New AMA codes that require prior authorization

Beginning April 1, 2026, we’ll require prior authorization for some new procedure codes that the American Medical Association has created for genetic and molecular testing. These codes are consistent with genetic and molecular tests that currently require prior authorization.

Affected plans

This affects the following participating UnitedHealthcare commercial plans and UnitedHealthcare Individual Exchange plans in all states:

• Neighborhood Health Partnership, Inc.
• UnitedHealthcare Level Funded
• UnitedHealthcare Oxford 
• UnitedHealthcare of the River Valley
• UnitedHealthcare exchange plans

What’s changing

In addition to the current in-scope procedure codes, we’ll add the following code to the existing prior authorization/advance notification requirements:

• 0605U

How to submit a request

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
  • If you don’t have a One Healthcare ID, register now
• From the left-hand tabs, select Prior Authorizations & Notifications
• In the Prior Authorization and Notification tool, scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
• Enter the required information and submit

If we don’t receive a prior authorization request before the date of service, we’ll deny the claim and you won’t be able to balance bill members.

Resources

• Genetic and molecular testing prior authorization 
• Prior Authorization and Notification: Interactive User Guide 
• UnitedHealthcare® commercial and Individual Exchange Medical Policies

Questions? We’re here to help.

If you have questions, please visit our Prior Authorization and Notification resource.