UnitedHealthcare (UHC) has announced a 20% reduction in its prior authorization requirements for its members and member physicians, effective from September 1. This move is part of a two-phased approach, with the first phase initiated on September 1, eliminating codes for various UHC plans, including Medicare Advantage, commercial, Oxford, and Individual Exchange plan members. While UHC states that this change aims to simplify the healthcare experience for members and healthcare professionals, some physicians believe that the eliminated codes are among the least used. Dr. Adam Bruggeman, an orthopedic surgeon at Texas Spine Care Center, mentioned that many of the removed codes haven’t been billed by him in the last decade. The second phase of cuts, targeting members with UnitedHealthcare Community Plans, began on November 1.
The removed codes span specialties like cardiology, genetic testing, hysterectomy, spine surgery, radiology, arthroplasty, vein procedures, and site of service sterilization. With the shift of cardiology, spine, and arthroplasty procedures to the ASC setting, ASCs specializing in these areas might experience a reduction in some prior authorization requirements.