Submit prior authorization via portal or phone

Submit prior authorization requests via the UnitedHealthcare Provider Portal Prior Authorization and Notification tool (UHCprovider.com Prior Authorization and Notification tab) or by phone at 844-284-0146. Emergency or urgent care does not require prior authorization; out-of-network providers must request prior authorization for all procedures and services.

Examples of services/codes requiring prior authorization

Certain services and codes require prior authorization, including bariatric surgery (example CPTs 43644, 43645, 43659, 43770, 43775, 43842, 43845, 43846), bone growth stimulators (20975, 20979), breast reconstruction codes (e.g., 19316, 19318, 19325, 19328, 19330, 19340) and specified cancer-supportive injectables listed in the policy (e.g., J1442, J1449, J2506, Q5101, Q5108, Q5110, Q5111, Q5120, Q5122).

Cardiology procedures require prior authorization

Prior authorization is required before performance for outpatient and office-based diagnostic catheterizations, echocardiograms, electrophysiology implants and stress echoes; prior authorization is required for lower extremity angiogram only.

Submit requests at UHCprovider.com or call 888-397-8129

Please submit requests online using the UnitedHealthcare Provider Portal at UHCprovider.com to sign in (Prior Authorization and Notification tool). Or call 888-397-8129 for phone submission.

Inpatient video EEG, outpatient chemo, implants require prior authorization

Prior authorization is required for certain inpatient services such as inpatient video EEG monitoring, injectable chemotherapy drugs administered in an outpatient setting for a cancer diagnosis, cochlear and other auditory implants (e.g., 69710, 69714, 69930, L8619, L8690) and continuous glucose monitors when billed with a Type 2 diabetes diagnosis.

Diagnostic exceptions — PA not required with specified Dx codes

Prior authorization is not required when services are billed with the listed diagnostic codes noted in the policy; the policy states "Prior authorization not required when billed with the following Dx codes below:" (see diagnostic exceptions section).

DME prior authorization applies to listed codes and high-cost items

Durable medical equipment (DME) requires prior authorization only for the DME codes listed when billed as a retail purchase or under a cumulative rental arrangement; some items are subject to a cost threshold (greater than $500).

Enteral and experimental services require prior authorization

Enteral services (e.g., B9002, B9004, B9006, B9998) and specified experimental/investigational procedures (examples include CPTs 33477, 36514, 64722) require prior authorization as noted in the policy.

How to obtain prior authorization — portal or phone

Submit prior authorization requests online using the UnitedHealthcare Provider Portal (UHCprovider.com) or call 888-397-8129. The policy repeatedly directs non-oncology submissions to the provider portal Prior Authorization tools.

Genetic/molecular testing requires prior authorization (outpatient)

Genetic and molecular testing requires prior authorization; prior authorization is required only in outpatient settings (including the member's site) for listed genetic/molecular testing codes (e.g., 81162, 81163, 81164, 81228, 81242, 81402, 81406, G0299, G0495, G0300, G0496, G0493).

Surgical/procedural codes require prior authorization

Prior authorization is required for listed surgical and procedural codes (examples include femoroacetabular impingement codes 29914–29916 and functional endoscopic sinus surgery codes 31240, 31253–31259).

Prior authorization for listed injectables and surgical CPTs

Prior authorization is required for specified injectable medications and listed CPT/HCPCS surgical codes; examples of injectable HCPCS codes include J0791, J7171, J1931 and example surgical CPTs include 58552, 58553, 58572, 58573 — submit requests via UHCprovider.com or by phone (888-397-8129).

PA rules for unclassified/temporary codes (C9399, J3490, J3590)

For unclassified/temporary HCPCS/CPT codes C9399, J3490 and J3590, prior authorization is required only for a specified list of named medications (e.g., Casgevy, Kebilidi, Lantidra, Leqembi, Lupaneta Pack, Lyfgenia, Ocrevus Zunovo, Pavblu, Revcovi, Rivfloza, Starjemza, Veopoz).

Recommend pre-determination for new-to-market medications

Check the Review at Launch for New to Market Medications policy and Review at Launch Medication List for up-to-date guidance; pre-determination is highly recommended for newly approved drugs.

