CurrentUnitedHealthcarePolicy N/A

Prior authorization crosswalk table

Governs how to use an approved prior authorization to provide an additional or different CPT/HCPCS-coded service for UnitedHealthcare members and specifies product applicability and exceptions. Affects providers submitting claims or modifying authorizations for UnitedHealthcare members.

Policy Summary

PayerUnitedHealthcare

PolicyPrior authorization crosswalk table

Policy CodePolicy N/A

Change TypeAdministrative update (no material coverage changes)

Effective DateApr 1, 2026

Next Review Date

Key ActionIf a performed service maps to an authorized code and Product Applicability = X for the member's product, use the original prior authorization; otherwise obtain or modify authorization via the Provider Portal as specified.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2026-04-01Effective date

MultipleMappings listed

Mostly XCommercial applicability

VariesMedicare Advantage

Mostly XCommunity Plan

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.

Prior Authorization Crosswalk — Coverage Criteria

Prior authorization crosswalk criteria

Use the table to determine whether an existing prior authorization can be used for a performed service based on CPT/HCPCS mappings and product applicability; the listing of a code does not itself determine coverage or payment.

If the original authorization code (left column) maps to the performed code (right column) and the Product Applicability column shows X for the member's product, the original prior authorization may be used.

If the mapping shows Product Applicability = N/A for the member's product, the Prior Authorization Crosswalk does not apply for that member's product.

If the performed service is not listed in the crosswalk table, then: for Community Plan or Medicare Advantage members, the provider must connect via chat 24/7 in the UnitedHealthcare Provider Portal to obtain a new authorization; for Commercial members, the provider must modify the original prior authorization request before claim submission (CPT/HCPCS changes allowed if medically necessary and made within 5 business days after providing the service).

Listing of a code is for reference only and does not imply coverage or guarantee payment; benefit coverage is determined by the member-specific benefit plan document and applicable laws; other policies and guidelines may apply.

Product applicability criteria

Code-level applicability to product lines (Commercial, Individual Exchange, Medicare Advantage, Community Plan) as stated for each CPT/HCPCS code.

Each CPT/HCPCS entry includes Product Applicability flags indicating applicability for Commercial, Individual Exchange, Medicare Advantage, and Community Plan (values shown as X or N/A).

Most codes in the crosswalk are marked Commercial = X and Community Plan = X; Medicare Advantage applicability varies by code (marked X for some codes and N/A for others).

Some codes direct providers to a referenced crosswalk (e.g., Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk) for Commercial product processing; those entries will indicate the crosswalk reference in the Product Applicability column.

Applicable codes and applicability flags

This section enumerates CPT/HCPCS codes and marks product applicability; it does not contain clinical coverage criteria in these chunks.

Each listed CPT/HCPCS code line includes product applicability flags (Commercial, Individual Exchange, Medicare Advantage, Community Plan) showing X or N/A for that code.

Example codes shown with applicability flags include breast surgery and related codes (e.g., 19350, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19396) where many are Commercial = X and Community Plan = X while Medicare Advantage is often N/A.

The code listings are reference-only; inclusion does not imply coverage or payment and may require consulting member-specific benefits and other policy requirements.

Code applicability mappings (examples)

Code applicability entries — each line maps a code to related submitted codes and marks product applicability.

Mappings show a primary CPT/HCPCS code and the 'Claim submitted for the following CPT/HCPCS code(s)' related codes; each mapping line includes product applicability flags for Commercial, Individual Exchange, Medicare Advantage, and Community Plan.

Example mapping: 21215 maps to related codes (Claim submitted for = 21208, 21209, 21210) and product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = X; Community Plan = X.

Another example: entries for facial/maxillofacial codes (e.g., 21235, 21240, 21242, 21244–21246) list related submitted codes and show product applicability flags (many = X across products in these chunks).

Code mapping applicability

Mappings and applicability flags for listed CPT/HCPCS codes

Entries in this section list CPT/HCPCS codes with 'Claim submitted for' mappings and indicate product applicability per line (Commercial, Individual Exchange, Medicare Advantage, Community Plan).

Many entries in this window show Community Plan = X even when Commercial or Medicare Advantage are N/A; providers should follow the per-line product applicability flag to determine whether the crosswalk applies.

Code mapping and product applicability

This section provides mappings between CPT/HCPCS codes and the claim-submission codes and indicates product applicability; it does not include clinical coverage criteria in these chunks.

Sequential entries list primary CPT/HCPCS codes with their related 'Claim submitted for' codes and include product applicability flags for Commercial, Individual Exchange, Medicare Advantage, and Community Plan.

Example (orthopedic/hip): codes such as 27120, 27125, 27130, 27132 show mapped submitted codes and product applicability; some hip procedure codes have Medicare Advantage = X while others vary by line.

Code mapping applicability

Code crosswalks and applicability should be used to determine which CPT/HCPCS codes require mapping for claims submission across product lines.

