Here's how upcoming prior authorization changes will impact orthopedics


On Sept. 1, UnitedHealthcare will begin its two-phased approach to eliminating prior authorization requirements. 

The goal is to eliminate prior authorizations planwide by 20 percent. On Sept. 1, codes will be eliminated for UnitedHealthcare Medicare Advantage, UnitedHealthcare commercial, UnitedHealthcare Oxford and UnitedHealthcare Individual Exchange plans. 

Prior authorization is often cited as the largest burden to musculoskeletal care by spine and orthopedic surgeons alike. 

"I would remove prior authorization. I have worked in systems where it does not exist and the delivery of care is more efficient, and the percentage of GDP spent on healthcare is less. This would streamline care, reduce overhead for practices and presumably payers, and improve delivery of care," Lali Sekhon, MD, a neurosurgeon at Reno (Nev.) Orthopedic Center, told Becker's when asked what he would change about spine surgery.

"Prior authorization is a waste of everyone's time," Roy Sanders, MD, president of the Florida Orthopaedic Institute in Tampa, echoed. 

UnitedHealthcare is taking small steps towards eliminating prior authorization in musculoskeletal care by removing four spinal surgery codes from prior authorization requirements. 

Additionally, UHC is removing several orthotics/prosthetics codes from its Medicare Advantage, individual exchange and Oxford plans. 



Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Podcast

Featured Whitepapers