MedicaidPrior AuthMedium impact
Medicaid: Prior authorization required for certain transcatheter heart valve procedures
UnitedHealthcare·AZ, CO, FL, HI, KS, KY, MD, NM, NY, OH, PA, RI, TN · Cardiology, Cardiothoracic Surgery·State news
Effective date
Jul 1, 2026
We identified it
Jun 3, 2026
Summary
Starting July 1, 2026, UnitedHealthcare Community Plans (Medicaid) will require prior authorization for transcatheter heart valve procedures using codes 0569T and 0570T. These codes were previously classified as unproven but are now considered proven in certain clinical circumstances requiring medical necessity review.
Action Required
By July 1, 2026: Billing team must update prior authorization requirements in billing system for CPT codes 0569T and 0570T for UnitedHealthcare Community Plan (Medicaid) patients. Update encounter forms and provider workflows to obtain prior authorization before performing transcatheter heart valve procedures. Review UnitedHealthcare Community Plan Medical Policy for specific criteria. Claims submitted without prior authorization will be denied.