New radiology and cardiology prior authorization codes
AI Summary
Starting April 1, 2026, UnitedHealthcare will require prior authorization for new radiology and cardiology procedure codes, including CT brain perfusion analysis, brain MRI quantitative analysis, nuclear cardiology blood flow analysis, and various leadless pacemaker procedures. This affects commercial plans, Community Plans, Exchange Plans, Oxford Plans, and Rocky Mountain Health Plans, but excludes Medicare Advantage and D-SNP plans.
Action Required
By April 1, 2026: Billing team must update system to require prior authorization for specified radiology codes (70472, 70473, 0865T, 0866T, 0742T) and cardiology codes (0795T, 0796T, 0797T, 0801T, 0802T, 0803T, 33274, 0823T, 0825T) for UnitedHealthcare commercial plans, Community Plans, Individual Exchange Plans, and Rocky Mountain Health Plans. Note: Oxford Plans exempt from cardiology prior auth requirement. Update encounter forms to alert providers. Claims without prior authorization will be denied.
Affected Billing Codes
Plan Types
Commercial, Medicaid, Exchange
Specialties
radiology, cardiology, diagnostic-imaging, nuclear-medicine