UnitedHealthcare removes 3 gastroenterology codes in an effort to cut prior authorization by 20%

On Sept. 1, UnitedHealthcare is set to begin a two-phased approach to eliminate prior authorization requirements for several procedure codes, including three gastroenterology-related codes. The code removals will account for almost 20 percent of its overall prior authorization volume.

On Sept. 1 and Nov. 1, codes will be eliminated for UnitedHealthcare Medicare Advantage, UnitedHealthcare commercial, UnitedHealthcare Oxford and UnitedHealthcare Individual Exchange plans. On Nov. 1, codes will be eliminated for the UnitedHealthcare Community Plan as well.

These cuts come as UnitedHealthcare has faced blowback from gastroenterologists for adding prior authorization requirements for patients undergoing surveillance colonoscopies.

Here are the three gastroenterology codes that will be eliminated from prior authorization requirements, according to lists published on UHC’s website:

United commercial plan codes

None

United Oxford plan codes

91040: Esophageal balloon distension study with provocation

91120: Rectal sensation, tone and compliance test

91122: Anorectal manometry

United individual exchange plan codes

None

United Medicare Advantage plan codes

None

United community plan codes

None

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