UnitedHealthcare to Expand Prior Authorization Requirements for Radiology and Cardiology Codes
UnitedHealthcare to Expand Prior Authorization Requirements for Radiology and Cardiology Codes
UnitedHealthcare has announced that it will expand its outpatient radiology and cardiology prior authorization programs effective April 1, 2026, in response to recent coding updates issued by the American Medical Association (AMA).
Under the update, additional advanced imaging and cardiology procedure codes will require prior authorization across multiple plans, including UnitedHealthcare commercial plans, UnitedHealthcare Community Plans, UnitedHealthcare Individual Exchange Plans, UnitedHealthcare Oxford Plans, and Rocky Mountain Health Plan. The changes do not apply to UnitedHealthcare Medicare Advantage or Dual Special Needs Plan (D-SNP) members.
Radiology code additions
| CPT® code | Procedure |
| 70472 | Computed tomographic (CT) cerebral perfusion analysis with concurrent CT or CT angiography of the same anatomy |
| 70473 | CT cerebral perfusion analysis without concurrent CT or CT angiography of the same anatomy |
| 0865T | Quantitative analysis of a brain magnetic resonance image (MRI) |
| 0866T | Quantitative analysis of a brain MRI |
| 0742T | Nuclear cardiology – Absolute quantification of myocardial blood flow |
Cardiology code additions
| CPT code | Procedure |
| 0795T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 0796T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 0797T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 0801T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 0802T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 0803T | Electrophysiology implant device – dual chamber leadless pacemaker |
| 33274 | Electrophysiology implant device – right ventricular leadless pacemaker |
| 0823T | Electrophysiology implant device – transcatheter insertion of permanent single-chamber leadless pacemaker |
| 0825T | Electrophysiology implant device – transcatheter insertion of permanent single-chamber leadless pacemaker |
*Oxford Health Plans will not require prior authorization for these cardiology CPT codes.
Services Exempt From Review
The new requirements will not apply to advanced imaging or cardiology services delivered in:
- Emergency rooms
- Urgent care centers
- Observation units
- Inpatient settings
Prior Authorization Submission
Providers must submit and manage prior authorizations through the UnitedHealthcare Provider Portal using a One Healthcare ID. After signing in, requests can be initiated by navigating to Prior Authorizations & Notifications from the main menu.
UnitedHealthcare has advised providers to review the updated radiology and cardiology prior authorization resources and the Administrative Guide to ensure compliance ahead of the April 2026 implementation date. Providers may also access 24/7 support through live chat within the Provider Portal.
Resources
