UnitedHealthcare will eliminate prior authorization requirements for certain spine and elbow surgery CPT codes across Medicaid managed care plans in 16 states and the District of Columbia, effective Oct. 1.
The changes cover many of the same codes across affected markets. They include CPT codes 22100-22102 for partial excision of posterior vertebral components, 22110-22114 for partial excision of vertebral bodies and 22850 and 22855 for removal of spinal instrumentation, according to a Sept. 1 announcement.
UnitedHealthcare is also dropping prior authorization for elbow arthroplasty codes 24360-24363. Laminectomy and intraspinal lesion codes 63170-63200 and 63250-63286 are included in most affected markets.
Kentucky’s list is broader, adding codes for chronic rotator cuff repair, radial head arthroplasty, wrist and distal radius arthroplasties, and several arthroscopy procedures.
The changes apply in Colorado, Florida, Hawaii, Idaho, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Michigan, North Carolina, Pennsylvania, Rhode Island, Texas, Virginia, Wisconsin and the District of Columbia.
The move follows UnitedHealthcare’s May 5 pledge to cut 30% of remaining prior authorization requirements by the end of 2026.
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