MedicaidPrior AuthMedium impact
Medicaid: New prior authorization codes for VBT and extremity prosthetics services
UnitedHealthcare·AZ, CO, FL, HI, IN, KS, KY, MD, MI, MO, NE, NJ, NM, NY, OH, PA, RI, TN, TX, VA, WA · Orthopedics, Neurosurgery·State news
Effective date
Sep 1, 2026
We identified it
Jun 3, 2026
Summary
Starting September 1, 2026, UnitedHealthcare will require prior authorization for vertebral body tethering (VBT) codes and upper/lower extremity prosthetics codes across multiple state Medicaid plans. The VBT codes were previously classified as unproven but are now considered proven in certain clinical circumstances, while the prosthetics codes are newly established AMA codes.
Action Required
By September 1, 2026: Billing team must update prior authorization requirements in billing software for VBT codes (0656T, 0657T, 0790T, 22836, 22837, 22838) and extremity prosthetics codes (L6034, L6035, L6036, L6038, L6039, L5657) for UnitedHealthcare Medicaid patients in affected states. Update encounter forms and EMR templates to remind providers to obtain prior auth before performing these services. Claims will be denied without proper prior authorization.