Two of the largest commercial payers have spent August telling providers they will ask for fewer authorizations. UnitedHealthcare published its list on August 1: the procedure codes it will stop requiring prior authorization for, in two phases, on September 1 and November 1, 2023. The company says the removals add up to nearly 20% of its overall prior authorization volume. Cigna followed on August 24, announcing it had removed more than 600 codes from prior authorization in its commercial plans, which it describes as about 25% of medical services, with roughly 500 more codes to come off for its Medicare Advantage plans before the end of the year.
The practices we work with are pleased, and a little suspicious. Both reactions are reasonable. Fewer authorizations is real relief for the referral coordinator who spends her mornings on hold. But an authorization requirement that disappears from one list does not always disappear from the claim, and the transition weeks are where new denials get created.
Key takeaways
- UnitedHealthcare removes codes in two phases, September 1 and November 1, 2023, and the November phase is the one that reaches Community Plan (Medicaid) members.
- Cigna's August 24 removal of more than 600 codes applies to commercial plans now; the Medicare Advantage list is still to come.
- Removing prior authorization does not remove medical necessity review. Documentation standards are unchanged.
- Track your authorization matrix by plan type and effective date, keep requesting authorizations until each date, and watch the first 60 days of remittances for payer processing errors.
What UnitedHealthcare announced
| Phase | Effective date | Plans affected |
|---|---|---|
| Phase 1 | September 1, 2023 | Medicare Advantage, commercial, Oxford, individual exchange plans |
| Phase 2 | November 1, 2023 | The same plans, plus UnitedHealthcare Community Plan (Medicaid managed care) |
The code list is published on the UHCprovider website and covers a range of services including many in genetic testing, durable medical equipment, and various surgical and diagnostic procedures. UnitedHealthcare first said in March that it intended to cut about a fifth of its authorization volume this year; the August 1 publication is the list that makes that promise specific. The company has also said publicly that it intends to introduce a national gold card program in 2024 for provider groups with consistently high approval rates, though details are not final and we would not plan around it yet.
What Cigna announced
Cigna's August 24 announcement removed more than 600 codes from prior authorization for commercial customers, including more than 100 surgical codes, close to 200 genetic testing codes, and a range of durable medical equipment, orthoses and prosthetics. Cigna says that with this change, prior authorization now applies to less than 4% of medical services for most of its commercial customers. The Medicare Advantage removals are promised for later in 2023.
Notably, imaging is largely absent from both lists. Advanced imaging remains one of the most heavily authorized service lines and, in our experience, one of the most frequently denied for authorization reasons. If your practice orders MRI and CT, your authorization workload is not changing much. The same is true of specialty drugs administered in the office, where both payers continue to require authorization for most products.
What does not change
Three things to be clear about with your team.
Medical necessity still applies. Removing prior authorization means the payer will not review the service before it is rendered. It does not mean the payer will pay without question. Post-service review, and retrospective denials for services that fail the payer's clinical policy, remain possible. The documentation standard is the same as it was.
Notification requirements may survive. UnitedHealthcare uses advance notification for some services, which is a different process from prior authorization. Read the list carefully to see whether a code moved from "authorization required" to "no requirement" or to "notification only".
Plan type matters. A code removed for commercial plans may still require authorization under the same carrier's Medicare Advantage or Medicaid product until the later phase, or indefinitely. The most common transition error we expect: a scheduler sees "UHC" on the card, assumes no authorization is needed, and the patient is on a Community Plan product a month before Phase 2.
How to adjust the authorization workflow
- Download both lists and map them to your own codes. Filter the payer list to the CPT and HCPCS codes your practice actually bills. For most specialties the overlap is a manageable list of 10 to 40 codes.
- Update the authorization matrix by plan, not by payer. If your practice keeps a grid of which payers require authorization for which codes, add columns for plan type and effective date. UHC commercial from September 1, UHC Community Plan from November 1, Cigna commercial from August 24, Cigna MA pending.
- Keep obtaining authorizations through the effective date. A service scheduled for September 5 that was authorized in August has an authorization on file; nothing is lost. A service scheduled for August 30 for which nobody sought authorization because "UHC dropped it" is a denial.
- Watch the first 60 days of remittances. Pull every CO-197 and related authorization denial from these two payers for September and October. Any denial on a removed code is a payer processing error and should be disputed with the payer's own announcement attached.
- Redeploy the time. If your authorization coordinator gains a few hours a week, point them at the imaging and specialty drug authorizations that still need chasing, or at authorization denials awaiting appeal.
A worked example: an orthopedic practice's matrix
A three-surgeon orthopedic group bills about 60 distinct CPT codes with any regularity. Filtering the UnitedHealthcare list against them turned up 14 codes, mostly arthroscopic procedures and a handful of durable medical equipment items; the Cigna list overlapped on nine. The practice's matrix, a spreadsheet the scheduler keeps open all day, gained two columns and now reads, for one code, roughly like this.
| Code | UHC commercial and MA | UHC Community Plan | Cigna commercial | Cigna MA |
|---|---|---|---|---|
| 29881 (knee arthroscopy with meniscectomy) | No auth from September 1 | Auth required until November 1 | No auth from August 24 | Auth required; list pending |
| 73721 (MRI lower extremity joint) | Auth required | Auth required | Auth required | Auth required |
Whether 29881 is on the final list for a given plan is something the practice confirms against the payer's published document, not against this article; the point is the shape of the matrix. The exercise took the practice manager an afternoon, and it surfaced two codes the practice had been authorizing for years that neither payer had required for some time.
What this means for denials
We think the net effect on denials will be smaller than the headlines suggest, and it could go either way for a given practice. Fewer authorization denials on the removed codes, yes. But practices that relax documentation because "there is no auth anymore" will see medical necessity denials after the fact, which are harder to overturn because the service has already been rendered. Post-service denials also land on the patient more often, since the patient cannot be told in advance that coverage was refused.
The practices that will do well are the ones that treat the removals as a workflow change and not a documentation change. If your denial management process categorizes denials by root cause, add a temporary category for "authorization denial on a removed code" so you can see whether the payers' systems have caught up with their announcements. In past payer transitions we have seen claims systems lag the policy announcement by several weeks, and the practices that noticed were the ones counting.
Questions we hear
Should we stop requesting authorizations on the removed codes right away?
On and after the effective date for the correct plan type, yes. Before it, no. Requesting an authorization that is not required costs a phone call; skipping one that is required costs the claim.
Will other payers follow?
Several have signaled reductions and the pressure from CMS, state legislatures and medical societies is real. We would not assume it, and we would not change a workflow based on a press release. Change it when the payer publishes a code list with dates.
Does this affect Medicare Advantage rules for 2024?
Separately, the CMS Medicare Advantage final rule issued in April 2023 (CMS-4201-F) tightens how MA plans use prior authorization starting January 1, 2024, including requiring approvals to remain valid for the course of treatment. That is a regulatory change and applies to all MA plans. The payer announcements above are voluntary business decisions layered on top of it.
What to do this month
- Download the UnitedHealthcare and Cigna lists, filter them to your codes, and put the filtered list where the schedulers work.
- Add plan type and effective date columns to the authorization matrix and fill them in for both payers.
- Brief the front desk and the referral coordinator on the plan-type distinction, with the two UnitedHealthcare dates written down.
- Set a reminder for November 1 to update the matrix for the second UnitedHealthcare phase, and another for when Cigna publishes its Medicare Advantage list.
- Tell providers that documentation expectations are unchanged, and add a temporary denial category for authorization denials on removed codes.