Primary-to-related code mappings are listed per line (e.g., 28020 maps to 28050; 28022 maps to 28052) and each mapping line shows product applicability flags (Commercial = X, Individual Exchange = X, Medicare Advantage frequently = N/A, Community Plan = X for many entries).

Arthroscopy-related group examples (e.g., 29877–29886 and related mappings) show Commercial = X and Community Plan = X while Medicare Advantage is often N/A; providers must consult the per-code flags when deciding mapping or authorization reuse.

Applicable codes and product applicability mappings (excerpt)

This section enumerates CPT/HCPCS codes and marks product applicability; it does not itself specify clinical coverage criteria in this excerpt.

Example block: Codes 29877, 29879, 29880, 29881, 29882–29885 are listed with 'Claim submitted for' related codes and product applicability flags showing Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.

Code applicability examples

Per-code product applicability and related submitted codes (partial list in this document segment).

Example: 33251 lists related submitted codes (33250, 33254, 33261) and product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.

Other cardiac device entries (e.g., 33202, 33250) also show per-code 'Claim submitted for' mappings and product applicability flags that must be followed for crosswalk application.

Code applicability (partial list)

Code applicability and product flags from this portion of the crosswalk:

Multiple procedure codes in this segment (for example 33771, 33774–33778, 33845, 33851–33853, 33894, 36470–36478, 36511–36513) are listed with 'Claim submitted for' mappings and product applicability flags; many show Commercial = X and Community Plan = X while Medicare Advantage is often N/A.

Providers should reference the per-code line to determine whether the mapping applies to the member's product before reusing or modifying an authorization.

Code applicability and crosswalk guidance

Code-level product applicability and crosswalk directions present in this section:

Each CPT/HCPCS code entry includes 'Claim submitted for' related codes and 'Product applicability' flags with values (X or N/A) that indicate whether the crosswalk applies to each product line.

Several 43200–43270 series entries instruct providers to 'Refer to the Product Applicability columns for crosswalk codes' and reference the Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk for Commercial product processing when indicated.

Community Plan applicability is frequently marked X for numerous entries in this section while Commercial and Individual Exchange applicability vary by code; always use the specific code line flags to determine applicability.

This module provides mapping information only and does not include clinical approval criteria or authorization durations in these chunks.

Product applicability mappings

Product-specific applicability and crosswalk rules for submitted CPT/HCPCS codes.

Example mapping: submitted code 43253 maps to 43232, 43238, 43242, 43259 and shows product applicability: Commercial = N/A; Individual Exchange = N/A; Medicare Advantage = N/A; Community Plan = X.

Example mapping: submitted code 43259 maps to a long list of esophagogastroduodenoscopy-related codes and product applicability: Commercial = N/A; Individual Exchange = N/A; Medicare Advantage = N/A; Community Plan = X.

Example mapping: 43644 maps to 43846 and shows applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.

Code-level product applicability (examples)

Product applicability flags indicate which product lines use the crosswalk or require advance notification for each listed code.

Example: 45388–45393 and similar colonoscopy-related entries reference the Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk for Commercial product handling (Product Applicability column contains the crosswalk reference).

Example: 45395 shows product applicability: Commercial = N/A; Individual Exchange = N/A; Medicare Advantage = N/A; Community Plan = X — indicating the crosswalk applies only for Community Plan for that code.

Example: 45990 shows product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.

Selected code-to-product applicability mappings

Product applicability per code (X = applicable; N/A = not applicable).

54406 — Product applicability: Commercial = N/A; Individual Exchange = N/A; Medicare Advantage = N/A; Community Plan = X.

54500 — Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = N/A (as shown in the excerpt).

58260 and 58541 — Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = X; Community Plan = X (these entries show applicability across all listed product lines).

Code applicability set

Code applicability and crosswalks

This set lists gynecologic procedure codes (e.g., 58541, 58542, 58543, 58544, 58550, 58552–58554, 58570–58573, 58292) with product applicability flags; per-line flags indicate whether the mapping applies for Commercial, Individual Exchange, Medicare Advantage, and Community Plan.

Example: 58292 product applicability shown as Commercial = X; Individual Exchange = X; Medicare Advantage = X; Community Plan = X in this excerpt.

Crosswalk examples

Additional code mappings (examples) and their product applicability indicators.

Example: 58600 maps to 58605 with product applicability: Commercial = N/A; Individual Exchange = N/A; Medicare Advantage = N/A; Community Plan = X.

Example: 58661 maps to 58940 and shows product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = X; Community Plan = X — demonstrating variation across code lines in which products the crosswalk applies to.

