Starting October 1, UnitedHealthcare will remove prior authorisation requirements across roughly 1,700 medical procedure codes. Healthcare Dive reported that around 120 of the nearly 1,700 total codes relate to Medicare Advantage and dual special needs plans. An analysis by the Center for Medicare Advocacy of UnitedHealthcare's published documentation identified approximately 70 procedure codes on the general Medicare Advantage and D-SNP list, with further codes applicable exclusively to D-SNPs. Enrollees in Medicare Advantage plans without dual-eligible status should verify which billing codes actually apply to their individual benefits. Eliminating the prior authorisation requirement does not obligate UnitedHealthcare to cover the expense. Those enrolled in Original Medicare alongside a Medigap plan are not subject to this requirement. The standard Medicare programme does not typically mandate prior authorisation, meaning the adjustment in question reflects a UnitedHealthcare policy decision rather than any modification to Medicare's own regulations. On September 1, UnitedHealthcare announced to healthcare providers that it would remove preapproval requirements for approximately 1,700 CPT codes, representing around 30% of its prior authorisation demands across commercial, Medicare Advantage, Medicaid, and ACA plan types. This follows a commitment announced earlier in 2025 to reduce prior authorisations by 30% before the close of 2026. The billing codes cover a broad range of medical categories, including cancer treatment, heart care, bone and joint procedures, genetic and laboratory diagnostics, chiropractic services, rehabilitative therapies, home-based care, and durable medical equipment, applied uniformly across all plan categories. Eliminating prior authorization removes one step from the approval process. The measure leaves intact network regulations, referral mandates, retrospective medical-necessity assessments, and patient cost-sharing obligations. Enrollees are still required to verify that their chosen provider falls within the network, that any necessary referral has been submitted, and that the requested service satisfies medical-necessity criteria. Insurance providers retain the ability to reject reimbursement requests after the fact when submitted records fail to justify the treatment performed. According to KFF data, roughly 12% to 18% of routine prior authorisation requests were turned down across health plans in 2025, with Medicare Advantage recording the lower end of that range at 12%. Among major insurers, UnitedHealth recorded a Medicare Advantage claim rejection rate of 17%, placing it at the top of that measure. According to the Center for Medicare Advocacy, denials of skilled nursing facility coverage and early patient discharges continue to rank as the foremost grievance among Medicare Advantage members — a concern left unaddressed by the announcement. Members' out-of-pocket expenses remain unchanged under the revised arrangement. Under Medicare Advantage, each plan determines its own hospital cost-sharing amounts, fees for skilled nursing facilities, and coinsurance rates, within the boundaries established by federal Medicare regulations and the plan's yearly out-of-pocket cap. The Part B premium for enrollees stands at $202.90 throughout 2026. Those who need confirmation before booking an appointment are advised to submit a request for an advance organisational determination. An official coverage ruling can only be reached through a formal organisational determination process. Plans altered during the Annual Election Period, which runs from October 15 to December 7, take effect on January 1 and leave any procedures already booked for autumn unaffected. From January 1 to March 31, beneficiaries have the opportunity to make changes through the Medicare Advantage Open Enrollment Period. Returning to traditional Medicare combined with a supplemental Medigap plan following a stint in Medicare Advantage typically requires applicants to go through medical underwriting, unless they qualify for a guaranteed issue window.
