CommercialPrior AuthMedium impact
New genetic and molecular prior auth program requirements
UnitedHealthcare·Genetics, Oncology, Cardiology +2 more·Prior authorization
Effective date
Oct 1, 2026
We identified it
Jul 2, 2026
Summary
UnitedHealthcare is adding two new AMA genetic and molecular test CPT codes (0648U and 0651U) to their prior authorization requirements, effective October 1, 2026. Billing teams must ensure these codes trigger prior authorization requests before service delivery to avoid claim denials and balance billing restrictions.
Action Required
By September 15, 2026: Billing team must update billing system and encounter forms to require prior authorization for CPT codes 0648U and 0651U for all affected UnitedHealthcare plans. Verify that the system is configured to deny claims and prevent balance billing if prior authorization is not obtained before the date of service. Notify providers and front desk staff that these genetic and molecular tests now require pre-authorization. Access the UnitedHealthcare Provider Portal using One Healthcare ID to submit prior authorization requests. Reference the Prior Authorization and Notification Interactive Guide for training. Failure to obtain prior authorization will result in claim denial with no balance billing option available to members.