Washington E-Newsletter

Cigna and UnitedHealthcare Reduce Use of Prior Authorization

Following sustained advocacy efforts by neurosurgery and others, UnitedHealthcare recently announced that beginning on Sept. 1, it would start a two-phased approach to eliminate prior authorization for 20% of covered services, including disc arthroplasty (CPT codes 22864 and 22865). The company also said it plans to roll out a “gold card” program next year, eliminating most prior authorization requirements for physicians with high approval rates.

On Aug. 24, Cigna followed suit and announced it would also take steps to reduce the number of procedures subject to prior authorization. Neurosurgical codes no longer requiring prior authorization include CPT code 37217, Transcatheter intravascular stent placement intrathoracic carotid or innominate artery via open ipsilateral cervical carotid artery exposure, and CPT code 61885, Insertion/replacement cranial neurostimulator pulse generator.