CommercialPrior AuthMedium impact
New genetic and molecular codes required for prior authorization
UnitedHealthcare·Oncology, Endocrinology, Neurology +1 more·Prior authorization
Effective date
Jul 1, 2026
We identified it
Jun 3, 2026
Summary
UnitedHealthcare is adding 10 new genetic and molecular testing procedure codes (0616U-0628U) to their prior authorization requirements, effective July 1, 2026. This affects specific commercial and Individual Exchange plans across all states.
Action Required
By July 1, 2026: Billing team must update systems to require prior authorization for genetic/molecular testing codes 0616U, 0618U, 0619U, 0622U, 0623U, 0624U, 0625U, 0626U, 0627U, and 0628U for UnitedHealthcare commercial and Individual Exchange plans. Update encounter forms and provider alerts. Claims submitted without prior authorization will be denied.