PA required for specific drugs billed with unclassified/temporary codes

Prior authorization is required when billing certain listed medications using unclassified/temporary codes C9399, J3490, and J3590 (the policy names specific drugs for which PA is required when billed under these codes).

Colony-stimulating factor J/Q codes require prior authorization

White blood cell colony-stimulating factor codes J1442, J1447, J1448, J2506, Q5101, Q5108, Q5110, Q5111, Q5120 and Q5122 require prior authorization.

Prior notification for Cimzia and Synagis via Optum Rx

Obtain prior notification for Cimzia and Synagis through Optum Rx prior notification services at 800-310-6826 (policy instruction for prior notification rather than standard PA).

Non-oncology submissions: use UHCProvider.com; oncology follows Cancer supportive care

Submit non-oncology prior authorization requests online at UHCProvider.com using the Prior Authorization tools; oncology requests should reference the Cancer supportive care section and follow that pathway.

Colony-stimulating factor codes require PA for oncology and non‑oncology

The policy lists the colony-stimulating factor HCPCS/J-code set (J1442, J1447, J1448, J2506, Q5101, Q5108, Q5110, Q5111, Q5120, Q5122) and instructs that these codes require prior authorization for both oncology and non-oncology diagnoses.

CSF prior authorization applies to oncology and non‑oncology — submission guidance

Prior authorization requirement for colony-stimulating factors applies to both oncology and non-oncology diagnoses; for oncology diagnoses see the Cancer supportive care section, for non-oncology diagnoses submit online at UHCProvider.com using the Prior Authorization tool.

How to submit CSF prior authorization — oncology vs non‑oncology pathways

For oncology diagnoses reference the Cancer supportive care section; for non-oncology diagnoses submit prior authorization requests online at UHCProvider.com using the Prior Authorization (and Additional Information) section and include the CPT/HCPCS code fields as instructed.

Submit non‑oncology CSF PA via UHCProvider.com Prior Authorization tools

Submit non-oncology colony-stimulating factor prior authorization requests online at UHCProvider.com using the Prior Authorization and Additional Information tools on the provider portal (include CPT/HCPCS codes in the designated fields).

Use UHCProvider.com Prior Authorization section for CSF and listed meds

The UnitedHealthcare Provider Portal (UHCprovider.com) Prior Authorization guidance in this policy directs providers to the portal for submitting prior authorizations for colony-stimulating factors and other listed medications.

Reiteration: listed CSF codes require prior authorization

The policy reiterates that codes J1442, J1447, J1448, J2506, Q5101, Q5108, Q5110, Q5111, Q5120 and Q5122 (white blood cell colony-stimulating factors) require prior authorization for both oncology and non-oncology diagnoses; non-oncology submissions should be made via UHCProvider.com.

Submit via UHCprovider.com (or call contact number)

Please submit requests online using the UnitedHealthcare Provider Portal (UHCprovider.com) or call the provider contact phone number shown in the policy (phone number appears truncated in one fragment but portal submission is primary).

Partial list: injectables, joint replacement, musculoskeletal, air ambulance, therapy

Partial list of services requiring prior authorization includes injectable medications (notification/instructions provided), joint total hip and knee replacement procedures, musculoskeletal surgeries (shoulder), non-emergent air ambulance transport, and occupational/physical therapy (authorization required after initial evaluation and before the initial therapy visit and for all ongoing visits).

Therapy prior authorization timing — initial and ongoing visits

Therapy services require prior authorization after the initial evaluation and before the initial therapy visit, and prior authorization is required for all ongoing therapy visits.

Age-based PA: therapy codes apply to members age 3+ only

Certain therapy CPT/HCPCS codes require prior authorization only for members age 3 years and older (policy note: "Only members 3 years of age and older require a prior auth").

Orthotics/prosthetics PA threshold: > $500 retail or cumulative rental

Orthotics and prosthetics require prior authorization only when the retail purchase or cumulative rental cost exceeds $500; the policy lists numerous L‑series HCPCS codes subject to this threshold.