CurrentUCarePolicy N/A

Services Requiring Authorization (UCare plans)

Lists services that require prior authorization or notification for various UCare plans and identifies delegated authorizations handled outside this list; affects providers and delegated organizations participating in the listed UCare plans in Minnesota.

Policy Summary

PayerUCare

PolicyServices Requiring Authorization (UCare plans)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization or provide required notification for the listed services per plan before delivering those services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3plan groups listed

~40distinct services

2025authorization list year

1-800-203-7225UCare contact

Services Requiring Authorization

Authorization requirements

Policy Summary

PayerUCare

PolicyServices Requiring Authorization (UCare plans)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization or provide required notification for the listed services per plan before delivering those services.

SourceLink

On This Page

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.

Acute inpatient rehabilitation

Adult Rehabilitative Mental Health Services (ARMHS) — MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare only

Adult residential crisis stabilization services — MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare only

Bariatric surgery (gastric bypass)

Back (spine) surgery

Children's residential treatment — UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare only

Cosmetic procedures

Cranial nerve stimulation (vagus and hypoglossal nerve)

Durable Medical Equipment (DME) (rental and purchase)

Early Intensive Developmental and Behavioral Intervention (EIDBI) — UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare only

Genetic or molecular diagnostic tests

Home care nursing (formerly private duty nursing) — MSHO, UCare Connect + Medicare and UCare Connect only

Home health care (skilled nurse visits and home health aide) — MSHO, UCare Connect + Medicare and UCare Connect only

Intensive Residential Treatment Services (IRTS) — MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare only

Inpatient hospitalizations

Long‑Term Acute Care (LTAC)

Nursing facility admission (custodial care) — MSHO, UCare Connect + Medicare, UCare Connect and MSC+ only

Personal Care Assistant (PCA) and Community First Services and Supports (CFSS) — MSHO and MSC+ only

Proton beam therapy

Psychiatric Residential Treatment Facilities (PRTF) — MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare only

Skilled Nursing Facility (SNF) or swing bed admission — MSHO and UCare Connect + Medicare only

Spinal cord stimulation

Substance use disorder outpatient treatment — MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare only

Substance use disorder residential treatment — MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare only

Transcranial Magnetic Stimulation (TMS)

Transplants

Vein procedures

Wheelchair (rental and purchase)

Wheelchair accessories (rental and purchase)

Provider Notification and Authorization Actions

Prior Authorization

Services requiring authorization (Individual & Family plans)

Providers: The following services require prior authorization or notification for UCare Individual & Family plans (including M Health Fairview variants where applicable). Obtain authorization before scheduling or delivering services to avoid claim denials or delays. See plan applicability notes for each service below.

