[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-283957-105":3,"detail-sidebar-cat-1-en-105":73,"doc-detail-283957-en":119},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":66,"head_meta":68,"extra_data":70,"updated_unix":72},105,"en","unitedhealthcare-provider-portal-prior-authorization-and-notification-instructions-coverage-rules-and-procedure-codes","UnitedHealthcare Provider Portal - Prior Authorization and Notification Instructions - Coverage Rules and Procedure Codes","","Submission of prior authorization requests must follow UnitedHealthcare Provider Portal instructions using the Prior Authorization and Notification tool after signing in with a One Healthcare ID. Coverage decisions require referencing the member-specific benefit plan document because terms vary by state. Prior authorization is not needed for emergency or urgent care, while non-emergent out-of-network and service-area exclusions may apply. The document lists procedures requiring prior authorization and associated CPT®/HCPCS codes, including arthroplasty, arthroscopy, bariatric services, bone growth stimulators, bone marrow or stem cell care, and breast reconstruction, plus cancer supportive care drug coding guidance.",{"@graph":14,"@context":65},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/unitedhealthcare-provider-portal-prior-authorization-and-notification-instructions-coverage-rules-and-procedure-codes/283957/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/unitedhealthcare-provider-portal-prior-authorization-and-notification-instructions-coverage-rules-and-procedure-codes/283957.png","ImageObject",442,249,{"name":42,"@type":43},"Berry Peter","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59],{"name":60,"@type":61,"acceptedAnswer":62},"Where can coverage rules for different states and services be verified?","Question",{"text":63,"@type":64},"Coverage decisions must reference the member-specific benefit plan document, since plan terms vary by state and site of service review may apply to certain codes.","Answer","https://schema.org",{"og:url":32,"og:type":67,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":69,"canonical":32},"index,follow",{"doc_id":71,"site_id":7},283957,1790215839,{"code":4,"msg":74,"data":75},"success",[76,81,86,91,96,101,105,110,115],{"id":77,"doc_module":22,"doc_module_name":25,"category_name":78,"show_sort_weight":79,"slug":80},11,"Presentations",90,"presentations",{"id":82,"doc_module":22,"doc_module_name":25,"category_name":83,"show_sort_weight":84,"slug":85},12,"Resumes",80,"resumes",{"id":87,"doc_module":22,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},14,"Invoices",70,"invoices",{"id":92,"doc_module":22,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},15,"Posters",60,"posters",{"id":97,"doc_module":22,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},16,"Social Media",50,"social-media",{"id":102,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":103,"slug":104},17,40,"forms",{"id":106,"doc_module":22,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},18,"Letters",30,"letters",{"id":111,"doc_module":22,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},21,"Paper Templates",5,"papers-templates",{"id":116,"doc_module":22,"doc_module_name":25,"category_name":117,"show_sort_weight":4,"slug":118},158,"General","general-158",{"code":4,"msg":74,"data":120},{"doc_id":71,"user_id":121,"nickname":42,"user_avatar":122,"doc_module":22,"category_id":102,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":123,"file_id":124,"file_url":125,"file_type":126,"file_size":127,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":128,"language":129,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":130,"faqs":131,"seo_title":132,"seo_description":12,"update_tm":133,"read_time":97},1374402524268,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","General information  \nPlease submit prior authorization requests using the following UnitedHealthcare Provider Portal instructions:  \n• Online: Use the Prior Authorization and Notification tool on the UnitedHealthcare Provider Portal. To get started, go to UHCprovider.com and click Sign In at the top-right corner to log in using your One Healthcare ID and password. Then, select the Prior Authorization and Notification tab on your dashboard. If you don’t have a One Healthcare ID, [visit](visit UHCprovider.com/access)[ UHCprovider.com/access](visit UHCprovider.com/access).  \nWhen deciding coverage, the member-specific benefit plan document must be referenced. The terms of member specific benefit plans vary by state. Site of service review may apply to certain codes on this list. Prior authorization is not required for emergency or urgent care.  \nFor these benefit plans, members have no non-emergent out-of-network coverage and no coverage outside of the service area.  \n\n| Procedures and services | Additional information | CPT® or HCPCS codes and/or\u003Cbr>how to obtain prior authorization |\n| --- | --- | --- |\n| Arthroplasty | Prior authorization required For all states | 23470\u003Cbr>24360\u003Cbr>2436525442\u003Cbr>25449\u003Cbr>27125\u003Cbr>27137\u003Cbr>27440\u003Cbr>27445\u003Cbr>27487\u003Cbr>2347224361\u003Cbr>24370\u003Cbr>2544326531\u003Cbr>27130\u003Cbr>27138\u003Cbr>27441\u003Cbr>27446\u003Cbr>27702\u003Cbr>2347324362\u003Cbr>243712544426536\u003Cbr>27132\u003Cbr>27437\u003Cbr>27442\u003Cbr>27447\u003Cbr>234742436325441\u003Cbr>2544627120\u003Cbr>27134\u003Cbr>27438\u003Cbr>27443\u003Cbr>27486\u003Cbr>Site of service also may apply\u003Cbr>24366 25445 26530 26535 |\n| Arthroscopy | Prior authorization required | Prior authorization is required for all states.\u003Cbr>29826 29843 29871 Site of Service also may apply\u003Cbr>29805 29806 29807 29819 29820 29821 29822 29823 29824 29825 29827 29828 29830 29834 29835 29836 29837 29838 29840 29844 29845 29846 29847 29860 29861 29862 29863 29870 29873 29874 29875 29876 |\n\n\n| Procedures and services | Additional information | CPT® or HCPCS codes and/or\u003Cbr>how to obtain prior authorization |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n| Arthroscopy (cont.) |  | 29877\u003Cbr>29882\u003Cbr>29886\u003Cbr>29891\u003Cbr>29895\u003Cbr>29914 | 29879\u003Cbr>29883\u003Cbr>29887\u003Cbr>29892\u003Cbr>29897\u003Cbr>29915 | 29880\u003Cbr>29884\u003Cbr>29888\u003Cbr>29893\u003Cbr>29898\u003Cbr>29916 | 29881\u003Cbr>29885\u003Cbr>29889\u003Cbr>29894\u003Cbr>29899 |\n| Bariatric | Prior authorization required\u003Cbr>There is a Center of Excellence requirement for coverage of bariatric surgery and services. In certain situations, bariatric surgery and other obesityrelated services aren’t covered by some benefit plans. | 43659 43772 43774 43886\u003Cbr>43887 43888\u003Cbr>Bariatric w/diagnosis (Dx) 43860* 43865*\u003Cbr>Indiana, Nebraska, South Carolina and Wisconsin excluded Notification/prior authorization required for the following diagnosis codes: E66 . 01, E66 . 09, E66 . 1–E66 . 3,E66 . 8, E66 . 9, Z68 . 1, Z68 .20– Z68 . 22, Z68 . 30–Z68 . 39,Z68 .41– Z68 .45. |  |  |  |\n| Body lengthening | Prior authorization required | Site of service also may apply for all states\u003Cbr>27685 27685 |  |  |  |\n| Bone growth stimulator\u003Cbr>Electronic stimulation or ultrasound to heal fractures | Prior authorization required | 20974 20975 20979 E0747 E0748 E0749 E0760 |  |  |  |\n| Bone marrow/stem cell | Prior authorization required | 38204 38205 38211 38230\u003Cbr>38232 38243 |  |  |  |\n| Breast reconstruction (non-mastectomy)\u003Cbr>Reconstruction of the breast except when following mastectomy\u003Cbr>Prior authorization required\u003Cbr>1577119328\u003Cbr>19350\u003Cbr>19368\u003Cbr>19396\u003Cbr>19316\u003Cbr>19330\u003Cbr>19357\u003Cbr>19369 L8600\u003Cbr>19318\u003Cbr>19340\u003Cbr>19364\u003Cbr>19370\u003Cbr>1932519342\u003Cbr>19367\u003Cbr>19371\u003Cbr>Notification/prior authorization not required for the following diagnosis codes:\u003Cbr>|  |  |  |  |  |\n\n\n| Procedures and services\u003Cbr>Additional information\u003Cbr>CPT® or HCPCS codes and/or\u003Cbr>how to obtain prior authorization |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n| Breast reconstruction  |  | C50.321 | C50.322 | C50.329 | \u003Cbr>C50.421 |\n| \u003Cbr>(non-mastectomy)(cont.) |  | C50.422\u003Cbr>C50.529 | C50.429","cbCainnegGlxQiTg","https://ap.wps.com/l/cbCainnegGlxQiTg","pdf",1251254,45,"English","# Prior authorization submission instructions\n## Portal access and tool usage\n# Coverage and authorization requirements\n## State-specific benefit plan references\n## Emergency and urgent care exceptions\n# Procedures and services with CPT®/HCPCS codes\n## Arthroplasty\n## Arthroscopy\n## Bariatric\n## Body lengthening\n## Bone growth stimulator\n## Bone marrow/stem cell\n## Breast reconstruction\n## Cancer supportive care","[{\"question\":\"Where can coverage rules for different states and services be verified?\",\"answer\":\"Coverage decisions must reference the member-specific benefit plan document, since plan terms vary by state and site of service review may apply to certain codes.\"}]","UnitedHealthcare Provider Portal - Prior Authorization and Notification Instructions - Coverage Rules and Procedure Codes | PDF",1789623460]