CurrentUnitedHealthcarePolicy N/A

Electrophysiology implant CPT codes requiring prior authorization

A UnitedHealthcare Community Plan reimbursement table listing CPT codes for electrophysiology implant procedures that require prior authorization and guidance on prior authorization validity and verification.

Policy Summary

PayerUnitedHealthcare

PolicyElectrophysiology implant CPT codes requiring prior authorization

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization before performing listed electrophysiology implant procedures and verify requirements by calling 866-889-8054.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

45 daysprior authorization number validity period

31 codeselectrophysiology implant procedures listed

no substitutesno substitute CPT codes allowed

866-889-8054verification phone

Coverage Stance

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 is required for the electrophysiology implant CPT codes listed in this policy.

Prior authorization numbers represent the specific procedure requested and are valid for 45 calendar days from the date they are issued.

To verify specific prior authorization requirements by member, call 866-889-8054.

There are no substitute CPT codes for electrophysiology implant procedures.

Electrophysiology Implant CPT Codes Requiring Prior Authorization

Covered CPT CodesCPTCovered

0571T	Insertion or replacement of implantable cardioverter defibrillator system with substernal electrode(s); includes generator placement; Device type = ICD
0614T	Removal and replacement of substernal implantable defibrillator pulse generator; includes generator placement; Device type = ICD
0795T	Insertion of permanent dual-chamber leadless pacemaker system (RA & RV components) via catheter; includes generator placement; Device type = Pacemaker
0796T	Transcatheter insertion of permanent right atrial component of dual-chamber leadless pacemaker system; includes generator placement; Device type = Pacemaker
0797T	Transcatheter insertion of permanent right ventricular component of dual-chamber leadless pacemaker system; includes generator placement; Device type = Pacemaker
0801T	Transcatheter removal and replacement of complete dual-chamber leadless pacemaker system; includes generator placement and removal of existing device; Device type = Pacemaker
0802T	Transcatheter removal and replacement of right atrial component of dual-chamber leadless pacemaker; includes generator placement and removal; Device type = Pacemaker
0803T	Transcatheter removal and replacement of right ventricular component of dual-chamber leadless pacemaker; includes generator placement and removal; Device type = Pacemaker
0823T	Transcatheter insertion of permanent single-chamber leadless pacemaker in right atrium; includes generator placement; Device type = Pacemaker
0825T	Transcatheter removal and replacement of permanent single-chamber leadless pacemaker in right atrium; includes generator placement and removal; Device type = Pacemaker

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Prior Authorization & Provider Responsibilities

Prior Authorization

Prior Authorization Required

The following CPT codes require prior authorization for UnitedHealthcare Community Plan members. Prior authorization numbers represent the specific procedure requested and are valid for 45 calendar days from the date they are issued. To verify specific prior authorization requirements by member, call 866-889-8054.

Affected CPT codes: refer to the Electrophysiology implant CPT code classification table (see source).
Prior authorization is valid for 45 calendar days from issue date.
Verification phone: 866-889-8054.

Denial Risk

Substitution Restriction

There are no substitute CPT codes permitted for electrophysiology implant procedures. Claims must include the exact CPT codes listed for the procedure; substitutions may result in claim denial or delay.

Do not submit alternate or substitute CPT codes for electrophysiology implant procedures.
Ensure claims include required accompanying CPT codes when applicable (e.g., catheterization crosswalk codes such as 93452-93461 as specified for related procedures).

Key Definitions

Prior authorization number validity

Prior authorization validityPrior authorization numbers are valid for 45 calendar days from the date they are issued.

Verification phone numberTo verify specific prior authorization requirements by member call 866-889-8054.

Applies toCPT codes listed in the Electrophysiology implant CPT code classification table that require prior authorization for UnitedHealthcare Community Plan members.

Substitute CPT codes

Substitute CPT codes allowedThere are no substitute CPT codes for electrophysiology implant procedures.

ScopeRestriction applies to all electrophysiology implant procedures listed in the policy (see Electrophysiology implant CPT code classification table).

Billing implicationClaims should use the exact CPT codes listed; do not replace with alternate or substitute CPT codes.