UnitedHealthcare prior authorization, page 10

Requirements

Commercial, Medicare Advantage, Community Plan, and Exchange each need their own source. This page does not use one requirement sentence for all four. The long descriptor is blank because no AMA-licensed CPT file was available to copy.

Commercial

Prior authorization codes

Prior authorization codes
Code	Description	Source
58291	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
58661	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
58720	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
58940	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
64856	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
64892	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
64896	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81162	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81163	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81164	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81228	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81229	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81277	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81349	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81400	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81401	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81402	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81403	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81404	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81405	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81406	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81407	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81408	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81410	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81411	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81412	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81413	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81414	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81415	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81416	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81417	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81425	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81426	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81427	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81431	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81432	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81435	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81437	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81439	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81440	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81441	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81443	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81445	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81448	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81449	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81450	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81451	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81455	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81457	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy
81458	Genetic and molecular testing to include BRCA gene testing	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 12 Original policy

UnitedHealthcare commercial advance notification and prior authorization requirements

Medicare Advantage

No reviewed Medicare Advantage code row is on this page. Medicare Advantage does not inherit the commercial row above.

Community Plan

No reviewed Community Plan code row is on this page. Community Plan does not inherit the commercial row above.

Exchange

No reviewed Exchange code row is on this page. Exchange does not inherit the commercial row above.

Forms

UnitedHealthcare prior authorization and advance notification plan requirements

Updates

Commercial removal supplement
Code	Long descriptor	Code system	Plan scope	Outcome	Source
0006M		CPT	Commercial plans covered by the October removal supplement	RemovedNo under this removal notice, effective October 1, 2026Removal does not establish coverage or code billability; check member-specific exceptions.	p. 1, Global CPT codes; introduction establishes removal of PA.