Effective December 1, health insurer UnitedHealthcare will stop requiring prior authorization for more than 2,000 pediatric care codes for members under age 18, including for CT, MRI, PET, and nuclear cardiology studies.
Imaging codes on the insurer’s commercial-plan list include the following:
CT and MRI of the head, spine, chest, abdomen, pelvis, and extremities, plus CT and MR angiography
Cardiac MRI and cardiac CT, including coronary CT angiography and CT-derived fractional flow reserve (FFR)
Breast MRI and breast CT
Oncologic and brain PET, PET/CT, and myocardial perfusion PET and SPECT
Radiation therapy delivery codes, including proton therapy and stereotactic radiosurgery, are also on the list. UnitedHealthcare said the change follows through on a May commitment to eliminate nearly two-thirds of pediatric prior authorization requirements.
The policy applies to its commercial, Individual Exchange, and Community Plans where state law permits. Certain injectable medications, genetic tests, surgical procedures, and state-regulated services will still need prior authorization, according to the company.
