Heart Valve Procedures Under Medicaid Now Require Prior Authorization
Heart Valve Procedures Under Medicaid Now Require Prior Authorization
Starting July 01, 2026, UnitedHealthcare will introduce prior authorization requirements for two transcatheter heart valve procedure codes under select UnitedHealthcare Community Plans:
- 0569T
- 0570T
Why this update is being made
These procedure codes were previously categorized as unproven. Following recent changes in clinical evidence, the services are now recognized as proven in specific clinical situations. Because of this update, requests for these services will now go through a medical necessity review to confirm whether coverage criteria are satisfied. More information can be found in the UnitedHealthcare Community Plan Medical Policy.
Affected plans
This change applies to UnitedHealthcare Community Plans in the following states:
- Arizona
- Colorado
- Florida
- Hawaii
- Kansas
- Kentucky
- Maryland
- New Mexico
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Tennessee
How to submit and manage a prior authorization
Providers can submit and manage requests through the UnitedHealthcare Provider Portal by following these steps:
- Sign in with your One Healthcare ID
- If you do not already have an ID, complete the registration process
- From the left-hand menu, select Prior Authorizations & Notifications
For additional help, providers can use the 24/7 chat support available through the UnitedHealthcare Provider Portal.
