Streamline prior authorizations with our crosswalk

Use our Prior Authorization Crosswalk to make it easier to determine next steps when you need to provide a service that is different from an approved service. Our Prior Authorization Crosswalk can help you bill for an appropriate code and decrease claim rework.

Crosswalk update April 1

Starting April 1, 2024, the Prior Authorization Crosswalk will feature new updates to:

• Include a more comprehensive list of CPT® and HCPCS codes
• Apply to more UnitedHealthcare plans, including:
  • Commercial
  • Individual Exchange
  • Medicare Advantage 
    
  • UnitedHealthcare Community Plan
• No longer have a Code Category column

Please note, until the update on April 1, 2024, the crosswalk will continue to only apply to UnitedHealthcare commercial plans and will continue to show the Code Category column.

How to use the Prior Authorization Crosswalk table

Use the crosswalk when you have an approved prior authorization for treating a UnitedHealthcare member and you need to provide a different service.

If you have prior authorization for a CPT or HCPCS code listed in the crosswalk’s left column, and you need to perform a: 

• Service not listed in the right column, your original prior authorization cannot be used
• Service listed in the right column and the Product Applicability column contains:
  • An X for your members product, your original prior authorization can be used
  • An N/A for your members product, the Prior Authorization Crosswalk does not apply to that member’s product

Out-of-scope services include:

• Genetic and molecular testing, including breast cancer gene (BRCA) codes
• Injectable medications, including hemophilia
• Oncology/chemotherapy medications

Questions?

Chat with us 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal. You can also visit our Prior Authorization and Notification web page for more information.

CPT® is a registered trademark of the American Medical Association.

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