CPT/HCPCS Crosswalk Tables and Code Lists

Example crosswalk entries (document is partial and contains many more mappings)CPT

10121	Crosswalk mapping examples and product applicability (e.g., 10121 maps to 10120; Commercial=X; Individual Exchange=X; Medicare Advantage=N/A; Community Plan=X)
10180	10180 maps to 10060, 10140; product applicability: Commercial=X; Individual Exchange=X; Medicare Advantage=N/A; Community Plan=X

Additional crosswalk entriesCPT

11960	11960 maps to 11970, 11971; product applicability includes Commercial=X; Individual Exchange=X; Medicare Advantage=X; Community Plan=X
11970	11970 maps to 11971; product applicability: Commercial=X; Individual Exchange=X; Medicare Advantage=N/A; Community Plan=X

Sample code applicability entries from documentCPT

12032	Referenced as claim submitted code; applicability: Commercial=X, Individual Exchange=X, Medicare Advantage=N/A, Community Plan=X
14000	Referenced with applicability: Commercial=X, Individual Exchange=X, Medicare Advantage=X, Community Plan=X
15750	Referenced with applicability: Commercial=X, Individual Exchange=X, Medicare Advantage=X, Community Plan=X
19396	Referenced with claim submitted code L8035; applicability: Commercial=X, Individual Exchange=X, Medicare Advantage=N/A, Community Plan=X

Breast surgery series (example group)CPT

19350
19361
19364

Musculoskeletal/injection codes (example group)CPT

20600
20604
20605

Maxillofacial/mandible reconstruction series (example group)CPT

21244
21245
21246

Head and facial bone procedure codes (sample)CPT

21215	Referenced as applicable across multiple products
21230	Referenced with related submitted codes
21247	Maps to a long list of related CPT/HCPCS codes

Spine surgery codes (sample)CPT

22556	Spine procedure crosswalk entries
22612	Spine fusion related codes

Shoulder/upper extremity code crosswalksCPT

24000	Claim submitted for CPT/HCPCS 23930, 23931, 23935
24006	Claim submitted for CPT/HCPCS 23930, 23931, 23935, 24000

Forearm/hand code crosswalksCPT

25441	Claim submitted for CPT/HCPCS 25442, 25443, 25444, 25445, 25447
25442	Claim submitted for CPT/HCPCS 25443, 25445

Upper extremity/hand procedure codes (example group)CPT

26200	Mapped claim submission code group includes 26200 and related codes
26215	Listed with product applicability flags

Hip arthroplasty codesCPT

27120	Total hip arthroplasty related mapping
27130	Revision hip arthroplasty related mapping

Example primary-to-related code mappingsCPT | HCPCS

28020	Claim submitted for the following CPT/HCPCS code(s) = 28050; Commercial=X; Individual Exchange=X; Medicare Advantage=N/A; Community Plan=X
28022	Claim submitted for the following CPT/HCPCS code(s) = 28052; Commercial=X; Individual Exchange=X; Medicare Advantage=N/A; Community Plan=X
28039	Claim submitted for the following CPT/HCPCS code(s) = 28043; Commercial=X; Individual Exchange=X; Medicare Advantage=N/A; Community Plan=X
28041	Claim submitted for the following CPT/HCPCS code(s) = 28039, 28043, 28045; Commercial=X; Individual Exchange=X; Medicare Advantage=N/A; Community Plan=X
28045	Claim submitted for the following CPT/HCPCS code(s) = 28039, 28043; Commercial=X; Individual Exchange=X; Medicare Advantage=N/A; Community Plan=X
28047	Claim submitted for the following CPT/HCPCS code(s) = 28046; Commercial=X; Individual Exchange=X; Medicare Advantage=N/A; Community Plan=X

arthroscopy-related codes (sample)CPT

29877	Listed with claim applicability and product applicability flags
29879	Listed with claim applicability and product applicability flags

nasal/sinus endoscopy codesCPT

31253	Endoscopic nasal/sinus procedure mapping
31255	Endoscopic nasal/sinus procedure mapping

cardiac device codesCPT

33202	Cardiac device procedure mapping
33250	Cardiac device procedure mapping

Sample codes from this chunkCPT

33202	Appears with product applicability flags and crosswalks
33203	Listed as claim-submitted related code
33250	Listed with product applicability
33251	Listed with related codes 33250, 33254, 33261

Additional codesCPT

33677	Listed with product applicability flags
33681	Crosswalks to 33257, 33259, 33600, 33602, 33924

Listed procedure codes with associated submitted codesCPT | HCPCS

33771	Referenced with claim submitted for CPT/HCPCS codes 33257, 33259, 33770, 33774, 33775, 33776, 33777, 33924; Commercial/Individual Exchange/Community Plan applicability noted
33774	Referenced with claim submitted for CPT/HCPCS codes 33257, 33259, 33924; Commercial/Individual Exchange/Community Plan applicability noted
33775	Referenced with claim submitted for CPT/HCPCS codes 33257, 33259, 33774, 33924; Commercial/Individual Exchange/Community Plan applicability noted
33776	Referenced with claim submitted for CPT/HCPCS codes 33257, 33259, 33774, 33775, 33777, 33924; Commercial/Individual Exchange/Community Plan applicability noted
33777	Referenced with claim submitted for CPT/HCPCS codes 33257, 33259, 33774, 33924; Commercial/Individual Exchange/Community Plan applicability noted
33778	Referenced with claim submitted for CPT/HCPCS codes 33257, 33259, 33770, 33771, 33774, 33775, 33776, 33777, 33924; Commercial/Individual Exchange/Community Plan applicability noted

