UnitedHealthcare's Prior Authorization Cut Falls Short

UnitedHealthcare announced it will eliminate prior authorization requirements for roughly 1,700 medical procedure codes starting next month. The company claims this move will cut its prior authorization requirements by 30%, reducing administrative work for doctors and removing barriers that can delay care for patients.

However, closer examination of the announcement reveals a more nuanced story. By the company's own accounting, prior authorization currently applies to only about 2% of medical services it covers. This means that eliminating these requirements would actually affect less than one-tenth of a percentage point of all medical services.

A review of UnitedHealthcare's published lists of codes found apparent duplication across different plans and state-specific lists. The actual number of unique CPT and HCPCS codes affected could be closer to 800-1,000, rather than the initially stated 1,700.

The changes are not as comprehensive as they seem. While some procedures like spinal surgeries and EEG monitoring will no longer require prior authorization, others such as specialty and injectable drugs, GLP-1 medications, and many cardiac device implants remain subject to these requirements.

Additionally, UnitedHealthcare is adding new prior authorization requirements for certain genetic and molecular testing codes, effective the same day. This move has sparked criticism that the company's announcement was a PR stunt to generate favorable headlines.