UnitedHealthcare prior authorization, page 17

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
CodeDescriptionSource
J7189Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7190Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7192Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7193Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7194Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7195Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7198Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7199Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7200Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7201Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7202Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7203Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7204Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7205Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7207Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7208Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7209Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7210Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7211Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7212Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7213Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7214Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J0596Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J0597Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J0598Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1290Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J7171Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J9038Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
90283Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
90284Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1459Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1551Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1555Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1556Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1557Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1558Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1559Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1561Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1566Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1568Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1569Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1572Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1575Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J9381Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J0491Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J0638Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J0490Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1823Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J9210Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J9301Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 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
CodeLong descriptorCode systemPlan scopeOutcomeSource
0006MCPTCommercial plans covered by the October removal supplementRemovedNo 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.

Sources

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.