The document lists services and associated CPT/HCPCS and diagnosis codes for which prior authorization or notification is required. Examples include arthroplasty, arthroscopy, bariatric surgery, behavioral health, BRCA testing, breast reconstruction, and cardiology/vascular procedures.
Arthroplasty: prior authorization required for listed arthroplasty CPT codes (examples include 23470, 23472, 23473, 23474, 24360-24363, 24365, 24370-24371, 25441-25446).
Arthroscopy: prior authorization required for listed arthroscopy CPT codes (examples include 29914, 29915, 29916).
Bariatric surgery and obesity-related services: prior authorization required; notification/prior authorization is required when billed with specified diagnosis codes (examples: E66.01, E66.09, E66.1-E66.3, E66.8, E66.9, Z68.1, Z68.20-Z68.22, Z68.30-Z68.39, Z68.41-Z68.45).
Behavioral health services: prior authorization required; many plans require referral/authorization through a designated behavioral health vendor — call the number on the member's health plan for referral.
Bone growth stimulators: prior authorization required for listed codes (examples shown in transplant/related lists).
BRCA genetic testing: prior authorization required before DNA sequencing; ordering provider must notify the laboratory and the laboratory will notify UnitedHealthcare; genetic counseling by a qualified professional is required prior to testing (example CPT/HCPCS codes: 81162, 81433, 81163, 81164, 81432).
Breast reconstruction (non-mastectomy): prior authorization required for listed CPT codes (examples include 15771, 19325, 19342, 19364, 19370, 19328, 19350, 19367, 19371, 19330, 19357, 19368, 19396, 19318, 19340, 19361, 19369).
Cardiology and vascular procedures: prior authorization is required for outpatient and office-based diagnostic catheterizations, echocardiograms, electrophysiology implants and stress echoes; lower‑extremity angiograms (vascular codes) require prior authorization. Example CPT codes referenced: 37225, 93653 (see cardiology prior auth guidance).