CommercialPrior AuthMedium impact
Updated documentation guidelines for cardiac ablation procedures
UnitedHealthcare·Cardiology·Prior authorization updates
Effective date
Jan 1, 2026
We identified it
Jan 12, 2026
Summary
Beginning January 1, 2026, UnitedHealthcare will require additional medical documentation for prior authorization requests for cardiac ablation procedures (CPT codes 93653 and 93656). The new requirements include ECG/rhythm documentation, recent physical exams, lab results, imaging studies, and failed treatment history.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows for cardiac ablation procedures CPT 93653 and 93656 to include comprehensive documentation package: ECG/Holter/rhythm strips, physical exam within 3 months, electrolytes within 6 months, TSH within 12 months, stress test within 12 months, LVEF by echo, and detailed treatment history. Notify cardiology providers of new documentation requirements and update EMR templates to capture required elements. Incomplete documentation will likely result in prior authorization denials.