Sample codes and descriptors from this sectionCPT | HCPCS

37296	Listed with product applicability flags and related claim-submitted-for codes
37298	Listed with product applicability flags and related claim-submitted-for codes
37718	Listed with related codes 37700, 37780 and product applicability
40510	Listed with related CPT/HCPCS codes and Community Plan applicability
40810	Listed with related code 40808 and product applicability
42420	Listed with product applicability
43200	Refer to Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk
43237	Lists many related 43xxx codes and Community Plan applicability

Code crosswalk groups referencedmixed

43259	Crosswalks to many esophagogastroduodenoscopy and related codes (e.g., 43191-43196, 43214, 43216-43220, 43226, 43229, 43231, 43235-43237, 43241, 43245-43251, 43255, 43270)
43496	Crosswalks to vascular codes 43100, 43300, 43305, 43360, 43361
43644	Crosswalk to 43846; Commercial and Individual Exchange applicability marked X

Additional crosswalk entriesmixed

44388	Refer to Product Applicability columns for crosswalk codes; Commercial uses Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk
44392	Commercial uses Advance Notification CPT Code List; Individual Exchange maps to 44389

Lower GI procedure crosswalks (examples)CPT

46230	Claim submitted for the following CPT/HCPCS code(s) = 46220.
46255	Claim submitted for the following CPT/HCPCS code(s) = 46250.
46257	Claim submitted for the following CPT/HCPCS code(s) = 46250, 46255.

Urology/Endoscopic crosswalks (examples)CPT

52325	Claim submitted for the following CPT/HCPCS code(s) = 52001, 52224, 52234, 52235, 52315, 52320, 52327, 52330, 52341, 52351.
52330	Claim submitted for the following CPT/HCPCS code(s) = 52005, 52007, 52204, 52214, 52224, 52234, 52260, 52265, 52276, 52281, 52283, 52285, 52287, 52310.

Genital procedure code group (partial)CPT

54406	Listed as claim submitted code; product applicability: Community Plan = X
54415	Listed as claim submitted code; product applicability noted
54416	Listed as claim submitted code; product applicability noted

Uterine/related procedure code group (partial)CPT

58260	Claim submitted for the following CPT/HCPCS code(s) = 58541, 58570; product applicability includes Commercial, Individual Exchange, Medicare Advantage, Community Plan
58541	Paired with multiple related codes; product applicability includes Commercial, Individual Exchange, Medicare Advantage, Community Plan

Common gynecologic procedure codes (sample)CPT

58541	Hysteroscopy/related procedure (as listed)
58542	Hysteroscopy/related procedure (as listed)
58543	Hysteroscopy/related procedure (as listed)

Neurosurgery/spine codes (sample)CPT

63001	Spinal surgery code (listed with crosswalks)
63003	Spinal surgery code (listed with crosswalks)

Code list completeness disclaimer

Scope of code listProcedure and diagnosis codes are provided for reference only and may not be all-inclusive; listing of a code does not imply coverage or payment.

What Providers Must Do

Prior Authorization

Using/Modifying Prior Authorizations

If a provider has an approved prior authorization for a CPT or HCPCS code listed in the left column of the crosswalk and performs a service listed in the right column, follow these rules when determining whether the original authorization applies or must be modified:

If the Product Applicability column contains an X for the member's product, the original prior authorization may be used for the listed service.
If the Product Applicability column contains N/A for the member's product, the Prior Authorization Crosswalk does not apply to that member's product — obtain a new authorization as required by the member's product rules.
If the performed service is NOT listed in the right column:
- For Community Plan or Medicare Advantage members: connect with UnitedHealthcare through chat 24/7 in the UnitedHealthcare Provider Portal to obtain a new authorization.
- For Commercial members: modify the original prior authorization request before submitting the claim. CPT or HCPCS code changes are allowed to an existing approved prior authorization if the service is medically necessary.
- UnitedHealthcare allows code changes before claim submission if the change is made within 5 business days after the service was provided. Connect through chat 24/7 in the UnitedHealthcare Provider Portal to request modifications.

Key Terms and Flags

X — Product Applicability indicator

'X' meaningAn 'X' in the Product Applicability column means the crosswalk or mapping applies to that member's product; if an original prior authorization maps to the performed service and the member's product column is X, the original authorization may be used.

Action when X presentWhen X is present and the performed service is listed, providers may use the existing prior authorization per crosswalk rules.

Applies across product linesThe X indicator is shown per CPT/HCPCS line for Commercial, Individual Exchange, Medicare Advantage, and Community Plan products.

N/A — Product Applicability indicator

'N/A' meaningAn 'N/A' in the Product Applicability column indicates the crosswalk does not apply to that member's product and the original authorization cannot be used for that mapping.

