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UnitedHealthcareCommercial · Prior Auth · Prior authorization updates · Nuclear Medicine, Radiology, CardiologyHigh impact

New radiology and cardiology prior authorization codes

Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
Jan 12, 2026

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.

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What to do

by Apr 1, 2026 · 4 steps
01Billing 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.
02Note: Oxford Plans exempt from cardiology prior auth requirement.
03Update encounter forms to alert providers.
04Claims without prior authorization will be denied.

Codes mentioned

704727047333274

Original notice

New radiology and cardiology prior authorization codes
uhcprovider.com · Always check the source before changing claims.
View original ↗

Related changes

See all UnitedHealthcare changes →
New radiology and cardiology prior authorization codesMediumEffective Apr 1, 2026 · Network NewsNew codes added to outpatient radiology prior authorization programMediumEffective Sep 1, 2026 · Prior authorizationBrowse every UnitedHealthcare change in the policy list

Related policy hubs

UnitedHealthcare policiesNuclear MedicineRadiologyCardiologyCode 70472Code 70473Code 33274

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