June 02, 2022

UnitedHealthcare Offers Prior Authorization Flexibility

UnitedHealthcare last week responded to a letter from the American College of Radiology® (ACR®) and the Radiology Business Management Association (RBMA) indicating it is aware of the iodinated contrast media shortage and outlined flexibilities it has put in place to assist patients and providers with prior authorization. In their letter, the ACR and RBMA sought flexibilities in the prior authorization process during the shortage.

Radiology practices around the United States continue to feel the impact of the contrast media shortage used in many imaging exams due to COVID-19 shutdowns in Shanghai. GE Healthcare’s Omnipaque and Visipaque contrast media were added to the U.S. Food and Drug Administration’s drug shortage list on May 9.

In an effort to ensure radiology practices have sufficient flexibility to change imaging orders as needed, the ACR and the RBMA had asked UnitedHealthcare to give providers the option of changing patient orders for CT scans with contrast as needed, without having to repeat the prior authorization process and potentially delaying patient care. The insurer said its prior authorization procedures allow providers who need to change an authorized CT with contrast study to a non-contrast study to do so without modifying the authorization. UnitedHealthcare has a Radiology Notification/Prior Authorization CPT Code List and Crosswalk Table available on its website. The insurer noted in the letter that this family of code prior authorization practice was in place prior to the contrast shortage.

If, however, a provider needs to change the authorized CT with contrast study to a different procedure entirely (e.g., different imaging modality), the provider must request the study through the usual prior authorization process.

Finally, UnitedHealthcare stated that a provider may request that the duration of the authorization be extended from 45 to 90 days for non-emergency and/or elective procedures during the contrast shortage.

The ACR has developed a resource page on the contrast media shortage. For questions regarding payer policies, please contact Katie Keysor, ACR Senior Director, Economic Policy.