Acute inpatient rehabilitation — prior authorization required.
Adult Rehabilitative Mental Health Services (ARMHS) — prior authorization required for UCare's MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare.
Adult residential crisis stabilization services — prior authorization required for UCare's MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare.
Adult residential crisis stabilization services — prior authorization required for Individual & Family plans where listed by plan rules; confirm with plan-specific requirements.
Back (spine) surgery — prior authorization required.
Bariatric surgery (gastric bypass) — prior authorization required.
Children's residential treatment — prior authorization required for UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare.
Children's residential treatment — prior authorization required for Individual & Family plans where included; verify plan applicability.
Cosmetic procedures — prior authorization required; many cosmetic services are not covered — confirm medical necessity and benefit coverage before billing.
Cranial nerve stimulation (vagus and hypoglossal nerve) — prior authorization required.
Durable Medical Equipment (DME) (rental and purchase) — prior authorization required; includes wheelchairs and wheelchair accessories (rental and purchase) where specified.
Early Intensive Developmental and Behavioral Intervention (EIDBI) — prior authorization required for UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare.
Genetic or molecular diagnostic tests (e.g., cancer panels) — prior authorization required.
Home care nursing (formerly private duty nursing) — prior authorization required for UCare's MSHO, UCare Connect + Medicare and UCare Connect.
Home health care (skilled nurse visits and home health aide) — prior authorization required for UCare's MSHO, UCare Connect + Medicare and UCare Connect.
Inpatient hospitalizations — prior authorization or notification required per plan inpatient admission rules.
Intensive Residential Treatment Services (IRTS) — prior authorization required for UCare's MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare.
Long-Term Acute Care (LTAC) — prior authorization required.
Nursing facility admission (custodial care) — prior authorization required for UCare's MSHO, UCare Connect + Medicare, UCare Connect and MSC+.
Personal Care Assistant (PCA) and Community First Services and Supports (CFSS) — prior authorization required for 2025 for UCare's MSHO and MSC+ only.
Proton beam therapy — added 2025; prior authorization required.
Psychiatric Residential Treatment Facilities (PRTF) — added 2025; prior authorization required for UCare's MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare.
Skilled Nursing Facility (SNF) or swing bed admission — added 2025; prior authorization required for UCare's MSHO and UCare Connect + Medicare.
Spinal cord stimulation — added 2025; prior authorization required.
Substance use disorder outpatient treatment — added 2025; prior authorization required for UCare's MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare.
Substance use disorder residential treatment — added 2025; prior authorization required for UCare's MSHO, UCare Connect + Medicare, PMAP, MSC+ and MinnesotaCare.
Transcranial Magnetic Stimulation (TMS) — added 2025; prior authorization required.
Transplants — added 2025; prior authorization required.
Vein procedures — added 2025; prior authorization required.
Wheelchair (rental and purchase) — added 2025; prior authorization required.
Wheelchair accessories (rental and purchase) — added 2025; prior authorization required.

Delegation and Definition Notes

inv-06: Delegated authorizations

Delegated authorization typesChiropractic care; Dental care; Pharmacy — these authorizations are handled by delegated organizations and are excluded from UCare's services requiring authorization lists.

Plans referenced for delegation (examples)Delegation applies to listed UCare plans including UCare Medicare, EssentiaCare, MSHO, UCare Connect (+ Medicare), UCare Connect, PMAP, MSC+, MinnesotaCare, and UCare Individual & Family plans as noted in plan sections.

Effect on authorization listsServices handled by delegated organizations are explicitly not included in the documented lists of services requiring prior authorization or notification.

Provider implicationProviders should not submit prior authorization requests to UCare for chiropractic, dental, or pharmacy services that are delegated; follow the delegated organization's authorization processes instead.

inv-07: Services requiring authorization

DefinitionServices requiring prior authorization or notification are those listed for each UCare plan (plan-specific applicability noted inline); some services require authorization for certain plans only.

Examples (Medicare / managed plans)Acute inpatient rehabilitation; ARMHS; adult residential crisis stabilization; bariatric surgery; back (spine) surgery; DME (rental and purchase); home care nursing; home health care; IRTS; inpatient hospitalizations; LTAC; nursing facility admission (custodial care).

Additional 2025 examplesPersonal Care Assistant (PCA) and CFSS (MSHO and MSC+ only); proton beam therapy; PRTF; SNF or swing bed admission; spinal cord stimulation; substance use disorder outpatient and residential treatment; TMS; transplants; vein procedures; wheelchair and accessories.

Individual & Family plan examplesAcute inpatient rehabilitation; adult residential crisis stabilization; back (spine) surgery; bariatric surgery; children's residential treatment; DME; genetic/molecular diagnostic tests; inpatient hospitalizations; IRTS; LTAC; proton beam therapy; PRTF; SNF or swing bed admission; spinal cord stimulation; TMS; transplants; vein procedures; wheelchair and accessories.

OpenPayer

Services Requiring Authorization (UCare plans)

Services Requiring Authorization

Document Identifiers / Codes

Provider Notification and Authorization Actions

Delegation and Definition Notes