UnitedHealth Group’s United Healthcare health insurance business said 1,700 diagnostic codes tied to treatments and procedures will soon no longer require prior approval.
The disclosure Tuesday by the nation’s largest health insurance company comes at a time industry business practices are under fire from patients, physicians, lawmakers and regulators at both the state and federal level to reduce or get rid of prior authorization, the process of insurers reviewing hospital admissions and medications.
A recent analysis by KFF, for example, revealed that insurers denied between 12% and 18% of prior authorization requests last year for Americans enrolled in either privatized Medicare Advantage coverage for older adults, Medicaid coverage for poor Americans or individual coverage under the Affordable Care Act, also known as Obamacare.
But UnitedHealthcare said it’s holding to its commitment announced earlier this year to reduce prior authorization volume by 30% by the end of 2026 by making public on Tuesday a list of the hundreds of procedures, treatments, diagnostic tests and other healthcare services no longer requiring prior approval.
The current procedural terminology (CPT) codes are five digits used by healthcare professionals to describe medical, surgical, diagnostic and other healthcare services. The CPT codes linked to procedures no longer needing approval by UnitedHealthcare are linked here.
UnitedHealthcare said the reduction, which will be implemented October 1, spans a “broad mix of services across multiple clinical specialties, including cardiology; genetic and laboratory testing; durable medical equipment; chiropractic care; physical, occupational and speech therapy; orthopedic and musculoskeletal procedures; home health services; and site-of-service reviews.”
UnitedHealthcare, which provides health insurance coverage for more than 48 million Americans, said the CPT codes no longer requiring prior authorization are across its health plans including commercial health insurance products as well as government subsidized coverage including Medicare Advantage for older adults, Medicaid for low income Americans, and individual insurance under the Affordable Care Act, also known as Obamacare.
“Earlier this year, we shared steps we’re taking to make healthcare less confusing, more affordable and easier for people to use,” UnitedHealthcare said in a statement accompanying the list of codes. “These latest actions are part of that work. They are designed to reduce unnecessary paperwork, make information easier to understand and help patients and care providers spend more time focused on care. It’s all part of our ongoing effort to build a healthcare experience that works better for everyone.”
The specific codes disclosed by UnitedHealthcare are among many reforms health insurers are making to their prior authorization and in some cases have eliminated it altogether. And a year ago, the biggest names in health insurance, including Centene, Cigna, CVS Health’s Aetna, UnitedHealth Group’s UnitedHealthcare and Humana were among more than 50 health insurers to commit to reducing prior authorization along with simplifying business practices in general.