UnitedHealthcare prior authorization, page 30

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
63688	Spinal cord stimulators	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
64553	Spinal cord stimulators	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
L8679	Spinal cord stimulators	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
L8680	Spinal cord stimulators	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
L8682	Spinal cord stimulators	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
L8683	Spinal cord stimulators	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
L8685	Spinal cord stimulators	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
L8686	Spinal cord stimulators	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
L8687	Spinal cord stimulators	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
L8688	Spinal cord stimulators	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
63663	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
20930	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
20931	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
20939	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22206	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22207	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22208	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22210	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22212	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22214	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22216	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22220	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22222	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22224	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22226	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22510	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22511	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22512	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22515	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22532	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22533	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22534	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22548	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22551	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22552	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22554	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22556	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22558	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22585	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22586	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22590	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22595	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22600	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22610	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22612	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22614	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22630	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22632	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22633	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 Original policy
22634	Spinal surgery	Prior authorization requirements for UnitedHealthcare commercial plans, Pg 29 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.