UnitedHealthcare will stop requiring prior authorization for more than 2,000 pediatric care codes for members under 18 starting Dec. 1.
The payer published the full list of CPT codes Nov. 2. The codes span common services, diagnostic imaging, sleep studies, cancer treatment and orthopedic care, according to a UnitedHealthcare news release. Examples are ear tube and tonsil procedures, MRI and CT scans, joint and cardiac procedures, and some oncology and chemotherapy services.
UnitedHealthcare said it chose services widely considered safe and effective in the medical community. The selection cuts pediatric prior authorization volume by nearly two-thirds and fulfills a commitment the insurer made in May.
Some complex services will still require prior authorization. These include certain injectable medications, genetic tests, surgical procedures and services that must be managed under state regulations. Some pediatric services will also still require advance notification.
The changes apply to UnitedHealthcare commercial plans, Individual Exchange plans and UnitedHealthcare Community Plans, where permissible by state law.
The pediatric reductions are part of UnitedHealthcare’s broader commitment, announced May 5, to cut its total prior authorization volume by about 30% in 2026. The company has steadily reduced prior auth requirements in recent years, including eliminating 20% in 2023 and launching a gold carding program in 2024 that exempts some providers for certain services.
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