UnitedHealthcare to Drop Prior Authorization for More Than 2,000 Pediatric Services Starting December 1
UnitedHealthcare announced on November 2 that, beginning December 1, children covered by its plans will no longer need prior authorization for more than 2,000 pediatric care services. The company published the full list of more than 2,000 distinct CPT codes that will no longer require prior authorization for patients under age 18, giving care providers the information to prepare for the changes.
The services span common care, diagnostic imaging, sleep studies, cancer treatment and orthopedic care. Examples include ear tube and tonsil procedures, sleep studies, MRI and CT scans, joint procedures, cardiac procedures, and some oncology and chemotherapy services. UnitedHealthcare said it fast-tracked services widely considered in the medical community to be safe and effective, resulting in a nearly two-thirds reduction in pediatric prior authorization volume, so clinicians, families and caregivers can spend more time focused on patients.
"Every child deserves a health care experience centered on their needs," said Tim Noel, CEO of UnitedHealthcare. "These changes will help make that experience simpler for children, their families and the physicians who care for them."
Select complex services will still require prior authorization, such as certain injectable medications, genetic tests, some surgical procedures, and services required to be managed by state regulations, and some pediatric services will continue to require advance notification. The changes apply to UnitedHealthcare commercial plans, UnitedHealthcare Individual Exchange Plans and UnitedHealthcare Community Plans, where permissible by state law, and are not limited to care delivered at specific pediatric facilities.
The publication follows the company's May commitment to eliminate nearly two-thirds of pediatric prior authorization requirements by the end of the year. UnitedHealthcare said the step builds on broader efforts to simplify prior authorization, including reducing total prior authorization volume by approximately 30 percent and expanding its Gold Card program for provider groups that consistently adhere to evidence-based care guidelines.
(Source: UnitedHealthcare press release via Business Wire)
Source: GSM · USA (original Chinese edition)
Photo: 图：儿科医生为女童看诊讲解（资料图）。Nenad Stojković 摄，CC BY 2.0，经 Wikimedia Commons。 / Photo: A pediatrician consulting with a young patient (file photo). Photo by Nenad Stojković, CC BY 2.0, via Wikimedia Commons.
