UnitedHealthcare has released the specific procedure codes it will exempt from prior authorization as part of the insurer’s previous pledge to reduce requirements by 30% before the end of 2026.
The code lists cover 1,700 procedure codes for a range of services across commercial, Medicare Advantage, individual exchange, and Medicaid plans. Effective Oct. 1, providers will no longer need to seek the insurer’s approval for many outpatient procedures, including lesion excisions, fracture treatments, joint injections, arthroscopies, colonoscopies, endoscopies, biopsies, hernia repairs and soft tissue tumor removals. Genetic and molecular testing codes also make up a large portion of the lists.
UnitedHealthcare CEO Tim Noel said in May that prior authorization “should only be used when it truly protects patients and improves care.” At the time, the insurer said it requires prior approval for just 2% of its medical services, with roughly 92% of submitted requests approved in less than 24 hours on average. The 30% reduction builds on an earlier 20% cut to commercial prior authorization requirements in 2023.
In June 2025, major insurers pledged to simplify and reduce prior auth requirements affecting plans covering 257 million Americans. As part of that, AHIP and the BCBS Association reported an 11% industrywide reduction in April. An AMA survey of 1,000 physicians published in May found that 95% reported prior auth can cause care delays, and physicians and their staff still spend an average of 13 hours per week on the process.
In August, a KFF analysis of first-ever publicly reported prior auth data found that insurers denied at least 1 in 8 standard requests across Medicare Advantage, Medicaid managed care and ACA marketplace plans in 2025, with denial rates ranging from 12% in MA to 18% in the marketplace. When denials were appealed, two-thirds were overturned in MA and nearly half in Medicaid, though KFF noted that appeals remain rare overall.
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