under B-series HCPCS codes that require prior authorization

DefinitionEnteral services (nutrition support) billed under B-series HCPCS codes (e.g., B4149, B4150, B4152, B4153) require prior authorization.

Example codesSample enteral codes listed include B4149, B4150, B4152, B4153 and additional B-series items shown in the enteral services block.

ActionObtain prior authorization per the enteral services entries before supply or billing.

eviCore

Vendor nameeviCore is referenced repeatedly as the external vendor managing prior authorization for many genetic and specialty codes.

Submission instructionsFor eviCore-managed codes submit requests online at www.evicore.com or call 800-792-8750 unless a code entry specifies another portal.

ExamplesSeveral genetic/molecular pathology codes in the listing are noted as (eviCore) indicating eviCore routing.

Genetic tests/lab services

Coverage requirementGenetic tests and laboratory services listed in the document are marked 'Prior authorization required' and must have authorization obtained prior to service.

eviCore routingMany genetic test codes are designated (eviCore) — use eviCore submission (www.evicore.com, 800-792-8750) where indicated.

Code examplesRepresentative genetic/test codes include 0001U, 0004M, 0005U, 0016M and broader molecular pathology ranges (81413–81596) listed in the sections.

Prior authorization (eviCore process)

eviCore prior authorization processFor codes routed to eviCore, submit prior authorization requests online at www.evicore.com to sign in, or call 800-792-8750 to obtain prior authorization.

UnitedHealthcare portal alternativeSome requests may instead be submitted via the UnitedHealthcare Provider Portal (UHCprovider.com) as specified in individual code entries.

Phone supportUse the listed phone numbers for eviCore (800-792-8750) or UnitedHealthcare portal assistance (866-889-8054) per section guidance.

Prior authorization

General statementPrior authorization is required for the codes and services explicitly indicated as 'Prior authorization required' throughout the document.

Provider responsibilityProviders must obtain prior authorization before scheduling or rendering services when the code entry indicates prior authorization is required.

Submission methodsFollow the submission instructions in each code entry — common channels include UHC Provider Portal, eviCore, fax for non-participating providers, or specified vendor (e.g., Optum Transplant for select J-codes).

Q4xxx series mappings (e.g., Q4118 = Q4132/Q4133/Q4134 for variants)

Q-code mapping exampleQ4118 maps to variants Q4132, Q4133 and Q4134 as shown in the Q4xxx mapping list.

Mapping tableThe document contains multiple Q4xxx-to-Q4xxx cross-reference entries showing variant mappings for Q-codes (see Additional Information Q-code mapping section).

UsageUse the specified Q-code mapping entries when billing or validating equivalent Q-code variants for prior authorization and claims processing.

Advanced outpatient imaging

ScopeAdvanced outpatient imaging requiring prior authorization includes certain CT, MRI, MRA and PET scans, nuclear medicine and nuclear cardiology procedures and radiation therapy.

Notification requirementCare providers ordering an advanced outpatient imaging procedure are responsible for providing notification prior to scheduling the procedure.

Submission portalsSubmit prior authorization requests for advanced outpatient imaging via eviCore (www.evicore.com, 800-792-8750) or the UnitedHealthcare Provider Portal (UHCprovider.com; call 866-889-8054) as noted.

eviCore and UnitedHealthcare Provider Portal

UnitedHealthcare Provider PortalUse the UnitedHealthcare Provider Portal (UHCprovider.com) Prior Authorization and Notification tool to submit many prior authorization requests; sign in with One Healthcare ID.

eviCore web/phoneFor items routed to eviCore submit online at www.evicore.com or call 800-792-8750 per code instructions.

When to use each portalFollow the 'How to Obtain Prior Authorization' guidance in each code entry to determine whether to use UnitedHealthcare portal, eviCore, or another vendor for submission.

Focused radiation therapy that uses beams of protons (tiny particles with a positive charge)

DefinitionProton beam therapy: Focused radiation therapy that uses beams of protons (tiny particles with a positive charge).

Example codesProton beam CPT codes listed include 77520, 77522, 77523 and 77525 in the radiation therapy section.

PA requirementProton beam codes are listed under radiation therapy procedures that require prior authorization per the radiology section.

Intensity-Modulated Radiation Therapy

DefinitionIMRT — Intensity-Modulated Radiation Therapy is listed with specific CPT/HCPCS codes subject to prior authorization.

Example codesIMRT codes shown include 77385, 77386 and HCPCS G6015, G6016, G6017.

ContextIMRT is included in the radiology/radiation therapy category that requires prior authorization for participating physicians.

UHCprovider.com submission portal

Portal URLUHCprovider.com — sign in using One Healthcare ID and access the Prior Authorization and Notification tool to submit prior authorization requests.

Use casePrimary submission channel for many non-eviCore prior authorization requests; instructions repeated across code entries to use the UnitedHealthcare Provider Portal.

AssistanceIf you do not have a One Healthcare ID, visit UHCprovider.com/access to register.

Alternate prior authorization vendor for specified codes

Alternate vendorevicore is the alternate prior authorization vendor referenced for specified codes marked with an asterisk; submit at www.evicore.com or call 800-792-8750.

When usedUse eviCore when the code entry or section explicitly directs submission to eviCore instead of the UnitedHealthcare portal.

ExamplesRadiology and certain specialty code blocks include the eviCore submission instruction; certain codes (e.g., C9762/C9763) reference eviCore routing.

Vendor handling prior authorizations for certain unclassified drug codes

Vendor nameOptum Transplant is designated to handle prior authorization for certain unclassified drug codes (J3490, J3590, C9399) when used for specific therapies.

Affected codesUnclassified codes J3490, J3590 and C9399 for therapies such as Amtagvi, Lenmeldy and Tecelra require prior authorization through Optum Transplant.

ActionFollow the document instruction to route those unclassified drug code prior authorization requests to Optum Transplant.

Prior authorization

Core requirementPrior authorization required for entries explicitly marked 'Prior authorization required' across multiple service categories (genetic tests, imaging, DME, injectable drugs, vein procedures, etc.).

Provider actionObtain prior authorization per the 'How to Obtain Prior Authorization' instructions in each code entry before scheduling or rendering services.

Submission optionsCommon submission methods include UnitedHealthcare Provider Portal, eviCore (www.evicore.com, 800-792-8750), fax for non-participating providers, or vendor-specific routes (e.g., Optum Transplant).