UnitedHealthcare Expands Prior Auth for Outpatient Procedures: The March 1 Deadline
UHC is adding prior authorization requirements for outpatient surgical procedures and advanced imaging, effective March 1, 2026. Claims submitted without authorization on or after March 1 will deny.
This is one of the more consequential PA expansions UHC has made in the last two years. The affected code categories include high-volume outpatient surgery and imaging that many practices have been billing without PA for years.
What's Changing
- Outpatient surgical procedures — additional musculoskeletal, ENT, and GI procedures now require PA when performed in an ASC or outpatient hospital setting
- Advanced imaging — expanded PA requirements for MRI, CT, and PET scans, including combinations previously exempt
- Sleep studies — new PA requirements for home sleep testing in certain plan types
March 1, 2026 for UHC commercial plans. Medicare Advantage plans may have a staggered rollout — confirm the effective date for each MA plan ID via the UHC provider portal.
| Category | Example CPT Codes | PA Required After March 1 |
|---|---|---|
| Musculoskeletal surgery | 27447, 27130, 23472 | Yes — new |
| ENT procedures | 42820, 42821, 31240 | Yes — new |
| GI procedures | 43239, 43254, 43255 | Yes — expanded |
| MRI — spine | 72141, 72146, 72148 | Yes — expanded |
| CT — abdomen/pelvis | 74177, 74178 | Verify by plan |
| Home sleep testing | 95800, 95801, 95806 | Yes — new for select plans |
- Pull your schedule for March 1 forward — identify all UHC patients with affected procedure codes
- Submit PA requests now for any affected procedure scheduled on or after March 1
- Update your scheduling system to flag UHC patients for PA check on affected code categories
- Set a denial monitoring alert for UHC claims with reason code "authorization required" starting March 1
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