UnitedHealthcare Cuts Prior Auth for 2,000+ Pediatric Codes
UnitedHealthcare will eliminate prior authorization requirements for more than 2,000 pediatric care codes for members under 18, effective Dec. 1, with the full CPT code list published Nov. 2. The codes cover common services, diagnostic imaging, sleep studies, cancer treatment and orthopedic care, including ear tube and tonsil procedures, MRI/CT scans, and some oncology services, cutting pediatric prior auth volume by nearly two-thirds. Some complex services, including certain injectables, genetic tests, surgical procedures and state-regulated services, will still require prior authorization or advance notification. The change applies to commercial, Individual Exchange, and UnitedHealthcare Community Plans (Medicaid managed care) where state law permits, fulfilling a May 2026 commitment to cut total prior auth volume by about 30% in 2026.