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Prior Authorization Requirements

 

Medical Benefit Prior Authorization List

UnitedHealthcare Community Plan Prior Authorization MD - Effective 10/1/2017 (PDF 283.87 KB)

 

Prior Authorization Fax Form 

Prior Authorization Fax Request Form

 

Specialty Prior Authorization Program Information

Our specialty prior authorization program helps ensure more consistent application of evidence-based and professional society guidance for select specialist procedures. 

Cardiology
Cardiology Prior Authorization CPT Code Crosswalk (PDF 59.3 KB)
Cardiology Prior Authorization FAQs (PDF 120.58 KB)
Cardiology Evidence Based Guidelines
(PDF 323.25 KB)
Cardiology Prior Authorization Quick Reference Guide (PDF 115.93 KB)
Prior Authorization Online Submission for Cardiology Services 

Chemotherapy
Outpatient Injectable Chemotherapy Prior Authorization Program Overview (PDF 72.44 KB) 

Radiology
Radiology Prior Authorization CPT Code List (PDF 496.38 KB) 
Radiology Prior Authorization Crosswalk Table (PDF 82.42 KB) 
Radiology Prior Authorization FAQs (PDF 73.23 KB)
Radiology Imaging Criteria
(PDF 6.32 MB)
Radiology Prior Authorization Quick Reference Guide (PDF 67.27 KB)
Prior Authorization Online Submission for Radiology Services
 

 

Pharmacy

Some medications require prior authorization. For information on prior authorization requirements for our pharmacy program, including specialty medications covered under the medical benefit, click here.