UnitedHealthcare prior authorization, page 18

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
J9312Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5115Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5119Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5123Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J0129Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J0717Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1602Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1628Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1745Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J1747Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J2267Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J2327Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J3245Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J3247Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J3262Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J3357Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J3358Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
J3380Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5098Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5099Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5100Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5103Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5104Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5121Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5133Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5135Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5137Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5138Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5156Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q5164Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q9996Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q9997Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 15 Original policy
Q9998Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
Q9999Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J0589Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J1072Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J0179Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J1552Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J1554Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J1576Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J2508Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J7320Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J7321Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J7322Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J7324Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J7325Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J7326Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J7327Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J7329Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 Original policy
J7331Injectable medications (cont.)Prior authorization requirements for UnitedHealthcare commercial plans, Pg 16 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.