Medicaid: New prior authorization codes for VBT and extremity prosthetics services
AI Summary
Starting September 1, 2026, UnitedHealthcare will require prior authorization for vertebral body tethering (VBT) codes and upper/lower extremity prosthetics codes across multiple state Medicaid plans. The VBT codes were previously classified as unproven but are now considered proven in certain clinical circumstances, while the prosthetics codes are newly established AMA codes.
Action Required
By September 1, 2026: Billing team must update prior authorization requirements in billing software for VBT codes (0656T, 0657T, 0790T, 22836, 22837, 22838) and extremity prosthetics codes (L6034, L6035, L6036, L6038, L6039, L5657) for UnitedHealthcare Medicaid patients in affected states. Update encounter forms and EMR templates to remind providers to obtain prior auth before performing these services. Claims will be denied without proper prior authorization.
Affected Billing Codes
Plan Types
Medicaid
States
AZ, CO, FL, HI, IN, KS, KY, MD, MI, MO, NE, NJ, NM, NY, OH, PA, RI, TN, TX, VA, WA
Specialties
ortho, neurosurgery