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Preauthorization for Procedures

The procedures for which UnitedHealthcare requires preauthorization include the list below (except for TennCare). If you have questions about whether a procedure requires preauthorization, contact a UnitedHealthcare Customer Service Representative. Other items requiring preauthorization are listed under DMEDrugs, and Other Services.

Note: The benefits on the pages below DO NOT apply to TennCare. Please call 1-800-690-1606 for TennCare preauthorization information.

Procedures that require Preauthorization
(Last Updated July 1, 2013):

  • Ablative Treatment for Spinal Pain
  • Abnormal Uterine Bleeding and Uterine Fibroids
  • Artificial Total Disc Replacement for the Spine
  • Autologous Chondrocyte Transplantation in the Knee
  • Bariatric Surgery
  • Blepharoplasty and Brow Ptosis Repair
  • Bone or Soft Tissue Healing and Fusion Enhancement Products (e.g., BMP)
  • Breast Reduction Surgery
  • Breast Repair/Reconstruction (Not Following Mastectomy)
  • Chelation Therapy for Non-Overload Conditions
  • Clinical Trials
  • Cochlear Implants
  • Cognitive Rehabilitation
  • Core Decompression for Avascular Necrosis
  • Cosmetic and Reconstructive Procedures
  • Diagnostic Catheterizations And Electrophysiology Implant Procedures/Outpatient Echo/Stress Echocardiograms (effective July 1,2013)
  • Deep Brain Stimulation
  • Elbow Replacement Surgery (Arthroplasty)
  • Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation
  • Facet Injections for Spinal Pain
  • Gastrointestinal Motility Disorders, Diagnosis and Treatment (Gastric electrical stimulation and SmartPill)
  • Genetic Testing for Hereditary Breast and/or Ovarian Cancer Syndrome (HBOC)
  • Glaucoma Surgical Treatments (effective 1/1/2013)
  • Gynecomastia Treatment
  • Hip Replacement Surgery (Arthroplasty)
  • Hip Resurfacing Arthroplasty
  • Hyperbaric Oxygen Therapy
  • Implantable Beta-Emitting Microspheres for Treatment of Malignant Tumors
  • Implantable Hearing Devices and Bone-Anchored Hearing Aids
  • In Utero Fetal Surgery
  • Inpatient Pediatric Feeding Programs
  • Intensity-Modulated Radiation Therapy
  • Intrastromal Corneal Ring Segments
  • Knee Replacement Surgery (Arthroplasty)
  • Laser Treatment for Cutaneous Vascular Lesions and Pilonidal Disease
  • Macular Degeneration and Ocular Tumor Treatment
  • Magnetoencephalography and Magnetic Source Imaging for Specific Neurological Applications
  • Mandibular Disorders (Treatment for TMJ)
  • Meniscus Implant and Allograft
  • Non-Surgical Treatment of Obstructive Sleep Apnea (effective 5/1/13)
  • Occipital Neuralgia and Cervicogenic, Cluster and Migraine Headaches
  • Orthognathic and Jaw Surgery
  • Oscillatory Positive Expiratory Pressure Devices
  • Osteochondral Grafting of Knee
  • Otoplasty
  • Outpatient Cardiovascular Telemetry
  • Panniculectomy and Body Contouring Procedures
  • Pectus Deformity Repair
  • Pneumatic Compression Devices
  • Polysomnography & Portable Monitoring for Sleep Related Breathing Disorders
  • Preimplantation Genetic Diagnosis
  • Procedures for Ablation of Varicose Veins
  • Propranolol Treatment for Infantil Hemangiomas: Inpatient
  • Proton Beam Radiation Therapy
  • Rhinoplasty, Septoplasty, and Repair of Vestibular Stenosis
  • Shoulder Replacement Surgery (Arthroplasty)
  • Sodium Hyaluronate (Medical Policy- preauthorization required through Pharmacy Care Management)
  • Surgical Treatment for Spine Pain
  • Surgical Treatment of Obstructive Sleep Apnea
  • Total Ankle Replacement Surgery (Arthroplasty)
  • Total Artificial Heart
  • Vagus Nerve Stimulation
  • Ventricular Assist Device (VAD)/Mechanical Circulatory Support Device Implantations
  • Wireless Capsule Endoscopy

UnitedHealthcare reserves the right to change this list at any time without notice. UnitedHealthcare does not guarantee that this list is complete or current. Contact a UnitedHealthcare Customer Service Representative to discuss your health plan's requirements.

Medical providers are independent contractors, not employees or agents of the health plan. Our members and their medical providers, not the health plan, decide what medical care members receive and how they receive it. UnitedHealthcare only determines what medical care will be paid for under members' benefit plan. UnitedHealthcare does not provide medical treatment or advice. We encourage you to talk to your doctor about any health concerns you may have.

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