August 10, 2023

UnitedHealthcare Removes Prior Authorization Requirements for Select Radiology Codes

UnitedHealthcare, one of the nation’s largest health insurers, is taking steps to reduce prior authorization requirements. The insurer released several lists of procedure codes that will no longer require prior authorization beginning on Sept. 1 and/or Nov. 1, depending on whether the plan is commercial, exchange, community or Medicare Advantage. This is the first step of a two-phase prior authorization procedure reduction by UnitedHealthcare and its announced goal of reducing prior authorization volume by 20%.

The recently released procedure code lists have over 60 imaging related exams, including several Magnetic Resonance Imaging and Magnetic Resonance Angiography codes. The American College of Radiology® (ACR®) believes UnitedHealthcare is taking a step in the right direction; however, the College believes the initial batch of radiology codes included will have minimal impact on most radiology practices.

In addition to reducing the number of codes subject to prior authorization, UnitedHealthcare plans to implement a national “gold card” program for select provider groups in 2024. The insurer said the program will require eligible providers to follow an administrative notification process that the insurer believes will be less burdensome than prior authorization.

Questions about the UnitedHealthcare prior authorization announcements should be directed to Katie Keysor, ACR Senior Director of Economic Policy.