When N/A and not listed

Policy Summary

PayerUnitedHealthcare

PolicyPrior authorization crosswalk table

Policy CodePolicy N/A

Change TypeAdministrative update (no material coverage changes)

Effective DateApr 1, 2026

Next Review Date

SourceLink

On This Page

No guarantee of payment

Inclusion of a code does not imply any right to reimbursement or guarantee claim payment; consult member-specific benefit plan and applicable laws.

Other policies may applyOther UnitedHealthcare policies and clinical guidelines may apply to determine coverage or authorization requirements.

Advance notification referenceRefer to Advance Notification and Clinical Submission Requirements for state or product-specific prior authorization requirements.

Medicare Advantage applicability

Medicare Advantage — many N/ANumerous code entries in the crosswalk are marked 'Medicare Advantage = N/A', indicating the mapping does not apply to MA for those codes.

Some MA entries = XCertain codes explicitly show 'Medicare Advantage = X' for select procedure codes; applicability varies by code — check individual lines.

Example (12032)12032 shows Medicare Advantage = N/A while Commercial and Individual Exchange = X (see code-level entries).

Medicare Advantage applicability

Many entries N/A in excerptIn the 332xx/related code segment, multiple product applicability fields show Medicare Advantage = N/A for listed codes.

Per-code variabilityMedicare Advantage applicability is indicated per code (e.g., 33202 = N/A for Medicare Advantage; 33250 = N/A), so review each line.

Community Plan differencesSome codes in this excerpt show Community Plan applicability as X while others show N/A; product applicability is code-specific.

Medicare Advantage applicability threshold

MA applicability mixedSome codes are explicitly marked 'Medicare Advantage = N/A' while other entries in the document (e.g., 54660, 54690, 58260) show Medicare Advantage = X; check individual code lines.

Verify per-lineBecause MA applicability varies by code, providers must verify the Medicare Advantage flag on each specific CPT/HCPCS line prior to relying on a crosswalk.

Examples of MA = XCodes such as 54660, 54690, 58260 are shown with Medicare Advantage = X in the document excerpts.

Product applicability flags required

Per-code product flagsEach listed CPT/HCPCS code line shows product applicability across Commercial, Individual Exchange, Medicare Advantage, and Community Plan using 'X' or 'N/A'.

Use flags for claims/authorizationProviders must use these product applicability flags to determine whether an existing prior authorization can be applied or whether a new/modified authorization is required.

Examples in the tableEntries like 12032, 23412, 28020 demonstrate the four-column product applicability pattern (Commercial, Individual Exchange, Medicare Advantage, Community Plan).

Billing Rule

Applicable Codes — mapping for claims submission

Providers must submit claims using the CPT/HCPCS codes listed in the crosswalk. For each primary (left-column) code, the crosswalk lists the CPT/HCPCS code(s) that should be used on claims and the Product Applicability flags indicating which product lines the mapping applies to. Always verify the Product Applicability flags for the member's product before claim submission or prior authorization modification.

When a primary code maps to multiple claim-submission codes, include the appropriate related codes on the claim per the crosswalk guidance.
If a crosswalk entry references a separate Advance Notification list (for example, Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk), follow the referenced list for Commercial product applicability.

Note

Applicable codes and product applicability (sample)

The crosswalk contains numerous sample CPT/HCPCS mappings with product applicability flags (Commercial, Individual Exchange, Medicare Advantage, Community Plan). Providers must reference these mappings when submitting claims or modifying prior authorizations. Examples (non‑exhaustive):

12032 → submit as 12001, 12002, 12031; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.
12034 → submit as 12001, 12002, 12004, 12031, 12032; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.
19364 → submit as 19361, 19367, 19368, 19369; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.
19370 → submit as 19328, 19330; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.

Note

Applicable Codes — sample entries

Additional sample entries show how to read claim-submission mappings and product applicability. Use these samples as a guide when preparing claims and authorization modifications.

21215 → product applicability Commercial/Individual/Medicare/Community = X (submit per related entries).
21230 → submit as 21209, 21235; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = X; Community Plan = X.
21235 → submit as L8035; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = X; Community Plan = X.
21296 → submit as 21295; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.

Note

Applicable Codes — additional entries

The crosswalk includes additional CPT/HCPCS entries and product applicability flags for many procedure groups. Verify mapping and applicability for each code submitted.

23472 → submit as 23470; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = X; Community Plan = X.
27120 → submit as 27122, 29915; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = X; Community Plan = X.
28020 → submit as 28050; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.
29877 → submit as 29850, 29870, 29871, 29873, 29874, 29875, 29880, 29881, 29884; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.

Billing Rule

Applicable Codes and Claim Submission Mapping

Some crosswalk entries map to grouped claim-submission codes and explicitly indicate which product types require advance notification or reference a separate advance-notification crosswalk. Follow these mappings exactly when submitting claims.

Codes in the 43200–43250 and 45388–45398 ranges frequently reference the Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk for Commercial applicability — consult that list when a crosswalk entry references it.
When a mapping lists multiple alternative claim codes, include the full set as indicated by the crosswalk to ensure correct adjudication.

