MedicaidPrior AuthMedium impact
Medicaid: View new genetic and molecular code updates
UnitedHealthcare·FL, HI, KS, KY, MD, MI, MO, NE, NJ, NM, NY, PA, RI, TN, TX, VA, WA, WI · Oncology, OB-GYN, Cardiology +1 more·State news
Effective date
Jul 1, 2026
We identified it
Jun 3, 2026
Summary
UnitedHealthcare is updating prior authorization and advance notification requirements for genetic and molecular procedure codes effective July 1, 2026, to comply with American Medical Association code changes. This affects multiple UnitedHealthcare Community Plans across 18 states.
Action Required
By July 1, 2026: Billing team must review the state-specific genetic and molecular code lists to identify which codes will require new prior authorization or advance notification. Update billing system workflows to require prior auth for affected genetic testing codes. Train staff on submitting prior authorizations through the UnitedHealthcare Provider Portal using One Healthcare ID.