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New AMA issued genetic and molecular prior auth requirements
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 1, 2026
Summary
Effective January 1, 2027, UnitedHealthcare will require prior authorization for five new AMA-issued genetic and molecular testing CPT codes (0672U, 0673U, 0674U, 0675U, 0686U) on commercial and Exchange plans. These codes align with existing genetic testing prior authorization requirements. Claims submitted without prior authorization will be denied and cannot be balance-billed to members.
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What to do
by Dec 31, 2026 · 3 steps
01Billing team must update billing system and prior authorization workflows to require prior authorization for CPT codes 0672U, 0673U, 0674U, 0675U, and 0686U for all affected UnitedHealthcare plans (Neighborhood Health Partnership, Inc., Level Funded, Oxford, River Valley, and Exchange plans).
02Providers must submit prior authorization requests before the date of service through the UnitedHealthcare Provider Portal.
03Update encounter templates and clinical decision support to flag these codes for prior auth review.
If missed: Failure to obtain prior authorization will result in claim denials with no balance billing allowed to members.
Original notice
New AMA issued genetic and molecular prior auth requirements
uhcprovider.com · Always check the source before changing claims.
Related changes
See all UnitedHealthcare changes →New genetic and molecular prior auth program requirementsMediumEffective Oct 1, 2026 · Prior authorizationNew genetic and molecular codes announced for prior authorizationMediumEffective Apr 1, 2026 · Network NewsNew genetic and molecular codes required for prior authorizationMediumEffective Jul 1, 2026 · Prior authorizationNew genetic and molecular codes announced for prior authorizationMediumEffective Apr 1, 2026 · Prior authorization updatesBrowse every UnitedHealthcare change in the policy list