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Medicaid: New policy for select embolization procedures
Act
by Dec 1, 2026
Effective date
Dec 1, 2026
Identified
Nov 2, 2026
Summary
Effective December 1, 2026, UnitedHealthcare Community Plans in Kansas, Kentucky, and New Jersey will implement a new vascular embolization policy and add prior authorization requirements for CPT code 37242. Services previously evaluated under multiple existing policies will now be consolidated under unified clinical criteria for therapeutic vascular embolization procedures.
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What to do
by Dec 1, 2026 · 4 steps
01Billing team must begin obtaining prior authorization for CPT code 37242 for UnitedHealthcare Community Plans members in Kansas, Kentucky, and New Jersey before claims are submitted.
02Update the prior authorization tracking system to flag CPT 37242 for these three states and plans.
03Instruct providers and front desk staff that CPT 37242 now requires prior authorization in these states under the new vascular embolization policy; claims submitted without prior authorization will be denied.
04Ensure medical records are prepared and available to support prior authorization requests, as the payer will request records to verify clinical criteria have been met.
Codes mentioned
37242
Original notice
Medicaid: New policy for select embolization procedures
uhcprovider.com · Always check the source before changing claims.
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