Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
UnitedHealthcareMedicaid · Prior Auth · State news · AZ, CO, FL, HI, KS, KY, MD, NM, NY, OH, PA, RI, TN · Cardiology, Cardiothoracic SurgeryMedium impact

Medicaid: Prior authorization required for certain transcatheter heart valve procedures

Act
by Jul 1, 2026
Effective date
Jul 1, 2026
Identified
Jun 3, 2026

Summary

Starting July 1, 2026, UnitedHealthcare Community Plans (Medicaid) will require prior authorization for transcatheter heart valve procedures using codes 0569T and 0570T. These codes were previously classified as unproven but are now considered proven in certain clinical circumstances requiring medical necessity review.

Get alerts when payers change rules like this one

We check UnitedHealthcare and other payers every day and email you when a change matches your specialty and state.

Get UnitedHealthcare alertsPolicy Monitoring is free. No card required.

What to do

by Jul 1, 2026 · 4 steps
01Billing team must update prior authorization requirements in billing system for CPT codes 0569T and 0570T for UnitedHealthcare Community Plan (Medicaid) patients.
02Update encounter forms and provider workflows to obtain prior authorization before performing transcatheter heart valve procedures.
03Review UnitedHealthcare Community Plan Medical Policy for specific criteria.
04Claims submitted without prior authorization will be denied.

Original notice

Medicaid: Prior authorization required for certain transcatheter heart valve procedures
uhcprovider.com · Always check the source before changing claims.
View original ↗

Related policy hubs

UnitedHealthcare policiesAZ policy changesCO policy changesFL policy changesHI policy changesKS policy changesKY policy changesMD policy changesNM policy changesNY policy changesOH policy changesPA policy changesRI policy changesTN policy changesCardiologyCardiothoracic Surgery

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account