UnitedHealthcare to cut 3 orthopedic surgery codes from prior authorization

On Sept. 1, UnitedHealthcare is set to begin a two-phased approach to eliminate prior authorization requirements for several procedure codes, including three orthopedic surgery-related codes. Overall, the code removals will account for almost 20 percent of its overall prior authorization volume.

On Sept. 1 and Nov. 1, codes will be eliminated for UnitedHealthcare Medicare Advantage, UnitedHealthcare commercial, UnitedHealthcare Oxford and UnitedHealthcare Individual Exchange plans. On Nov. 1, codes will be eliminated for the UnitedHealthcare Community Plan as well.

Here are the three orthopedic surgery codes that will be eliminated from prior authorization requirements for UHC’s Oxford plan holders, according to lists published on UHC’s website:

25320: Capsulorrhaphy, reconstruction of the wrist, any method

26260: Radical resection ostectomy for tumor, proximal or middle phalanx of finger

27350: Patellectomy/hemipatellectomy

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