HEALTH POLICY NEWS: United Healthcare Nixing Prior Authorization Requirement for SPECT MPI

Last week, United Healthcare (UHC) announced a plan to reduce prior authorization requirements for many procedure codes, including for SPECT MPI (codes 78451-78454), in Medicare Advantage plans. The new policy will go into effect Nov. 1, 2023. 

The codes whose prior authorization requirements are being eliminated account for nearly 20 percent of UHC's overall prior authorization volume, according to the company's announcement. The change is part of an "effort to simplify the health care experience for our members and network health care professionals," the policy states.  

ASNC has strongly advocated for streamlining prior authorization requirements. Recently, ASNC delivered a robust response to CMS-proposed policy change intended to streamline and improve the transparency of prior authorization processes across health plans. Last year, ASNC also supported the Improving Seniors' Timely Access to Care Act, which would have streamlined prior authorization requirements under Medicare Advantage plans. 

“ASNC commends United Healthcare for recognizing the burden prior authorization can place on patients and providers,” says Friederike Keating, MD, chair of ASNC's Health Policy Committee. “We are pleased efforts are underway to minimize this burden.”

National Gold Card Program Also Coming

UHC also announced plans to implement a "national Gold Card program" wherein eligible provider groups will be able to submit most procedure codes through an administrative notification process rather than being subject to prior authorization. Eligibility will require meeting specific requirements to be outlined by the payer. UHC says it will announce plan details in the coming months.