Beginning Sept 01, 2026, UnitedHealthcare Community Plans will require prior authorization for certain vertebral body tethering (VBT) and upper and lower extremity prosthetic codes.

This update applies to select community plans in the following states:

The affected codes include new AMA codes and codes that were previously listed as unproven. Since these services fall under categories that already require prior authorization, adding these codes to the review process is part of the standard policy update.

Codes Included in This Update

VBT Codes
0656T, 0657T, 0790T, 22836, 22837, 22838

Upper Extremity Prosthetics Codes
L6034, L6035, L6036, L6038, L6039

Lower Extremity Prosthetics Code
L5657

Coverage may vary by plan and state Medicaid rules. If a code is not covered under a specific plan, it will not be included in that plan’s prior authorization requirements. Because of this, some plans may require prior authorization for only certain codes from the list, not all of them.

Why This Change Is Being Made

VBT codes were previously considered unproven. However, recent clinical evidence now supports these services as proven in certain medical situations. Prior authorization will help UnitedHealthcare review medical necessity and confirm that services meet the required clinical criteria.

The prosthetic codes listed above are newly established AMA codes. They have been added to the related Community Plan medical policies for upper and lower extremity prosthetic devices. Prior authorization will help ensure proper review and consistent use of coverage guidelines.

How Providers Can Submit Prior Authorization

Providers can submit and manage prior authorization requests through the UnitedHealthcare Provider Portal.

To get started:

1. Sign in using your One Healthcare ID
2. Register for a One Healthcare ID if you do not already have one
3. Select Prior Authorizations & Notifications from the left-hand menu
4. Use the Prior Authorization and Notification interactive guide for training support

For questions, providers can connect with UnitedHealthcare through the 24/7 chat option in the Provider Portal.