Billing Rule

Pelvic/Hip Procedure Codes Mapping

Pelvic and hip procedure codes include many mappings where Medicare Advantage applicability may be marked X for certain codes and N/A for others. Confirm product applicability before submission.

27120, 27125, 27130, 27132 group — mapped codes include 27122, 29915 and others; Product applicability varies by code and product line.
27096 → submit as G0259, G0260; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.
28041 → submit as 28039, 28043, 28045; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.

Note

Provider code crosswalks and applicability

Provider code crosswalks group primary codes with their related claim codes and indicate product applicability for each product line. Use these crosswalks to determine whether an existing authorization covers a performed service and which codes to use on the claim.

When a primary code maps to many related codes (for example, 29879 maps to 29850, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29880, 29881, 29884, 29886), ensure all relevant related codes are reported as indicated.
Some primary codes are not applicable for certain products (Commercial or Medicare Advantage marked N/A) — confirm the Product Applicability flag prior to relying on an authorization.

Note

Applicable ENT/airway codes block

ENT and airway procedure codes in the crosswalk include grouped mappings and product applicability flags. Follow the mapping and product applicability guidance for ENT/airway claims.

31529 → Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.
31530 → submit as 31511, 31525, 31526, 31528, 31529, 31535, 31577; Product applicability: Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.
33202 → submit as 33203; Product applicability varies and may be N/A for some products — check the crosswalk entry before submission.

Documentation Required

Applicable Codes and Product Applicability

Each crosswalk entry includes a Product Applicability designation indicating whether the mapping applies to Commercial, Individual Exchange, Medicare Advantage, and Community Plan. Always check these flags for the member's product before using a mapping or prior authorization.

An X indicates the crosswalk mapping applies for that product line.
N/A indicates the mapping does not apply for that product line; do not rely on the crosswalk for members in that product line.
Where a crosswalk references an external Advance Notification list for Commercial product applicability, follow the referenced list for Commercial adjudication and authorization rules.

Documentation Required

Product applicability designation for listed codes

The crosswalk contains extensive line-by-line CPT/HCPCS mappings with Product Applicability. Examples showing Product Applicability designation usage:

12032 — Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.
23412 — Commercial = N/A; Individual Exchange = N/A; Medicare Advantage = N/A; Community Plan = X.
37296 — Commercial = X; Individual Exchange = N/A; Medicare Advantage = X; Community Plan = N/A.
31529 — Commercial = X; Individual Exchange = X; Medicare Advantage = N/A; Community Plan = X.

Billing Rule

Applicable CPT/HCPCS codes and product applicability

Several CPT/HCPCS codes in the crosswalk explicitly list the claim-submission codes and product applicability for each. Use these entries to ensure correct coding and authorization handling.

43200–43215 series entries — many reference the Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk for Commercial product applicability; Individual Exchange and Medicare Advantage are often N/A.
45388–45398 series entries — Commercial entries often reference the Gastroenterology Endoscopy Advance Notification list; Community Plan and other products vary by code.
58292, 58294, 58541–58544 series — full mappings and Product Applicability flags indicated; confirm the set of related codes before claim submission.

Prior Authorization

Advance notification crosswalks (partial list)

Some crosswalk entries require advance notification or refer to partial crosswalks. When a crosswalk entry references an Advance Notification CPT Code List, follow that list for Commercial product lines and consult the crosswalk for Community Plan or other product-specific guidance.

Entries such as 43200, 43201, 43202, 43204, 43205 and many 45388–45398 entries reference the Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk for Commercial applicability — providers must follow that advance-notification process where indicated.
Where a mapping lists alternative crosswalk codes in the Product Applicability column (for example, showing specific related codes for Individual Exchange or Community Plan), use those specific related codes for members in that product.

Billing Rule

Crosswalks and product applicability (partial)

Crosswalks frequently pair a primary code with one or more claim-submission codes and include product applicability per product line. Confirm both mapping and applicability before relying on an authorization or submitting a claim.

When Product Applicability = X for the member's product, the mapped claim codes may be used under the original authorization (if the mapping references that authorization).
When Product Applicability = N/A, obtain a new authorization or follow the product-specific instruction (modify the PA for Commercial; contact via portal chat for Community Plan/Medicare Advantage).

Billing Rule

Submit claims with listed CPT/HCPCS codes and verify product applicability

Before submitting claims, providers must: verify the CPT/HCPCS code(s) to use per the crosswalk, confirm the Product Applicability flags for the member's product, and modify or obtain prior authorization as required by the member's product rules.

Submit claims using the listed CPT/HCPCS codes from the crosswalk or the referenced advance-notification crosswalk where applicable.
Verify Product Applicability (Commercial, Individual Exchange, Medicare Advantage, Community Plan) for each mapping.
If a mapping does not apply to the member's product (N/A), do not use that crosswalk mapping — obtain or modify authorization per product instructions.

