CommercialPrior AuthMedium impact
New radiology and cardiology prior authorization codes
UnitedHealthcare·Radiology, Cardiology, Neurology·Network News
Effective date
Apr 1, 2026
We identified it
Jun 13, 2026
Summary
Starting April 1, 2026, UnitedHealthcare will require prior authorization for 5 new radiology codes (including CT cerebral perfusion and brain MRI analysis) and 8 new cardiology codes (primarily dual chamber and leadless pacemaker procedures) across most commercial and Medicaid plans, but not Medicare Advantage plans.
Action Required
Before April 1, 2026: Billing team must update prior authorization system to require pre-approval for the 13 new radiology and cardiology codes listed. Update encounter forms and EMR templates to alert providers when these procedures require prior auth. Note that Oxford Health Plans are exempt from cardiology code prior auth requirements. Emergency room, urgent care, observation unit, and inpatient services are exempt from these requirements.