Billing Rule

Extended CPT/HCPCS code list for claim submission

The crosswalk includes extended lists of CPT/HCPCS codes for claim submission across many specialties. Always consult the crosswalk entry for the primary code to find the full set of related claim codes and product applicability.

Examples of extended lists include gynecologic/obstetric (57xxx–58xxx series), pelvic/hip (27xxx series), arthroscopy (29xxx series), and endoscopy/colonoscopy series (43xxx–45xxx and 453xx series).
Where the crosswalk lists many related codes for a single primary code (for example, 58267 mapping to numerous 58xxx and 585xx codes), include the complete mapped set on the claim as applicable.

Billing Rule

Claim code crosswalks

Claim code crosswalks link submitted codes to related CPT/HCPCS codes for correct adjudication. Some entries indicate codes that are not applicable for certain products — confirm applicability and include all related codes indicated by the crosswalk.

29879, 29877, 29880, 29881 groups — include the mapped arthroscopy-related codes as listed.
45398 and other listed codes that reference the Gastroenterology Endoscopy Advance Notification list require following that referenced crosswalk for Commercial members.
When a primary code's mapping includes codes from different procedure families, report the full mapped set as indicated (e.g., 58294 mapping includes many 58xxx and 585xx codes).

Note

Additional applicable codes

Additional applicable codes and crosswalks are present throughout the table. This section is a consolidated reminder to consult the full crosswalk for any code not shown here and to follow product-specific instructions for authorization and claim submission.

Codes and mappings not listed in these examples may still appear in the full crosswalk — always reference the crosswalk entry for the primary code you have an authorization for.
If in doubt about applicability or required steps to modify an authorization, connect via chat 24/7 in the UnitedHealthcare Provider Portal for assistance.

If the performed service is not listed and the member is Medicare Advantage or Community Plan, providers must obtain a new authorization via Provider Portal chat (24/7).

Per-code designationN/A is applied per CPT/HCPCS line — some codes use N/A for Individual Exchange and Medicare Advantage while Commercial may reference an external advance-notification crosswalk instead.

Product applicability flag

Flag typesProduct applicability flags use 'X' or 'N/A' to indicate whether the listed CPT/HCPCS code applies to a specific UnitedHealthcare product line.

Four product columnsFlags are shown for Commercial, Individual Exchange, Medicare Advantage, and Community Plan on each code line.

Determine authorization useProviders must reference the appropriate flag for the member's product to decide if an existing authorization applies or if a new/modified authorization is needed.

Product applicability

Flags indicate mapping applicabilityProduct applicability flags indicate whether the listed CPT/HCPCS code mapping applies to specific UnitedHealthcare product lines (Commercial, Individual Exchange, Medicare Advantage, Community Plan).

Example entriesEntries such as 28020 and 29877 show Commercial and Individual Exchange = X while Medicare Advantage = N/A and Community Plan = X for those codes.

Use for claims submissionProviders should use these flags when submitting claims and determining whether to modify or reuse prior authorizations per product rules.

Product applicability

Applicability per product lineFlags indicate whether the listed code is applicable to a product line (Commercial, Individual Exchange, Medicare Advantage, Community Plan) using X or N/A.

Related submitted codes shownMany entries include 'Claim submitted for the following CPT/HCPCS code(s)' alongside product applicability flags to guide mapping decisions.

Code-level verification requiredBecause flags differ across codes, verify the product applicability on the specific CPT/HCPCS line before relying on the mapping.

Product applicablity

Mapping applies to specified productsFlags indicate whether the mapping applies to specific product lines; some codes reference an external Gastroenterology Endoscopy Advance Notification list for Commercial applicability.

Community Plan commonalityMany codes across sections are marked Community Plan = X, but this varies by code and must be checked per line.

Commercial may use crosswalk sourceCertain 43xxx series codes show Commercial = 'Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk' instead of a simple X/N/A—follow that referenced list when applicable.

Product applicablity

Indicates mapping applicabilityFlags indicate whether the mapped code applies to the listed products; entries like 29877 show Commercial = X and Medicare Advantage = N/A.

Per-code decision toolUse these flags as a decision aid to determine if an existing prior authorization covers a related performed service for the member's product.

Examples providedNumerous primary-to-related mappings in the document include product applicability flags to guide claims and prior authorization processing.

Product applicablity

Indicates code applicability to productsFlags indicate whether the mapping applies to specific UnitedHealthcare product lines; e.g., 45388 references the Gastroenterology Endoscopy Advance Notification list for Commercial applicability.

X = applicable, N/A = not applicableProduct applicability flags follow the X/N/A convention to show applicability or non-applicability per product line.

Crosswalk guidance includedMany entries include crosswalk instructions or references to alternate codes for product-specific processing or advance notification requirements.

Product applicablity

Per-code applicability flagsFlags indicate whether the mapping applies to specific product lines (Commercial, Individual Exchange, Medicare Advantage, Community Plan) for each CPT/HCPCS code listed.

Example code setCodes like 58541–58573 and 58292 are listed with product applicability flags across all four product columns.

Required for prior authorization useProviders must reference the per-line flags to determine whether an existing authorization covers a performed service for the member's product.

Product applicability

Mapping indicates whether code applies to productsFlags indicate whether a given CPT/HCPCS code mapping applies to specific product lines; some 43xxx codes direct users to the Gastroenterology Endoscopy Advance Notification list for Commercial applicability.

Claim-submitted crosswalks presentEntries frequently include 'Claim submitted for the following CPT/HCPCS code(s)' to show related codes for claims submission across products.

Check individual linesBecause applicability and crosswalks vary by code, verify each CPT/HCPCS line when determining authorization or claim coding.

Claim submitted crosswalk

Maps to product-specific codesCrosswalks map a submitted CPT/HCPCS code to one or more alternative codes for product-specific processing or advance notification (e.g., 33251 maps to 33250, 33254, 33261).

Used for advance notificationSome crosswalks are tied to advance notification requirements and must be followed per the referenced lists.

Per-code flags guide useProduct applicability flags shown with each mapping indicate whether the mapped codes apply to Commercial, Individual Exchange, Medicare Advantage, or Community Plan products.

Product applicability

Applicability across four productsFlags indicate applicability to Commercial, Individual Exchange, Medicare Advantage, and Community Plan for each CPT/HCPCS code line.

Commercial sometimes references external listCertain codes (notably in the 43xxx and 45xxx series) show Commercial applicability via the Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk rather than a simple X.

Community Plan usageMany entries indicate Community Plan = X for codes where other products may be N/A.

Referenced crosswalk list

Referenced list nameGastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk is cited as the crosswalk source for many Commercial product mappings in the 43200–43250 and related ranges.

Follow referenced crosswalkWhen a code's Commercial applicability references this list, providers should consult that advance-notification crosswalk for applicable mappings and requirements.

Applies to advance notification codesThe referenced list is used to determine advance-notification requirements for endoscopy-related CPT codes listed in this document.

Product applicability description

X = applicable; N/A = not applicableProduct applicability indicates whether a listed CPT/HCPCS code is applicable (X), not applicable (N/A), or maps to alternate codes for each product line.

Per-code determinationThis designation is made on each CPT/HCPCS line and affects whether an existing prior authorization may be used for a performed service.

Use in authorization decisionsProviders must check these flags to determine if they can reuse or must modify/obtain an authorization based on member product and code mapping.

Referenced crosswalk source

Common referenced sourceThe Gastroenterology Endoscopy Advance Notification CPT Code List and Crosswalk is a referenced crosswalk source used for many Commercial product mappings and advance-notification determinations.

Used for commercial advance notificationWhen Commercial applicability references this source, follow its crosswalk and advance-notification steps for prior authorization handling.

Document cross-referencesSeveral 43xxx/44xxx/45xxx entries in this document explicitly direct users to that referenced crosswalk for code-level mapping.

Product applicability label reference

Product applicability label useProduct applicability labels (X or N/A) are used to indicate whether a code is applicable for Commercial, Individual Exchange, Medicare Advantage, or Community Plan products.

Explicit four-column labelingCodes in the 585xx and related ranges show applicability flags across all four product columns in the table.

Decision support roleThese labels serve as the primary decision support for whether an original prior authorization can be used for a performed service on a given product line.

Crosswalk

Mapping definitionA crosswalk maps a submitted CPT/HCPCS code to one or more alternative CPT/HCPCS codes for product-specific processing or advance notification requirements.

Crosswalks used for claim submissionClaim-submitted crosswalks show related CPT/HCPCS codes that may be submitted in association with the listed code to route claims/authorizations properly.

Product-specific handlingCrosswalks often include product applicability guidance (X/N/A) and may reference external advance-notification lists for certain products.

Product applicability flags definition

Flags indicate applicability (X/N/A)Product applicability flags indicate whether a specific UnitedHealthcare product line (Commercial, Individual Exchange, Medicare Advantage, Community Plan) applies to the listed CPT/HCPCS mapping (X = applicable, N/A = not applicable).

Per-line verification requiredProviders must verify the flag on the exact CPT/HCPCS line — flags vary by code and determine whether a prior authorization crosswalk applies.

Used for authorization reuse decisionsThese indicators are the determinant for whether an original prior authorization can be used when a different but related CPT/HCPCS service is performed.

Product applicability indicator

Indicator purposeIndicates whether a code is applicable for a product (Commercial, Individual Exchange, Medicare Advantage, Community Plan) using X or N/A; if X for the member's product and the performed service is listed, the original authorization may be used.

Action when not applicableIf the flag is N/A for the member's product, the crosswalk does not apply and providers must obtain or modify authorization according to product-specific instructions.

Provider obligationsFor services not listed, Community Plan and Medicare Advantage members require chat-based new authorization via Provider Portal; Commercial members must modify the original authorization within 5 business days if changes are medically necessary.